Introduction and question

[Lea_T]

This is my first post but I've been lurking here about 10 days and you all have helped me so much already!

Intro: I'm 42 and have hypothyroidism. Even with a fairly high dose of natural thyroid hormone I have continued to be constantly fatigued and sometimes sleepy. Last December my primary care doc asked if we should consider sleep apnea and I said I was sure I didn't have it--I don't snore, my husband has never noticed me not breathing, etc.

But just a couple months later, my mom was diagnosed with severe OSA (if she told me her numbers correctly, her AHI was about 140!). It was actually her dermatologist who noticed her yawning all through an appointment and sent her off to get tested. An unexpected side effect of my mom being on CPAP was that her IBS symptoms dramatically improved. I have IBS also, and that was enough to motivate me to get a sleep study.

I had my study June 13, and although I only slept a couple of hours apparently they got enough data: my AHI was 19.2. Not in the same class as my mom's, but obviously worth treating. However I didn't sleep enough for them to titrate me. I got my CPAP June 20th (fortunately a data capable one). Thanks to this forum I also now have a card reader and am learning to use Onkor, and have a Regenesis buckwheat pillow that I love.

My first two nights with the machine were hell on earth and I hardly slept at all. They had set the pressure range as 5-18 to titrate me, and by the end of the second night I had figured out that my problem was that I felt like I was suffocating at a pressure of 5 cm. Hard to relax and go to sleep when every breath is a conscious effort! So (again, thanks to what I learned here and at the Apnea Board) I got into clinician mode and played around with the minimum pressure. I finally settled on 10, and the next two nights were very good, though I still felt sleepy during the day from the two bad nights earlier. Last night I had some problems with leaks but even so I am feeling more rested today! Also, it's too early to be sure, but my IBS symptoms have been much better the past few days.

I may need to get a new mask, though. I have the GoLite--for HIM, as I found out when I was filling out my profile on this site! I'm not too impressed that the DME was apparently unaware that there is a GoLite for Her. I picked it because I found the nasal pillows more comfortable than those of the Swift FX, but I'm having trouble with the pillows wanting to rotate toward the tip of my nose too much. Also I'm not sure I like the rigid cheek parts; I tucked some fleece under them and they're reasonably comfortable, but they push the nasal pillows out of place if I try to sleep on my side (and I would like to sleep on my side at least part of the night). I wanted to try the Swift LT for her, which my mom has and loves, but the DME told me it was an older model, with the implication that therefore she didn't carry it. That annoys me because I see it is still for sale at cpap.com.

Well, that was kind of long, but I still want to tack on my question here at the end: how concerned should I be about the central apneas measured by the machine, and is there anything I can do about them? Or should I not worry this early into it? Here are my numbers from the first 5 nights:

AHI 21.39; OA 2.16; CA 13.54; H 5.69 (awake about 4 hrs, then slept about 4 hrs); pressure 5-18
AHI 16.37; OA 1.35; CA 11.89; H 3.14 (was awake about 5 hrs before taking mask off); pressure 5-18
AHI 3.54; OA 0.38; CA 2.28; H 0.88 (slept well); pressure 10-18
AHI 4.30; OA 0.61; CA 1.84; H 1.84 (slept well); pressure 10-18
AHI 8.78; OA 1.44, CA 6.37, H 0.96 (slept ok but had a lot of mask leaks); pressure 9.5-18

[Janknitz]

Don't worry about the CA's. As you can see, they are higher when your sleep is disrupted because they typically happen when you transition from sleep to wakefulness and vice versa. They should settle down as your sleep improves.

And if you want a Swift LT your DME can get it for you. They are very popular masks in no danger of being discontinued. Your DME was probably out if stock and to lazy to order them before the next shipment.

[Emilia]

The Swift LT for HER is not an OLD model.... I got one when they first came out last fall! I love it as the pillows can be rotated to fit the angle needed and they stay that way until you move them again. The headset is very stable and comfortable. With the pillows you are using now, you might find a dab of Lansinoh (pure lanolin found on the baby aisle of your pharmacy or Walmart) will help greatly in getting a good seal. It has a tacky consistency and helps to not only seal but protect your nares from any irritation.

