How reliable and trustworthy is data from a CPAP machine?

[palerider]

Sounds like your doctor is looking for more sleep studies and therefore more $$$$$$.

I don't know the motivation of my doctor, but I will say that, although he's younger than me (I'm 71), he seems like he's lost his fast ball and is sort of just mailing it in. I don't have a lot of options where I live, but I'll be looking for an alternative.

For the most part, getting cpap adjusted isn't that difficult, you just need to learn a bit of how to intepret the data and make educated guesses about what it tells you, then make adjustments to the machine.

You becoming an involved patient will result in far better results than any doctor that sells you 5 minutes of his time every few months.

[zonker]

You becoming an involved patient will result in far better results than any doctor that gives you 5 minutes of his time every few months.

SELLS you, not gives you.

[palerider]

You becoming an involved patient will result in far better results than any doctor that gives you 5 minutes of his time every few months.

SELLS you, not gives you.

Noted, corrected in original post
Thank you!

[chunkyfrog]

When I showed my Sleepyhead data to my sleep doc, I noted that my focus was on TRENDS.
He was so fascinated, I suspect at least his next two patients were forced to wait .
He is most certainly a keeper, because he realizes the importance of STATISTICS.
His staff downloads the last month's data before my yearly appointments.

[zonker]

When I showed my Sleepyhead data to my sleep doc, I noted that my focus was on TRENDS.
He was so fascinated, I suspect at least his next two patients were forced to wait .
He is most certainly a keeper, because he realizes the importance of STATISTICS.
His staff downloads the last month's data before my yearly appointments.

oh, certainly.

i'm not here to say ALL sleep doctors are worthless. but it must be noted that yours is one of the exceptions, at least from what i glean from this forum and my own experience.

[zonker]

You becoming an involved patient will result in far better results than any doctor that gives you 5 minutes of his time every few months.

SELLS you, not gives you.

Noted, corrected in original post
Thank you!

and

[chunkyfrog]

With doctors, it is well-advised to dump the dunderheads, as soon as identified.
I changed PCPs when the old guy was getting forgetful and slow-witted.
I still wonder how long into his decline they let him practice.
(Edit--holy cr@p--he's STILL practicing!)

[barney999]

I don't know the motivation of my doctor, but I will say that, although he's younger than me (I'm 71), he seems like he's lost his fast ball and is sort of just mailing it in. I don't have a lot of options where I live, but I'll be looking for an alternative.

if you share where you live someone here may know a worthy doc

see if this helps
http://health.usnews.com/doctors/specialists-index

Thanks for the link! I have another doctor in mind.

[barney999]

Sounds like your doctor is looking for more sleep studies and therefore more $$$$$$.

I don't know the motivation of my doctor, but I will say that, although he's younger than me (I'm 71), he seems like he's lost his fast ball and is sort of just mailing it in. I don't have a lot of options where I live, but I'll be looking for an alternative.

For the most part, getting cpap adjusted isn't that difficult, you just need to learn a bit of how to intepret the data and make educated guesses about what it tells you, then make adjustments to the machine.

You becoming an involved patient will result in far better results than any doctor that sells you 5 minutes of his time every few months.

Thanks for the comment. Based on what I've learned reading thru the forum here against my experience with my doctor, I'm a believer!

[barney999]

I think you're going to be a great asset to the forum

Please don't start a new topic though - we really need to be able to follow your story even if daily topics change within it, and it should make more sense in the end that way.

Thanks for your kind words, and also for the advice about not starting a new topic, which I now see is in the Sticky:Newbies PLEASE READ BEFORE POSTING!

I actually did read that helpful Sticky at one time, but it seems I need to re-read it, 'cuz it didn't stick!

Anyway, thanks! I'll be adding comments here within this topic about my issues, hopefully within the next day or two after I read about adding Oscar data to comments and I have a little more time.

[barney999]

Here's a description of my current sleep issues that I'd like to explore to see if I can improve on them.

