New to CPAP, 10 nights in

[Wulfman]

Then I had the Heart Attack, End of Story.. Jim

No, Jim, that was just the end of a chapter and the beginning of a new one
If it was the "End of the Story", you wouldn't be writing these posts.

This is one thing that keeps me reading these stories on the forums. Everybody has different stories, but there are similar events in many of them that we all can relate to.

I'm glad your car had the sense to pull over and ask directions.....must have been of the feminine gender.....

Hope you're doing well.

Den

[ozij]

Very smart car, Jim, to wander only to the right shoulder. Can you imagine what would have happened if it had strayed left?

I like Den's correction!
O.

[SkylineGTR]

1. It takes a bit but you have to hang in there. The first 2 weeks when i started my therapy I would wake up with the mask on top of my head or next to me in bed because I'd pull it off in the middle of the night and not realize it. Everyone is always going to wake up a bit groggy. Especially if you have your schedule timed to where you are getting up in the middle of a REM period. A sleep Cycle lasts 90-120 minutes and the end of it is a REM period. Each cycle the rem period gets longer so usually if you go to bed at 10pm and want to wake up at 4:30-5am your going to get a rude awakening.

2. I have found messing with pressures messes with your tolerance. if you are overtitrated you will start having central apneas. If you get a perscribed pressure and stick with one number untill you get adjusted to just that pressure. you are better off then having it changed and adjusted every night. Seeing you have lost weight if you do find yourself going into central apneas then lessen the pressure. I dont trust the auto machines as far as i can throw them. You dont increase pressure for central apneas and thoes machines will see centrals as obstructive apneas and increase for them. A central apnea happens in a couple of cases. 1) the pressure is to high. 2) You will see transitional centrals on occassion then you are falling asleep while adjusting to a new pressure. 3) During a rem period you are going to naturally have abnormal breathing. Sometimes when you move or twitch in REM you will have a central.

When you are at a study you get hooked up to all that equpiment for a reason. 1) to monitor the stages of sleep you are in. If you are awake holding your breath that can bee seen. if you are in rem having abnormal breathing, the tech knows its normal. 2) to monitor your breathing as well as the respitory effort you are putting forth. so you can distinguish between central/obstructive apneas and hypopneas. 3) to monitor muscle activity. While you are asleep when you move you are naturally going to have something happen in your breathing. most of the time it will cause hypopnea . this is normal. This is why people with RLS have big problems.

Auto machines just see that you arent breathing or decreased breathing and adjust higher/lower but if you go into a central fit because of overtitration the machines dont know what to do. I've had many patients come in that have been over titrated on auto machines.

3. Most machines have auto censors in it for humidification. Sometimes you can crank it up and the canister will be full when you wake up. sometimes you can turn it down and the thing will be empty when you wake up. its based on relative humidity. Just find a good setting and leave it. thats what i do. I think i have my machine at 2 and it fine.

4. Try some over the counter decongestants before the sprays. I have found afrin works great for me but it does have a rebound effect and can burn out your nose with constant use.

5. The pressure you need is based on your physiology. Some people may have alot of fatty tissues or alot of muscle tissues in their neck. When you fall asleep you relax your muscles and thats where the constriction happens. The weight starts pushing down on you. The pressure that you need may not be the same as the pressure of someone your exact height and weight because they may carry their weight differently. Women tend to need alot less pressure then men for the fact that their weight is generally carried downstairs rather then up. You can never fully get rid of the apnea. but you can lessen the severity of it and the pressures you need with weight loss.

I have been working as a sleep tech since last june and have been on CPAP since last feburary. You need to be at an "effective" pressure. This pressure may not get rid of everything but what it should do is
1) keep your blood oxygen above 90%
2) Clear any obstructive events so you can breath
3) Not let events disturb the continuity of your sleep.

[NightHawkeye]

Auto machines just see that you arent breathing or decreased breathing and adjust higher/lower but if you go into a central fit because of overtitration the machines dont know what to do. I've had many patients come in that have been over titrated on auto machines.

