Need help/advise

unknown12345 · Post by **unknown12345** » Mon Mar 25, 2019 6:51 pm

Hi,

I was diagnosed with OSA back in 2009 and been on CPAP ever since. Never really had a good night sleep and always tired with mild headache (foggy head) all the time.
Have also seen 2-3 different sleep doctor & had a few sleep study done as a result. All studies have shown episodes of CA (Central Apnea).
Attached is a typical one-night graph from SleepyHead. No matter how far I raise the max pressure setting I never get more than 3 hours of sleep at a time and in the
morning always tired with headache. I am certain that some of the CAs flagged by SleepyHead is while I was awake.

Also, leak is always very very low when I go to bed & every time I am awake. But for some reason large leak % hovers around 30% when I am sleep.
My wife tells me that I move a lot while I am sleep ... I am not sure if there is anything I can do about the way I sleep!!
(Note: I have set the large leak threshhold to be 20 rather than the standard of 24)

My current machine is "ResMed S9" which obviously does not treat CA.
I am planning on getting a "ResMed AirCurve 10 ASV" pretty soon. Would the new machine make any difference (I know this is rather a hypothetical question!!)

About me : 63-year old caucasian male, 5'7'', 150 lb, in good shape & no other medical issues whatsoever, mouth breather and haven been taping my mouth with no issues.
Pressure settings : APAP, Min 13, Max 14.8, Initial 6, ramp in 10 minutes, EPR is off ... been using nasal pillow mask with no issues.

Regardless of how low the AHI is on any given night, I sleep max of 3 hours & suddenly I am up (not gasping for air or anything else & feel fine) ... then would fall sleep in a few minutes.

I would very much appreciate if anyone can comment on my situation (are CA episodes the underlying factor that I never sleep more than 3 hours and always feel tired?)
I can upload more graphs of needed.

Thanks for all your help/comments/suggestions.

: SleepyHead_March_12_2019.JPG (403.16 KiB) Viewed 2472 times

zonker · Post by **zonker** » Mon Mar 25, 2019 7:15 pm

unknown12345 wrote: ↑
Mon Mar 25, 2019 6:51 pm
Hi,

hello. i'm not one of the experts you are waiting on. but i thought i'd give you an example of what format the experts wish to see regarding your charts. here's an example-

screenshot-3-16-19.png

also, if you would be so kind, could you fill out your equipment in your profile so it always shows up at the bottom of your posts?

good luck!

LSAT · Post by **LSAT** » Mon Mar 25, 2019 8:05 pm

This may not help your CA issue, but some of your treatment is being blocked because of your max pressure...it needs to be increased. The CAs are really insignificant. You are right,,,the S9 will not treat them, but the bilevel machine may not help either.

unknown12345 · Post by **unknown12345** » Mon Mar 25, 2019 8:58 pm

LSAT wrote: ↑
Mon Mar 25, 2019 8:05 pm
This may not help your CA issue, but some of your treatment is being blocked because of your max pressure...it needs to be increased.

I have done a lot of experimentation trying to find the correct max pressure. Two years ago (and on several different occasions) I set max=17 and it never reached the max of 17 which, to me, means max 17 is ideal.But, absolutely nothing changed in my sleeping quality (still would wake up after 3 hours, fall back sleep in 10-15 minutes, same cycle would repeat til morning, tired w/ headache n the morning). I am going to repeat the same experiment again, find the max pressure that it will never be reached and leave it at that pressure ... but I am almost 100% sure nothing is going to change in my sleep pattern/quality.

unknown12345 · Post by **unknown12345** » Mon Mar 25, 2019 9:20 pm

unknown12345 wrote: ↑
Mon Mar 25, 2019 6:51 pm
I am certain that some of the CAs flagged by SleepyHead is while I was awake.

Question : "CA" flagged by ResMed S9 are really Central Apnea?
As I mentioned in my post, I am 100% sure that some of the "CA"s flagged by S9 is while I was awake.
Also, as I mentioned in my original post, the two different sleep lab studies that I did showed that I have CA ... percentage was low ... I will find & post sleep reports soon.

kteague · Post by **kteague** » Mon Mar 25, 2019 9:27 pm

Did your sleep study make any mention of limb movements? Thought it was worth asking since you mentioned moving around a lot in your sleep.

palerider · Post by **palerider** » Mon Mar 25, 2019 11:00 pm

unknown12345 wrote: ↑
Mon Mar 25, 2019 8:58 pm

I have done a lot of experimentation trying to find the correct max pressure. Two years ago (and on several different occasions) I set max=17 and it never reached the max of 17 which, to me, means max 17 is ideal.But, absolutely nothing changed in my sleeping quality (still would wake up after 3 hours, fall back sleep in 10-15 minutes, same cycle would repeat til morning, tired w/ headache n the morning). I am going to repeat the same experiment again, find the max pressure that it will never be reached and leave it at that pressure ... but I am almost 100% sure nothing is going to change in my sleep pattern/quality.

