Home Sleep Study

I have already had a PSG and have been on CPAP for over two years - This is for my brother-in-law (wife's younger brother).

He is constantly sleepy, falls asleep the minute he sits still any time of the day, snores like crazy (per my sister-in-law), and is cranky a lot. The whole family has equated what he is going through with exactly what I felt like prior to my diagnosis (and it reminds me of me back then) - so we are trying to act on his behalf. Due to having paltry health insurance and a lot of medical bills he is already paying on (hypochondriac wife of his), he is not covered for or able to pay for a complete PSG. He is about 22, about 6' 4" and about 225 (not obese). I just bought him a used M Series Pro CPAP (so we can get full data) and a Quattro FFM. I am wondering what your opinions might be about a good place to start in evaluating/treating him. I know that this is best done - scratch that - SUPPOSED to be done - in a sleep lab with appropriate personnel monitoring it. But since this is the only option he has right now (better than nothing), and we are talking about a little air pressure from a glorified hair dryer motor (not trying to make home-made blood pressure medicine or insulin), this is what he is left with. I am intending on swapping with him and letting him use my M Series Auto APAP with C-flex while we are trying to nail down what will be effective and help him. He is going to end up with the regular CPAP one, so we are shooting for getting him a fixed pressure.

So I need to get feedback from you guys:

Should I try this with the APAP as I planned - or the CPAP?

How low (or high) of a pressure/range should I start him experimenting with?

How many nights of trying a setting (especially the first setting) should we stay with before reacting to the data and moving up or down?

Should I listen to him/symptoms more (which is my instinct as a paramedic) or the data more in making determinations (since there is a period of getting accustomed to the machine/mask)?

I appreciate any and all advice (and ESPECIALLY experiences) anyone has to offer. But I will ask that you resist the urge to post in this thread if all you want to do is remind me of how this should not be done at home - I feel like I have explained that above. We are just wanting to throw a drowning man a life preserver because he can't make it back to the boat.

Thanks!

Tracy

I'm no doctor, but I would go with a narrow pressure range; 6-10cm or maybe 8-12cm. I think that you're doing the right thing in a "better than nothing" situation, but the best thing for him would be a study in a lab.

SLEEP WELL

ycartf wrote:Should I try this with the APAP as I planned - or the CPAP?

That depends on:

• How well do you think you can sleep on the CPAP?
  How long are you ready to forgo the use of your APAP
  If things get complicated - how do you guys handle the return of your APAP without either of you feeling that it is the sign of failure.
  What happens if he turns out to sleep much better on APAP than on CPAP?

Wichever way you do it - take the necessary time. And make sure he feels that it is his therapy: he is not a child, he is a conscious grown up. Teach him how to set up the machine, give him advice, be there for him, but don't fall into the temptation of doing it instead of him - he has to accept the responsibility for making the therapy work.

How many nights of trying a setting (especially the first setting) should we stay with before reacting to the data and moving up or down?[/quote]

If you want to gather base rate data, and he doesn't feel bothered by a pressure of 4 - that's what you use for base rate. One night is enough.

For finding out the pressure minimum pressure to start with, I would ask him to try 10 (lying down) and see if he feels comfortable breathing against that when he's awake. If he does - fine. If he doesn't, try something lower.

As for limiting the top of the range if you're doing it the APAP way: Leaving the top or the range open may give you good info sooner than limiting - but you (both) must realize that sometimes pressure may be driven inordinately high by snores so then you'd have to limit it.

When attempting therapy, a narrow range is better for those people who are disturbed by pressure changes. But at the diagnostic stage - you may still want a wide range. When the range is wide pay more attention to the numbers and less to how rested he feels. Once you're trying the recommended pressure, pay attention to both the numbers and his sleep quality, how rested he feels, etc. A slight change up or down may make a difference in how he feels - without causing dramatic change in the reported numbers.

I would stick to one pressure setting for a week or two - unless there's a very clear inidcation it doesn't work.

