Someone please help this Newbie!

[DreamDiver]

Wow - just checking in. Welcome.
From the summary graph you shared, I can see a couple things that stick out in my mind:

First and foremost, you have large leaks on a higher-than-preferred basis.
Anything over the red line constitutes a large leak. And many of your nights show you're coming close to large leak territory as it is.
You'll also notice that on many of the days when your AHI seems lower, the large leaks are at their worst. This is primarily because the machine cannot get reasonable a read on your AHI when large leaks hover around the red line.

It might help to look closer at your large leaks for a night with low AHI and a night with very high AHI.
Could you please post a couple of these as detailed graphs like you did before?
Ideally, it would be nice to see in order in one pane your AHI, flow and leak rate for the night.

For instance, here's my recent summary graph with a little detailed explanation, followed by some leak data for the 20th of Jan and 23 of Feb.


Here's February 23rd (Fairly typical for me):


And January 20th:


And one last example - January 19th (Less typical for me, but it still happens for all of us.):


You'll notice I get a lot of maximum just below the red line in my summary graph. This is not a problem. It usually means I'm adjusting my mask or moving the mask just long enough to scratching my nose. The total time at maximum might be less than 30 seconds for whole night where you see a bar that's totally light green. The ones to watch for are the 95th percentile (medium green) and the median (dark).

If you see lots of medium green and dark green over the red line or hovering near it, this is an indication that part of the problem with your AHI is either that your mask is ill-fitting or you need a chin strap or something else to help stabilize the mask better through the night.

It also looks like you could use a bit more mask time than you're getting. It may be difficult, but sleep debt is hard to overcome if you don't wear the mask for the entire duration of every sleep session, nap or otherwise. Be kind to yourself!

Good luck checking in with your RT and Sleep Doc.

[ozij]

Sorry guys and gals, when a person has that bad an AHI under therapy, you do not recommend raising the pressure before you see their data.

The data we see here has 2 characteristics:
1. Extremely short periods in which the results were recorded
2. Tons of central apneas -- that's those black bars, as opposed to the red bars. Which is why the following advice is irresponsible.

You could uncheck the AHI and Pressure in both windows since they don't tell you anything you don't already know.

THE EVENTS SHOW ALEX HAS VERY MANY CENTRAL APNEAS.

Now, either all those reported apneas -- obstructive or central -- are an artifact of some of those super short measuring times -- or they are awake breathing, or else, Alex, they could indicate you are suffering from complex sleep apnea syndrome: COMPSAS. The appearance of many central apneas under CPAP therapy is one indication of COMPSAS, as is an inability to keep the mask on.

When a person really has COMPSAS, they have tens of central apneas an hour appearing under cpap pressure. In that case, raising pressure can make it worse, and so can an APAP.

I'm not saying that's what you have, Alex, I'm not a doctor, and furthermore, none of us know if you were asleep during those times you showed us, and since, as DreamDiver has shown, you have tremendous leaks, I would say the following:

1. Don't make any changes in your pressure at this point
2. Do your best to handle mask leaks
3. Do your best to record when you are asleep and when just tossing and turning
4. If your doctor does not respond, get yourself anonther one, and discuss COMPSAS with that other doctor.

People with COMPSAS need a different type of machine, called ASV, and they have to be re-titrated for that.
In some cases, COMPSAS settles down after a while. You need a good professional guiding you through this.

Good luck
O.

[Pugsy]

When Ozij speaks, I listen.
She has helped me tremendously in the past.

So I amend my idea to light a fire under the doctors ass. Or get another doc.

How can this happen? If I remember correctly there were no centrals reported from the onscreen data before he got the software. Pretty sure I looked at that number.

[rested gal]

I had not read this thread until just now. Wow, lot of catching up to do.

Doesn't look to me like centrals are a problem.

Looks to me (but I'm not a doctor!) like the pressure reduction EPR gives during exhalation is the problem...as others have suggested.

If I were prescribed a pressure of 11 and were seeing that kind of "treated AHI", I'd give any of these changes a try, depending on how I wanted to use EPR.

EPR Off or during "ramp" only:
I'd leave the pressure at the prescribed 11.

EPR "1" full time:
I'd set the pressure at 12.

EPR "2" full time:
I'd set the pressure at 13.

EPR "3" full time:
I'd set the pressure at 14.

One other thought -- I'm not quite sure "why", but when I've looked at my own data after a very short sleep session (a session of two hours or less) the AHI is a LOT higher than what I usually see for a sleep session of 5 hours or longer. That might be playing in somewhat to the horrendously high AHIs you've been registering, AJimen05.

