AHI 131 !! - Help me understand my SleepStudy & CPAP results

[Pugsy]

I would start with the DME but they will probably tell you the sleep doctor has to order it but in reality your family doctor could do it.
DME could have given you the 750/760 to start with and just set it for the fixed bilevel mode (that's what your Pro is doing anyway).

It appears that for parts of the night the fixed bilevel pressures are sufficient and parts of the night they aren't.
Auto adjusting would let the machine figure out what to use.. While I assume that maybe a little more EPAP and IPAP will get the job done I really don't know for sure...heck you may need a lot more and someone wouldn't want to use a LOT more all night when an auto machine could make the adjustments as needed.

I was able to tweak my PR S1 BiPap in fixed bilevel mode so that my therapy was optimal and was quite comfortable but I had more tweaking room than you do since my EPAP was doing a good job at 8 or 9 with IPAP at 13.
I actually liked the way that the BiPap in fixed mode felt because of the PS used. 4 cm PS is more comfortable than 2 cm PS and in Auto mode the default PS is 2 so while awake that's what I felt until the events started driving the pressures up.
Once asleep it doesn't really matter.

[pablomac]

One thing I will ask because I had it happen to me. You don't happen to have a pet that sleeps with you that snores do you?
I had some really ugly snore reports like yours that would pop up some nights and have no snores other nights. Couldn't figure out what was going on until one night I realized the machine was hearing my little Pug dog snore when he was up on the pillow with his chin resting on my shoulder. So now I always ask because I know the machine can pick up other noise beside what we produce.

Seriously? Is that how the snoring is detected? These machines have an integrated mic? I guess I always thought that all the data was measured and calculated from the actual breathing. The reason I bring this up is that I have a little Boston Terrier that snores at human volumes. My charts show some snoring but my fiance says she can't hear me snore. We both can definitely hear our dog!

[archangle]

I’ve woken up with headaches and migraines. I nod off watching TV with the family at night. I’ve fought sleepiness while driving and at work. The wifey has complained that I stop breathing all night long. The snoring has gotten so bad; one of us always has to sleep on the couch.

Just to be clear, are the headaches, nodding off, etc. pre-CPAP problems? Are they much better now?

Right now, job one is to wear the machine all night, every night, every time you sleep, even naps. Just doing that should make an enormous improvement in your outlook. Are you able to do that?

Think of it as like being in a car wreck. Wearing the machine is like stopping the major bleeding, now you're worried about the road rash.

There's a lot of complicated stuff that goes on with the nose stuffing up. Some may be the filtered air, but there are some feedback mechanisms from pressure, airflow, lungs, and heart. For whatever reasons, many CPAPers find their nose clears up.

As for "snoring," there can be "chainsaw" snoring all the way down to nearly silent snoring. I don't think the machine distinguishes. I don't think there's a microphone, just the pressure and airflow sensors in the blower unit. Although, if you think about it, a pressure sensor is a microphone of a sort, but probably not a very good one. I think it only "listens" though the hose, though.

[khauser]

Seriously? Is that how the snoring is detected? These machines have an integrated mic? I guess I always thought that all the data was measured and calculated from the actual breathing. The reason I bring this up is that I have a little Boston Terrier that snores at human volumes. My charts show some snoring but my fiance says she can't hear me snore. We both can definitely hear our dog!

Not necessarily ... there is some sort of vibration detection. I suppose whatever it really is you could call it a Mic. It's probably a piezoelectric element of some sort. The problem is that no matter how it detects snoring it can't tell where said snoring originates.

[mollete]

Seriously? Is that how the snoring is detected? These machines have an integrated mic? I guess I always thought that all the data was measured and calculated from the actual breathing. The reason I bring this up is that I have a little Boston Terrier that snores at human volumes. My charts show some snoring but my fiance says she can't hear me snore. We both can definitely hear our dog!

Not necessarily ... there is some sort of vibration detection. I suppose whatever it really is you could call it a Mic. It's probably a piezoelectric element of some sort. The problem is that no matter how it detects snoring it can't tell where said snoring originates.

A single pressure signal is used to determine both snoring and breathing. Then, it just depends on how you want to filter it (example from PTAF2):

[Kenwood]

I’ve woken up with headaches and migraines. I nod off watching TV with the family at night. I’ve fought sleepiness while driving and at work. The wifey has complained that I stop breathing all night long. The snoring has gotten so bad; one of us always has to sleep on the couch.

Just to be clear, are the headaches, nodding off, etc. pre-CPAP problems? Are they much better now?

Right now, job one is to wear the machine all night, every night, every time you sleep, even naps. Just doing that should make an enormous improvement in your outlook. Are you able to do that?

Archangle,

Yeah....that was ALL those problems were before my sleep study and being on CPAP.

I had a LOT of anxiety about CPAP and wearing the mask. Backstory - As about 6 years ago I was have massive headache issues that just continued to get worse. So part of the diagnose nightmare I went through was a Sleep Study. I couldn't sleep. They did try me of a mask and I kept freaking out and ripping it off. Since I couldn't sleep...no results but I didn't care or want it so I didn't care. I'd rather die than wear that mask and have to sleep that way. I eventually figured out the main issue what's called "rebound headaches" from the Excedrin Migraine pills.

