cpap compliant, great data, still waking often

[robysue]

For all intents and purposes, "Flow Limitations" don't really matter much with regard to the therapy......they and Snores are what the APAPs use to trigger pressure changes.

I have to respectfully disagree.
When trying to figure out why a person is waking up (and we can't see any logical reason) I prefer to have all available information at my finger tips...just in case.
The FLs and UARS thing is always a possibility and even if remote....bears keeping one eye open.
After all...there is a reason why the apap mode will respond to a FL.

And, in my opinion, the reason is of dubious value. One has to interrogate the reports to see how many FLs turn into Hypopneas, Snores or Apneas. Also, one should look to see how many snores precede apnea events.

Many people have "frank" apneas (without preceding events) and will never get a pressure increase BECAUSE of the lack of preceding events.

Considering that these machines use "air flow" to interpret events, there are many things that a sleeper could do that would NOT be an actual event worth increasing pressure for. Just turning over or repositioning yourself could be interpreted as a flow limitation. The hose rubbing across the edge of the bed could be interpreted as a snore.

But, we were talking about straight pressure for this user and his sleep disturbances. Tracking FLs may be interesting to see how many times the machine didn't have to bump the pressure......but that's about it.
If Flow Limitations were that important, the machines would record them in CPAP mode, too. Yeah, I know, ResMed Elite machines do.......whoopie!

As far as UARS.......???

Upper Airway Resistance Syndrome (UARS) - part of the spectrum of obstructive sleep-related breathing disorders in which repetitive increases in resistance to airflow in the upper airway lead to brief arousals and daytime fatigue. Apneas and hypopneas (see RDI) may be totally absent. Blood oxygen levels can be in the normal range.


Den

.

Den,

You're missing Pugsy's point. Flow limitations by themselves can be disruptive to some people's sleep. That's the basic problem in untreated UARS: The FLs themselves lead to arousals before they are bad enough to be scored as a full-fledged hypopnea. And there are some sleep labs and some sleep docs who believe that during a titration study, the sleep tech who does the titrating should attempt to eliminate all the FLs well as the OAs, Hs, RERAs and snoring. In other words, there are some sleep med professionals who believe that a properly titrated CPAP pressure should be high enough to eliminate the FLs as well as the other stuff.

In light of that, it's not hard to see that if a person's titrated CPAP pressure is high enough to take care of the OAs and Hs, but low enough to allow a substantial number of FLs to continue to happen, then the residual FLs themselves could lead to problems in some OSA patients using straight CPAP. And that's why Pugsy is saying to eliminate the APAP variable by setting min Pressure = max Pressure in APAP mode: You get the benefits of a nonvarying pressure (if pressure changes are what is triggering the wakes) and you still get the FL data (in case its FL that are causing the wakes instead of the pressure changes.)

If Flow Limitations were that important, the machines would record them in CPAP mode, too.

Are you aware that PR machines only record half the snoring data when in CPAP mode? Does that mean the VS2 snores are somehow more important than the VS snores?

In my (not so humble) opinion, PR made a stupid programming mistake when they chose to make their machines record only half the snore data and none of the FL data when their machines are run in CPAP mode.

[robysue]

i struggled mightily with cpap since august, i have FINALLY fallen asleep (24 days ago was the 1st time) with cpap and swift nasal pillows/chin strap combo, but have woken up every 1-2 hours similar to pre-cpap. i have been cpap compliant 24 straight days, and have fallen asleep easily at night for over 3 weeks. the following is consistent data as per PR S1 auto-cpap for the last 24 days. ahi 0.9-1-8; 90% @ 8.0; leaks 0 (i am a back sleeper and the nasal pillows fit perfectly, also, there has never been a leak during any of my awakenings) 0 periodic breathing; 7+ usage hours each night i went over this data with my sleep doc and he was baffled by my 1-2 hour repeated awakenings and suggested the therapy was working based on data. i asked about possibly incresing pressure but he said no as 90% @ 8.0 indicated it was good. he is trying to get approved an actual sleep study to see what is happening.

