Just got AHI (24), waiting on CPAP

[Billymadison420]

NIGHT #2:

First question.

Is there a better way to post my OSCAR data than a screenshot? I got the detailed info:

LINK: https://www.dropbox.com/s/ph0w3asbj82l9 ... M.png?dl=0

2. I noticed that my AHI was higher last night. I keep waking up with cotton mouth early in the morning, so it seemed like I kept opening my mouth.
3. The apneas, again, seem to happen totally in the morning. This is what my Apnea Nightowl test showed at diagnosis.
4. It is during that time that I have extreme REM sleep. I fall in and out of sleep and REM sessions with elaborate dreams.
5. (for a recap) Doctor 1 said he thought that was Narcolepsy, Doctor 2 is not so sure. Slipping instantly into REM seems like Narcolepsy. Now I am more confused.
6. Many of the Apneas showed as CA, central Apnea. What does this mean, if anything? (my dog was going crazy this morning around that exact time, which kept waking me up)
7. With this data, do I have to play dumb with my Doctor/Clinician. Will they be mad if I reference this data?
8. I guess an AHI of 7, and the first night of 3 is still much lower than 21. But will that only mean much, if I am truly just treating OSA and not Narcolepsy?
9. I need to be more patient don't I

For point/question #2, should I go for the facemask?

[Pugsy]

Time to learn how to zoom in on those centrals and lets see if you were asleep or not when they were flagged.

Watch the videos here
http://freecpapadvice.com/sleepyhead-free-software

And lets see if we can use SleepHQ to let us see what you are seeing in real time.
I think there is a link to the app here
viewtopic.php?f=1&t=184641&p=1415144&hi ... Q#p1415144
I haven't done it yet myself so I don't have experience to explain how to use it..sorry...I just haven't had the time or energy or need.

I have seen quite often what you are seeing in terms of so many centrals late in the night. I have some thoughts on what we can try to do about them but first we need to know if you are for sure asleep or not.

As for the dry mouth...that means you are likely mouth breathing and it doesn't take much mouth breathing to dry out the mouth. The amount of large leak last night...that may or may not be from the mouth breathing...isn't very much so at this point I don't know that a full face mask is urgently needed in terms of therapy effectiveness as to the loss of effectiveness from mouth breathing. I just don't see it at this point.
And don't assume that using a full face mask will automatically fix the dry mouth issues because it doesn't. We have a LOT of full face mask users here who complain of still having dry mouth and have to use other measures to deal with the dry mouth.
Your time in large leak (no matter what the cause) is minimal and not enough to seriously impact therapy effectiveness.

[Billymadison420]

Time to learn how to zoom in on those centrals and lets see if you were asleep or not when they were flagged.

Watch the videos here
http://freecpapadvice.com/sleepyhead-free-software

And lets see if we can use SleepHQ to let us see what you are seeing in real time.
I think there is a link to the app here
viewtopic.php?f=1&t=184641&p=1415144&hi ... Q#p1415144
I haven't done it yet myself so I don't have experience to explain how to use it..sorry...I just haven't had the time or energy or need.

I have seen quite often what you are seeing in terms of so many centrals late in the night. I have some thoughts on what we can try to do about them but first we need to know if you are for sure asleep or not.

As for the dry mouth...that means you are likely mouth breathing and it doesn't take much mouth breathing to dry out the mouth. The amount of large leak last night...that may or may not be from the mouth breathing...isn't very much so at this point I don't know that a full face mask is urgently needed in terms of therapy effectiveness as to the loss of effectiveness from mouth breathing. I just don't see it at this point.
And don't assume that using a full face mask will automatically fix the dry mouth issues because it doesn't. We have a LOT of full face mask users here who complain of still having dry mouth and have to use other measures to deal with the dry mouth.
Your time in large leak (no matter what the cause) is minimal and not enough to seriously impact therapy effectiveness.

Ok thank you so much for your time this morning. Much appreciated.

