If you were me ... ?

[123.Shawn T.W.]

I'm still trying to find my pressure ... for those that don't know ... I bought a used APAP off Craig's List Monday, I set it to 6-12 & A-flex 3 ... the first night was not good, and had an AHI of 14.3 (data from machine, I could not access data card) with a 90% of 10.0, I then reset the data on the machine ... and the next night with the setting the same but A-flex 2 ... but it just did not seem to be enough air for me ... I just got home yesterday, and got my data downloaded into SleepyHead, here is the second night:


My AHI went down, still have some Centrals ...

Since I was on the road, and only had access to data in the machine, I decided to increase the pressure to 7-13! And I got this:


Decided to increase pressure more, and went to 8-13:


Decided to bump it up more to 8.5-13:


My centrals get higher, and higher. . . makes me think I should back down the min ... but my leaks also climbed with increase of pressure ... I'm not sure why it is showing two lines on the leaks . . .

When I got home, I also got a copy of my sleep study and titration, here is what it says in part:




SO ... I'm thinking to try to drop the pressure ... and get more use to the mask, and whole octopus stuck to my face and blowing air at me, and increase my length of time actually sleeping in one time, I get up quite often now ... and to get a better look over a longer period of time, not just a day or two ...

If you were in my shoes, what would you do?

[-tim]

Up it to 15 and try again. The AHI is events per hour. That is why they ramp up. Your goal is less than 5 per hour.

You could just tell it go to to 20 but that may be too annoying this early and then you may stop using it. At this point crank up the pressure until your leaks go up and then drop it by about one and try to keep the leaks mostly low. Once you get used to the leaks, let the machine do its magic and that may require a setting to 20. The default for most autos is 4 to 20.

If you feel like your not getting enough air, increase the staring pressure by one. I use 5 to 6 on mine as the low pressure but when I get a bad allergies, cold or flu, I set it to 7.

[jweeks]

My centrals get higher, and higher. . . makes me think I should back down the min ... but my leaks also climbed with increase of pressure ... I'm not sure why it is showing two lines on the leaks . . . If you were in my shoes, what would you do?

Shawn,

Having a lot of centrals at the lower end of the pressure scale means one of two things to this non-medical person...you either have complex apnea (ie, are pressure sensitive), or you have a neurological condition. In any event, you need medical help. And not just the person at Joe's Sleep Clinic down the street in a converted gas station, but rather, you need an expert sleep doctor at a major medical facility. Complex apnea can be really hard to treat because the machine has to walk the tight rope between high enough pressure to treat the events and backing the pressure down to prevent the centrals. This is typically done with a BiPAP. BiPAP does it by running with different pressures for inhale versus exhale. Since your other events are pretty reasonable (hypos are typically not show stoppers), it is possible that they can find an APAP range that works for you.

The two leak lines are probably average and peak. If that is the case, the leaks look OK to me (but I haven't used Sleepy Head, and I wouldn't claim to be an expert).

As far as getting bye until you can get a sleep study, put your machine on the maximum value for A-FLEX (which is 3), keep the lower end pressure number around 8, and back the upper number down until the centrals drop off. This is not a great solution, but it might help you make it until you can find a good sleep doctor and get your insurance squared away.

-john-

[Lizistired]

I would put it on 6 for a couple of days, like the titration recommended. At least you will have a baseline and fewer variables while you get used to using the machine.

[Pugsy]

Could you do me a favor and turn off the AHI graph so that graph is omitted from SleepyHead report?
See if you can get the event graph, flow graph, pressure graph and leak graph all on one screen shot.
It is more important to see the entire event graph than the AHI graph.
Need to see if those centrals are being flagged at the times that I see breaks in therapy line which could indicate that the centrals are sleep onset or sleep transition.
Then post a fresh screen shot of Aug 4.

Pick whichever AFlex setting feels better to you as far as comfort with breathing. Stick with it. A setting of 3 is NOT a per cm reduction like with the ResMed machines. Flex relief is based on your own breathing. Some people find that a setting of 3 seems like the machine is wanting a respiration rate that is too fast...sort of like hyperventilating.

How is your your sleep? Still waking often? Why the breaks in therapy line?

There is no sense in increasing the maximum pressure...the machine doesn't ever want to get close.
If these centrals are the real deal centrals brought on by pressure..increasing the pressure is the last thing you want to do.

I would back up and start all over... 6cm minimum and reduce max to 8 cm. Flex setting at whatever feels good to you. Heck even try it with Flex off.
Let's see if the centrals reduce with the pressures limited. Per your sleep study there was no mention of centrals at the RX pressure.
I know this is a tight range and unless we know for sure that those centrals can be explained away as sleep onset, awake or semi awake events then we need to back up and see if reducing the pressure makes any impact on the centrals.

When you have highly fragmented sleep then you have an increased time spent in sleep onset and sleep transition which increases the chances of centrals popping up during those times.
If these are the real deal then APAP with a wide range of pressures is not what we want to use.
Before panic sets in about the centrals we need to try to figure out if pressure is making them crop up or if they are related to your fragmented sleep.

So can you get me a picture of Aug 4 that includes the event graphs? Answer questions about fragmented sleep?
And are you laying in bed with machine/mask on but not asleep for any of this time on the Aug 4 report?

The leak lines...the top one is the total leak line and the bottom one is the excess leak line. Not everyone sees the bottom line. I didn't get a bottom line with my PR S1. SH software bug.

[123.Shawn T.W.]

Just to clarify I had a sleep study, and went back a second time for titration, I just did not have that info available when I first got my machine.

I bought my machine to use while I'm waiting for ins and DME to get everything straight so I can get a machine from them ... And than this used machine will be a backup to carry in my big truck, just in-case ...