It's worth trying to get approved for the sleep study just to rule out PLMD as a possible continuing cause for those wakes. But if there's no PLMD, then the sleep study may not show much other than "you wake up every couple of hours for no identifiable reason."

With the history of pre-CPAP wakes similar to the ones that you're continuing to experience, it may just be that your body is so used to waking up every couple of hours that it needs to be taught how to not do this. And that can be devilishly hard to do. The timing of the wakes makes it sound like some of them could be post-REM wakes, which are pretty normal. It's just that most people with post-REM wakes immediately go back to sleep and don't even remember the wake in the morning. So that raises the question: When you find yourself awake in the middle of the night, what's the first thing you think and what's the first thing you do? Some middle of the night behaviors tend to perpetuate the tendency to wake up and remember the wakes; others tend to help the body get back to sleep within a minute or less (it takes a 5 minute wake for most people to remember it the next morning.)

i too feel the therapy is working a little as the trainwreck headache i have had for months is a little less, the dense fog my brain has been in is a little less, and my focus/concentration is slightly improved. but no where close to how i should be feeling as i am still so tired.

Remember, you've only been sleeping halfway decently with your PAP for a month---you said that in the first several months you struggled mightily and that you finally were successful in falling asleep for the first time only 24 days ago. So in some sense, you're only one month into "sleeping with the machine" since the first three or four months were more along the lines of "struggling to sleep with the machine." And it does take time after you are sleeping reasonably decently with the machine to start feeling better. It sounds like the healing is starting and as you continue to use the machine, you should see a steady (but slow) improvement in the headaches and the dense brain fog. You may want to track these things in a journal because the improvement in how you feel may be so gradual that you don't realize it---unless you've got a record of how badly you're feeling right now.

the 1-2 hours of sleep with cpap is certainly better than 1-2 hours without. the repeated wakenings is frustrating, i am not gasping for air, i am not overwhelmed by pressure, not with rapid heartbeat, i am not turning or tangled in tubing, i am just waking up, if that makes sense.

Makes perfect sense if those wakes are post-REM wakes. A lot of people with perfectly normal sleep wake up briefly after most REM cycles; they quickly scan the surroundings and note that there's nothing unusual that needs their attention, and go back to sleep---all within a minute or two. And they don't remember these wakes in the morning and these kinds of wakes are not particularly problematic in getting good quality restorative sleep.

But what happens with some people is that they overreact to the post-REM wake and start trying to figure out why they're awake and how long they've slept since the last wake and how much more time there is to morning. These kinds of thought patterns tend to prolong the wakes and also tend to reinforce the "desire" to remember all the wakes that occur, which in turn make it more likely that you'll remember the wakes the next night when they happen in roughly the same time spots relative to your sleep cycles.

i take .5- 1mg klonpoin at night, have done so for 3+ years so increasing that won't help, having full endocrine work up to check/rule out any hormonal imbalance.

Any chance the klonopin might be causing some side affects? According to http://www.drugs.com/sfx/klonopin-side-effects.html, klonopin's common side effects include: headache; trouble with concentrating; and trouble with sleeping. Maybe taking the klonopin earlier in the night might make it less likely to cause trouble with sleeping in you.

is this perhaps sometimes normal with cpap adjustment? is data reliable? would sleepyhead data show something else as possible cause for wake-ups? i know it is only 3 weeks of compliance, but is has been a long 22 months of this

Continued waking in a pattern that predates CPAP usage is pretty common among PAPers, particularly if there was something that caused the pre-CPAP wakes in addition to untreated OSA. PAP doesn't fix anything other than sleep disordered breathing, and so if there are other sleep issues in addition to OSA, they have to be dealt with before genuinely high quality sleep can be restored.

