If you were me ... ?

[123.Shawn T.W.]

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?

NO Coffee for over 10 years!

I'm 46, 6'1" 195 pounds. Dr said very slightly enlarged prostate at my last physical in March '12

I use to (prior to last week, and previous 10 years) get up 1-2 times in the night to pee, occasionally 3-4 times per night ... but that was maybe 2-3 times per MONTH!

I very rarely stay up past 10 pm. but of course I also deal with time zone changes ...I try to get an early start, and that forces me to be shut down after my 14 hours is up, then a required 10 hour break!

The mask is not as bad now, as the first night, I still get a red mark on the bridge of my nose, but no other marks on my face in the morning after 6+ hours. But only in the last hour or two, do I notice it is leaking ... very rarely do I mess with the mask at night, and when I do it is just a pull away from my face and re-seat or just wiggle it, the straps are in the same place as the first night, I have a few others to try, and thought I'd maybe try them out, I put a few on last night before bed but decided to stick with the Mirage Quattro, not sure if it is just because I'm starting to get use to it ... I have a OptiLife, PerformaTrak Nasel to play with, My wife has claimed the Swift FX (for now)

[GumbyCT]

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)

Thank you, Thank YOU, THANK YOU....I could tell and figured that is what he was doing <smile>

And Bless his Heart for knowing enuff to find another way to "Git it done" <Big Smile>

Shawn, 1 Step at a time - 1 knob a week <smile>
I know you are anxious but you have likely been sleeping like this for years. For me was 35 yrs.
I will lecture you another time about coffee but consider weening yourself down a bit to see how much that plays a role in you sleep or lack of.

You are writing all this knob turning and tweeking down in your sleep logbook? Right?

Now back to Pugsy...

[Sloop]

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.

Ok -- I won't quibble over the pressure (I am on 12 and have never had a central that I know of). So have him cut the pressure to 6. What I was MAINLY suggesting is that he switch from APAP to CPAP for a one-night trial. It isn't going to do him any damage to try this.

[123.Shawn T.W.]

Yes, Gumby, I'm keeping a journal per some smart sugestion ...

BTW ... NO COFFEE for this guy!

I only drink WATER 100% of the time!

I try to eat as healthy as I can on the road, I stop at grocery stores, and rarely ever eat out ... Normally have at least a fresh banana and apple for breakfast, whole grain bread for lunch, and a green salad for dinner! Although I'll confess that my junk food is about 3 containers/tubes of Pringles per WEEK ...

[Lizistired]

Ok -- I won't quibble over the pressure (I am on 12 and have never had a central that I know of).

So that makes it an appropriate pressure for someone else?
His airway is open. Pressure won't help.

[Pugsy]

NO Coffee for over 10 years!

A truck driver not drinking coffee? That is totally wrong.
So okay, caffeine in any other way....tea, soda, energy drinks, etc? Do you see what I am trying to do? I am trying to eliminate other factors that might affect sleep quality along with maybe increase pee breaks.

Slightly enlarged prostrate...probably not a huge factor in the pee breaks. Could be fluid intake in general and/or habit and/or a little sleep apnea stress hormone mixing things up.

Back to question about your overall sleep quality. Let's just talk about Aug 4...since it is a pretty ugly report anyway.
Other than the pee breaks how was the overall sleep? Restless? Little mini arousals?
Or do you put mask on and in 5 minutes sound asleep and don't remember waking at all for any reason until you wake up and need to pee and you turn the machine off immediately when you wake up?
Or do you put the mask on and fiddle with mask, toss and turn, don't go right to sleep immediately, lay in bed thinking and when you do go to sleep when it comes time for the pee break do you again lay there for a little while thinking about "do I really need to pee" doze in and out a bit, toss and turn a bit.
I am trying to determine how much time you spend with mask and machine on and you are either awake or partially awake and tossing and turning or whatever.
Figuring that out helps us figure out how much we need to worry about those centrals.

I use this as an example ...image below... I know for sure I awake awake this night for about an hour and I never turned the machine off. I lay there tossing and turning because I was really nauseated. I think you can spot it pretty easily. The machine reports awake stuff and can get it totally wrong. So in your situation I am trying to figure out if the machine is flagging a bunch of awake or semi awake or tossing and turning events by mistake and maybe making things look a whole lot worse than they are. Or do we have a problem with pressures perhaps triggering centrals and we get to have a whole different discussion if that is what is happening.