The proper setting for max pressure, absent of situations like aerophagia, is 20.

No experimenting needed. It's Min pressure that's important, not Max.

palerider · Post by **palerider** » Mon Mar 25, 2019 11:03 pm

unknown12345 wrote: ↑
Mon Mar 25, 2019 9:20 pm

unknown12345 wrote: ↑
Mon Mar 25, 2019 6:51 pm
I am certain that some of the CAs flagged by SleepyHead is while I was awake.
Question : "CA" flagged by ResMed S9 are really Central Apnea?
As I mentioned in my post, I am 100% sure that some of the "CA"s flagged by S9 is while I was awake.

They're really central apneas... ie, you're not breathing and your airway is open.

The question is whether they're legitimate central sleep apneas...

Your leaks, btw, are horrific. I'd be awake most of the night with leaks that bad.

unknown12345 · Post by **unknown12345** » Tue Mar 26, 2019 6:38 am

kteague wrote: ↑
Mon Mar 25, 2019 9:27 pm
Did your sleep study make any mention of limb movements? Thought it was worth asking since you mentioned moving around a lot in your sleep.

Yes, there was a very very minor episodes of RLS (Resless Leg Syndrome). But I don't believe that would be the underlying factor(s) contributing to my situation.

unknown12345 · Post by **unknown12345** » Tue Mar 26, 2019 6:49 am

palerider wrote: ↑
Mon Mar 25, 2019 11:03 pm

unknown12345 wrote: ↑
Mon Mar 25, 2019 9:20 pm

unknown12345 wrote: ↑
Mon Mar 25, 2019 6:51 pm
I am certain that some of the CAs flagged by SleepyHead is while I was awake.
Question : "CA" flagged by ResMed S9 are really Central Apnea?
As I mentioned in my post, I am 100% sure that some of the "CA"s flagged by S9 is while I was awake.
The question is whether they're legitimate central sleep apneas...
Legitimate as apposed to what? Fake? Meaning S9 is not truly capable of detecting CAs ??
Your leaks, btw, are horrific. I'd be awake most of the night with leaks that bad.
As I mentioned in my original post, and evident from the graph, when I go to bed mask is nicely & tightly fit w/ very very little leak.
It is when I fall sleep that the leak is noticable (not sure if I would call it "horrific" !!). But what can I really do about that!!
I plan to video myself at night & see all my movements ... even after that not sure if there is anything I can do while I am sleep !!

unknown12345 · Post by **unknown12345** » Tue Mar 26, 2019 7:01 am

palerider wrote: ↑
Mon Mar 25, 2019 11:00 pm

unknown12345 wrote: ↑
Mon Mar 25, 2019 8:58 pm

I have done a lot of experimentation trying to find the correct max pressure. Two years ago (and on several different occasions) I set max=17 and it never reached the max of 17 which, to me, means max 17 is ideal.But, absolutely nothing changed in my sleeping quality (still would wake up after 3 hours, fall back sleep in 10-15 minutes, same cycle would repeat til morning, tired w/ headache n the morning). I am going to repeat the same experiment again, find the max pressure that it will never be reached and leave it at that pressure ... but I am almost 100% sure nothing is going to change in my sleep pattern/quality.
The proper setting for max pressure, absent of situations like aerophagia, is 20.

No experimenting needed. It's Min pressure that's important, not Max.

From my personal experience, raising the Max has to be done in incremental (.20) fashion (it takes my brain & body about a week to get used to the new Max pressure).
So, I don't think I am just going to raise the Max to 20 in one shot !!

Question : you mentioned it is Min that is important, I've been thinking of setting the Min to the 1-month average of Median (makes sense to me!!)
Current Min = 13, I've calculated 1-month average median to be 13.5 ... I guess I can experiment & set the Min=13.5 .... any comments?