( i was undiagnosed for quite some time) the 1st few nights that i fell asleep i was SO happy just to have fallen asleep with cpap/gear. i'm just happy i have adjusted, and hopeful that each night will bring better quality sleep. if anyone has experienced this, or any advice/insight at all, that would be greatly appreciated. thanks

Some of your story resembles my own difficult, insomnia-laden adjustment to PAP therapy back in 2010-2011. If you'd like the full synopsis of my journey to "more-or-less happy PAPer who is feeling better on a daily basis (most of the time), you can read about it on the Success Stories thread at viewtopic.php?f=1&t=14494&st=0&sk=t&sd= ... 35#p864314

[49er]

Hi Billyc,

Since you mentioned you had narrow nasal passages, have you been evaluated by an ENT to see if that is an issue regarding pap therapy tolerance? I have experience similar type problems to you for longer unfortunately and am finally going to have a septoplasty and turbinate reduction around the beginning of February to hopefully improve my pap therapy tolerance.

Also, could your Klonopin be causing the wakes? Initially meds can be helpful but then sadly wlll have a paradoxical effect. Of course, I am not a doctor so take that into account.

hello, i 1st posted/joined here mid december in regards to my 4 months of struggling with cpap adjustment. This site has been a blessing with some very kind/insightful people. to recap, 47, male, narrow nasal/airway cause of osa, ahi 14, may not be accurate as my sleep study was done in my house as insurance did not approve. no other health issues. i struggled mightily with cpap since august, i have FINALLY fallen asleep (24 days ago was the 1st time) with cpap and swift nasal pillows/chin strap combo, but have woken up every 1-2 hours similar to pre-cpap. i have been cpap compliant 24 straight days, and have fallen asleep easily at night for over 3 weeks. the following is consistent data as per PR S1 auto-cpap for the last 24 days. ahi 0.9-1-8; 90% @ 8.0; leaks 0 (i am a back sleeper and the nasal pillows fit perfectly, also, there has never been a leak during any of my awakenings) 0 periodic breathing; 7+ usage hours each night i went over this data with my sleep doc and he was baffled by my 1-2 hour repeated awakenings and suggested the therapy was working based on data. i asked about possibly incresing pressure but he said no as 90% @ 8.0 indicated it was good. he is trying to get approved an actual sleep study to see what is happening. summary of my settings- auto cpap; 7.0-15 (i don't use ramp), c-flex at 2 (c-flex feels like natural breathing to me) humidifier at 2. i too feel the therapy is working a little as the trainwreck headache i have had for months is a little less, the dense fog my brain has been in is a little less, and my focus/concentration is slightly improved. but no where close to how i should be feeling as i am still so tired. the 1-2 hours of sleep with cpap is certainly better than 1-2 hours without. the repeated wakenings is frustrating, i am not gasping for air, i am not overwhelmed by pressure, not with rapid heartbeat, i am not turning or tangled in tubing, i am just waking up, if that makes sense. i even used quatrro f/x for a few days thinking maybe my mouth was opening a little with chin strap and mouth/air pressure disturbance was cause of waking. i fell right to sleep with f/x, and still woke up like clockwork. i take .5- 1mg klonpoin at night, have done so for 3+ years so increasing that won't help, having full endocrine work up to check/rule out any hormonal imbalance. is this perhaps sometimes normal with cpap adjustment? is data reliable? would sleepyhead data show something else as possible cause for wake-ups? i know it is only 3 weeks of compliance, but is has been a long 22 months of this ( i was undiagnosed for quite some time) the 1st few nights that i fell asleep i was SO happy just to have fallen asleep with cpap/gear. i'm just happy i have adjusted, and hopeful that each night will bring better quality sleep. if anyone has experienced this, or any advice/insight at all, that would be greatly appreciated. thanks

[billyc17]

For all intents and purposes, "Flow Limitations" don't really matter much with regard to the therapy......they and Snores are what the APAPs use to trigger pressure changes.

I have to respectfully disagree.
When trying to figure out why a person is waking up (and we can't see any logical reason) I prefer to have all available information at my finger tips...just in case.
The FLs and UARS thing is always a possibility and even if remote....bears keeping one eye open.
After all...there is a reason why the apap mode will respond to a FL.

And, in my opinion, the reason is of dubious value. One has to interrogate the reports to see how many FLs turn into Hypopneas, Snores or Apneas. Also, one should look to see how many snores precede apnea events.

Many people have "frank" apneas (without preceding events) and will never get a pressure increase BECAUSE of the lack of preceding events.