But I do think this is going to turn out to be more a matter of the straw that broke the camel's back... that it takes at least _X_ amount of CPAP pressure during breathing out to keep your airway open enough to be able to inhale again. I think the amount of EPR (expiratory pressure relief) you've been using is dropping that needed pressure too much for you. It may be that you're a person who absolutely needs 11 and not one bit less. Or 12. Or 13. And not one bit less.

I personally like pressure reduction when I exhale. I'd keep using EPR, but I'd sure raise the prescribed pressure considerably...to keep the pressure up where needed when EPR does its comfort thing. I'd use EPR, but I'd also set the pressure to whatever it takes to keep my airway from collapsing while breathing out, and especially to keep it from collapsing during any pause there might be before starting to breathe in again.

Good luck!

[ozij]

Rested Gal,
There are a lot of centrals on this chart.
ResScan shows central apneas as black bars.

I do agree that they are accompanied by much snoring and flow limitations - and raising EPR might help, and yes, they might be post obstructive, not a response to pressure.

But one can just brush them off an ignore them - which seems to me what was happening in the thread.
O.

[DreamOn]

Hi Alex,

For the same date as the chart that ozij has posted right above this post, would you give us some information from the Statistics page in ResScan? Under Apnea Index, it would be helpful to know the numbers for Obstructive, Central, and Unknown. And we need to know what is says for AHI that date. I can't tell by your graphs if what we're seeing are actually central apneas or if those lines are dark because there are SO many events piled on top of each other.

Also, I have read this entire thread, but now I don't remember if you have your sleep study report information. If not, you need to obtain the full reports (from both diagnostic and titration sleep studies) so you can have a complete understanding of your situation. It is really important to know if these are central apneas or obstructive apneas, as the therapy is different for each type. Pressure from a regular CPAP/APAP machine won't treat central apneas, since the airway is already open (not obstructed). Your sleep study reports should have some very valuable information.

Of one thing I am certain -- you are going to feel like a new man once therapy is optimized!

[AJimen05]

"Hallelujah"!!!!!

It worked! Somewhat. I usually EVERYDAY would get up frustrated around 2:30 or earlier. I woke up refreshed today at 5:30am, looked at my sleep quality and I see an AHI of 20! I didn't know whether to cry or shout...I'm sure I would of woken up some cranky neighbors if I did. I know things have to show some consistency over time to make sure it was...what it was. But this is definitely a step in the right direction for me and you guys definitely got me on the right path and educated me a lot.

Thank you so much...

I looked at my graph of apneas and spread them out to see if there were any centrals and they were all read. See below...

[AJimen05]

Hi Alex,

For the same date as the chart that ozij has posted right above this post, would you give us some information from the Statistics page in ResScan? Under Apnea Index, it would be helpful to know the numbers for Obstructive, Central, and Unknown. And we need to know what is says for AHI that date. I can't tell by your graphs if what we're seeing are actually central apneas or if those lines are dark because there are SO many events piled on top of each other.

Also, I have read this entire thread, but now I don't remember if you have your sleep study report information. If not, you need to obtain the full reports (from both diagnostic and titration sleep studies) so you can have a complete understanding of your situation. It is really important to know if these are central apneas or obstructive apneas, as the therapy is different for each type. Pressure from a regular CPAP/APAP machine won't treat central apneas, since the airway is already open (not obstructed). Your sleep study reports should have some very valuable information.

Of one thing I am certain -- you are going to feel like a new man once therapy is optimized!

DreamOn, here is the statistics page for the same day...showing no Central: (BTW, I have a comparison study and it shows both nights...The PSG night and the CPAP night. There is nothing here that talks about centrals. On my report it shows 691 apneas and 40 Hypoapneas before treatment and 3 apneas and 25 hypoapneas after treatment at 11cm/H20.

[DreamOn]

That's wonderful! I do hope that the positive trend continues!!!

Thanks so much for showing your graph with the apnea indicators spread out. And it helped to see the Statistics too. I suspected that the bars could be obstructive apneas that only looked dark because of the sheer numbers, but it was difficult to tell. It's helpful to know exactly what you're dealing with. It will be very interesting to see what your charts look like once you're getting more sleep time.

Did you sleep such short durations before CPAP? You may have explained earlier and I missed it, but I'm wondering why you don't wear the mask for very long each night. Increasing mask time needs to be one of your primary goals. Your body needs a chance to heal from the oxygen deprivation you've been experiencing. You have a lot of very long apnea events on that chart. The duration of each event is the number on top of each event bar.

One more thing, do you sleep on your back? If so, you may want to try sleeping on your side or stomach, to see if that reduces the number of apneas. Many people have more apneas on their backs because the tongue falls back and tissues collapse, blocking the airway.

[rested gal]

"Hallelujah"!!!!!

