Newbie here... My time to post

kvozel · Post by **kvozel** » Mon Feb 01, 2021 10:55 am

Here's the background. I have been reading and researching the Forum since I started using my device on 1 January. I have learned a lot, and actually made some adjustments to my device based upon comments here. Now it's time for me to ask for some advice.

The basics:
I am a 66 year old male.
Equipment described in my signature.
Sleep study results attached.
Latest OSCAR graphs included. While these were from last night, they are pretty typical.

I was very surprised at the results of my study because I would have never said I had issues. I thought I always slept well, all night, and was rarely tired during the day. So when my doctor reviewed the results I was sure they were from someone else. Even today, I feel skeptical, but oh well.

It took me awhile to get comfortable with everything (typical I understand), I do better now but still not where this is second nature. My biggest concern is that in one month I don't think I have slept the entire night, and my sleep is not very good. I think I have regressed. It takes forever (1 hour) to get to sleep, and I'm not in a very deep sleep. The issue might be my nose pillows. I think they fit Ok, but they seem to either move a bit, or just not fit tight. The end result is air leaking. I can move them, or even just reposition my head and things are fine for awhile. I find myself removing everything at around 5AM-ish just to get some good sleep; which I do almost immediately. Depending on the input I receive from you experts, maybe it is time to visit the therapist and see about different pillows or a different mask.

So, I would appreciate any input or insight you could provide.
|
|
|

Pugsy · Post by **Pugsy** » Mon Feb 01, 2021 11:04 am

It's time right now to see your DOCTOR about your therapy. ASAP....when is your follow up appt with your DOCTOR scheduled?
Age 66...Medicare???? If so you will have to have a face to face appt with your doctor before the 90th day after beginning therapy.
I would move that appointment up to sooner...get on a cancellation list.

Way too many central apneas and you had a very large number on your initial in lab sleep study.
I doubt that this machine is going to be the right machine for you. It can't deal with centrals at all. While an occasional central isn't a big deal....your number of centrals far exceed more than occasional and you had it during your sleep study so we know that cpap itself didn't cause them.

Do you take any medications of any kind? If so, what?

Do you have any history of heart disease?

kvozel · Post by **kvozel** » Mon Feb 01, 2021 11:11 am

Thanks for the quick replay. See my answers below to your questions...

Pugsy wrote: ↑
Mon Feb 01, 2021 11:04 am
It's time right now to see your DOCTOR about your therapy. ASAP....when is your follow up appt with your DOCTOR scheduled?
Follow-up 14 February

Age 66...Medicare???? If so you will have to have a face to face appt with your doctor before the 90th day after beginning therapy.
I would move that appointment up to sooner...get on a cancellation list.
Yes, Medicare

Way too many central apneas and you had a very large number on your initial in lab sleep study.
I doubt that this machine is going to be the right machine for you. It can't deal with centrals at all. While an occasional central isn't a big deal....your number of centrals far exceed more than occasional and you had it during your sleep study so we know that cpap itself didn't cause them.

Do you take any medications of any kind? If so, what?
Currently take Eliquis, Metoprolol, Cartia, Losartan-Hydrochlorothiazide, Atorvastatin

Do you have any history of heart disease?
Hypertrophic Cardiomyopathy. Cardiac Ablation scheduled at end of the month.

Pugsy · Post by **Pugsy** » Mon Feb 01, 2021 11:27 am

Changing masks is unlikely to make a dent in your therapy except maybe make your therapy down the road easier to manage and eliminate leaks waking you up. Your main problem isn't leaks...it's the fact that your issues aren't being dealt with at this time with this machine and it simply can't.

About the only thing I would offer right now is turn off ERP (exhale pressure relief) and see what happens. In all honesty I doubt it will do anything except maybe reduce the OAs a little bit.

2 weeks until your doctor appointment....call and see if you can get in sooner by telling them to put you on a cancellation list.
Sometimes it works.