Considering that these machines use "air flow" to interpret events, there are many things that a sleeper could do that would NOT be an actual event worth increasing pressure for. Just turning over or repositioning yourself could be interpreted as a flow limitation. The hose rubbing across the edge of the bed could be interpreted as a snore.

But, we were talking about straight pressure for this user and his sleep disturbances. Tracking FLs may be interesting to see how many times the machine didn't have to bump the pressure......but that's about it.
If Flow Limitations were that important, the machines would record them in CPAP mode, too. Yeah, I know, ResMed Elite machines do.......whoopie!

As far as UARS.......???

Upper Airway Resistance Syndrome (UARS) - part of the spectrum of obstructive sleep-related breathing disorders in which repetitive increases in resistance to airflow in the upper airway lead to brief arousals and daytime fatigue. Apneas and hypopneas (see RDI) may be totally absent. Blood oxygen levels can be in the normal range.


Den

.

let me 1st start by thanking everyone for their insight and time in responding to this. it reassures me that there are kind and caring people in this world looking out for others, and i have learned a great deal from this, more from any MD. the snoring is significant, i am a horrible snorer when i get going. with the absence of any real data after my "in home" sleep study, i set up recorder next to the my pillow 1 night (this was without any cpap) and collected 1 hour's worth of, what i feel, is reliable data. 3 similar patterns/events within the hour. after 10 minutes or so, can start to hear the mild snore develop, gradually gets heavier, then the grunting, farting, bellowing, atomic snort happens and then i wake up. that pattern happened 3 times in an hour. of importance, i feel, is that there were no significant breathing stoppages to be heard. some shallow inhales at times, but that was it. after each exhale there was a about a 2 second pause until next inhale, and that was consistent for each cycle. so, if while using cpap i am going at least an hour, on rare occassions 2, before wakening/disruption, versus the 20 minutes or so without cpap, my uneducated guess would point to snoring. i am sure i snore with nasal pillows, they don't "cure" snoring, do they? well, last night was rough, set cpap for 8, and it may have been too much as i couldn't even fall asleep, changed masks an hour in, probably not the best thing to do, frustration set in, and around 3am crashed on the couch for a little sleep, as poor as it was. tonight i may work "up" instead of down in terms of pressure. perhaps start at 7 and see if i can get some extended sleep cycles. thanks everyone

[billyc17]

[quote="49er"]Hi Billyc,

Since you mentioned you had narrow nasal passages, have you been evaluated by an ENT to see if that is an issue regarding pap therapy tolerance? I have experience similar type problems to you for longer unfortunately and am finally going to have a septoplasty and turbinate reduction around the beginning of February to hopefully improve my pap therapy tolerance.

Also, could your Klonopin be causing the wakes? Initially meds can be helpful but then sadly wlll have a paradoxical effect. Of course, I am not a doctor so take that into account.


Hi 49er. saw ent recently, getting oral device as well. i am blessed with a very small jaw as well as the narrow nasal/airway. really don't want to be messing with my teeth so i hope i can get cpap under control without wearing oral device to pull lower jaw forward. i would certainly consider surgery for cpap assistance and have thought to myself "if i have a narrow nasal passage, snore, have a small jaw and while asleep structures relax and fall back causing obstruction, at least why not open nasal passages up a little wider" klonopin, i was waking up 2-3 times a night pre-klonopin, pre-osa, pre-cpap for years and always thought it was normal as i functioned/lived/slept. just fine. was never tired or fatigued. the 2-3 times up night turned into 5-8 times a night over the last 2 years.

[penuel]

billyc17, why did you mention: to recap, 47, male, narrow nasal/airway cause of osa?

By any chance do you suffer from UARS (Upper Airway Resistance Syndrome)?