I've downloaded both 1.0 Beta and 1.1 Beta. Both don't seem to import the data. They both find the data, but don't actually import it. Any ideas?

Here is what happens: https://www.dropbox.com/s/qk9br5vy3x91z ... k.mov?dl=0

[Billymadison420]

Ok so. I can't know for sure, but during the period with the Centra Apneas I was half awake (conscious) a LOT. My dog was whimpering like crazy to go out, and I was trying to sleep (as she was up hours before she usually gets up). So that could have been the cause.

I guess my question is:

1. Did my doctors not know that my Apnea is largely CA, and not OA?
2. Does that mean there is something wrong with my brain?
3. Could it have simply been a faulty reading?

[Pugsy]

I am sorry. I have zero experience with
1...Macs
2...SleepHQ
I am totally useless here but there are other members who can and will help as soon as they see you need help.

In the meantime....you can do the zooming in thing using OSCAR...
Or maybe email me the entire contents of your SD card and let me use my OSCAR and evaluate those centrals.
It has to be a compressed/zip copy of the ENTIRE card in one step though. I cannot do it with bits and pieces.
Do you know how to compress/zip the entire card in one step?

Also...how did you sleep last night in general? Soundly for the most part or did you have a lot of fragmented sleep?
Lots of remembered tossing and turning.

I will send you a PM with my private email address to send the compressed SD card if you can figure it out.

I have a couple of ideas to try to see if we can reduce the centrals.

1...turn EPR down or off or use in ramp only if you need EPR
2...reduce the max pressure

I don't like to do 2 different things in terms of changes at one time though....if we get positive results we don't have any way to know immediately which change in settings brought about the change in results.

I am leaning towards reducing or turning EPR off as the first experiment to see if we can reduce the centrals...
BUT FIRST I need to figure out if we need to reduce those centrals because you were asleep when they happened.

If you weren't asleep...gotta fix the sleep problem first and that's a different fix.

[Billymadison420]

I am sorry. I have zero experience with
1...Macs
2...SleepHQ
I am totally useless here but there are other members who can and will help as soon as they see you need help.

In the meantime....you can do the zooming in thing using OSCAR...
Or maybe email me the entire contents of your SD card and let me use my OSCAR and evaluate those centrals.
It has to be a compressed/zip copy of the ENTIRE card in one step though. I cannot do it with bits and pieces.
Do you know how to compress/zip the entire card in one step?

Also...how did you sleep last night in general? Soundly for the most part or did you have a lot of fragmented sleep?
Lots of remembered tossing and turning.

I will send you a PM with my private email address to send the compressed SD card if you can figure it out.

I have a couple of ideas to try to see if we can reduce the centrals.

1...turn EPR down or off or use in ramp only if you need EPR
2...reduce the max pressure

I don't like to do 2 different things in terms of changes at one time though....if we get positive results we don't have any way to know immediately which change in settings brought about the change in results.

I am leaning towards reducing or turning EPR off as the first experiment to see if we can reduce the centrals...
BUT FIRST I need to figure out if we need to reduce those centrals because you were asleep when they happened.

If you weren't asleep...gotta fix the sleep problem first and that's a different fix.

1. I will turn EPR off tonight and see what's what. Thats a good start. Thank you! It was off by default, so perhaps clinically, when they set it up, they meant to do that.
2. I was tossing and turning that entire period in the morning 6-8AM, because of the dog.
3. I slept like shit, and feel like shit. lol. Anytime I felt back asleep in that 6-8AM range I went straight to REM, crazy dreams.

I can compress and send the card! I can do that no problem. Thank you! You are so so kind.

EDIT: Sent you a PM

[Pugsy]

I guess my question is:

1. Did my doctors not know that my Apnea is largely CA, and not OA?
2. Does that mean there is something wrong with my brain?
3. Could it have simply been a faulty reading?