Background
I'm a 71 year old active male of normal weight in good health. I don't smoke or drink. I don't take any prescription drugs, but I do take a few supplements, mostly in the morning.

About 7 months ago, I was tested for Sleep Apnea because I was feeling so poorly almost every morning upon waking . A home study from my Sleep Doctor showed Severe Sleep Apnea with an AHI of 31.

I've been using APAP for almost 7 months now. My ResMed Airsense 10 Autoset settings are 6 to 20 with a 3 ERP. No ramp. Humidity level is 6.

I've been using Bleep for around 2 months. This corrected leak problems I had with a Nasal Mask.

I tape my mouth to eliminate mouth leaks.

Pre-APAP and using APAP, I generally have no problem falling asleep. I also generally wake up after around 4 hours of sleep to relief myself.

Pre-APAP, I would generally go right back to sleep. Under APAP, I generally have a hard time going back to sleep.

Pre-APAP, I don't recall being awakened during sleep other than to relief myself. Since APAP, I'm awakened numerous times during sleep, though much less so since changing to Bleep and sleeping on my side.

I have two main issues I'd to explore to see if I can make improvements on.

(1) I generally get around 4 hours of continuous "good" sleep a night. I'd like to extend that number to at least 6 hours if possible.

I seem to sleep in 2 main blocks. The first block generally lasts 3 or 4 hours, where the sleep quality is pretty good, usually under 2 AHI if I sleep on my side and generally under 5 AHI if I sleep on my back.

The 2nd block of sleep usually lasts 2 or 3 hours, of restless sleep, if I can get to sleep, usually above 5 AHI.

I don't usually have any Obstructive Apnea, and if so, usually no more than a couple for the whole night. Most of my Apnea shows up as Central.

(2) I'd like to get "good" sleep when sleeping on my back.

I get very good sleep results when sleeping on my side, generally around 2 or under AHI, which I couldn't do until I switched to Bleep. However, sleeping on my side causes aches and pains to my shoulders, wrists, knees and hip, so I'd like to sleep on my back if possible. Here's the problems I have when sleeping on my back:

I wouldn't say I feel all that well rested after sleeping on my side, but I definitely feel much less rested after sleeping on my back, often waking up dizzy and/or with a headache and/or a foggy feeling.

When I sleep on my back, my cheeks will periodically fill with air like a chipmunk and I'll be awakened a number of times a night by it.

Also, when dozing off when on my back and right before I fall asleep, there's times when I stop breathing very briefly, just enough to wake me up. This might happen 2 to 4 times one after another, until I fall asleep.

Based on the above, is it possible for me to get good sleep while sleeping on my back?

I'm sure I left something out, so please let me know if you need any further information.

The two Oscar reports are from me sleeping on my back with Bleep and are pretty representative of my issues.

This is the first time I've posted Oscar graphs, so please let me know if I've included enough data. Also I welcome any suggestions for how I could improve the graphs provided. Thanks very much.

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[Pugsy]

Try turning EPR off or if you feel you need it to fall asleep set it so it is in use only during ramp and make use of your ramp feature.

No other changes...just turn EPR off.

Sleep on your back since that is what you prefer and lets see what shows up.

[barney999]

Try turning EPR off or if you feel you need it to fall asleep set it so it is in use only during ramp and make use of your ramp feature.

No other changes...just turn EPR off.

Sleep on your back since that is what you prefer and lets see what shows up.

Thanks for the quick response! I appreciate it.

For tonight's sleep, I'll be on my back with EPR off.

[barney999]

As advised, I slept on my back last night with EPR off. I don't usually move around when I sleep, so I'm pretty confident that I was on my back the entire time I was in bed.

(1) Going to bed, before sleep.
Upon connecting to the APAP machine, I immediately had difficulty in exhaling, which felt kind of like a minor type of suffocation feeling. Because of this feeling, I didn't think I'd be able to fall asleep (fortunately, I was wrong about that!).

After a few minutes I also started having a headache, which lasted pretty much the whole night.

