Kenny's CPAP Thread

[SheZAAM!]

Kenny.....

Take a deep breath and relax. You're putting too much thought into this.

Chill.

[Kiralynx]

Do you think it's likely I'll be put on a BiPAP machine for one CSA event?

In my case, when I went to try masks before my titration, the mask specialist set a low CPAP pressure for me to try with -- and I could not breathe out against it. It was a struggle. He frowned, and said they could try bi level pressure, but that most people did not like it. He tried it on me, and I liked it just fine. So I ended up with a bilevel titration.

One central isn't necessarily (as I understand it... and someone will doubtless correct me if I'm wrong!) abnormal.

The reason I ended up with the fancy machine is because I had no centrals in my original study, but when they started the titration, and the pressures went up, I started throwing centrals.

So I have a machine which can push the pressure up to clear an obstructive event, but then backs off before it can create a central event.

The one thing you absolutely must have is a data-capable machine which gives full data. Get the card reader and software for your machine.

Mine was originally set with too high an EPAP (exhalation pressure) and only by reading my data on a daily basis could I figure out that it was causing problems. Then, being a mostly law-abiding person (unlike some of the hooligans around here! at other Forumites!), I discussed those problems with the RT and got my prescription changed. My therapy's now working pretty well -- only three months in -- and I count the information available here as a major factor in the success.

You're researching like I did... and worrying like I did. <g> If it's any consolation, successful therapy seems to help the panic issues. Although I still claim that just because I'm paranoid doesn't mean the Universe isn't out to get me!

[rested gal]

Do you think it's likely I'll be put on a BiPAP machine for one CSA event?

No.

I repeat (with a little more emphasis:)
"Even if you had some scattered central apneas, no big deal. The one central on your study is absolutely nothing to worry about. Nothing at all. Zip, zilch, nada."
Links to Central Apnea discussions
viewtopic.php?p=22702

There was a lot of reading in that link I posted earlier in this thread, so perhaps you missed quite a bit of it:

Here's one little excerpt --

________________________________________

http://www.apneasupport.org/viewtopic.php?p=24677

In a reply titled "Nope" sleepydave (RRT, RPSGT and manager of an accredited sleep center) responds to honda's question:

honda wrote:

Thanks for the comments, one other question though, do the 4 central apneas have any significance ?

None whatsoever.
sleepydave

sleepydave's nickname on cpaptalk is "StillAnotherGuest" (SAG)

____________________________________________________

And in christinequilt's post
viewtopic.php?t=5331

"6 centrals is not a lot- less then 1 per hour, and is perfectly normal. Everyone has central apneas- take 3 or 4 very slow & deep breaths right now, then count how many seconds after the last inhale until you feel the need to inhale again. Was it more then 10 seconds? If it was, you just had a central apnea. Next time you sigh take note how long before you inhale again....yep, another central apnea. Yawn? same thing can happen. Pick up a heavy box or weight- did you remember to breath? if you didn't, then you had another central apnea. Think of what you hear exercise trainers lecture about breathing while exercising- its human nature to not breath when we exert themselves.

Of course all of these are awake apneas- but any time you don't breath for 10 seconds, you technically have an apnea. While sleeping, you can have similar things happen- you can take several deep breaths and not need to breath for several seconds. During transitions between sleep stages, it is common to have central apneas because the acceptable levels of O2/CO2 are different for each stage...sort of like when you're still going 55MPH as you enter the 35MPH zone. When you turn over at night, it is common to not take a breath- just like when you lift something or exercise when awake. In people with OSA, they don't consider centrals a problem until they are well above 5 per hour- central apneas can be a symptom of OSA, just like snoring, arousals, etc. A few centrals are nothing to worry about- most sleep labs don't get concerned about centrals unless there are a lot of them."

_________________________________________________

Kenny, forget about "centrals."

[tattooyu]

Centrals? What centrals?


I did my titration study last night!

First, I have to say that my sleep technician, Christina, was SO awesome. She was funny and really tried to put me at ease, which as you can tell, is no easy task. The study itself went so-so. I had a really hard time falling asleep with the CPAP even with C-Flex turned on. 3 1/2 hours and only some Stage 1 sleep.

So, I was switched to BiPAP, which I tolerated better, and finally fell asleep. I think I gave them only 2-3 hours of real sleep (don't really know for sure). The sleep was not all in one shot. She thought it might be enough data for a complete study and that it would be a close call. I never did go back to CPAP last night. Where I did well, she said, was tolerating the pressures. I know I had gotten up to 12cm/9cm at one point, but she said she bumped it up a couple of times after that, and I still tolerated it well. That's good news for me, because that means the falling asleep part was just "me not relaxing", and not so much "me getting used to the equipment".