1.....tell me about your sleep study....home study or in a sleep lab? If a home study did you wear something around your abdomen or chest that was just a little bit restrictive.
I doubt seriously if your sleep apnea is largely CA and not OA.

2. No

3..not so much a faulty reading but a misinterpreted reading....false positive is what I call it because we all understand false positives. The machine doesn't know if you are asleep or not....it only measures air flow and the irregular breathing we do when awake or half awake can "confuse" the machine into thinking that irregular flow rate is some sort of apnea.

I think what we are seeing with you is likely a combination of false positive awake breathing flags and maybe some sleep onset central (normal to have) apneas.....but while sleep onset centrals are normal we don't want a truckload of them because we can't complete the transition to sleep very well.
Is there a possibility that EPR itself or the pressure itself has triggered real centrals...yes it is possible but at this point way too early in the therapy to go down that road and worry. Too many other potential culprits possible as well.

To fix any problem....we first have to identify the problem and right now we are in the identification process.

[Pugsy]

Okay....I got the OP's SD card contents and he's now in my OSCAR.
I reviewed all the central flags from last night....99% he was awake or half awake and so blatantly arousal/awake related flags that a blind man could see it.

The central flags are a symptom of crappy sleep and not the cause of the crappy sleep.
The problem is crappy sleep....and fixing it won't be easy for a brand new to cpap user.

I doubt seriously that EPR is causing the centrals and I doubt that the higher pressures are the cause.
So I doubt that changing either will cause any change in the number of centrals.

The problem with the dog....didn't help the crappy sleep but probably not the sole culprit.
People just starting cpap tend to have hyper vigilant brains and they are just more sensitive to anything and wake up way too easily from the least little thing. The brain is just not yet recognizing the mask and machine as its new best friend.

Did you take your "sleep med" last night?

[Billymadison420]

Okay....I got the OP's SD card contents and he's now in my OSCAR.
I reviewed all the central flags from last night....99% he was awake or half awake and so blatantly arousal/awake related flags that a blind man could see it.

The central flags are a symptom of crappy sleep and not the cause of the crappy sleep.
The problem is crappy sleep....and fixing it won't be easy for a brand new to cpap user.

I doubt seriously that EPR is causing the centrals and I doubt that the higher pressures are the cause.
So I doubt that changing either will cause any change in the number of centrals.

The problem with the dog....didn't help the crappy sleep but probably not the sole culprit.
People just starting cpap tend to have hyper vigilant brains and they are just more sensitive to anything and wake up way too easily from the least little thing. The brain is just not yet recognizing the mask and machine as its new best friend.

Did you take your "sleep med" last night?

Hi!! Thank you again for your help!! I did take my sleep aid last night. Only other thing of note is I had 1 beer around 6PM yesterday. I made sure to drink lots of water though. That said, 1 beer, even hours earlier in combination with the Mirtazipine can be like 3-4 beers without it. I was told its fine, and not dangerous, but it could have had an affect. It does seem like that 5-8AM period if where all my wakeups occur, both before and after CPAP treatment. Obviously we are still early in the game here, so there will a big adjustment period.

It does seem like the Obstructive events are way down. From the AHI of 24 from my original test, can I assume that that AHI was from OA? I remember of course waking up gasping for air. Anyway.... At least I know what is going on at the moment. Thank you all so much. This is a tremendous learning process.

2 Part question:
1. Did the machine come set with what the respiratory therapists WANTED me to use? I.e they programmed it custom for me?
2. Assuming thats true, would restoring it to factory restore it back to that setting?

[Pugsy]

2 Part question:
1. Did the machine come set with what the respiratory therapists WANTED me to use? I.e they programmed it custom for me?
2. Assuming thats true, would restoring it to factory restore it back to that setting?

Did you ever have a sleep study, where the tech put you on cpap and mask, to figure out pressure needs?
If you didn't...no one has a clue what pressures you need and even if they did it doesn't mean they were correct.
Think about it...how would anyone even have the least little idea what pressure to use?