By the way, this here http://sleepapnea.respironics.com/clini ... 5B1%5D.pdf has some pretty could troubleshooting charts for rescuing cpap therapy before bi-pap is attempted -- it's worth reading.

Edits:
Changed the link from one with brackets to one with codes for the brackets. Apparently the forum software in IE7 breaks the link befor the first square bracket in the link as posted originally.

You can also try to download it from http://sleepapnea.respironics.com/clini ... raphs.aspx, it the first monograph in the list.

O.

Hi Ozij,

May I have the link......

By the way, this here http://sleepapnea.respironics.com/clini ... _Monograph[1].pdf has some pretty could troubleshooting charts for rescuing cpap therapy before bi-pap is attempted -- it's worth reading.

Mckooi

I saw what the problem was, Mckooi, here it is again, this time with jules' FireFox as an intermediary

http://sleepapnea.respironics.com/clini ... 5B1%5D.pdf

It works for me from this link, hope it will for you too.

O.

ycartf wrote:I have already had a PSG and have been on CPAP for over two years - This is for my brother-in-law (wife's younger brother).

He is constantly sleepy, falls asleep the minute he sits still any time of the day, snores like crazy (per my sister-in-law), and is cranky a lot. The whole family has equated what he is going through with exactly what I felt like prior to my diagnosis (and it reminds me of me back then) - so we are trying to act on his behalf. Due to having paltry health insurance and a lot of medical bills he is already paying on (hypochondriac wife of his), he is not covered for or able to pay for a complete PSG. He is about 22, about 6' 4" and about 225 (not obese). I just bought him a used M Series Pro CPAP (so we can get full data) and a Quattro FFM. I am wondering what your opinions might be about a good place to start in evaluating/treating him. I know that this is best done - scratch that - SUPPOSED to be done - in a sleep lab with appropriate personnel monitoring it. But since this is the only option he has right now (better than nothing), and we are talking about a little air pressure from a glorified hair dryer motor (not trying to make home-made blood pressure medicine or insulin), this is what he is left with. I am intending on swapping with him and letting him use my M Series Auto APAP with C-flex while we are trying to nail down what will be effective and help him. He is going to end up with the regular CPAP one, so we are shooting for getting him a fixed pressure.

So I need to get feedback from you guys:

Should I try this with the APAP as I planned - or the CPAP?

How low (or high) of a pressure/range should I start him experimenting with?

How many nights of trying a setting (especially the first setting) should we stay with before reacting to the data and moving up or down?

Should I listen to him/symptoms more (which is my instinct as a paramedic) or the data more in making determinations (since there is a period of getting accustomed to the machine/mask)?

I appreciate any and all advice (and ESPECIALLY experiences) anyone has to offer. But I will ask that you resist the urge to post in this thread if all you want to do is remind me of how this should not be done at home - I feel like I have explained that above. We are just wanting to throw a drowning man a life preserver because he can't make it back to the boat.

Thanks!

Tracy

It can be done with a data-capable CPAP. In fact, I would recommend it being done with one......because the single pressure of a CPAP will still allow him to sleep without the pressure changes disturbing him. Changing pressures from snores and leaks will drive an Auto crazy and disrupt sleep.
I would start with a pressure he can handle (to sleep with).....maybe 9 or 10 cm. If his condition is as obvious as you describe, there will still be events showing up at those pressures, initially. Then, after you see some data in the software downloads, you can adjust from there.

Den

Thanks Den, I had wondered about that (CPAP over APAP). I was thinking that trying two or three nights at one pressure, getting data, and adjusting accordingly might be the more stable way to go. I have only this past week figured out how to get the Encore Pro working (problem with the family PC was it - using daughter's now) with myself. I have been using APAP, and it seems if I try a range of 9-12 (initial Rx 28 months ago was 9cm), it tells me that 11 or 12 was most effective. Try it with 10-13, it tells me 12 or 13 was most effective. So I am thinking of monitoring myself with it set to CPAP also - then maybe setting the CPAP setting I get as my low threshhold, and go 3 or 4 higher with my high threshhold. I just hope this can benefit him as much as it has me (although I have been having some hard times lately with fitting/adjusting three different masks at home and each of my two jobs - all UMFFM).