I started out on a ResMed Mirage Activa nasal mask. Since I wasn't sleeping well, Christina asked if I wanted to try a nasal pillow mask. "Sure. Why not? Couldn't hurt?" She fitted me with a ResMed Mirage Swift II (she called it the LT, but it was definitely the snorkel one), and I loved it!

My biggest issues:

• Not waking up on the transition from inhale to exhale.
• Aerophagia. My belly got really uncomfortable last night, and I have a lot of gas pains today.
• Learning to relax and accept the change. Although to my defense, the sleep center is NOT my room with MY bed in MY home. The bed was way too firm!

I wonder if I'll be prescribed a BiPAP machine instead? Do people with OSA use BiPAP machines?

[nomoore]

Aerophagia could get better with time on the machine. When I first started my therapy I was getting it bad. After about 3 weeks it got better (tolerable) for me. It has slowly got better since then. Most of the time now when I wake up it is barely noticeable (after about 5 months I think). I couldn't take CPAP without the Auto machine though. The pressure I need when in deep sleep would cause my aerophagia to be terrible if I had that pressure all the time.

Some people simply can't tolerate the pressure on exhale so these people can be prescribed a BiPAP. This is a lot more common with higher pressures such as 15cm H2O or more. If they had to put you on BiPAP to get you to sleep then it is possible they will prescribe one for you. If they don't then I would HIGHLY recommend that you get a Respironics M-Series Auto with A-flex (make sure it is the A-flex model not the C-flex model). It has A-flex as well as C-flex and the A-flex just might be what you need to be able to tolerate it without BiPAP.

[tattooyu]

Thanks nomoore. Perhaps you can tell me why I'm having a hard time breathing today after my titration study?

[nomoore]

Hard to breathe how? Does it feel like your throat is closing up? Or is it just that your lungs feel tired and a little sore and you just are more conscious of your breathing or need to breathe?

If it's the latter then that is normal until your lungs get conditioned to breathing out against the pressure, because even with the BiPAP you are still breathing out against pressure that wouldn't be there normally. If I remember correctly, for me the soreness and tiredness in my lungs lasted for about a week of every day compliance.

Also, I don't know about you but for me high anxiety makes it feel difficult to breathe sometimes. Before CPAP, when my anxiety was really bad I would sometimes breathe out and then hold my breath until I finally realized it and breathed in again. I don't have central apneas but before I had the sleep study done I wondered if I might because I observed this during the day.

[tattooyu]

Hard to breathe how? Does it feel like your throat is closing up? Or is it just that your lungs feel tired and a little sore and you just are more conscious of your breathing or need to breathe?

If it's the latter then that is normal until your lungs get conditioned to breathing out against the pressure, because even with the BiPAP you are still breathing out against pressure that wouldn't be there normally. If I remember correctly, for me the soreness and tiredness in my lungs lasted for about a week of every day compliance.

Also, I don't know about you but for me high anxiety makes it feel difficult to breathe sometimes. Before CPAP, when my anxiety was really bad I would sometimes breathe out and then hold my breath until I finally realized it and breathed in again. I don't have central apneas but before I had the sleep study done I wondered if I might because I observed this during the day.

I feel like it's more the latter. I had a panic attack today, and they are almost always 100% related to digestion issues for me. Sure enough, I spent a lot of time in the bathroom this afternoon. And, as always, now I feel better. What's weird is I have had digestive problems after both times with the CPAP on. It's probably just nerves.

Oh, and I think I'm going to come up with a new acronym: PFM = Phantom Face Mask. I can still feel the straps on my face today. LOL.

[nomoore]

Hard to breathe how? Does it feel like your throat is closing up? Or is it just that your lungs feel tired and a little sore and you just are more conscious of your breathing or need to breathe?

If it's the latter then that is normal until your lungs get conditioned to breathing out against the pressure, because even with the BiPAP you are still breathing out against pressure that wouldn't be there normally. If I remember correctly, for me the soreness and tiredness in my lungs lasted for about a week of every day compliance.

Also, I don't know about you but for me high anxiety makes it feel difficult to breathe sometimes. Before CPAP, when my anxiety was really bad I would sometimes breathe out and then hold my breath until I finally realized it and breathed in again. I don't have central apneas but before I had the sleep study done I wondered if I might because I observed this during the day.

