first night with cpap, please help interprety graphs

[zackds]

hi, i have a phillips respironics system one auto flex. last night was my first use with it and i slept a bit better than i have been recently but still need to tweak it i think. i started with the lowest pressure at 6 and highest at 14. a couple of the times i woke up i changed the settings up a bit to 9 lowest and 17 highest. probably shouldve just left it the same throughout the night to see how the original pressure was but eh. i have a sleepyhead report and any input would be awesome. im not sure if i screenshot the right info you guys would need, let me know if you need something else screenshot

[Pugsy]

Some history here folks.
OP is self diagnosing and self treating...no sleep studies to give us any history. No doctor involvement at this time.

So all this is entirely new to the OP and he's doing it all himself and started off with the Quattro full face mask.
I am sending him a P10 nasal pillow mask to try.
Right now he isn't using the humidifier because the machine given to him was minus the water chamber. I am also sending him a water chamber but I am unsure if it will fit in his PR S1 CPAP Auto model 550. It has the dark colored lid for the 560 on it and I can't tell if there is a difference in it besides the color. I know the bottoms are all the same. He should get what I sent either Monday or Tuesday.

To Zack...you didn't tell people that when you went with the higher minimum that you had some nausea pop up. I am not sure why that happened but let's back up and try to get you some solid blocks of sleep to evaluate before you go screwing with the pressures all that much. Let's try to figure out what you need first.
The machine didn't see the need to increase the pressure. Those spikey saw tooth increases are the test pressure probes and not the machine responding to anything. You didn't sleep well and had a lot of wake ups so I don't know just how much you actually slept for the machine to maybe need to respond to anything.
Don't worry abut the AHI right now....with all the wake ups there's a good chance that some of those are awake breathing irregularities getting a flag and if you are awake they don't count.

These machines have no way to know if you are asleep or not. All they do is measure air flow and our awake breathing air flow is much more irregular than our asleep breathing air flow. The machine can and will make mistakes if your awake breathing happens to mimic what happens with an apnea event.

It's your first night and all this is totally new to you.
You are attempting to self diagnose...at some point share with us why you think you have sleep apnea...the machine didn't see anything it wants to kill. Now maybe nothing happened because you really didn't get much sleep.
Use the least minimum pressure that you can use and breathe comfortably. Don't mess with the max...the machine is NOT going anywhere near the max so it is a moot point.

Right now we just want to establish need...worry about optimal settings once the need is proven.
You need good solid blocks of real sleep before we can get an idea about need.
I want you to use the lowest minimum pressure you are comfortable with...and lets see if the machine ever wants to get off of that pressure while you are for sure asleep. This is the self diagnosing part. You have to do that before you can go self treating.

Your primary job right now....get good solid chunks of real sleep. Whatever it takes...even maybe a dose of an OTC sleep aid if you need it. It's hard to sleep with all this crap attached to us.

[zackds]

Some history here folks.
OP is self diagnosing and self treating...no sleep studies to give us any history. No doctor involvement at this time.

So all this is entirely new to the OP and he's doing it all himself and started off with the Quattro full face mask.
I am sending him a P10 nasal pillow mask to try.
Right now he isn't using the humidifier because the machine given to him was minus the water chamber. I am also sending him a water chamber but I am unsure if it will fit in his PR S1 CPAP Auto model 550. It has the dark colored lid for the 560 on it and I can't tell if there is a difference in it besides the color. I know the bottoms are all the same. He should get what I sent either Monday or Tuesday.

To Zack...you didn't tell people that when you went with the higher minimum that you had some nausea pop up. I am not sure why that happened but let's back up and try to get you some solid blocks of sleep to evaluate before you go screwing with the pressures all that much. Let's try to figure out what you need first.
The machine didn't see the need to increase the pressure. Those spikey saw tooth increases are the test pressure probes and not the machine responding to anything. You didn't sleep well and had a lot of wake ups so I don't know just how much you actually slept for the machine to maybe need to respond to anything.
Don't worry abut the AHI right now....with all the wake ups there's a good chance that some of those are awake breathing irregularities getting a flag and if you are awake they don't count.

These machines have no way to know if you are asleep or not. All they do is measure air flow and our awake breathing air flow is much more irregular than our asleep breathing air flow. The machine can and will make mistakes if your awake breathing happens to mimic what happens with an apnea event.

It's your first night and all this is totally new to you.
You are attempting to self diagnose...at some point share with us why you think you have sleep apnea...the machine didn't see anything it wants to kill. Now maybe nothing happened because you really didn't get much sleep.
Use the least minimum pressure that you can use and breathe comfortably. Don't mess with the max...the machine is NOT going anywhere near the max so it is a moot point.