It worked! Somewhat. I usually EVERYDAY would get up frustrated around 2:30 or earlier. I woke up refreshed today at 5:30am, looked at my sleep quality and I see an AHI of 20!

Good! Never thought I'd be saying "good!" about an AHI of 20, but considering what you'd been looking at...

What setting did you use? The one quoted below that you mentioned on page 4? If pressure of 12, which EPR level did you use?

I think tonight i'm going to reduce the EPR to 2 or 1 and increase my pressure to 12 and see how everything goes...

Whatever you had it on last night (Thursday night) I'd raise the pressure another full cm, Alex, and keep watching the data results closely. But that's up to you. It's sure not "medical advice"...it's just what I'd try.

[AJimen05]

That's wonderful! I do hope that the positive trend continues!!!

Thanks so much for showing your graph with the apnea indicators spread out. And it helped to see the Statistics too. I suspected that the bars could be obstructive apneas that only looked dark because of the sheer numbers, but it was difficult to tell. It's helpful to know exactly what you're dealing with. It will be very interesting to see what your charts look like once you're getting more sleep time.

Did you sleep such short durations before CPAP? You may have explained earlier and I missed it, but I'm wondering why you don't wear the mask for very long each night. Increasing mask time needs to be one of your primary goals. Your body needs a chance to heal from the oxygen deprivation you've been experiencing. You have a lot of very long apnea events on that chart. The duration of each event is the number on top of each event bar.

One more thing, do you sleep on your back? If so, you may want to try sleeping on your side or stomach, to see if that reduces the number of apneas. Many people have more apneas on their backs because the tongue falls back and tissues collapse, blocking the airway.

Speaking of sleep....it's almost 3 a.m. here and I haven't even gone to bed yet! Time to do that now! I hope you start feeling much better soon!

Hey Dreamon,
Before cpap I wouldn't sleep much and get up pretty much every hour or two.But when i would normally sleep I usually get up around 5 or 6am for work. So this definitely falls in line with better results.With mask time, I'm thinking that i wasn't getting much rest at all and the maskwould really irritate me and i would take it off and leave. Tonight, I was out...totally knocked out, maybe because of the increased pressure I was able to get so much rest, the mAsk never bothered me. I usually sleep on my back but this time i slept on my side and the results were much better.

Get some sleep and we'll chat later...

[AJimen05]

"Hallelujah"!!!!!

It worked! Somewhat. I usually EVERYDAY would get up frustrated around 2:30 or earlier. I woke up refreshed today at 5:30am, looked at my sleep quality and I see an AHI of 20!

Good! Never thought I'd be saying "good!" about an AHI of 20, but considering what you'd been looking at...

What setting did you use? The one quoted below that you mentioned on page 4? If pressure of 12, which EPR level did you use?

I think tonight i'm going to reduce the EPR to 2 or 1 and increase my pressure to 12 and see how everything goes...

Whatever you had it on last night (Thursday night) I'd raise the pressure another full cm, Alex, and keep watching the data results closely. But that's up to you. It's sure not "medical advice"...it's just what I'd try.

I used 12 cm of pressure and an EPR of 2...Tonight I might go to 13 and keep the EPR.

[ozij]

Hallelujah and congratulations from me too, Alex.

Thanks so much for showing your graph with the apnea indicators spread out. And it helped to see the Statistics too. I suspected that the bars could be obstructive apneas that only looked dark because of the sheer numbers, but it was difficult to tell. It's helpful to know exactly what you're dealing with. It will be very interesting to see what your charts look like once you're getting more sleep time.

Good thinking, Dreamon. Now the data is as clear as anything - I was wrong about them being central apneas.

Whatever you had it on last night (Thursday night) I'd raise the pressure another full cm, Alex, and keep watching the data results closely. But that's up to you. It's sure not "medical advice"...it's just what I'd try.

You were right, rested gal. If it were me, Alex, I'd do what rested gal says she'd do.

[DreamOn]

I'd like to throw this out there for feedback from everyone....

I just took another look at the chart that Alex just posted, with the events spread out over a one-hour period. It could be that my own sleep-deprived brain isn't comprehending correctly, but is it even possible to have that many apneas in a one-hour period? Seriously, look at the event durations!

Could this be a problem with the machine? It's extremely odd to me that Alex would have such a high AHI during therapy at home, yet he had only 3 apneas and 25 hypopneas during titration. Very strange.

[DreamOn]

Before cpap I wouldn't sleep much and get up pretty much every hour or two.

You know, with your AHI as high as it was before treatment, it's no wonder that you were waking up so often. Your body was telling you to wake up and breathe! It may take a while for your body (and brain) to get used to not having to do that anymore. But you will be amazed at the results! Try to wear the mask as much as you can. You'll see improvement much quicker that way. It really does get easier!