SkylineGTR, actually while the Respironics machines don't recognize centrals, per se, they do recognize apneas that are not responding to pressure increases and simply back off on the pressure. They also record the event so that the user will know that if using monitoring software.

I'm also curious about your statement about patients over-titrating on Auto machines. Does your sleep lab routinely prescribe auto machines, maybe in lieu of sleep studies? Not trying to be critical, just trying to understand the facts of the situation.

Regards,
Bill

[Darth Vader Look]

SkylineGTR posts - You dont increase pressure for central apneas and thoes machines will see centrals as obstructive apneas and increase for them.

NightHawkeye responds - SkylineGTR, actually while the Respironics machines don't recognize centrals, per se, they do recognize apneas that are not responding to pressure increases and simply back off on the pressure. They also record the event so that the user will know that if using monitoring software.

Bill is right about the Respironics backing off if the apnea event can't be resolved. I believe that when an apnea event does occur at a pressure 10 or greater the Auto will adjust up 3cm or to the maximum level set, whichever is less and back off if the event does not show signs of clearing. It has determined that the event is central in nature and will not try to resolve it. I thought that was a function of all Auto's but it may just be the Respironics Auto. One thing we know for sure is that a straight CPAP isn't going to resolve a central. Having C-flex engaged at it's max or the Resmed EPR at the maximum setting may be of some help with the central but if you are having centrals then a BiPAP would be the best route to go. The fact still remains that if you don't like APAP you can still set it to CPAP mode. Now that's versatility.

[CheezWiz]

For the nasal congestion,

You do need to consult your doctor on this. I have sinus scarring from years of chronic rhinitis due to allergies. Ever since they took Seldane off the US market, I have been struggling for a solution. Claritin D and Allegra D have been my only help but the side effects are too much (D forms only).

I was using the Afrin method, but a little research will show that is not a good thing. My doctor is very adamant that I never use afrin for more than three days without a few days or more in between. Afrin will cause the sinus to swell as the medicine wears of resulting in a physiological dependence. That is a fact.

I had tried every nasal allergy relief on the planet with no luck until I found NasalChrom over the counter. One squirt in each side three times a day is good but expensive. I just started Astelin in an effort to get me off the Afrin again and it is working wonderfully. I am able to get by on one squirt in each side twice daily. I still need Allegra or Claritin to handle asthmatic reactions, skin reactions and itchy eyes in the spring and fall.

I am allergic to everything they tested for on the skin-prick test except horses. I am allergic to cows though!

Does anyone else here ever feel like an alien who has been stranded on this planet?

[Linda3032]

Cheez Louiz CheezWiz, you sound like me. I've never been tested (and why start at my age), but I've got to be allergic to alot of things.

Surprisingly, the cpap and humidity help to keep my nasal passages clearer.

I've never been able to take the Claritin or Allegra because they keep me awake - feel like I'm on speed (although I've never tried that). I take two Actifed every day of the year - have for 20 years and have few problems. The doctors hate Actifed and keep getting me to try all the prescription stuff, including Flonase, but I like my Actifed.

Have you tried flonase? That's supposed to be some good stuff.

[ozij]

[quote ="SkylineGTR"]
You dont increase pressure for central apneas and thoes machines will see centrals as obstructive apneas and increase for them. [/quote]

Sounds like typical sleep lab myths to me.

If there's more to it than that, would you care to give us links to the descriptions of the algorithms used by specific companys on their automatic machines - inculding machine name and model, please?

Auto machine planner have heard of overtitration, and have built in protection for that. It not prefect, but its there.

Specifically:
Resmed will not raise pressure in response to apnea above 10 cm/h2o, because they do not want to hazard overtitration. Resmed calls this the A10 algorithm (see http://www.talkaboutsleep.com/sleep-dis ... chat.htm#6)

Puritan Bennett distingiush between obstructive apneas, and those which are non-obstructive by identifying the heartbeat oscillations in the air flow (this is "apnea with cardiac oscillation" in PB terminology)(look at the manuals).

