Nube looking for advice on settings and altitude

[Wulfman...]

For the record, I don't know if 10 cm. is or will be the ideal pressure. I was recommending it as a starting point and a "constant" to be able to see what happens at that pressure and whether it may need to be increased.
The present settings aren't working and are probably counterproductive.


Den

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[MJColorado]

OkyDoky, Wulfman, thanks to you both for the interest and feedback. One thing you both have right is this isn't productive at what I'm doing. Sadly for me, I'm not one of those great cases where the first night is a miracle. Welcome to my world... I'm leaning hard toward getting that sleep study pushed up so I can get some diagnosis criteria. I think I can use a little influence and maybe just use the sleep clinic lab. In the mean time, I'll see if that baseline or the closer ranges can do some good. OkyDoky, I will follow your direction and get better shots.

[D.H.]

At least according to SleepyHead, you are having significant Central events. As somebody already suggested, you shouldget tested in a lab to see if they're really Central Events, or whether your CPAP is failing to register your effort to breathe. I have the same machine, and it's pretty good. However, it cannot take the readings that they can take in a sleep lab (they hook up stuff all over your body).

The general rule is to turn the pressure up if you have obstructive events and down if you have central events. Note that that isn't always right. Also note that since you appear to be having both, you need to balance two contrary indications.

I recommend seeing a neurologist sleep doctor (since you appear to have significant central events).

[Guest]

I'm leaning hard toward getting that sleep study pushed up so I can get some diagnosis criteria. I think I can use a little influence and maybe just use the sleep clinic lab.

Ask if they have a cancellation list. Many times people will cancel at the last minute. If they do just keep a bag packed for last minute notice.

[D.H.]

I neglected to ask this before, but why are you using a full-face mask? It's generally recommended only if a patient has tried a nose mask and has experienced significant mouth-breathing, or if there is a known and complete obstruction of the nostrils.

[Wulfman...]

I neglected to ask this before, but why are you using a full-face mask? It's generally recommended only if a patient has tried a nose mask and has experienced significant mouth-breathing, or if there is a known and complete obstruction of the nostrils.

Why not?
Could be personal preference.
I've never even tried anything other than a full face mask and never intend to.
I also disagree with your assertion about the "generally recommended" statement, too.

Den

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[Goofproof]

I neglected to ask this before, but why are you using a full-face mask? It's generally recommended only if a patient has tried a nose mask and has experienced significant mouth-breathing, or if there is a known and complete obstruction of the nostrils.

Why not?
Could be personal preference.
I've never even tried anything other than a full face mask and never intend to.
I also disagree with your assertion about the "generally recommended" statement, too.

Den

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Ditto, a FF mask covers the fact mouthbreathing may be happening, and also gives a option for conjestion, D.H. doesn't have a clue. Also Nasal masks are pushed by higher profit per unit, and later we can soak you for the cost to buy the FF ,mask. At no time is the DME's concern for your health! Jim

[MJColorado]

I set it at 11 and had a really bad night. I am really in need of help here.

[MJColorado]

For further clarification, I slept VERY restlessly last night and not so good on the other two nights. As to CSA, I do not use drugs, have no evidence or history of brain damage and just got a clean bill of health from a pulomonologist. I do live at 9000 feet but have lived at this altitude for several years. After last night's sleep, I slept for two plus hours with my head in the lap of my RN wife early this morning. (She is an angel for her patience with this.) Perher watching me that entire time: I snored a little, but had no apnea episodes at all. She said I breathed normally the entire time.

Any advice from anyone?

[Guest]

Any advice from anyone?

It has to be determined whether those are real centrals or just that you have trouble exhaling (fully) against the pressure. That is best determined in a sleep lab.

As to CSA, I do not use drugs, have no evidence or history of brain damage and just got a clean bill of health from a pulomonologist. I do live at 9000 feet but have lived at this altitude for several years.

afaik - Drugs or brain damage are not a requirement.

[Wulfman...]

For further clarification, I slept VERY restlessly last night and not so good on the other two nights. As to CSA, I do not use drugs, have no evidence or history of brain damage and just got a clean bill of health from a pulomonologist. I do live at 9000 feet but have lived at this altitude for several years. After last night's sleep, I slept for two plus hours with my head in the lap of my RN wife early this morning. (She is an angel for her patience with this.) Perher watching me that entire time: I snored a little, but had no apnea episodes at all. She said I breathed normally the entire time.

Any advice from anyone?

Give this setting a few more nights to see if this is "real" or not.
This is precisely why you need a "constant" to see what's what.
Glad to hear you slept restfully. That's important, too.

Edit to ask: Did you mean RESTFULLY or RESTLESSLY? If I misread that, I apologize, but I still think you should still give it a few more nights. Often times, making even a small change can take some nights to acclimate to them.