Clearly, you are working toward good therapy, as your numbers have been improving. However an AHI of 8.78 is still too high. Most of us prefer to be down around 1 or 2 although anything under 5 is considered 'good.'

Once you can get some data from using the software, you will be able to 'see' where the issues are. Viewing your 90%tile pressure will be very helpful in guiding you to a better range of pressures. Once you can tighten the range up a bit, you will probably have much better results.

I will leave it for those with your machine/software to guide you further. I know nothing about them so they can help you better.

Welcome to the club... you will benefit greatly from this. I, too, am hypothyroid and my sleep study yielded an AHI of 17.5 so we are pretty much in the same boat. Best of luck to you.... hope tonight brings your better results and sweet dreams!

[Pugsy]

how concerned should I be about the central apneas measured by the machine, and is there anything I can do about them? Or should I not worry this early into it? Here are my numbers from the first 5 nights:

Welcome.

I would completely discount the first 2 nights of data with the elevated centrals. By your own admission you were awake an awful lot. Last night was leaky and that could impact things. Some of these reported centrals may not have been real centrals. A long sigh awake or asleep. Turning over in bed holding your breath or even sleep onset centrals.

3rd and 4th night reports are quite decent. AHI seems to be roughly 50 % centrals. When you look at the report graphs are these bunched together in clusters or random? You are using APAP. Look at a night with minimal leak and good hours of sleep and see where the pressure wants to go. APAPs will increase pressure trying to fix leaks so leaky reports can be misleading.

If this were my report I might lower the minimum just a bit on the off chance the reported centrals are related to pressure but only after I had many valid data worthy nights showing same trend. Plus I would want to evaluate where and when those centrals were happening... All at bedtime or wake up time? Most likely sleep onset and nothing to be concerned with. If that were the case I would not change anything.

So it is more than numbers we look at..we look at the overall picture.
When you get a chance post an image of a good valid data night and we can offer more specific thoughts.

[Lea_T]

Thanks for the reassurance about the CAs. They do seem to cluster a bit; more so on the very disrupted nights. As far as my pressures go, when my machine was set to 5-18 my 90% pressure was somewhere around 10; the max it hit was about 12 or 12.5. I lowered the minimum to 9.5 last night and will leave it there for awhile, and then see if I can stand to lower it to 9.

One question I have about Onkor is how to calculate the 90% pressure for one night? I don't see that anywhere, and my machine just gives me a running 7 day average.

Also I am going to stick to my guns and ask my DME to order me the Swift LT. I'm glad to see I'm not crazy to think it's not "old"!

I should have mentioned that, again thanks to this board, I'm already using Lansinoh--still had some, left over from nursing kids many years ago. So far I've had no nasal irritation.

Okay, I'm going to attempt to post the Onkor graphs from my "best" night, Day 3, AHI = 3.54. It looks to me like leaks were pretty minimal on this night. Interestingly, the one major leak I had coincided with (maybe preceeded?) my only 3 OSAs that night:



It also seems to me that even on this good night I had quite a few RE--that's respiratory effort related arousals, right? Is that a lot or is that pretty common?

[Pugsy]

Don't worry about trying to calculate 90% number. It is just a number and not always the "perfect" setting that some think it is.
It is only a number where 90 percent of the time you were either at OR below. Sometimes it makes a useful starting number for some people but it is not always the gospel.

Your RE is not all that high. I wouldn't worry about it now but later after you get more used to all this you could maybe try cpap mode or very tight APAP mode on the chance that pressure variations are causing the REs

[Lea_T]

I'm happy to say I'm now in possession of a Swift LT for Her mask. My DME apparently had them in stock--wonder why she didn't even let me try it the first time I saw her?

Pugsy, thanks for reassuring me about the REs. I will try not to obsess about RE and CA, and spend the next few weeks focusing on just getting used to CPAP.