Right now we just want to establish need...worry about optimal settings once the need is proven.
You need good solid blocks of real sleep before we can get an idea about need.
I want you to use the lowest minimum pressure you are comfortable with...and lets see if the machine ever wants to get off of that pressure while you are for sure asleep. This is the self diagnosing part. You have to do that before you can go self treating.

Your primary job right now....get good solid chunks of real sleep. Whatever it takes...even maybe a dose of an OTC sleep aid if you need it. It's hard to sleep with all this crap attached to us.

ah crap. how can you tell i didnt sleep well? last night felt a bit better than it has for a while haha. granted i still woke up tired, feeling like i should stay in bed.
the reason i think/thought i had sleep apnea is because i havent slept well for over a year now, and the last two months ive been waking up with my heart beating like it trying to compensate for me
when i wake up, i am not necessarily gasping for breath, but it just feels like i am not breathing right/my body isnt getting oxygen
now, i also feel like this during the day (not being able to breathe right) so...
both my parents have sleep apnea
what else could it be if i didnt have sleep apnea?
im sure you guys come across people like me a lot who turn out to have something else wrong

[Pugsy]

How did I know you didn't sleep so great...well the multiple breaks in therapy where you screwed with the machine settings was the first dead give away.
And actually I would have been surprised if you hadn't had some poor sleep from the mask and machine on the first night with never having any past experience doing this stuff.

Heck, it took me over 2 weeks to remotely start sleeping halfway decently with the mask and machine.

You can't always self diagnosis just from one night. I know you wanted to but sometimes we don't get what we want.
As to what else might be going on....the list is long and I haven't ruled out OSA....I am just saying that last night wasn't the best lab experiment to establish need. It wasn't clear cut...that's all I am saying and it wasn't clear cut because of crappy sleep.
With any diagnosis you have to sleep to get one.

There's therapy value even at 4 cm minimum pressure so even if you used 4 cm all night long and the machine didn't move off it...that wouldn't mean absolutely no OSA because maybe 4 cm takes care of the OSA. It does for some people.
So just because the machine doesn't move doesn't mean no OSA...just means it doesn't need more pressure.
It is nice when it does move though...gives a clearer answer to the question "do I have something going on like OSA that the machine says I need more pressure?"

The plan...if you wish to try it.
1...get the sleep quality better so we have real sleep for the machine to deal with
2...and use the machine for at least 3 months to see if you feel better or sleep better or whatever.

Then you should have your answer...is it OSA or some sleep disordered breathing that is fixable with cpap.
If you aren't better at all...then whatever is going on is probably unrelated to sleep apnea and the machine can't fix it.
There's a long list of culprits that will mess with sleep quality besides sleep apnea. Cross that bridge in 3 months if you need to.
Maybe you won't need to.

I am hoping that maybe once you actually get more solid chunks of sleep that the machine will give you a nice clear cut answer by some movement or an improvement in how you feel or sleep.

Please note...I am not saying that you don't have OSA. All I am saying right now is we didn't get a good night to evaluate things and even if we had it wouldn't necessarily mean no OSA. We don't sleep the same each night either.

Self diagnosing...takes time and patience.

[zackds]

i remember adjusting the machine a few times before falling asleep
that was probably 30-40 minutes or so
i dont know how many times i woke up to change it or woke up during the night
where do i look to see when ive woken up on the graphs?
im looking at flow rate right now
it seems i slept from around 12-1 then the flow rate goes off where i may have changed settings
then i sleep from around 1-4 then the flow goes off to change settings
then i sleep from 4 to around 8 with a few breaks after that where i was waking up
is that what youre looking at?
and does it show if i woke up anywhere else in there?


i am all for your plan btw
ill do 4 for the lowest pressure tonight

[Pugsy]

Do the 4 cm ONLY if you are comfortable with it. If you feel the least bit air starved or suffocating like...don't do it.
Some people are okay with 4 cm...and some people aren't. If you aren't comfortable you won't be able to fall asleep easily or stay asleep. My own sister needed 6 cm to even remotely get comfortable and she's a big whiny ass baby about it when I screened her.

There is a way to zoom in and look for awake breathing vs asleep breathing. There's a rather high learning curve and I will admit that even now I can't always tell for sure with 100% certainty.
You can start learning if you wish by reading and watching all the videos here.
http://freecpapadvice.com/sleepyhead-free-software

I can easily see at least 5 breaks in therapy last night where the machine was turned off and then back on. You were awake to do that and if you were awake at least 5 times...there's probably even more where you didn't turn the machine off. It also shows when you screwed with the minimum.
Those 5 breaks in therapy alone were enough to tell me you didn't sleep soundly for the bulk of the night. Experience tells me you likely had more awake times than that. I don't need to see any more details to know that.
It's enough to know that when you were asleep it wasn't long enough to progress naturally through the sleep cycles in the normal percentage in each cycle. It just can't be done. Something gets reduced or eliminated when the sleep is so fragmented.