Den

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[jtravel]

The whole benefit of having Apap is it will adjust the pressure as needed to prevent events.
Setting the Min & Max at the same is not taking advantage of Machines intelligent capabilities.
Straight Cpap is normally Prescribed after a Sleep study and Titration performed to find the specific pressure needed to prevent events.
Insurance companies today are refusing to pay for Titration and just approve Apap Machines with a Min & Max
Review of the collected apap data can then be used by your doctor to adjust the pressures as needed.
Some like myself have done this using Sleepyhead software.

[MJColorado]

Den and others,

The only rest I got was when I was asleep with my head in my wife's lap, without the mask on. Having the mask on has been quite honestly one of the worst experiences of my life with little or no sleep for days at a time. Last night was about 40 minutes of sleep on the machine and by far the worst of the 3 days I've been trying this. I'm wondering if the initial incident was a back-sleeping apnea incident with more of anxiety/panic attack. It was just after the annual Christmas visit which was unbelievably stressful.

At this point, going into my bedroom is actually giving me a sense of dread. I'm thinking to put the mask down until I can get into the full blown sleep study to see what exactly my deal is. After all, I have not had any recent significant physiological changes and if I have sleep apnea, I've had it for a long time. What is another couple of days without the machine then? I have done enough Google and WebMD etc, to have a genuine fear (paranoia) about the consequences of untreated apnea enough to actually be afraid to go to sleep at this point with the mask or without. I am fairly sure my machine is not helping me for several reasons, the least of which is I'm not sure I have it set correctly, another is my understanding of my charts isn't showing that the machine is correcting or making things better.

I've worked my ass off to get where I am in life and owe to the family I love dearly to be my best and be here for them.

I truly appreciate your concern for those like me who are: new, naive, and clueless.
MJ

[jtravel]

when using Cpap (fixed Pressure) or Apap (adjustable pressure) you need to wait for at least three days or longer to collect data and then decide on additional changes to the pressure setting.
You are New user who has not had a Titration study.
My concern is advise I have just read is Counter to all of the Apap usage recommendations I have heard.
Normally the Apap would be set to 5 min and 20 max and then data collected to see what is happening for several days.
My advise is because fixed pressure of 11 is not working, that should be set as the Min and the upper limit of 20 should be used as the Max.
Use like this for 3 days Min and review the sleepyhead data.
Sleepyhead data will shows you the Max Pressure the machine used to prevent events during the night and the 90% pressure.
90% pressure is the pressure it used or lower pressure for 90% of the time in use.
I look at this 90% number and then set my min 2 under it. I look at the Max pressure actually used by the machine and set my Max pressure at 2 over that.
Once the AHI looks decent I then start trying different Aflex settings to see what effect lower exhale pressure may have on the results.
If The AHI is still running high after doing this then a sleep study with titration is definitely needed to find out what is going on.

I want to add that free advise is plentiful on the internet as on this site.
Most like myself are not experts and can only tell you what worked for us as individuals.
In most cases you should be better served by letting the Professionals in the medical field do their job and test and then advise.
I however found the DR lacking and did much better on my own.

[Wulfman...]

when using Cpap (fixed Pressure) or Apap (adjustable pressure) you need to wait for at least three days or longer to collect data and then decide on additional changes to the pressure setting.
You are New user who has not had a Titration study.
My concern is advise I have just read is Counter to all of the Apap usage recommendations I have heard.
Normally the Apap would be set to 5 min and 20 max and then data collected to see what is happening for several days.
My advise is because fixed pressure of 11 is not working, that should be set as the Min and the upper limit of 20 should be used as the Max.
Use like this for 3 days Min and review the sleepyhead data.
Sleepyhead data will shows you the Max Pressure the machine used to prevent events during the night and the 90% pressure.
90% pressure is the pressure it used or lower pressure for 90% of the time in use.
I look at this 90% number and then set my min 2 under it. I look at the Max pressure actually used by the machine and set my Max pressure at 2 over that.
Once the AHI looks decent I then start trying different Aflex settings to see what effect lower exhale pressure may have on the results.
If The AHI is still running high after doing this then a sleep study with titration is definitely needed to find out what is going on.

They don't (normally) use APAPs in a range of pressures in in-lab sleep studies.
APAPs can create numerous problems trying to evaluate what the problems are and the solutions. Lots of things depend on the person's breathing characteristics. Too many Flow Limitations or Snores can skew the pressure requirements. Nasal congestion can exacerbate both of those and are many times independent from the apneas and hypopneas.
Pressure ranges may work for some but not all. It's not a "one-size-fits-all" solution. Many people find their sleep disrupted by the changing pressures. Many people have reported using ranges of pressures for month or years and never feeling rested. Many of those have found their sleep quality improved by switching to straight pressure.
The main "advantage" that APAPs have is they have more OPTIONS to choose from.......which also includes straight pressure (as do Bi-level machines).
The primary objective(s) is to reduce or eliminate the Apneas and Hypopneas AND to improve sleep quality.

MJ now has a better idea of what to look for going into his in-lab sleep study. That's a big advantage in my opinion.


Den

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