Most likely they just sent you a machine with factory defaults (or near defaults) and then hoped the machine itself would sort out the pressure needs and deal with things. That the most common thought for both doctors and DMEs and respiratory therapists when it comes to dispensing auto adjusting machines.
And hey....sometimes the defaults work well for some people so worth starting with and then adjusting later if there is a proven need.
A big problem with the defaults is that the very low starting pressure simply isn't comfortable and people feel air starved and can't sleep well because of feeling like they are suffocating. They won't suffocate but try telling the brain that fact.
The brain won't listen and it will try to keep its human awake so it can't suffocate. Result...can't fall asleep.

From the AHI of 24 from my original test, can I assume that that AHI was from OA?

Yep. Safe assumption. Your machine is doing its job...preventing obstructive apnea events...extremely well.
Easily seen with the minimal number of OAs and hyponeas (those are obstructive in nature events).

The CAs/centrals are primarily false positives related to crappy sleep...and once we get you to sleeping more soundly those will go way down in numbers.
An occasional real central is normal and no big deal anyway. So don't think you won't ever see a real central because you will...centrals aren't problem unless present in large numbers (and you were for sure asleep) or they cause desats or in the case of sleep onset centrals they bounce you out of sleep repeatedly. I don't see that with your last night's results.
What I see is simply crappy sleep from probably external stimulus issues.
You had a bad night...it happens...we shrug our shoulders and move on.

You are new to all this stuff and people new to cpap tend to think everything wrong with sleep is apnea related and fixable by the machine and the cold hard fact of life is that nothing is further from the truth.
Last night was a "bad sleep" night...but not from apnea or airway issues....just a bad night in general and nothing we can do from the machine's stand point can fix the cause of the bad sleep last night.

Quit trying to micro analyze it....combination of just being new to cpap therapy causing the brain to be hyper sensitive and likely your worry about your dog is the cause of the bad sleep last night. It's water under the bridge....tonight will be better.

[Billymadison420]

2 Part question:
1. Did the machine come set with what the respiratory therapists WANTED me to use? I.e they programmed it custom for me?
2. Assuming thats true, would restoring it to factory restore it back to that setting?

Did you ever have a sleep study, where the tech put you on cpap and mask, to figure out pressure needs?
If you didn't...no one has a clue what pressures you need and even if they did it doesn't mean they were correct.
Think about it...how would anyone even have the least little idea what pressure to use?

Most likely they just sent you a machine with factory defaults (or near defaults) and then hoped the machine itself would sort out the pressure needs and deal with things. That the most common thought for both doctors and DMEs and respiratory therapists when it comes to dispensing auto adjusting machines.
And hey....sometimes the defaults work well for some people so worth starting with and then adjusting later if there is a proven need.
A big problem with the defaults is that the very low starting pressure simply isn't comfortable and people feel air starved and can't sleep well because of feeling like they are suffocating. They won't suffocate but try telling the brain that fact.
The brain won't listen and it will try to keep its human awake so it can't suffocate. Result...can't fall asleep.

From the AHI of 24 from my original test, can I assume that that AHI was from OA?

Yep. Safe assumption. Your machine is doing its job...preventing obstructive apnea events...extremely well.
Easily seen with the minimal number of OAs and hyponeas (those are obstructive in nature events).

The CAs/centrals are primarily false positives related to crappy sleep...and once we get you to sleeping more soundly those will go way down in numbers.
An occasional real central is normal and no big deal anyway. So don't think you won't ever see a real central because you will...centrals aren't problem unless present in large numbers (and you were for sure asleep) or they cause desats or in the case of sleep onset centrals they bounce you out of sleep repeatedly. I don't see that with your last night's results.
What I see is simply crappy sleep from probably external stimulus issues.
You had a bad night...it happens...we shrug our shoulders and move on.