The following are the Clinical Features:


Patients with UARS have symptoms similar to those seen in OSAS, although there are some distinct features. Much of the research performed has attempted to identify and describe a group of patients with significant daytime sleepiness and disrupted sleep, but without the other dominant clinical features seen in OSAS. Typical symptoms reported by patients with UARS include excessive daytime sleepiness, fatigue, difficulty concentrating, morning headaches, and unrefreshing sleep. There can be also be a significant impairment in daytime functioning; a recent study demonstrated that subjects with UARS performed worse than patients with obstructive sleep apnea hypopnea syndrome and normal control individuals on different aspects of the Psychomotor Vigilance Task.16 In a separate study, upwards of 30% of subjects with UARS had abnormal sleep-onset latency on the Maintenance of Wakefulness Test.17 Individuals with abnormal airway anatomy are at increased risk, including those with a decreased retrolingual space, narrow nasal passages, or a small neck circumference.6 Patients are typically not obese, with a mean BMI often <25 kg/m2.3 They are also usually younger than those in whom OSAS is diagnosed, with a mean age of approximately 38 years.3 Snoring is not a requisite symptom, with 10% to 15% or more of patients having never or only intermittently snored.3,18

Patients with UARS are also more likely to report symptoms of frequent nocturnal awakening with difficulty falling back to sleep.19 This is thought to be a potential reason for increased complaints of insomnia amongst patients with UARS, including sleep onset and sleep maintenance problems. In addition to difficulties with acute insomnia, patients with UARS also have an increased likelihood of carrying a diagnosis of chronic insomnia. Other notable complaints include parasomnias, especially sleepwalking, sleep talking, and sleep terrors.20 Patients may also have symptoms of abnormal autonomic function, including lightheadedness or dizziness on rising from a supine or sitting position, cold hands and feet, and low resting blood pressures (defined as a systolic BP <105 mm Hg with a diastolic BP <65 mm Hg). In a study of 400 patients with UARS, more than 20% met criteria for low BP, a significantly higher prevalence when compared with people who have OSAS (0.6%) or insomnia (0.9%).21 Interestingly, all subjects in the study had evidence of a small oral cavity on examination with a narrowed airway space dimension on cephalometric radiographs, consistent with other reports.22 Lastly, patients with UARS have increased rates of symptoms such as gastroesophageal reflux, muscular pain, diarrhea, abdominal pain, depression, and anxiety. This has led some authors to suggest a link between UARS and functional somatic syndromes, such as irritable bowel syndrome, chronic fatigue syndrome, and fibromyalgia. In a study of 75 subjects equally divided into three groups (UARS, mild to moderate OSAS, and severe OSAS), those with UARS were more likely to report symptoms of headache, irritable bowel symptoms, and sleep-initiation insomnia.23 Subjects with UARS were also more likely to have alpha intrusion during slow-wave sleep, a polysomnographic finding described in a number of fatigue syndromes.24 In children with UARS, symptoms consistent with attention deficit disorder or attention deficit hyperactivity disorder may be present, with behavioral changes leading to poor school performance.25 Table 1 lists symptoms associated with UARS.


Summary:


Table 1—Clinical Features Associated With UARS


Daytime symptoms:
Excessive daytime sleepiness:
Fatigue
Morning headaches
Myalgias
Difficulty concentrating

Sleep disturbances:
Frequent nocturnal awakenings
Difficulties initiating sleep
Insomnia
Bruxism
Restless leg syndrome
Unrefreshing sleep

Autonomic nervous system:
Hypotension
Orthostasis
Cold hands and feet

Functional somatic syndrome associations:
Depression
Anxiety
Chronic fatigue syndrome
Irritable bowel syndrome
Fibromyalgia

Polysomnographic abnormalities:
Increased RERAs
Increased nocturnal arousals
Increased CAP rate
Alpha intrusion during sleep

Many of those with UAR Syndrome have Palatal two point neurological lesions on the soft palate (both sides of the uvula) which could also been caused by using CPAP and/or by snoring.


If you suspect that you might have UARS, then you should seek a test study in a sleep lab that can check for UARS. Most don't.

[Pugsy]

Not all awakenings are caused by sleep apnea related happenings. Would be nice if they were because they would be pretty easy to treat.
Not everyone has problems with cpap pressure disturbing sleep but it is always worth investigating to make sure that an easy fix is not overlooked. Hurts nothing to try something simple first.