[Sloop]

Ok -- I won't quibble over the pressure (I am on 12 and have never had a central that I know of).

So that makes it an appropriate pressure for someone else?
His airway is open. Pressure won't help.

Geezus, but you people love to argue. NO - I was simply showing my pressure of 12 as the reason I originally SUGGESTED 12. And, to be precise, when I made that recommendation, we had not yet seen the full sleep study report which showed he has nothing but centrals. His original post and photos alluded to MILD OSA.

Let me reiterate one more time. His original post showed great difficulty with CAs and he has been trying out an APAP. And yet the first glimpse we got from his sleep study alluded to him using a CPAP and experiencing only MILD OSA. My logic suggests he try a regular CPAP and see if things improve.

[Pugsy]

Ok -- I won't quibble over the pressure (I am on 12 and have never had a central that I know of). So have him cut the pressure to 6. What I was MAINLY suggesting is that he switch from APAP to CPAP for a one-night trial. It isn't going to do him any damage to try this.

I have hit 18 cm pressure often. I have never had any particular increase in centrals either but that doesn't mean that someone else couldn't/wouldn't have an increase in centrals with something as low as maybe 9 cm of pressure.
Centrals don't have to be tied to only high pressures. They can pop up with a mere 6 or 7 cm of pressure if that is how a person's body is going to respond. High pressures don't trigger centrals in all the population but low pressures don't guarantee that they won't occur either.

Switching to cpap actually would be an appropriate suggesting but using the RX prescribed pressure would be the best choice first. Heck, it hasn't even been tried yet. Shawn went immediately to APAP with ranges and was changing stuff all over the place and not even giving himself time to adjust to one thing before he changed another. For all we know the titration study might have got it right. They do manage to do that sometimes.

The reason I suggested the tiny range around his prescribed pressure was because the flow limitation scoring could be helpful and cpap mode won't score FLs. Instead it just puts a 0.0 in there and gives the false sense of security that flow limitations are well controlled when they may not be. The machine won't respond to the centrals but it should respond to the hyponeas...so with a small range we can look to see if the machine was trying to respond to the hyponeas and flow limitations. Using cpap mode we can't see if it is even trying. Using a lower maximum pressure helps us try to figure out if pressure is part of the problem. Since he was spending some time above 8 cm...let's see if not letting it go above 8 reduces the centrals any.

I don't mean to get into an argument. I am trying to explain things so people (not just you) can learn about when, where and why such and such idea might be appropriate. It is never a good idea to suggest an increase in pressure to someone having a truck load of centrals (doesn't matter what the sleep study might have said) on a report from last night until we figure out what lies behind the centrals. If you had said "try cpap at 6 or heck even I wouldn't have said anything but to suggest 12 cm cpap is potentially harmful and that is why I speak up so loudly about it.

[123.Shawn T.W.]

Pugsy,

Only water, very little sugar ...

Last night I fell asleep within 10 minutes ... Not sure if my wife woke me up by her getting up to go pee, or it was just my time to wake up (normally when I'm home Cyndi can get up and I won't even notice!)

After we both got back to bed around 10 last night, I lay away for maybe 10-15 minutes (Cyndi was complaining that she did not have the pressure she had before we got up) other times it was maybe only 5 minutes ... I finally couldn't sleep anymore after 4 sometime and got up and let Cyndi sleep.

Over all I'd say while I was laying down I felt like I was sleeping

[Sloop]

Ok -- I won't quibble over the pressure (I am on 12 and have never had a central that I know of). So have him cut the pressure to 6. What I was MAINLY suggesting is that he switch from APAP to CPAP for a one-night trial. It isn't going to do him any damage to try this.

I have hit 18 cm pressure often. I have never had any particular increase in centrals either but that doesn't mean that someone else couldn't/wouldn't have an increase in centrals with something as low as maybe 9 cm of pressure.
Centrals don't have to be tied to only high pressures. They can pop up with a mere 6 or 7 cm of pressure if that is how a person's body is going to respond. High pressures don't trigger centrals in all the population but low pressures don't guarantee that they won't occur either.

Switching to cpap actually would be an appropriate suggesting but using the RX prescribed pressure would be the best choice first. Heck, it hasn't even been tried yet. Shawn went immediately to APAP with ranges and was changing stuff all over the place and not even giving himself time to adjust to one thing before he changed another. For all we know the titration study might have got it right. They do manage to do that sometimes.

