Newb with some ?

[natethegreat]

Hello everyone!

Hi my name is Nate and I have a sleeping problem

Age caught up with me and I couldn't survive on the little sleep I get anymore, so I got myself in to a sleep study. Turns out my AI was 9.6 during the study and I was sent home with a cpap machine and mask a few weeks later. I wasn't excited about the gear, but I am determined to do whatever it takes to finally get some sleep. Unfortunately this is about as much progress as I have been able to gain so far. The first night of treatment was pure comedy. An over-tight mask and over humidification led to some initial discouragement, but I got through it - I expected a learning curve. But one thing concerned me: I was waking up during treatment and realizing that I needed to start breathing. Is this normal? I thought this was what the cpap was supposed to eliminate? Is the machine working properly? Am I doing something wrong?

These are the questions that brought me here. I found the instructions for enabling the setup on my S9 here, and also downloaded the 3.13 rescan software. I don't exactly understand what I am looking at with the software so I was hoping someone could give me a crash course. I did find out that my S9 is set up with :

Pressure - 5 cmH2O
EPR - 2 cmH2O

Does this seem pretty low? Especially with the 2cmH20 EPR? I have been on treatment for 6 days now and I have acclimated to the mask, but havn't had one good day of sleep yet. According to rescan, I have an average of 13.3 AHI, with 95th % at 1.2 L/min. Any thoughts or suggestions are welcome!

Thanks,
-NTG

[kteague]

Welcome to the forum. Seems your reading thusfar has you on the right track. That is a low pressure, and your AHI indicates the pressure is not enough to resolve your events. Actually, if I'm reading right, your events are more now than in your diagnostic study. Not sure if you want to go through your doctor or how much you are willing to take on yourself, but your doctor should recommend some changes if they know it's not therapeutic. But the first thing I would do is turn the EPR off. You could see how that affects your AHI then decide if the pressure is an issue.

Did your study report any central apneas? Just thinking about your comment about waking up realizing you need to breathe. Maybe once your treatment is therapeutic regarding the obstructions and hypopneas this will stop.

Let us know how you do without the EPR.

Kathy

[WonderlandGirl]

"Hi my name is Nate and I have a sleeping problem"


I appreciate your humour, Nate! Welcome to the forum. I'm still all new with this and am unable to help you. But I DO want to welcome you and thank you for your humor! Hope this can all get figured out for you as it does sound like your apneas are increasing. Hope to hear back from you with better readings. Stay in touch.

[cflame1]

does this help some?

http://montfordhouse.com/cpap/resscan_tutorial/

Google's a good resource.

[Lizistired]

Hi Nate, The first thing I would do is set the EPR to 0 (ZERO). I imagine you are used to the machine now and with your low pressure you can probably get by without it. Try it with straight pressure for a couple of nights and see if that is better. My DME set mine to 3 on a pressure of 7cm and it took me a month before I turned it off and my AI dropped. Give that a try first.

[natethegreat]

First off, thanks to everyone who replied

I decided to turn off the EPR as it seemed I could live without it. After a night of sleep with it off I didn't even notice a difference. Maybe it would be more beneficial at higher pressures. Still having pretty poor sleep quality, I woke up with a slight headache after this night of sleep:



Do the little tags at the top of the apnea events mean how long they lasted?

http://montfordhouse.com/cpap/resscan_tutorial/

Google's a good resource.

Thanks for the link cflame1, that was kinda what I was looking for. I was actually more concerned with what the data meant than how to customize its appearance. BTW, If Google is free to use I will give it a try sometime...

edit: Rehosted pics

[robysue]

The night's data you posted has two really significant clusters of events. And the first one starts between 1 1/2 and 2 hours after you went to bed and the second starts not quite 90 minutes after the first one ended.

Any chance your AHI is much, much higher in REM than non-REM sleep? Have you got a copy of the doctor's dictated summary of the sleep study and the summary graphs? If so, you should be able to determine if your apnea is much worse in REM than nonREM.

Or is there any chance that you were sleeping on your back during the two big clusters of events and not sleeping on your back the rest of the night? Again, if you've got your sleep study, compare the Supine AHI to the non-Supine AHI. Is the Supine much higher?