Respironics, as has been described, limits its response to a non-responsive apnea to three nudges.

So, which automatic machines do you know that increase pressure - uncontrollably - for central apneas?

3. Most machines have auto sensors in it for humidification

Most machines? Can you name 3? 2?



O.

P.S. I am just a patient, and my worst case of central apnea was when I was hugely overtitrated in the sleep lab by a sleep tech who tried to raise the pressur to 16.

The RT (or sleep tech) who used an auto to titrate me at home figured my stable pressure should be 7.5 - which was too high. It took my complaining, refusal to continue therapy, demands to meet the doctor, and a change of RT to get me the machine and pressure range I need.

I now use an automatic machine, it runs on 5.5 to 7.5


O.

[roztom]

O:

How do you find breathing that low pressure?

DO you have C-Flex on when it's that low?


I was titrated at 9 and I am finding (after a too short data set) that my number seems to be way lower 6 - 7 ish.

AS my pressure goes up my OSA/Hypop goes up. GRRR.

DO you get that - I got no air feeling at the low pressure?

What I find weird, so far, is that the APAP is not finding the best pressure for me. I probably have the wrong expectation.

The limited data (6 days) is beginning to point to a different pressure than what the machine is putting me at.

Any comments on this?

Thanks,

Tom

[Moogy]

AS my pressure goes up my OSA/Hypop goes up. GRRR.

Tom, You probably already thought of this, but in case you didn't...
Is it possible that the exact opposite is occurring? That the OSAs are going up, and that bumps the pressure up?

Moogy

[roztom]

I can't tell what came first the chicken or the egg?

There are nights with OSA's like 16 and the machine doesn't respond.

Other nights no OSA's and the machine is up and down a few times.

I tried raising the low pressure thinking maybe the machine had too far to go to respond but the Hypop's/OSA's went up.

Not sure what to make of it.

Tom

[Moogy]

Tom,

How is your average AHI now, and how does it compare to your pre-CPAP AHI? I think that is more critical that what happens at any given time during the night.

I think I remember that you were also fighting with leaks, and that would make a difference on both the pressure changes and the OSAs.

The EncorePlus software has a chart (if you toggle "detailed" instead of "summary," that shows when during the night the OSAs happened and when the pressure changes happened and when the leaks happened. Comparing those has been useful for me. MyEncore doesn't have this chart (didn't need it I guess, since it is already available in EncorePlus.)

Good luck and good sleep to you,

Moogy

[roztom]

Actually I do have all the charts - my AHI seems to be going all over the place.

It's better than untreated, way better but I am trying to get to the best treatment and based on my titration of 9 that doesn't seem like it is the best.

I may just need more data.

Tom

[Aswab]

Have you tried flonase? That's supposed to be some good stuff.

I use Flonase and Astelin. I don't use the Astelin everyday but the Flonase is supposed to be used everyday because it shrinks tissue (cortisoid) and that takes time.

I had a nice surprise $$wise when I refilled my Floanase - it has gone generic.

They work for me but I hate being on meds, hate, hate, hate, hate, being on meds so I am still thinking about Septoplasty etc.


David

[ottsca]

Heya Hogdaddy,

I've been doing APAP for about 3 weeks now (still too new to have had time to figure out how to put the pictures at the bottom of the post!!) and I too have had no epiphany of energy or suddenly feeling better than before I started therapy.

However, I do have the REMStar auto with the EncorePro and MyEncore, card reader, and smart card. I have been monitoring my progress. My AHI for my sleep study was 30 and my AHI scores in MyEncore are around 5 on average. My bed partner also says I do not snore like I used to do.

So even tho I don't necessarily feel like a new man, other indicators of success abound. The software helps me know that something is happening and the anecdotal evicence of my bed partner also confirms some change is ongoing.

Just because you don't have a bunch of "new" energy doesn't mean that changes aren't happening!

Good luck and stick with the therapy!!

Ottsca