We particularly want you to sleep long enough and well enough to get some REM sleep because often that's where the OSA worsens if a person has OSA. I have lots of experience in this area myself. My own OSA is 5 times worse in REM than in non REM.
Pre cpap I didn't get much REM because every time I would enter REM the apnea events starting happening about 1 per minute and in just a few minutes I would be awake and no more REM and would have to start the sleep cycle process all over again. No wonder I felt like crap. Not only did my O2 go in the toilet but I didn't get the required amount of sleep in each cycle and I woke up more times than I knew or could count.

I know money is really tight with you right now but another tool we might think about using down the road is one of those overnight recording pulse oximetery devices. See for sure what might or might not be going on with your oxygen levels. That's down the road a bit though...when you get some money...we can get a decent one that will do well enough for about $50 depending on where you get it from. At this point the need isn't urgent though...let's sort through some of this other stuff first and then decide if it is worth using that tool or not.

Oh....for sake of ease in following...keep all your reporting and questions in this thread. Will be much easier to follow and see what might have been already discussed. Don't go starting a new thread which each new report or question. While I personally don't find it a horrible offense to have multiple threads...some forum members do and I will admit that having everything in one thread (for a while a least) does make it a lot easier on folks who are following you and/or wanting to help.

[Pugsy]

Oh...when you get a chance add your equipment to your profile like I have mine.
Your machine.. the link to that machine is broken so you need to add it in the comments section...PR S1 Auto #550 is sufficient...we all know what that is.
When you do add the humidifier the humidifier choice will be
PR System One Humidifier.
I don't think that it mentions 50 series as a choice but there is a 60 series humidifier which isn't what yours is.
I think it just offers System One Humidifier as that was the first model in the System One line. The 60 series came later.

[Julie]

I suggest you ask your MD for a general check-up with labs and some cardio work. Nausea may be due incidentally to anything including what you had for supper, but may not be and has been associated with cardiac issues. I would not just assume you have apnea because your parents did or that whether or not you have it something else is not going on coincidentally.

[zackds]

I suggest you ask your MD for a general check-up with labs and some cardio work. Nausea may be due incidentally to anything including what you had for supper, but may not be and has been associated with cardiac issues. I would not just assume you have apnea because your parents did or that whether or not you have it something else is not going on coincidentally.

i went to the doctor a few weeks ago
she had a complete blood count done as well as iron, b12 checked
she checked kidney function as well. im not sure what else she had run
but they came back normal
about 8 months ago now i had a more thorough set of blood tests run
including thyroid etc by an endocrinologist that all pretty much came back normal
the problem now is i dont have insurance but youre probably right
after pugsy was asking me why i thought it was sleep apnea
i was thinking it could be cardiac issues as well
ive not had nausea like that in the morning so i just figured it was from the machine
i do have nausea when eating though, even when i dont eat much
i will go see a cardiologist soon though i think
thanks for the input

[Julie]

What about an endoscopy to see what's going on with your GI tract - seems to be an area you might want to check out.

[zackds]

What about an endoscopy to see what's going on with your GI tract - seems to be an area you might want to check out.

yea im not sure exactly what to do. ive developed shortness of breath and circulation issues(cold hands/feet, decreased vein plumpness in those areas periodically) which point me to believing
it may be cardiac related. i also feel my heart 'skip a beat' in my chest or flutter during the day as well as every night(which makes me think sleep apnea)
also slight chest pain. i thought that was due to my heart working harder at night but i dont know

[Julie]

New doctor... or something, but don't wait.

[Pugsy]

Julie...he lost his job. There is zero money right now for any doctor.
He lives in a state that elected to NOT give everyone, who couldn't afford to buy in with Obamacare, access to state funded Medicaid which even if he had it isn't so easy to get good care.
He's one of those that has fallen through the cracks right now.
Getting state funded medical care isn't as easy as some people might think...They deny more medicaid applicants than they approve.
He could go to the emergency room and wouldn't be denied life saving care but that's about it. They don't do the other stuff like he might need for a good work up. They would do and say just like you....go see your doctor or get a new doctor.
Only problem is doctors won't see people who can't pay. They are funny like that. Most of them want a check before you even see them.

I don't see things getting any better anytime soon in terms of helping people with medical care who have fallen through the cracks. The 2 idiot parties we have that run things can't agree on what time of day it is much less anything really important. Each would block the other's good idea just because they didn't come up with it.

[zackds]

pugsy, whenever i try to sleep on my back, i always sleep worse. i almost always wake up with a racing heart. i know this is true for people who have sleep apnea. could it also be true if someone didnt have sleep apnea?

[palerider]

pugsy, whenever i try to sleep on my back, i always sleep worse. i almost always wake up with a racing heart. i know this is true for people who have sleep apnea. could it also be true if someone didnt have sleep apnea?

Generally only if they have sleep apnea, or at least some form of sleep disordered breathing.