First three days; not so good?

[Scooter32]

Okay, so today marks my first three days on CPAP and I am kinda wondering how I am doing here. My sleeping in the three days has seemed to get slightly better though I still am waking up and having a hard time going back to sleep. First day I maybe slept 2-3 hours, second was maybe 4.5-5, and last night maybe 5-5.5 hrs. I am sure that will get better with time but I see my AHI score is pretty bad. Can I expect this to maybe get better in time or will it basically mean an up in pressure once the sleep doc reviews it? Any advice is welcome.

Day1:



Day2:



Day3:

[BlackSpinner]

your images have to be hosted somewhere, like flikr or photobucket

[Pugsy]

How to post images so we can see them explained in this thread.

viewtopic.php?f=1&t=81072&p=737779#p737779

[Scooter32]

Okay, I fixed it! Noob mistake.

[Pugsy]

Yes, I suspect a pressure increase is likely in your future.

Not sure what to make of those CAs but since they mainly seem to accompany the OA clusters my first thought is that they are arousal CAs related to the OA waking you up a little and thus perhaps a sleep stage transition central which is normal.

How is your quality of sleep? Waking often for various little reasons? If so, trouble going back to sleep?
Some of the CA clusters look like they might be related to possible awake/semi awake times since they are real close to starting and stopping the machine.

[Scooter32]

Urgh, the joys to loo forward to!

Quality of sleep is less than great. Once I get to sleep, I sleep for maybe 2-3 hours then usually wake. If I can get back, it make take anywhere from 1/2 - 3 hours. After I fall back, the next block of sleep seems even shorter. Last night I remember waking three times. Once just after 3 AM, once again around 6, then again near 7 AM where I decided to doze off for maybe another half hour without my CPAP afterwards. Each night it seems my total time asleep gets a little bit higher but quality is not the best. I hope as I get more used to it, it may get a bit easier. Oh man, I would just love to get a 6-7 hour block of sleep without waking up! Is it the apneas waking me up?

[Pugsy]

Is it the apneas waking me up?

It could very well be that the apneas are causing the arousals. It's difficult to know for sure with the data we get from the machine which is coming first. I am pretty sure that some of that ugly mess is most likely awake/semi awake breathing irregularities getting flagged but I don't think we can blame all of it on post arousal Sleep/Wake/Junk (SWJ).
The machine is more apt to flag awake breathing irregularities as CAs...not so much the OA category but the OAs could cause the arousal which in turn could cause SWJ to get flagged.

Your report just screams out "poor sleep quality" to me and the first suspect that comes to my mind would be the OAs.
I always figure...try to fix the obvious first and then see what's left or what happens.
And the fix for the OAs would be a little more pressure.

Also we have the usual adjustment period in the mix. The brain still doesn't know what to expect with having the alien plastered on the face so it sort of becomes "hyper" aware of everything. So even if the OAs were well controlled the brain can sometimes want to keep waking us up and saying "hey, dude...do you know there's an alien stuck on your face"... along with the possible arousals from the OAs.

The periods of time where you are laying there for prolonged amount of time...any of those flagged events aren't real so they have to be mentally removed from the evaluation of your reports. You are the best judge for those possible time frames.

[Todzo]

I think you can do a couple of things that may help right now:

Spend some quality time with the machine during the day learning to breath quietly. The constant pressure of the machine tends us toward using more air and we need to learn to compensate. I think reflexes are best developed while conscious. Some of the time in bed getting used to all the positions and moving between them. Some time while distracted with light distraction. Read a book, listen to music, watch light TV.

Raise the head of your bed a few inches. Gravity can be our friend to lessen swelling in the airway passage and so lessen the need for pressure. I have also found it helpful to lessen GERD and some posit it may help with the rostral fluid shift often found with OSA.

Eat less inflammatory and more anti-inflammatory foods.

Have a great week!

Todzo

[Scooter32]

Thanks for the feedback. Since I am home today, perhaps I will just put it on and run it while I watch a little tv. I do have problems with stomach acid and all and have noticed in the past few days that I am not eating as much and being consciously better about what I do eat and when. I had a tendency to eat late suppers then go right to bed which is not a good thing. I am not sure, but do you count Hypopneas as OA? On my sleep tests, I had 0-2 OA's but quite a bit of Hypopneas. Not sure why now the machine is recording all the OA's. I will try to have to watch my sleep times better to see if I can correlate a lot of the events with being awake or whatnot. Well, guess its upstairs to use my machine while watching some golf.