I found that low pressure was difficult ... But I think Liz is right about at least trying it for a few more days, and I'll try A-flex 1 or none, which may help me feel like I have more air!


Ok, Pugsy I'll get that up shortly (I see you posted while I was typing the above ...

The breaks are when I turn off the machine to go pee ...

[greatunclebill]

in the first parts of the graphs i can see, you're not reaching 12 but there's alot of activity at the bottom number. try 8-12 if you can handle the pressure, then work on eliminating the leaks, making little adjustments on the straps. wherever you set it, leave it there for at least several days and only change one thing at a time. don't change pressure, flex, humidity and adjust the mask at the same time because when something changes you won't know which change really helped or hurt. the key to this thing is slow and steady, giving your body time to adjust to the changes you do make. that's what i would do if i was you.

sorry, was typing while pugsy was posting.

[Sloop]

FWIW -- In reading your sleep study conclusions, everything I see mentions CPAP and there is no mention of APAP.

If I were you, I would switch my machine for one night to straight CPAP and set the pressure at 6 (edited). And then see what the results look like.

[Pugsy]

If I were you, I would switch my machine for one night to straight CPAP and set the pressure at 12. And then see what the results look like

Way to high of a pressure on cpap with these centrals and the machine never really even wanted to go that high anyway.
Until we know what the issue is with the centrals we don't want higher pressures at all because higher pressures could very well make the situation worse if these centrals happen to be the real deal and related to pressure.
When we see centrals we back off on pressure until we can determine if they are asleep real centrals possibly popping up because of pressure or if they are just centrals from sleep onset, awake, or semi awake centrals.

I suggested tight range at lower end pressures where his RX said things were fine mainly to utilize the Flow limitation scoring.
If we switch to CPAP mode we lose flow limitation scoring on this machine.

[Sloop]

If I were you, I would switch my machine for one night to straight CPAP and set the pressure at 12. And then see what the results look like

Way to high of a pressure on cpap with these centrals and the machine never really even wanted to go that high anyway.
Until we know what the issue is with the centrals we don't want higher pressures at all because higher pressures could very well make the situation worse if these centrals happen to be the real deal and related to pressure.
When we see centrals we back off on pressure until we can determine if they are asleep real centrals possibly popping up because of pressure or if they are just centrals from sleep onset, awake, or semi awake centrals.

I suggested tight range at lower end pressures where his RX said things were fine mainly to utilize the Flow limitation scoring.
If we switch to CPAP mode we lose flow limitation scoring on this machine.

Yes, but his sleep study made no mention of Central Apneas. They reported only MILD OSA.

[Blessed2BeeAlive]

Posted for my husband:

Much clearer screen shot from my computer (his desktop died, and his laptop will not for some reason sign onto our wifi, so he has been taking a picture of his laptops screen with his iPhone, then emailing to me,and putting on photobucket)

[Pugsy]

yes, but his sleep study made no mention of Central Apneas. They reported only MILD OSA.

I know that but they also used 6 cm and he had no centrals. We are seeing centrals now with the pressures in the 8 range.
They never got above 7 cm to even see what would happen at higher pressures.
We have no idea what would have showed up at 8 cm. Would the centrals have started at that pressure? Heck, we just don't know. Wouldn't be the first time the sleep study missed something.

These "centrals" may or may not warrant concern but until we have a better picture of what is going on it is always best to go conservative.

I am concerned that the hyponeas seemed unchanged and the machine doesn't deal with them well but I am more concerned about the centrals at this point. If we find out that the bulk of the centrals aren't the real deal then we can maybe increase the minimum a bit to deal with the hyponeas and mimic cpap mode with a tight range but if we do it would be best to start low and work our way up. Why use higher if lower does a good job. Besides..it is easier to adjust to higher pressure needs if one goes up slowly and who knows might get lucky and not need nearly as much as we first thought.

You won't find any of the veterans here siding with you about the 12 cm cpap suggestion. It is not good advice in this situation. We never suggest higher pressures when we see centrals in this number and it doesn't matter what the sleep study said.

[123.Shawn T.W.]

Here is my Original sleep study:


So you can see I was originally (untreated) having centrals

And my titration:

[Pugsy]

Thanks for the new image. It helps a lot.

I see lots of clusters of everything. Especially around times that a person might be awake or semi awake and I see lots of Periodic Breathing and I know that often awake breathing can be flagged as PB.
So let's talk about sleep quality. That report looks an awful lot like a really restless night. Pee breaks? Do you drink a lot of coffee? I know a stupid question to ask a truck driver I am married to a truck driver and even when he is home he doesn't sleep so great because of the habits that he has fromssleeping in the truck. It just doesn't promote good sleep hygiene at all.
I know all about the middle of the night deliveries...and the fact that your schedules really mess with things. Also know about the stuff that goes on at truck stops that mess with good sleep.
From your pictures I assume a fairly young man (not old enough to have prostrate issues)...so the pee breaks....is this common for you or have you notice that they have reduced in frequency at all? I am trying to see if we can blame the coffee for the pee breaks or the sleep apnea for the pee breaks.

Is your sleep highly fragmented and do you have trouble getting to sleep and sleeping soundly when you do sleep? Do you find that you have a lot of little mini wake ups? How is the mask situation? Are you totally comfortable with the mask or are you still finding yourself fiddling with it during the night?

[Pugsy]

The number of centrals noted on the initial sleep study is not hugely remarkable but they are there.
The other stuff reported is fairly common.
REM and supine sleeping isn't particularly remarkable in regards to AHI.
Sleeping prone on your stomach sure is though. Much worse in regards to number of events.
How are you sleeping now? Much time prone?