[natethegreat]

Thanks for the reply robysue

Yep, you got me on the REM related apneas. At least, that is what the PA that I talked to said. I believe he told me 48 events/hour during REM. I scanned the graph the sleep study ladies gave me after it was over, but I don't know if its that easy to read.

http://i1122.photobucket.com/albums/l53 ... ap/IMG.jpg

edit: Re-Hosted Pic

[Pugsy]

What was the actual breakdown of the AHI? Can you stretch out the clusters and zero in on the time more. I think ResScan software allows this. Overall average won't reflect how serious the REM groups are though.

Any centrals (CA)? Hard to see but maybe those darker ones are just Obstructives sitting on top of each other.

I am much worse in REM also, over 50 events per hour. My reports would look like yours if I hadn't changed the minimum pressure.
Is the PA aware of this report? You have already turned off EPR with no improvement. Leak is acceptable. Only thing left to change is pressure. Can you get the PA on board with this? 5 cm pressure is not enough to break up the clusters of events. If no centrals in history or reports, more pressure is likely needed.

5 cm is rather "low". When I had my titration study that is where they started when I first put the mask on and was awake. Though some people do obtain quite adequate therapy with 5 or 6 cm of pressure, most people are going to need more.
Also if you didn't have much REM sleep during the titration study then they may not have had much to work with in finding out which pressure is best for you. 5 may work just great for the run of the mill events but those in probably REM sleep are super duper tough.

[Lizistired]

Nate, Does your prescription and the machine say 5cmh2o? It's rare, but not unheard of for a DME to set up the machine wrong. Just a thought.
I think since you can't get with the doc til Monday anyway, I would set the machine on auto 5-6 and see what difference it makes.
I'm not familiar with your mask. I'm wondering is the mask is leaking or your mouth opens during those same periods.

[natethegreat]

Nate, Does your prescription and the machine say 5cmh2o? It's rare, but not unheard of for a DME to set up the machine wrong.

I have the prescription right here in front of me and it says

CPAP Pressure : 5 cmH2O
Ramp : 15 min
CFLEX/EPR : 2

I have confirmed the pressure is set at a constant 5 cmH2O, disabled EPR, and can't figure out where the ramp settings are

What was the actual breakdown of the AHI? Can you stretch out the clusters and zero in on the time more. I think ResScan software allows this. Overall average won't reflect how serious the REM groups are though.

Any centrals (CA)? Hard to see but maybe those darker ones are just Obstructives sitting on top of each other.

Reset graph to a 2 hour block over the first event, but its still kinda overlapped :




Thanks for the replies everyone!

edit: Re-Hosted pics

[Pugsy]

Ramp? Report says 15 minutes. With setting of 5 cm ramp is not even needed as it only has to go from 4 to 5. EPR is not even a factor being off and at this pressure shouldn't even be needed.

You are having a whole bunch of obstructive events back to back and an occasional central. Leak is fine, can't blame it.

Basically the pressure of 5 is not enough to address the events. If this were my report I would increase the pressure use by small amount and watch those centrals. They may not mean anything significant but the warrant watching should they increase.
How much increase? I would start with 6 at straight CPAP and see what happens. Sometimes minor change will make huge impact. Leave EPR off.
APAP? maybe 6 min and 9 max but with centrals I probably would choose CPAP first.

Ideally before any changes made, speak with PA about what this is showing. I felt comfortable doing the changes myself when my report looked similar to yours and when I finally saw the PA about what had happened she agreed completely with what I had done but I didn't have any history of centrals in sleep study but of course my machine doesn't show centrals. My titrated pressure was 8 cm. I found I need 10 cm minimum to prevent the bulk of REM events. Minimum of 9 still allows a few groups to slip past.

So your choice but what you have now is not as effective as it should or could be.

[natethegreat]

Just checking again after another night of sleep.

Still having troubles with groups of apneas during sleep, but I am adjusting to the gear fairly well. I guess I will be making a call on Monday to see if they will ok a pressure bump for me. I hope that goes well...

I will be checking back here with updates if there are any.

Thanks for all the replies!

-NTG

[DoriC]

Nate, welcome! I'm looking forward to your updates as they will be helpful to us. I'm a bit confused about your RX. Your machine's pressure settings are 4-20 so if your pressure was titrated at 5cms why would you even need EPR=2 which lowers the pressure by one number for each EPR setting. Most people find it difficult to breathe at such a low pressure and you would probably benefit from a higher pressure to eliminate or prevent those events you're having. Keep us posted.

[ozij]

For some reason I can't see the images -- I get a frog frozen in an ice-cube with a "Domain Unregistered" caption underneath.