[Pugsy]

Hyponeas are in the same category grouping as OAs. The only difference is the reduction in air flow is less than what is needed for an OA....50% or so vs 90% or more for OA.

Since your sleep is so poor at the moment and there is likely a good bit of SWJ going on...maybe not get horribly excited (or worried) until you don't have so much time where awake stuff may be getting mixed in and making evaluation more difficult.

In your sleep studies was there any mention as to whether you had more apnea events when sleeping on your back and/or during REM stage sleep? Either one or both is very common and might account for some of the clusters (OAs and hyponeas) (assuming you were asleep) perhaps needing more pressure during either or both.

Remember the CAs (centrals) we sort of set aside right now since we don't treat those with pressure using this machine (assuming they are real and not awake artifacts).
Hopefully as the obstructive stuff gets reduced the CAs will also get reduced. I have seen it happen when the CAs are post arousal flags. So it wouldn't be impossible.

When is your follow up visit with the doctor scheduled for?
Oh, BTW...the 460 machine that you have does have limited APAP capabilities..
I wouldn't go messing with it right now while the DME still has the modem on the machine and insurance compliance is involved but maybe later when they are out of the picture it might be something to consider trying.
Do you have the provider/clinical manual for your machine?
If not you can request it here.
Just make sure that you request the "PR System One 60 Series Pro CPAP with CFlex" so that you get the correct manual.
I don't have a direct link for that particular manual like I do with a couple of the others.

[Scooter32]

In your sleep studies was there any mention as to whether you had more apnea events when sleeping on your back and/or during REM stage sleep? Either one or both is very common and might account for some of the clusters (OAs and hyponeas) (assuming you were asleep) perhaps needing more pressure during either or both.

My RDI was much higher on my back but that's all I saw and I spent very little time supine.

Remember the CAs (centrals) we sort of set aside right now since we don't treat those with pressure using this machine (assuming they are real and not awake artifacts).
Hopefully as the obstructive stuff gets reduced the CAs will also get reduced. I have seen it happen when the CAs are post arousal flags. So it wouldn't be impossible.

I don't think they are since I averaged about 35 during my sleep studies per night (both with CPAP and without).

When is your follow up visit with the doctor scheduled for?

With my regular doctor, early September I think. Never even met the sleep doctor (only went to the sleep studies). Think the DME said after 30 days they send stuff to the doctor but they would check in with me again next week.

Oh, BTW...the 460 machine that you have does have limited APAP capabilities..
I wouldn't go messing with it right now while the DME still has the modem on the machine and insurance compliance is involved but maybe later when they are out of the picture it might be something to consider trying.
Do you have the provider/clinical manual for your machine?
If not you can request it here.
Just make sure that you request the "PR System One 60 Series Pro CPAP with CFlex" so that you get the correct manual.
I don't have a direct link for that particular manual like I do with a couple of the others.

I have the operations manual for my machine, but that's it. I saw that you can do the trial but I was going to leave that alone for now. Bout the only thing I did currently was to peg out my humidifier setting.

[Pugsy]

I don't think they are since I averaged about 35 during my sleep studies per night (both with CPAP and without).

Could you please clarify?
35 centrals all night??? or average per hour?
If all night...what would the hourly average be approximately?

[Scooter32]

Yes, 35 centrals for the night (which was 428 minutes) so that's like 4.9/hr for no CPAP and 39 centrals (over 519 minutes) or 4.5/hr on CPAP.

[Pugsy]

Ahhhh, okay...we can't pooh pooh off those centrals..

Keep working on improving your sleep quality the best you can and let's see what happens over the next few nights.

Might want to be checking into seeing the sleep doctor if your primary doctor doesn't have a lot of experience in this stuff.

[DoriC]

I can't tell from your report but are you using Cflex (exhalation relief)? That's a comfort feature that might make it easier to exhale and the patient can adjust that herself.