Can't seem to get a good nights sleep.

joshc · Post by **joshc** » Wed Apr 30, 2008 4:17 pm

I have been using my cpap for around 6-7 months now after giving up for a long time. I got my hands on a M-Series Auto, the card reader and software.

I can't seem to ever get fully rested. Every day its constant yawning. This is what my encore pro results look like:

I have 3 different masks. Swift Mirage II, FF Resmed Quattro, and some under the chin full face mask that I hate.

I have also tried setting my cpap to 9-10 range but it does not seem to help the situation. Anything above 13 and I will get mouth leaks when using the swift mirage II which is my favorite mask.

I recently got the results of my sleep study because I was wondering if I did any better during the sleep study than I do today. Here are the results of my sleep study:

Any feedback would be appreciated. I don't really understand the sleep study very well.

alnhwrd · Post by **alnhwrd** » Thu May 01, 2008 4:52 am

Josh,

I don't have your machine or software, and I am not a dr or RT, but if I were you, I think I would try the following.

If you like the Swift, use it and tape your mouth closed at night, or use the FF mask you like as long as it does not leak.

Did your Dr talk to you about RLS? I see on the sleep study report that you have 73 leg movements per hour. That could be what is keeping you sleepy.

As far as pressure, I noticed that your sleep study had you up to 13, so why are you at 9-10? If it is the leaking, tape or use the full face mask as I said above. Looking at your "CPAP Respiratory Analysis" at the bottom of your PSG report, it looks like at 11 you had your lowest scores. Why not start there, run it on straight Cpap, try it for a few nights, maybe a week, and see how you feel and how your scores are? If you aren't any better, try inching your way up and see if that helps. If not, maybe you need to talk with your Dr again.

I hope this helps you. Best of luck.

Alan

joshc · Post by **joshc** » Thu May 01, 2008 5:41 am

Oops I suppose I should have provided more information.

I was on setting of 13 for about 2 years before giving up on cpap. It had never lead me to a good nights sleep. My doctor rarely speaks to me on my visits its usually the nurse. When I met my doctor his information on cpap features was just plain incorrect or out of date.

I use 9-10 now because that seems to produce the lowest numbers for AHI.

I was not prescribed an Auto with a range. I requested a pro unit to monitor AHI myself and the medical equipment provider was nice enough to give me the auto instead. So if I schedule an appointment to visit the doctor...i mean nurse they will probably just try to change the pressure im prescribed to.

Edit: left out more info again. Last visit was in early 2007 when I decided to give cpap another try.
_________________

CPAPopedia Keywords Contained In This Post (Click For Definition): CPAP, AHI, auto

joshc · Post by **joshc** » Thu May 01, 2008 6:38 am

Another thing that concerns me is the final impression:
Obstructive sleep apnea, partially corrected with the application of nasal CPAP.

Perhaps I just been wasting a whole lot of money aiming for a much lower AHI?

ozij · Post by **ozij** » Thu May 01, 2008 7:15 am

Josh,
"Tonsillar hypertrophy" in that first paragraph means your tonsils are larger than normal, and obstructing your airway. They can't be pushed aside by the pressurized air.

The number of events per hour left after your titration (where they checked for the right pressure), the Apnea Hypopnea Index=AHI is too high. You've got 14 obstructive events an hour, that is above the number of events at which therapy should be started. And not the way to send a person home. Proper therapy should bring you down to 5 or less - it is no wonder at all that you feel CPAP isn't working for you, . The cpap keeps you from desaturating badly, which is good, but you're not getting the sleep quality you need and deserve.

From what I've read on the forum (I'm no medical professional, nor anything professional to do with sleep medicine) I suggest you find a good ENT, and ask about having your tonsils taken out. That will give cpap a much better chance to help you.

Do not let the doctor talk you into any kind of further surgery in your throat or palate (e.g. a UPPP). Do listen if he/she has anything to say about nasal obstructions.

Don't leave things as they are. You are a young man, your Obstructive Sleep Apnea is severe and is not being properly treated - and you have a chance for many year with a far better quality of living than you have now. Doing nothing is a sure way of getting yourself into lots of health problems, since OSA like yours can cause high BP, obesity, heart problems, type II diabetes - and more.

A tonsillectomy is very painful for grown-ups. But it seems to me (looking at your papers, not knowing anything else about you...) that you really cannot afford not to have it.

Look for" tonsils" in posts by "socknitster" - she may chime in on her own, because she's been back recently.

Your daily events per hour chart indicates that you need higher pressure than 9-10, you are spendig at least 21% or your time at 14-15 and another 16.6% at 12-13. 9-10 is undertreating you and nothing in the chart suggests you should stay there. Your AHI at higher numbers is a mathematical result of the fact you spend less time there.

Meanwhile I would try the auto at 10-13, or if possible, 10-15.

And tell us what you decide and how you're doing - and ask anything you want to know.

Good luck !
O.

joshc · Post by **joshc** » Thu May 01, 2008 7:54 am

I did visit a ENT specialist but mostly asking about my nasal passages since the first doctor I visited said they looked a little narrow but the ENT specialist said they were fine. Im not sure if the ENT looked at my tonsils or not I can't remember but I will certainly look into it thanks.

Your AHI at higher numbers is a mathematical result of the fact you spend less time there.