Barbee · Post by **Barbee** » Tue Mar 26, 2019 7:49 am

unknown12345 wrote: ↑
Mon Mar 25, 2019 8:58 pm

From my personal experience, raising the Max has to be done in incremental (.20) fashion (it takes my brain & body about a week to get used to the new Max pressure).
So, I don't think I am just going to raise the Max to 20 in one shot !!

Question : you mentioned it is Min that is important, I've been thinking of setting the Min to the 1-month average of Median (makes sense to me!!)
Current Min = 13, I've calculated 1-month average median to be 13.5 ... I guess I can experiment & set the Min=13.5 .... any comments?
[/quote]

If you never hit 17, then raising it to 20 all at once should not matter. The machine will not go higher than it needs to.

You want to set your Min high enough to prevent events from happening in the first place. If you get events at 13.5, then a bit higher just might prevent the event from happening at all. Thats how it makes sense to me, anyway.

You do have an ugly leak graph. And you’re probably going to have to address that at some point.

The good folks on this forum can help you. Welcome!

unknown12345 · Post by **unknown12345** » Tue Mar 26, 2019 7:54 am

unknown12345 wrote: ↑
Mon Mar 25, 2019 6:51 pm
Hi,

I was diagnosed with OSA back in 2009 and been on CPAP ever since. Never really had a good night sleep and always tired with mild headache (foggy head) all the time.
Have also seen 2-3 different sleep doctor & had a few sleep study done as a result. All studies have shown episodes of CA (Central Apnea).
Attached is a typical one-night graph from SleepyHead. No matter how far I raise the max pressure setting I never get more than 3 hours of sleep at a time and in the
morning always tired with headache. I am certain that some of the CAs flagged by SleepyHead is while I was awake.

Also, leak is always very very low when I go to bed & every time I am awake. But for some reason large leak % hovers around 30% when I am sleep.
My wife tells me that I move a lot while I am sleep ... I am not sure if there is anything I can do about the way I sleep!!
(Note: I have set the large leak threshhold to be 20 rather than the standard of 24)

My current machine is "ResMed S9" which obviously does not treat CA.
I am planning on getting a "ResMed AirCurve 10 ASV" pretty soon. Would the new machine make any difference (I know this is rather a hypothetical question!!)

About me : 63-year old caucasian male, 5'7'', 150 lb, in good shape & no other medical issues whatsoever, mouth breather and haven been taping my mouth with no issues.
Pressure settings : APAP, Min 13, Max 14.8, Initial 6, ramp in 10 minutes, EPR is off ... been using nasal pillow mask with no issues.

Regardless of how low the AHI is on any given night, I sleep max of 3 hours & suddenly I am up (not gasping for air or anything else & feel fine) ... then would fall sleep in a few minutes.

I would very much appreciate if anyone can comment on my situation (are CA episodes the underlying factor that I never sleep more than 3 hours and always feel tired?)
I can upload more graphs of needed.

Thanks for all your help/comments/suggestions.

SleepyHead_March_12_2019.JPG

A general purpose question : for those of you who have central apnea and are using machines that have algorithm that treat central apnea, have these machines
made a difference? Are these machines truly capable of detecting and treating CA ??

Thx.

unknown12345 · Post by **unknown12345** » Tue Mar 26, 2019 8:10 am

Barbee wrote: ↑
Tue Mar 26, 2019 7:49 am

unknown12345 wrote: ↑
Mon Mar 25, 2019 8:58 pm

You do have an ugly leak graph. And you’re probably going to have to address that at some point.

Attached is two pic from last night, is 24.86% large leak (I've set threshhold to be 20) really that bad ??
Again, no leak at all while I am awake ... what can one really do while they are sleep to control the leak other than to make sure the mask is nicely/tightly fit when they go to bed !! ??

: SleepyHead_March_26_2019_Pic2.JPG (400.57 KiB) Viewed 2393 times

: SleepyHead_March_26_2019_Pic1.JPG (404.45 KiB) Viewed 2393 times

loggerhead12 · Post by **loggerhead12** » Tue Mar 26, 2019 8:22 am

unknown12345 wrote: ↑
Tue Mar 26, 2019 7:01 am
From my personal experience, raising the Max has to be done in incremental (.20) fashion (it takes my brain & body about a week to get used to the new Max pressure).
So, I don't think I am just going to raise the Max to 20 in one shot !!

Palerider's point is that if the machine never got to 17 in your prior testing, it's not going to get to 20 regardless of what you set it to. Absent other factors, the max pressure is pretty much irrelevant unless it's not high enough. The minimum pressure is what keeps your airway open.

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