You are new to all this stuff and people new to cpap tend to think everything wrong with sleep is apnea related and fixable by the machine and the cold hard fact of life is that nothing is further from the truth.
Last night was a "bad sleep" night...but not from apnea or airway issues....just a bad night in general and nothing we can do from the machine's stand point can fix the cause of the bad sleep last night.

Quit trying to micro analyze it....combination of just being new to cpap therapy causing the brain to be hyper sensitive and likely your worry about your dog is the cause of the bad sleep last night. It's water under the bridge....tonight will be better.

Awesome. Thank you so much. All noted. I am learning, and this will help me be more patient and not catastrophize the bad days. I think since working with the first doctor and getting the N diagnosis (Possibly false diagnosis), I had been living with this assumption that something is wrong with my brain. That really put a damper on my mental health. I was beating myself up for something I couldn't control, or didn't even know for sure. This view (understanding my sleep, and being patient with the process) will at least allow me to take each day in stride instead of catastrophizing.

In good news my blood pressure was much lower yesterday! Even in the middle of the day. Instead of being like 145/90 it was 120/88. Maybe a coincidence, maybe not.

Coffee, at current, doesn't feel like enough though. I am tempted to use the stimulants to wake up, but I know there is a downside to that too. I get the sense my new doctor didn't like that I was prescribed them at ALL.

[Pugsy]

I am tempted to use the stimulants to wake up, but I know there is a downside to that too. I get the sense my new doctor didn't like that I was prescribed them at ALL.

Don't, don't, don't go down the daytime stimulants road if at all possible.
You haven't really had a chance to give cpap therapy itself a good trial. There is a time and place for all such meds but at this point it is way too soon to go down that road. You are already having trouble sleeping....I guarantee that daytime stimulants will make it worse for sleep quality.

Drink more coffee or stronger coffee and accept that last night was a bad night overall.
I would rather see you take a nap than legalized speed...and I am not keen on your taking a nap.

It is possible that effective OSA therapy can reduce elevated BP...it happens for some and not for others (I wasn't as lucky) but remember 1 time of anything doesn't a trend make. You need long term consistent anything to know for sure.

Take another one of those big hard to swallow nasty tasting patience pills.

[Billymadison420]

I am tempted to use the stimulants to wake up, but I know there is a downside to that too. I get the sense my new doctor didn't like that I was prescribed them at ALL.

Don't, don't, don't go down the daytime stimulants road if at all possible.
You haven't really had a chance to give cpap therapy itself a good trial. There is a time and place for all such meds but at this point it is way too soon to go down that road. You are already having trouble sleeping....I guarantee that daytime stimulants will make it worse for sleep quality.

Drink more coffee or stronger coffee and accept that last night was a bad night overall.
I would rather see you take a nap than legalized speed...and I am not keen on your taking a nap.

It is possible that effective OSA therapy can reduce elevated BP...it happens for some and not for others (I wasn't as lucky) but remember 1 time of anything doesn't a trend make. You need long term consistent anything to know for sure.

Take another one of those big hard to swallow nasty tasting patience pills.

ohhhhhh I know you are right. I just want to stop feeling this horrible so badly. I am a shell of the person I know I can be. I will get through today, again <3

[zonker]

ohhhhhh I know you are right. I just want to stop feeling this horrible so badly. I am a shell of the person I know I can be. I will get through today, again <3

you can do this. i have every confidence in you. you are asking questions, getting answers and then applying them. so many don't so it's encouraging to see you do it.

continued good luck!

[Billymadison420]

ohhhhhh I know you are right. I just want to stop feeling this horrible so badly. I am a shell of the person I know I can be. I will get through today, again <3

you can do this. i have every confidence in you. you are asking questions, getting answers and then applying them. so many don't so it's encouraging to see you do it.

continued good luck!

Thank you. That is very kind. I will keep at it. I will also keep working with my new Sleep (actual Sleep specialist and not just a pulmonologist) Doctor to try and figure this all out, as well.