I don't know how much of an impact the klonopin is having on the situation but I suspect it is at least having some impact.
http://en.wikipedia.org/wiki/Clonazepam
It concerns me especially because of the effect on REM stage sleep. It is known to mess with sleep architecture and that opens up a bigger can of worms....especially with someone who already has trouble with good sleep architecture in the first place.

[billyc17]

billyc17, why did you mention: to recap, 47, male, narrow nasal/airway cause of osa?

By any chance do you suffer from UARS (Upper Airway Resistance Syndrome)?

.

because the doctor board certified in internal medicine, sleep medicine, and pulmonology told me so after looking in my throat and nose with a flashlight. i would love a "real" sleep study to see what i may suffer from. thanks

[penuel]

May be your Doc is the same as I used to go to. He holds the same MDs in each of the three disciplines. Well, the one I have seen, does not know much even about S9 Autoset in APAP mode. Besides, to check for Upper Airway Resistance Syndrome, reliably, I have yet to find a lab that could do it for me even though I am not a typical UARS suferrer. I been using the S9 Autoset in APAP mode for almost 3 years and I see that I still have residual Flow Limitations (which suppose to include RERAs and UARs). So apparently all the posts that you see above talking about the automatic treatment of UARS by XPAPS in the APAP modes are NOT that much EFFECTIVE. Some posters from this site who were treated at Stanford Sleep Lab (the top place for UARS experts) came back to post that they are still not cured even after going thru CPAP, oral appliances, surgeries, etc. But others did see some success with these procedures.

This is a typical Flow Limitation graph that I see from my S9 Autoset:



my other events are all adequately treated:


p.s. I have yet to spend more time checking my data while I sleep without my removable dentures and see if it reduced the Flow Limitation. Who knows? Soon I'll be asking about that FL, my new sleep doc from Duke who suppose to be the best awarded sleep doc along the East coast.

[Wulfman...]

Den,

You're missing Pugsy's point. Flow limitations by themselves can be disruptive to some people's sleep. That's the basic problem in untreated UARS: The FLs themselves lead to arousals before they are bad enough to be scored as a full-fledged hypopnea. And there are some sleep labs and some sleep docs who believe that during a titration study, the sleep tech who does the titrating should attempt to eliminate all the FLs well as the OAs, Hs, RERAs and snoring. In other words, there are some sleep med professionals who believe that a properly titrated CPAP pressure should be high enough to eliminate the FLs as well as the other stuff.

In light of that, it's not hard to see that if a person's titrated CPAP pressure is high enough to take care of the OAs and Hs, but low enough to allow a substantial number of FLs to continue to happen, then the residual FLs themselves could lead to problems in some OSA patients using straight CPAP. And that's why Pugsy is saying to eliminate the APAP variable by setting min Pressure = max Pressure in APAP mode: You get the benefits of a nonvarying pressure (if pressure changes are what is triggering the wakes) and you still get the FL data (in case its FL that are causing the wakes instead of the pressure changes.)

If Flow Limitations were that important, the machines would record them in CPAP mode, too.

Are you aware that PR machines only record half the snoring data when in CPAP mode? Does that mean the VS2 snores are somehow more important than the VS snores?

In my (not so humble) opinion, PR made a stupid programming mistake when they chose to make their machines record only half the snore data and none of the FL data when their machines are run in CPAP mode.

No, I didn't miss the point. I just happen to disagree (or not fully agree) with it, but I DO agree that setting the minimum and maximum will at least report the data........I did comment to that........"Tracking FLs may be interesting to see how many times the machine didn't have to bump the pressure......but that's about it."
Increasing pressures with an APAP on a Flow Limitation could actually contribute to more flow limitations (the human reflex reaction to pressure increases).
Sleeping position can contribute to how the machine interprets "air flow". If a person happens to tuck their chin down to their chest, they're probably going to restrict their air flow.......Flow Limitations, Hypopneas or Apneas.
Even the sleep labs don't fully agree with how to titrate them. I've read some topics on Binary Sleep and have read many other documents regarding the protocol. There are some protocols which advocate increasing, then decreasing and then increasing again. However, there were discussions as to whether bumping the pressure may actually result in waking the subject.
Some sleep labs and doctors believe the FLs are important and some.......not so much.