Thanks again,

Tracy

He (my brother-in-law) came over this afternoon and said he had slept over 12 hours last night and woke up tired as could be. We got him set up with a medium standard UMFF mask. I was going to give him the medium Quattro I didn't want to have to get used to but he had some leaks into the eyes and we measured his face dimensions. That said he should have a small Quattro or a medium standard UMFF mask, and I have three medium standard UMFF (now two), and it did fit him lots better. He also has an M Series Pro CPAP with HH (400 model) with full data and a card set to monitor his progress. Lying flat, we tried the initial prescription for me (9cm) and he could tolerate it - felt a little uncomfortable with the expiratory pressure - and settled comfortably on a C-flex setting of one (with instructions on how to increase the C-flex setting should he need it). With a basic set of instructions on cleaning/setup/what-to-expect, we sent him off. He said he wanted to pay me back whatever I had spent when he could, and I told him the way he could pay me was to use it every night for at least a month (that after that it would be "paid in full" and he wouldn't want to be without it). So he is willing (desperate for good sleep) and understands it may take a few nights to get right and the data will tell the rest. I am very excited and hope the best for him. He said he would call and let me know how he felt and his AHI in the am (showed him how to check from the LCD and emphasized only the AHI so as not to overwhelm him for now). Here's to good sleep!

Goodnight,

Tracy

You're a great brother-in-law!

I wonder if you could watch him sleep----either at night or during a nap. Except for the fact that you might have to turn the machine off to adjust the pressure, it might be like a sleep study. Start at 6 cm or something, and if you observe apnea, snoring, or other symptom, raise the pressure a cm or two.

That's probably unrealistic, but what about asking his wife if she noted any diffences in his sleep each time you get data?

Thanks for the update, Tracy.


Den

Why not titrate him with a CPAP AUTO with the pressure set from 4 to 20 (just like they titrate us), I had a home study and that is the way they set mine... I titrated at a pressure of 9 so now when I set my auto, I set it from 6 to 16.5... I had to work my way up from the 4 to the 6, Seems to work great for me.
Goodluck,

SleepyNoMore

Well I don't have any data on him yet (we were going to wait and get at least a few days' worth), but my brother-in-law called me this morning. He forgot to read the AHI screen - because he was running late this morning - because he slept so soundly that he did not hear his alarm clock. He also said that he felt better today than he usually does, and that his wife only recalled being awakened by his snoring once around 1am (said she usually hears him all night). I will add that he is a chronic back-sleeper - says that is the only way he ever sleeps. So it looks like we are on the right track and correct about him needing CPAP therapy. I am as excited as he is and can't wait to get my hands on some data!

Goodnight,

Tracy

Tracy,

You may have just saved another life! You are awesome!!

Bev

He texted me last night right before I went to bed and told me his AHI was 11.2 (from Sunday night). That was on 9cm CPAP. I am thinking about seeing what three nights' average is, and if it is still that high, reminding him how I showed him to bump it up (to maybe 10cm). I will see him to get the card/data again this weekend, but I figure with an AHI of 11.2 he needs a little more pressure to be therapeutic.

Thanks,

Tracy

ycartf wrote:He texted me last night right before I went to bed and told me his AHI was 11.2 (from Sunday night). That was on 9cm CPAP. I am thinking about seeing what three nights' average is, and if it is still that high, reminding him how I showed him to bump it up (to maybe 10cm). I will see him to get the card/data again this weekend, but I figure with an AHI of 11.2 he needs a little more pressure to be therapeutic.

Thanks,

Tracy

I'll bet that AHI is a lot better than what he was having, UN-treated though.

Den