A few questions

[Airwolf]

Hi all,

New to CPAP as of 12/4/17. Diagnosed End on Nov by a split night sleep study with an AHI around 26. Was titrated up to 12cm with an AHI of 2.7, given a script for the pharma, and have apparently a compliance only Resmed airsense 10 with FFM. 99% of my events were hypopnea.

Now back to the real world. My AHI is all over the chart, it’s been 3 weeks and I have had a total of 3 days below 5. The same setting I had for a 3.9 would result in a 12 the next night. On the plus side, I can directly correlate my AHI to how tired I am when I wake up. Downside is 12 didn’t work at home, my respiratory gal at the hospital bumped me up to 14 and that was effective for 1 night then bam, back to 12.

I do have allergies, I started the first couple weeks with Afrin then switched to mucinex for a few nights to get off the Afrin. That backfired an shot my AHI up so now I’m using Flonase/Claritin spray, plus Claritin pill (generic) and able to breath consistently through my nose most of the night.

I’m doing OK with the mask; I want this to work, and I’m emotionally and mentally committed to success with treatment, and just want to feel better. And be able to provide compliance data to the FAA when I go get my next medical.

What’s the best way to dial this in?

What should my expectations be?

Is a compliance only model worth slapping a card in and figuring out sleepyhead?

Any tips for lowering numbers outside of the cpap itself (beyond the obvious weight loss)?

Thanks in advance!

[Airwolf]

Also, I’ve been granted the divine knowledge of the config menu and the permission to adjust. My RT is part of the hospital pharmacy, and my Primary Care isn’t Resp and trusts my judgement. So I have a free hand.

[Pugsy]

Is a compliance only model worth slapping a card in and figuring out sleepyhead?

No. You won't get any detail data because the compliance only models don't gather/report/record any details.

Are you sure you have the half assed brick that only reports the total AHI and the 95% leak number?
Is it the AirSense 10 CPAP???

You are a pilot? I wouldn't want to rely on the half assed brick if it were me for more reasons than just the compliance stuff. I would want a full detailed data machine.

What’s the best way to dial this in?

Nearly impossible to come up with anything but guesses when we don't have the data to tell us what is going on.

Where do you live? You mention "pharma" so sounds like you aren't in the USA.

How is your sleep quality itself? Waking often and using the machine and mask while spending time awake? This can give us false flags sometimes because the machine doesn't know if you are awake or not.

[Airwolf]

Yes, it’s an airsense 10 cpap.

I’m in the beautiful West Virginia Panhandle. Not yet a certificated airman, but it’s on the near term goal sheet so I’m absolutely committed to effective treatment.

Regarding being awake, a couple of nights I’ve been incomniac and taken it off while I was awake. One one morning, I woke up and hour or so early and laid in bed with it on until wake up time. Mostly I’ve been tolerating treatment well, asleep with 15-20 minutes, then wake 2-3 times per night for little things like mask adjust or my nose itching...

[Pugsy]

Do you have insurance or are you self pay?

There is some data on the machine but it's not going to help you much if you are having problems.

If the AHI is nice and low and the leak numbers within acceptable ranges then that's pretty much all you have to go on and the rest you have to go on how you feel.

If you have insomnia issues...they may or may not be associated with the sleep apnea thing and remember these machines can only fix issues related to sleep apnea and they don't do much for other problems that are caused by things unrelated to sleep apnea.
Example...the insomnia (sleep onset when we have trouble falling asleep at the beginning of the night) and insomnia (sleep maintenance when we wake up during the night more than is normal and have trouble going back to sleep) can come from a lot of different factors like meds, stress, noisy neighbors, etc and the best cpap therapy in the world can't fix a problem that isn't caused by sleep apnea.

Hours of sleep...very important to feeling better. Until you can get probably at least 6 hours of fairly solid sleep (I need over 7 hours to feel my best) you aren't going to likely notice a lot of improvement and even then it may take time but you have to start with good solid and decent hours of sleep first to have any chance of feeling better.

Those hours of sleep have to be fairly solid with minimal number of remembered wake ups during the night. It's normal to wake some (like after a REM stage) but we normally don't remember those times as they are so brief. If we remember a dozen wake ups...there's a real good chance there was a lot more we don't remember and that creates a potential problem.
When we wake too often the body doesn't get to go through the normal sleep cycles and get the normal amount of sleep in each cycle...and the body needs the nice normal progression through the sleep stages for the magic of the restorative powers of sleep to work.

Finally...it does take a while for the brain to get used to having the alien plastered on the face...I know that even with me it took a couple of months before the brain stopped poking me to wake me up just to say "hey dude, do you know you have a weird alien on your face?"
With time the brain comes to accept its new best friend and at least those wake ups reduce but we might still have other wake ups from stuff going on outside sleep apnea or therapy.

[Pugsy]

What are your leak numbers running?

[Airwolf]

Sub-10. I switched masks to get a better seal as my first mask didn’t seem to work for me. This one seems to seal ok; the old one woke me up every time it leaked.

[Pugsy]

Sub 10 leak numbers...and your machine reports what we call a 95% number which means "at OR BELOW" that number for 95% of the time..
So in terms of therapy effectiveness leaks aren't an issue.
Now of course any leak, no matter how tiny, that wakes us up...that leak needs to be worked on because it is messing with sleep itself.

How many hours of actual sleep are you averaging?
How many wake ups do you remember during those hours of sleep?

[Airwolf]

I’d say 3 wakes on average, 5-7 ona bad night and it tracks with the AHI. Most nights I sleep 7.5 total, probably 7 actual weeknights, then 8-8.5 with the same 30 or so minutes of not asleep yet.

I also typically use a 5 minute ramp at the beginning of the night and shut it off on wakeups. I seem to be adjusting physically well.

[jnk...]

Do you have the exact wording of the results of the study?

[Airwolf]

On paper, yes. I have some summary stuff online.

[jnk...]

So during the diagnostic portion of the study, the first half of the night, was when "99% of my events were hypopnea"? Or was that during the treatment portion of the night? Or is that your result now with home-machine treatment? Or other? Is there anything else that seems worthy of mention from the report from the diagnostic portion of the study?

My family has roots and property in Doddridge county--not quite panhandle, but close.

[Airwolf]

Patient blah blah for 439.5 minutes... sleep onset of 5 minutes, sleep efficiency 49% during diagnostic. Improved to 65% during treatment. Sleep arch during diag 5 min stage 1, 96.5 stage 2, 5.5 min 3, 0 rem. During treatment, 1.5 s1, 103 s2, 16.5 s3, 16 rem. Frequent episodes sleep disorder breathing. Ahi 25.8 min o2 88%. Met criteria for titration, initiated at 4cm and titrated for real events/snoring. At 12cm ahi to 2.7. Min sat o2 89%. 44.1 min sleep at 12cm including 5.1 rem.

Sorry for the shortcuts, typing on my iPhone.

[Airwolf]

My family has roots and property in Doddridge county--not quite panhandle, but close.

WV is the best kept secret in the country. Moved here when I got married. Never looked back.

[jnk...]

Sorry about making you phone-type! So the "99% hypopneas" statement is based on . . . ?