Apparently you agree with the discrepancies because here are your own words in a post last year on the ASAA.

Some lab will titrate until the flow limitations disappear; others only aim to find a pressure that makes the AHI = 0 (or close to 0).

Throwing all those things (FLs, UARS, RERAs) together can be confusing and they're not necessarily all present together.
In other words, a person could have any, some or none with any regularity. Just because a person has a few FLs, doesn't necessarily mean they have UARS.

Even the "definitions" of Flow Limitation vary quite a bit. (some excerpts)

Flow Limitation - the partial closure of the upper airway impeding the flow of air into the lungs.

During the flow limitation event, only a slight decrease in flow occurs during each inspiration.

However, quantifying the magnitude of flow limitation is difficult, because the conventional concept of airflow resistance (or its reciprocal conductance) is not directly applicable during flow limitation.

The contour of inspiratory flow tracing from a PAP system can be used to infer the presence of elevated upper airway resistance and flow limitation, and this contour appears to be the simplest vari­able that best correlates with the lowest esophageal pressure during PAP titration.

"Flow limitation as a noninvasive assessment of residual upper-airway resistance during continuous positive airway pressure therapy of obstructive sleep apnea." Condos R, Norman RG, Krishnasamy I, Peduzzi N, Goldring RM, Rapoport DM.


My point is that the OP (billyc17) needs to get some decent sleep and the pressure changes with APAP are probably not helping. There MAY be other factors involved, but he needs to try to narrow the list of "the usual suspects".

I'm not familiar with how the PR System One reports Snores, but I would presume they had their reasons for doing what they did. Maybe they didn't think they needed ALL of the snores to see if they were still present.


Den

.

[Wulfman...]

let me 1st start by thanking everyone for their insight and time in responding to this. it reassures me that there are kind and caring people in this world looking out for others, and i have learned a great deal from this, more from any MD. the snoring is significant, i am a horrible snorer when i get going. with the absence of any real data after my "in home" sleep study, i set up recorder next to the my pillow 1 night (this was without any cpap) and collected 1 hour's worth of, what i feel, is reliable data. 3 similar patterns/events within the hour. after 10 minutes or so, can start to hear the mild snore develop, gradually gets heavier, then the grunting, farting, bellowing, atomic snort happens and then i wake up. that pattern happened 3 times in an hour. of importance, i feel, is that there were no significant breathing stoppages to be heard. some shallow inhales at times, but that was it. after each exhale there was a about a 2 second pause until next inhale, and that was consistent for each cycle. so, if while using cpap i am going at least an hour, on rare occassions 2, before wakening/disruption, versus the 20 minutes or so without cpap, my uneducated guess would point to snoring. i am sure i snore with nasal pillows, they don't "cure" snoring, do they? well, last night was rough, set cpap for 8, and it may have been too much as i couldn't even fall asleep, changed masks an hour in, probably not the best thing to do, frustration set in, and around 3am crashed on the couch for a little sleep, as poor as it was. tonight i may work "up" instead of down in terms of pressure. perhaps start at 7 and see if i can get some extended sleep cycles. thanks everyone

Billy,

Please keep us informed as to how your therapy (and changes) are working.
If you're not doing nasal cleansing before bedtime, I would suggest doing so. That cuts down on snoring or the "sound" that can be interpreted and scored as snoring. It may also help the airflow through your nasal passages.

I was a horrific snorer before and when I started, but nasal cleansing and a little extra pressure ( 2 cm ) reduced it from the "hundreds" to less than 0.3 on the Snore Index.

Keep a close eye on your downloads and reports.


Den

.

[Wulfman...]

I guess "penuel" must have deleted his post.
But, since I went to the trouble to answer his post, I'm going to post it anyway. I know it's just "words", but here it is.

Den

.

Den Wulfman, you never show illustrated data from your own treatment. Just words. Why?

I've never utilized an Internet storage site to store images.......and I never will.

But, here are some of last year's stats (average for the whole year) from my MyEncore program (Encore Pro database):

2013

AHI - 0.2

Average hours of use per night - 8.6

Snore Index - 0.2

Average time in apnea per night - 1.3 sec.