You have complex sleep apnea....where you have both obstructive sleep apnea and central sleep apnea and you had this going on before starting cpap therapy. It's very likely going to require a different machine that can force you to breathe when you aren't breathing because of the centrals. Central apnea...hold your breath for 15 seconds...that's essentially a central apnea of 15 second duration.
The airway is open but no air is flowing because you aren't making an effort to breathe. A few of them here or there isn't a big deal and won't cause a problem.
The machine you are using now can effectively deal with the obstructive side of your diagnosis (with a little tweaking of your pressure settings) but it simply can't do anything for your central apneas. You need a machine that will act like a ventilator and force you to breathe.

Do you happen to know if you have a congestive heart failure diagnosis and what your ejection rate is????

You have more than enough data that points to a need for a different machine to satisfy Medicare requirements.

ASV type of machine would be ideal since it will auto adjust for both central apneas and obstructive apneas.
Some docs might be scared of it depending on your heart ejection rate status.

Read up on the ResMed AirCurve 10 ASV model machine....that's what I would be wanting if I were in your shoes.

kvozel · Post by **kvozel** » Mon Feb 01, 2021 1:57 pm

Pugsy wrote: ↑
Mon Feb 01, 2021 11:27 am
Changing masks is unlikely to make a dent in your therapy except maybe make your therapy down the road easier to manage and eliminate leaks waking you up. Your main problem isn't leaks...it's the fact that your issues aren't being dealt with at this time with this machine and it simply can't.

About the only thing I would offer right now is turn off ERP (exhale pressure relief) and see what happens. In all honesty I doubt it will do anything except maybe reduce the OAs a little bit.

2 weeks until your doctor appointment....call and see if you can get in sooner by telling them to put you on a cancellation list.
Sometimes it works.
What is your reason for the urgency? I'm not challenging, just trying to understand.

You have complex sleep apnea....where you have both obstructive sleep apnea and central sleep apnea and you had this going on before starting cpap therapy. It's very likely going to require a different machine that can force you to breathe when you aren't breathing because of the centrals. Central apnea...hold your breath for 15 seconds...that's essentially a central apnea of 15 second duration.
The airway is open but no air is flowing because you aren't making an effort to breathe. A few of them here or there isn't a big deal and won't cause a problem.
The machine you are using now can effectively deal with the obstructive side of your diagnosis (with a little tweaking of your pressure settings) but it simply can't do anything for your central apneas. You need a machine that will act like a ventilator and force you to breathe.

Do you happen to know if you have a congestive heart failure diagnosis and what your ejection rate is????
No

You have more than enough data that points to a need for a different machine to satisfy Medicare requirements.

ASV type of machine would be ideal since it will auto adjust for both central apneas and obstructive apneas.
Some docs might be scared of it depending on your heart ejection rate status.

Read up on the ResMed AirCurve 10 ASV model machine....that's what I would be wanting if I were in your shoes.
I will read up

Pugsy · Post by **Pugsy** » Mon Feb 01, 2021 2:20 pm

What is your reason for the urgency? I'm not challenging, just trying to understand.

Because your therapy is so sub optimal that it is entirely possible that you are having serious oxygen level drops and damage to your body.

No where near being adequately treated and your sleep is still crap.
We like to see the AHI numbers below 5....yours are essentially unchanged from the sleep study.

Plus you had some significant periods of Cheyne Stokes Respiration both now and even without cpap. Read up on it....it's scary especially with people who have a history of heart issues.

The machine sure isn't helping you at all and I hate to see people go without at least some help.
I have zero patience for doctors who aren't doing what they are paid to do.

kvozel · Post by **kvozel** » Mon Feb 01, 2021 2:24 pm

Thank you.

Obviously I am new to this and didn't even think I had issues. I will follow up as you suggest and report back as I can.

Great Forum this is for info!

Newbie here... My time to post

Newbie here... My time to post

Re: Newbie here... My time to post

Re: Newbie here... My time to post

Re: Newbie here... My time to post

Re: Newbie here... My time to post

Re: Newbie here... My time to post

Re: Newbie here... My time to post

Machine	Mask

Machine	Mask

Machine	Mask

Machine	Mask