Don't understand if I set it to 15...it will go that high and spend alot of time there and waking up is a nightmare. Though I wonder if waking up with more energy at 9-10 is a result of me not really reaching a deep sleep and instead able to wake up without dragging around.[/quote]

DreamStalker · Post by **DreamStalker** » Thu May 01, 2008 7:57 am

In addition to what ozij said ... you are prone to central and mixed apneas in addition to obstructive apnea. You need a more sofisticated machine than plain CPAP or APAP. You probably also need a better doctor since he/she should have known your condition is more complex than simple OSA.

Find a better doc.

joshc · Post by **joshc** » Thu May 01, 2008 8:39 am

I do not know of another sleep specialist in the general area. Ive searched but without any luck im from columbia, SC.

----------------------------------------------------------------
I don't have too much faith in the doctors in the area. To share a funny story I once went to 4 doctors and a neurologist. I even had a cat scan. I told all the doctors (and doctors nurses) the same thing:

1. I have severe headaches on the weekends, sometimes monday too. Never on any of the other days.
2. I work Monday-Friday, off saturday and sunday. 7am to 5pm
3. The headaches usually start in the morning.

Spent alot of money trying to figure out why i kept getting headaches. I even had an issue with my insurance where the cat scan area use to be in network but then was no longer in network when I got my scan done. It was pricey. They never figured out what caused my headaches.

So one day im sitting at lunch with some co-workers and I tell them about my headaches. Then one of them smirks at me and asks if I drink anything with caffeine on my days off (which I dont).
<-this is what my face looked like.

ozij · Post by **ozij** » Thu May 01, 2008 8:49 am

DreamStalker is right in noticing those central and mixed apneas in the PSG - my bad.

Stick to 10-11 max, especially since about there you feel better.
13 seems to be giving you pressure induced apneas.

I'm not sure all those central and mixed apneas at 0 pressure should concern you - only the ones at high pressure and they can be avoided by not going there.

Even your saturation is better at 11 that at 13, and your AHI was just about normal. 9 is too low, if we're to trust the PSG....

The doc who prescribed 11 originally (last year's posts) was right - as far as reading the data was concerned.
O.

Wulfman · Post by **Wulfman** » Thu May 01, 2008 8:49 am

DreamStalker wrote:In addition to what ozij said ... you are prone to central and mixed apneas in addition to obstructive apnea. You need a more sofisticated machine than plain CPAP or APAP. You probably also need a better doctor since he/she should have known your condition is more complex than simple OSA.

Find a better doc.

This was the conclusion I came to when reading your sleep study, too.
In the meantime, I'd suggest a straight CPAP pressure of 9......based on your "Daily Events Per Hour" report. That Auto is also chasing your snores and doesn't want to stop till it gets rid of them. And, since you're having more A/H events above 9, it's going after those, too. Leakage can/will also increase pressure in an Auto.

Den

ozij · Post by **ozij** » Thu May 01, 2008 8:57 am

Den, I agree with your analysis of the daily events, the machine (like the tech...) is responding to snores, but I'm concerned by the low saturation at 9 on the PSG.

O.

Wulfman · Post by **Wulfman** » Thu May 01, 2008 9:10 am

ozij wrote:Den, I agree with your analysis of the daily events, the machine (like the tech...) is responding to snores, but I'm concerned by the low saturation at 9 on the PSG.

O.

Problem is, that sleep study was done in 2003. I take sleep studies with a grain of salt as they're only a one-night snapshot......and this one is 5 years old.
Right now, I'm more inclined to trust Josh's Encore data.
It doesn't show any Non-Responsive events till the pressure gets to 13.....so that was one of my criteria. (Yeah, I looked at the NR THIS time)

Anyway.......that's how I drew my conclusion......to DITCH THE AUTO MODE.

Den

ozij · Post by **ozij** » Thu May 01, 2008 9:36 am

Wulfman wrote:
ozij wrote:Den, I agree with your analysis of the daily events, the machine (like the tech...) is responding to snores, but I'm concerned by the low saturation at 9 on the PSG.

O.
Problem is, that sleep study was done in 2003. I take sleep studies with a grain of salt as they're only a one-night snapshot......and this one is 5 years old.
Right now, I'm more inclined to trust Josh's Encore data.
It doesn't show any Non-Responsive events till the pressure gets to 13.....so that was one of my criteria. (Yeah, I looked at the NR THIS time)

Anyway.......that's how I drew my conclusion......to DITCH THE AUTO MODE.

Den

Wulfman · Post by **Wulfman** » Thu May 01, 2008 9:41 am

ozij wrote:
Wulfman wrote:
ozij wrote:Den, I agree with your analysis of the daily events, the machine (like the tech...) is responding to snores, but I'm concerned by the low saturation at 9 on the PSG.

O.
Problem is, that sleep study was done in 2003. I take sleep studies with a grain of salt as they're only a one-night snapshot......and this one is 5 years old.
Right now, I'm more inclined to trust Josh's Encore data.
It doesn't show any Non-Responsive events till the pressure gets to 13.....so that was one of my criteria. (Yeah, I looked at the NR THIS time)

Anyway.......that's how I drew my conclusion......to DITCH THE AUTO MODE.

Den

joshc · Post by **joshc** » Thu May 01, 2008 9:48 am

I tried that for 1 day, I set it to 9/9 but then the readings on the card did not include the specifics it showed me the first page with the solid lines but the next page was missing with the specific data like leaks etc. Is that normal?