The reason I suggested the tiny range around his prescribed pressure was because the flow limitation scoring could be helpful and cpap mode won't score FLs. Instead it just puts a 0.0 in there and gives the false sense of security that flow limitations are well controlled when they may not be. The machine won't respond to the centrals but it should respond to the hyponeas...so with a small range we can look to see if the machine was trying to respond to the hyponeas and flow limitations. Using cpap mode we can't see if it is even trying. Using a lower maximum pressure helps us try to figure out if pressure is part of the problem. Since he was spending some time above 8 cm...let's see if not letting it go above 8 reduces the centrals any.

I don't mean to get into an argument. I am trying to explain things so people (not just you) can learn about when, where and why such and such idea might be appropriate. It is never a good idea to suggest an increase in pressure to someone having a truck load of centrals (doesn't matter what the sleep study might have said) on a report from last night until we figure out what lies behind the centrals. If you had said "try cpap at 6 or heck even I wouldn't have said anything but to suggest 12 cm cpap is potentially harmful and that is why I speak up so loudly about it.

As I've already explained, I have NO problem scrapping my suggestion of 12 and going with the pressure setting of 6, and yes, on rexamining his first post, I see where the Lab also had him at 6. The ONLY reason I provided any input at all, is because no one had yet suggested he simply try the CPAP mode. And I doubt now, because of this side-show, that he will even consider it. Such is life.

[sylvie]

I lay there tossing and turning because I was really nauseated. I think you can spot it pretty easily. The machine reports awake stuff and can get it totally wrong.

Pugsy,
I hope you don't mind me interjecting and asking a question about your graph--but in that hour on your graph where we see a lot of centrals and OAs, I did not know that the machine would also score OAs while you were awake. I understand why it would score centrals. So now I'm thinking that I may at least excuse some OAs in my report? (If I happen to have a particularly bad night?)

[123.Shawn T.W.]

Something I just thought of ... When I first got the machine I tried all the variations of A-Flex and thought 3 was best, but after the first night I switched to 2.

There are to times I've noticed prior to falling asleep that I get out of sinc with the machine ... As in I'm not ready for another breath ... But most of the time it feels natural.

[Pugsy]

Okay. Some of the events might be explained away with awake events (your 15 minutes maybe laying there that you talk about).

Experiments for tonight if you can do it.
Try the 6 minimum and 8 maximum. AFlex at whatever is comfortable to you. There is a demo...try them all and see which one is easiest for you to breathe with. I found 3 too fast, 1 too slow and 2 was perfect....you need to try them to see which you like the best. My reasons for this choice of pressures I have documented in my response to Sloop. It will likely max out but that is okay for right now.
If you wake up during the night....turn the machine off immediately right at the moment you are aware you are awake. If you feel like you aren't going to get up to pee...then turn the machine back on (don't want you going back to sleep with machine off). All we are wanting to do is see if you have clusters of awake or semi awake events immediately preceding the time the machine is turned off and again when turned back on. Try as best you can to limit the time that you are awake and the machine is on. If you get up to pee then when you turn your machine back on and lay there for a bit....no sleep right away...again turn the machine off and back on. I don't want you watching the clock but if you feel 5 minutes passes without your going back to sleep...just a quick off back on again.
Pick the most comfortable mask for you and stick with it if you can. Don't go changing masks unless it is horrible. When you add variables like mask changing..it makes it harder to evaluate cause and effect for any changes that might show up on the reports.

I understand about feeling you have to get up after 4 hours...can't sleep thing. A lot of that is habit from your weird schedule. Not much we can do about it except try to figure out if it is habit or events causing the wake up.
The off/on thing shows up on the reports and gives us a better time line to evaluate.

[Lizistired]

Sloop, I'm not here to argue either, but I'm really frustrated at the frequent misinformation provided on this forum lately.
Shawn's situation is a perfect example of why sleep docs don't want us to have data.
He got in a hurry.. or was proactive... and got a machine so he could get started before he had the results of his titration.
He hasn't yet tried the sleep docs prescription which was based on a titration, during which he achieved REM in the supine position, but if you notice, no deep sleep.
How he arrived at a minimum of 8, I don't know, but I can safely assume he got that impression from someone here who thinks more is better. Real men need lots of pressure!
It also takes time to adjust to a mask on your face and air blowing up your nose. So sometimes, less is better. Any therapy is better than no therapy.

[GumbyCT]

Only water, very little sugar ...

I worded my original question rwong - I should have asked about caffeine products? NOT coffee <smiles again>