Fast forward back to today. I only ripped off my mask once during my sleep study. Just felt like i was suffocating from my own breath (full face mask). But I also took some TylenolPM's to help me sleep. And I made ever effort to relax. The first nite was tough. I made sure to take sure to take some TylenolPM's and get really tired until I fell asleep on couch. Then when I woke up (2am) go upstairs and get I'm bed and put mask on (used ramp). I woke up once ripping off mask. It was hard dealing with the bi level air pressures. But night two was easier and slept through the night. Then the next night was even better. Then by the 5th nite, I stopped using the ramp feature - (13/18 pressure). Now 10 days into CPAP, I'm only working on trying to stop leaks. I don't do the "head bob" while driving to work at 6am. Not do I need to nod off during the day feeling like I need a nap. I feel awake all day and into the evening. I have fallen asleep on the couch watching TV (but that's like at 11pm) - so that's just being tired. I don't need to take a piss a couple times a night like I used to. It feels great to no longer have me or my wife sleeping on the couch. We have slept in the same bed all 10 days I've been on CPAP. She now sleeps better and the machine doesn't even bother her - she says sometimes it sounds like the ocean (white noise).

[Pugsy]

Seriously? Is that how the snoring is detected? These machines have an integrated mic? I guess I always thought that all the data was measured and calculated from the actual breathing. The reason I bring this up is that I have a little Boston Terrier that snores at human volumes. My charts show some snoring but my fiance says she can't hear me snore. We both can definitely hear our dog!

I have no idea how the snoring is ultimately detected.
Only recounting what I discovered by accident. When I get those long chain saw looking snores from my Pug dog it is only when he is up on my pillow with his little chin on my shoulder (between my neck and shoulder). I don't get them when he is snoring while laying next to my back or legs. Only when up near my face. I have been wondering if it was the vibration that gets conducted through my body that is getting detected. It has only a very short distance to travel when he is just a few inches from my mask and hose.

Some snoring will just happen anyway and that's normal. But to have 2 hours of pretty much solid bars of snores...that's not so normal and warrants investigation. Since my other sections of my reports point to minimal to none FLs, RERAs or apnea events it makes me suspect if the snores are mine or not.

If your little dog isn't sleeping up by your face....I doubt he is to blame for the snores. It's easy enough to deduce though.
Have him sleep elsewhere and see what still shows up on the reports.

[Kenwood]

Okay, last night I tried something new:
I made a mask liner from a T-shirt for my mask. It seems to have really helped with the leaks that would wake me up and adjust the mask. I didn't fight with my mask at all. But I made it too thin and eventually it got moved off center later in the early morning. So now, I know I need to order some mask liners.

This is probably my best sleep stats yet (that was the fantasy football stat addict in me)

[Pugsy]

If you think you are likely going to keep this particular mask then you might consider Padacheek mask liner.
Hers actually anchor to the mask frame so eliminates the crawling around of the non attached liners.
http://www.padacheek.com/PAC_Maskliners.html

See the leak line right in the middle of the leak graph where it is around 45 L/min. That's more what your baseline is with minimal excess leak. I would rather see that line the majority of the night (or close to it) instead of pushing 90 L/min 2/3 of the night.

If you think that you may be going to try a different FFM then you might wait before purchasing a mask liner specific to one mask.

Your report from last night is indeed looking better.

[Kenwood]

I do like my mask a lot ~ ComfortGel Blue FF...now that I know the leak issues can be minimized with the help of mask liners. I wouldn't mind trying the ComfortFull2 FF - seeing the difference as I would assume its improved for the one I have?

[Pugsy]

I wouldn't mind trying the ComfortFull2 FF - seeing the difference as I would assume its improved for the one I have?

When it comes to masks....don't ever assume anything. Just when you do it will jump up and bite you in the butt.

Always worth trying though. We always learn something....might not be what we expected but we learn something.
Even with mask failures we learn something.

This is why you will see people jump on a new "latest and greatest" mask. There's a part of us that wonders if so and so might be a little better in some way even though we are very likely very content with what we have.

[Kenwood]

Would just like to see if it's a better fit in the upper nose area. My eyes are puffy sometimes in the morning. The newer one curves in more towards nose and away from eyes. Just don't wanna regret trying, and be stuck after my 30 day window expires.

[Pugsy]

Then by all means try it....while you can for free.
If you don't you will be "what iffing" all the time.
The fact that it interests you is enough reason to try it.
Sometimes the manufacturers do get it right and newer is better.
Of course sometimes I think they must be using one of my alien friends head to go by though. Like no human trials.

[Kenwood]

I would start with the DME but they will probably tell you the sleep doctor has to order it but in reality your family doctor could do it.

DME could have given you the 750/760 to start with and just set it for the fixed bilevel mode (that's what your Pro is doing anyway).

It appears that for parts of the night the fixed bilevel pressures are sufficient and parts of the night they aren't.
Auto adjusting would let the machine figure out what to use.. While I assume that maybe a little more EPAP and IPAP will get the job done I really don't know for sure...heck you may need a lot more and someone wouldn't want to use a LOT more all night when an auto machine could make the adjustments as needed.

I called my Sleep Study center and made an appointment for next Monday with the Sleep Doctor to review my CPAP data/stats (see if I need to switch to an Auto BiPap) and discuss everything with him. I never got to really have everything explained to me (sleep or family doctor). My stats were so bad...the next thing I know the CPAP machine was in the mail to me.

I also called the DME company and they are going to let me try the Amara FF mask. I also need to mail them my SD card for them to process the data and fax to my sleep study doctor.

[Pugsy]

Before you mail that SD card to the DME make a copy of the entire card either onto your computer or better yet another SD card so that you can continue getting the data and as an insurance policy in case something happens to that SD card.
A cheap generic SD card will work just fine.
Your machine stores most detailed data for about 3 weeks but it doesn't store flow graphs which are used for wave form graphs.
It may not be critically needed but better to have them and not need them then need them and not have them.
It's a cheap insurance policy.

Just make a copy on a SD card and then put it in your machine. Machine will just start writing to the new SD card.