High Anxiety- Adjusting to CPAP Life

[MyJanine]

I posted an hour or so ago asking about the SD card. I've tweaked "My Profile" so you should be seeing the device, humidifier, and mask type now. I am new to this forum as of this morning.
My specific question as to ask if any of the readers here have apnea that presents itself with increased anxiety? This become a beast that just feeds on itself with more anxiety, then more loss of sleep. I am attaching a print-screen of last night, which might be one of my worst nights as there appears to be 61 Obstructive Apnea Events.
Today is the day I have been asked to mail the SD Card to my clinic, and I have... but I must say that the feedback I am getting from them is not very informative. Someone calls me and says: "Looks OK, keep it up, you are developing good device habits" Or something like that.
60 days ago I was filled with optimism about the possibilities of CPAP, now I'm almost sad.
Screenshot:

[Janknitz]

I can't see the whole chart to tell you why, but your therapy is obviously not working well for you YET, and it doesn't sound like you are getting any help from your doctor. There's an explanation for your anxiety.

Maybe others who can see the whole chart will have some suggestions. Don't give up--when we can get a handle on why your apneas aren't well controlled and figure out what settings (or perhaps a different machine?) will work, you WILL start to feel better--pinky swear.

[Julie]

Hi, how do you feel about the way the mask fits and were you aware of any major leaks overnight (I realize what the chart says, but there can be reasons for that)? Have you ever been aware of, or been told you have restless legs overnight? Are you taking any meds at all?

[palerider]

it would help a lot if you'd show some other things.

turn off the calendar, (click the little ^ by the date), show the details, not the events, on the left panel.

show the event flags, flow, pressure, leaks on the right adjust the sizes of the graphs. you can drag graphs around to get them in that order.

[Pugsy]

Whatever pressure you are using is sub optimal....way too many OAs and hyponeas...unless your leaks are big enough to let the events sneak past the defenses.

Can you please post a different image with the graphs that palerider mentioned. AHI and mask pressure graphs on the right side aren't needed and take up space...turn them off in Preferences/graphs by removing the check mark.

Need to see the detailed report so it shows the graphs and data like this example of mine below.

[MyJanine]

OK, Here's another print-screen with hopefully the proper fields adjusted. And THANK YOU for any encouragement. Even a raised "pink finger" would help at this point. Yes, Julie, I am taking 20 mg of Amytriptaline (sp) nightly to help some, and on rare occasions a Lorazapam (sp) out of desperation.

[Pugsy]

Your starting pressure of 6 cm is too low to give the machine an optimal head start to do a better job holding the airway open during the periods of times where you see those clusters of OAs.
For some reason you need a little more pressure at that time (usual suspects are supine sleeping or REM stage sleep or maybe a little of both).
It just can't get to where it needs to be quickly enough to keep the airway held open. These APAP machines don't make huge jumps in pressure in the blink of an eye. They go up a little and test the airway and then go up a little more and test the airway again.
Sometimes the airway collapses before it gets to where it needs to be.

When is your next follow up scheduled?

Probably going to need somewhere along the lines of where your median pressure is as a minimum pressure and if you get lucky with a more optimal pressure the 90/95% numbers will actually reduce. Right now they are going high in an effort to fix things. These machines work better if they are in prevent mode rather than "fix it" mode.

[MyJanine]

Thank You Pugsy (where'd that name come from? )
My next follow up appointment is somewhat in flux right now as it will l possibly happen after the specialist looks at my SD card (mailed today). When they last looked at the stick I was only finishing my first week (now it's 42 days old). I hope they respond in a more proactive manner this time, with some corrections.
Hey, another silly question.... Why would we "mail" (usps) the SD stick when the file sizes are almost tiny? Why aren't they asking me to email it? Faster.

[Pugsy]

Thank You Pugsy (where'd that name come from?

Another forum years ago that I participated in. One of the guys knew that I had Pug dogs so he called me "Pugsy" instead of my usual handle. Sort of a term of endearment. I liked it and brought it over here to make it official....and yes...I still have my Pug dog...just one Pug at the moment but have had as many as 4. Now I have other breeds to go along with the Pug.

You are still having enough OAs to put stress on the body when you see those big ugly clusters.
Hopefully the powers that be will quickly see what needs to be done. This happens a lot when people are given APAP machines with pretty much a wide open range like yours is.
It would work great if you only need 8 or 9 cm but you are going to need more at least during some periods of the night.
I had the same thing happen to me with my first APAP machine when I was first starting therapy. AHI about like yours and in ugly clusters. Mine was because of REM stage sleep. My OSA is worse in REM and sometimes those events just need more pressure...maybe not all the time but enough of the time that I had to raise the minimum.

If they drag their feet too much and you want to come over to the dark side where the rest of us who aren't afraid to change our own pressure....just let us know as it is easy to do. I personally never saw the big deal with changing the minimum...they have the darn thing wide open up to 20 anyway...

[Julie]

I would really look into doing something about the amitriptylline as it may well be affecting your sleep. You need to talk with your doctor to find out about alternative answers... and I'd do that first, before a lot of other possibilities.

[palerider]

Hey, another silly question.... Why would we "mail" (usps) the SD stick when the file sizes are almost tiny? Why aren't they asking me to email it? Faster.

most medically things I've seen are woefully behind the times as far as computers and internet go... how long ago was it when you stopped seeing walls of paper charts? and email? oh my no!!! *lol*

[Pugsy]

20 mg of amitryptiline is a relatively low low dose. I can't imagine it doing anything but helping you sleep a little better.
I take it at night for help with pain myself. If I didn't I would have a gazillion little wake ups every time I moved in bed and it hurt.

[englandsf]

My titration "suggested" 16-18 but turns out I has lots of leaks above 15. They set my machine at 10-12 and I'm commonly at 11-12 so have not changed the setting, just turned on EPR and adjusted my humidity.

[MyJanine]

OK, Please help. The doctor finally called back and informed me the after reviewing my SD card data it appears I need to move the "pressure" from the 6 setting to the 7 setting. Pugsy, whoever? How do I tweak this setting change? (my machine is listed in my profile below)

[Pugsy]

It's easy to change the pressure.

Go here and request a copy of the provider manual for your machine...it explains how to get to the clinical setup menu plus it has some other useful information in it.
http://www.apneaboard.com/adjust-cpap-p ... tup-manual

For a quick visual aid for how to get to the clinical setup menu with pictures ...here
http://www.apneaboard.com/pr-system-one ... structions
there's also a little video that might help you...it's down near the bottom of the page