Den

.

[Wulfman...]

These stats are from my first year - 2005. However, I started in mid-May, so it isn't a complete year.
I'm currently using the same model of machine I used back in 2005.....and with the same firmware. So, they should be fairly close regarding event measurements.


2005

AHI - 0.8

Average hours of use per night - 6.5

Snore Index - 82.2

Average time in apnea per night - 5.0 sec.


Den

.

[Wulfman...]

OK, here's the progression of years since I started.

2005

Pressure: 10 cm.

AHI - 0.8

Average hours of use per night - 6.5

Snore Index - 82.2

Average time in apnea per night - 5.0 sec.



2006

Pressure: 10, 11 and 12 cm. (with one week on APAP with a range of 10 - 15)

AHI - 0.9

Average hours of use per night - 7.1

Snore Index - 21.2

Average time in apnea per night - 4.2 sec.



2007

Pressure: 12 cm.

AHI - 0.7

Average hours of use per night - 7.5

Snore Index - 4.6

Average time in apnea per night - 3.1 sec.



2008

Pressure: 12 cm.

AHI - 0.6

Average hours of use per night - 7.5

Snore Index - 1.1

Average time in apnea per night - 3.0 sec.



2009

Pressure: 12 cm.

AHI - 0.6

Average hours of use per night - 7.1

Snore Index - 1.4

Average time in apnea per night - 2.9 sec.



2010

Pressure: 12 cm.

AHI - 0.6

Average hours of use per night - 7.6

Snore Index - 1.2

Average time in apnea per night - 3.6 sec.



2011

Pressure: 12 cm.

AHI - 0.4

Average hours of use per night - 8.2

Snore Index - 0.2

Average time in apnea per night - 4.0 sec.



2012

Pressure: 12 cm.

AHI - 0.4

Average hours of use per night - 8.4

Snore Index - 0.2

Average time in apnea per night - 1.9 sec.



2013

Pressure: 12 cm. (after using a C-Flex setting of 2 for nearly 8 years, I turned it off on 04/01/13)

AHI - 0.2

Average hours of use per night - 8.6

Snore Index - 0.2

Average time in apnea per night - 1.3 sec.


Den

.

[49er]

Hi Billyc,

Since you mentioned you had narrow nasal passages, have you been evaluated by an ENT to see if that is an issue regarding pap therapy tolerance? I have experience similar type problems to you for longer unfortunately and am finally going to have a septoplasty and turbinate reduction around the beginning of February to hopefully improve my pap therapy tolerance.

Also, could your Klonopin be causing the wakes? Initially meds can be helpful but then sadly wlll have a paradoxical effect. Of course, I am not a doctor so take that into account.


Hi 49er. saw ent recently, getting oral device as well. i am blessed with a very small jaw as well as the narrow nasal/airway. really don't want to be messing with my teeth so i hope i can get cpap under control without wearing oral device to pull lower jaw forward. i would certainly consider surgery for cpap assistance and have thought to myself "if i have a narrow nasal passage, snore, have a small jaw and while asleep structures relax and fall back causing obstruction, at least why not open nasal passages up a little wider" klonopin, i was waking up 2-3 times a night pre-klonopin, pre-osa, pre-cpap for years and always thought it was normal as i functioned/lived/slept. just fine. was never tired or fatigued. the 2-3 times up night turned into 5-8 times a night over the last 2 years.

Hi billyc17,

It sounds like you are having combination oral appliance/pap therapy. I share the same reluctance about wearing a dental device although I feel it can be helpful for many people depending on the situation.

Den gives good advice about trying nasal cleaning before bedtime to see if that helps open your nose and hopefully, make it easier to stay asleep without waking up. In my case, it works for 30 minutes and then gets alot worse which my former allergist who worked on the White House Staff has said can occur. That is why I am having the septoplasty and turbinate reduction to open up my nasal passages.

If this doesn't work, I would strongly urge you to look into this. And again, please consider the Klonopin as a possible culprit in all of this which of course, needs to be run by your doctor.

49er