After a few minutes, air also started filling my mouth, but not full-blown puffed out cheeks. If my mouth wasn't taped, I'm pretty sure the air would have escaped thru my mouth.

(2) Sleep.
Fortunately, I was pretty tired and actually fell asleep fairly quickly. Oscar shows I slept around 3.5 hours.

I was awakened with my cheeks fully puffed out by air, chipmunk style, with the feeling that air was seeping out of the edges of the tape that covered my mouth.

I also experienced this same thing at some time right before I became more fully awake.

After being awakened, I got up and relieved myself.

(3) Trying to go back to sleep.
Going back to bed, I don't believe I fell back to sleep. Oscar shows that I was in bed for a little over 2 hours after I first got up.

During this time, air would come and go filling my cheeks. Again, if I didn't have my mouth taped, I think air would likely have escaped my mouth.

(4) After getting up for good.
When I finally got up for good, I felt dizzy and sort of foggy with a slight headache.

That said, surprisingly, overall I don't feel that bad from a sleep perspective even though I likely got less than 4 hours sleep and my AHI was 9.24.

Also, because I was on my back the whole time I was in bed, I don't have the aches and pains in my shoulders, wrists, knees and hips that I experience when I sleep on my side.

The feeling of difficulty in exhaling lasted pretty much the whole time I was awake throughout the night, though there were times when I didn't notice it as much.

The excess air in the mouth sort of came and went to a various degree throughout the night while I was awake.

Because I had limited sleep, I'm pretty sure I'll tire out fairly early in the day today and will likely have to nap.

I've included the Oscar data from last's night sleep. Please let me know if you have any questions or require any further information. Also, should I continue with this same APAP setup for tonight and beyond?

Thanks very much.

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[Pugsy]

I was hoping that reducing EPR would help with the central (CA) apneas but doesn't look like it did. Darn.

What are the chances you were awake from 3:45 to roughly 4:45?

I do not know what to make of the complaint of headache that started early in the night and last all night. Nothing showing at the beginning of the night that we could maybe blame the headache on. Now the 3:45 to 4:45 time frame is a maybe in terms of blame.

It does sound like you had a lot of time awake with the chipmunk cheek thing. What are the chances it might have been going on for that hour between 3:45 and 4:45?

What I am trying to figure out if those centrals flagged are real asleep centrals in which case there are a potential problem or if they are simply awake breathing irregularities getting flagged by mistake.

Guess you need to take a crash course in flow rate evaluation.
Watch the videos here with special attention to the bottom one.
http://freecpapadvice.com/sleepyhead-free-software

If the bulk of the central flags are real asleep centrals then you need to be having a chat with your doctor.
But if they are a symptom of poor sleep quality and most are awake breathing related then we need to figure out what is causing the awakenings and try to reduce that from happening.

In terms of OSA and back sleeping though....in your case it doesn't appear to markedly make it worse or make you need more minimum pressure or anything like that. That's what I wanted to see...the worse case scenario and your OA/hyponea count didn't seem to be worse for it.
Sleep in whatever position you want to sleep in. In your situation I don't see it really being a problem in terms of worsening your OSA.
While it is common for some people...not everyone will have a much worse OSA problem when supine. Mine isn't...but REM sure is.

Do you happen to have one of those overnight recording pulse oximeters to see what your oxygen levels might be doing during the night?

If the starting pressure of 6 feels too stifling...consider maybe trying 7 cm just from a comfort and air moving aspect...or add back in EPR but use it during ramp period .....at least until a few more nights with EPR being off gets documented.
I was hoping we could blame the centrals on EPR and could reduce them that way but it doesn't look like that's your culprit and after maybe a week with no EPR but still seeing these centrals in high numbers....I see no harm in adding EPR back in because it doesn't look like EPR was the cause of the centrals.

Next time/tonight....when you find yourself awake because of chipmunk cheeks or anything...reach over and push the on/off button. This will give a break in therapy line that is easily seen and we can know for sure that you were awake at that time and can disregard any events that might be flagged around that break in therapy time frame.