I feel like it's more the latter. I had a panic attack today, and they are almost always 100% related to digestion issues for me. Sure enough, I spent a lot of time in the bathroom this afternoon. And, as always, now I feel better. What's weird is I have had digestive problems after both times with the CPAP on. It's probably just nerves.

Oh, and I think I'm going to come up with a new acronym: PFM = Phantom Face Mask. I can still feel the straps on my face today. LOL.

Hmmm.... I haven't really heard that complaint yet. But I guess it's like when I forget my watch at home and feel it on my wrist all day long still. Well hopefully you can't still see marks from it. If you want more comfort for the straps you can buy some fleece strap covers from padacheek (http://www.padacheek.com/) or of course you can make them yourself if your handy with a sewing machine.

[SharkBait]

And in christinequilt's post
viewtopic.php?t=5331

"Of course all of these are awake apneas- but any time you don't breath for 10 seconds, you technically have an apnea. While sleeping, you can have similar things happen- you can take several deep breaths and not need to breath for several seconds. During transitions between sleep stages, it is common to have central apneas because the acceptable levels of O2/CO2 are different for each stage...sort of like when you're still going 55MPH as you enter the 35MPH zone. When you turn over at night, it is common to not take a breath- just like when you lift something or exercise when awake. In people with OSA, they don't consider centrals a problem until they are well above 5 per hour- central apneas can be a symptom of OSA, just like snoring, arousals, etc. A few centrals are nothing to worry about- most sleep labs don't get concerned about centrals unless there are a lot of them."

This was a great point. I've noticed upon looking at the reports that MOST of my apneas are occurring while I'm awake and also while I'm starting to fall asleep while reading. After seeing these little "trouble spots" clustering together on my report, it has since dawned on me that I'm taking little pauses in my breathing while reading. So my "actual OSA" AI is actually much lower than what shows on my report.

Last night I show ~33 apnea events in ~9.2 hours. On the report I can identify 22 of those that definitely occurred while I was awake. I don't think all of these are centrals; I'm coming to the conclusion that I'm doing something with coughing or mask movement that is registering these...

But the graph clearly shows that while I'm asleep, I go an hour or two without an apnea event. Yet another reason that I'm tickled to have data/reporting capabilities!!!

[tattooyu]

I noticed that I pause on exhale sometimes when I'm awake, but only for a second or two, and not all the time. I'm not worried about the centrals any more, because I only had one. No biggie.

By the way, rested gal gave me a great tip for sleeping while I wait for my prescription. Sleep sitting up (or as close as possible)! I normally sleep on a wedge pillow, but last night I propped myself about 30°. It was weird falling asleep that way, but I awoke this morning more refreshed than I can remember in a long time. I even woke up before my alarm went off (about 15 minutes).

I can only imagine how much better I'll feel after getting used to my new mask. I'm starting to feel very hopeful!


Just wanted to add that I am leaving for Vegas tonight for a few days relaxation, so I may not respond until Sunday. First thing when we get there is to request extra pillows to prop myself up at night!

[tattooyu]

GOOD NEWS!

My equipment order has been approved and sent to the DME (Western Drug in Glendale, CA?). However, I won't have time to get written records of my sleep study before I get the equipment, most likely on Monday. Looks like they carry the REMstar BiPAP Auto with Bi-Flex, since I'll probably need a bilevel machine.

[tattooyu]

Hi everyone! I'm back from VEGAS! I wish I could tell you what happened there, but you know the "Vegas" rules...

I feel rested from the vacation. It took almost a whole night and day to get out the stress I had put on myself about this whole diagnosis. After that, I slept well (on my stomach of course). I think I only had one or two awakenings that I remember. I slept very well without the stress of work and all that. By the way, the Luxor is pretty good. If you ever stay there, upgrade your room to a spa suite. It cost us an extra $280 for a 3-night stay, but it was well worth it to have a spa tub to soak in right there in the room after a long day of walking.

MORE IMPORTANTLY...

I just got back from my DME with my new machine. They titrated me at 10cm, and the titration results showed that my AHI went from 73 without the mask to an AHI of 4 with the mask!

Right now they want to keep it on straight CPAP but will write my DME rep. a new prescription for "auto" down the road if I request it. I have to say that my DME (Western Drug) is awesome. I had no problems whatsoever getting the machine I wanted. I was a bit firm with him at first telling him that I absolutely have to have a machine with a card and a heated humidifer. He said, "No problem, man, we'll get a machine you want." He even offered to look into getting me the card reader and software since they might be able to get a better price. He knew all about CPAP.com and says he visits the site regularly.

Boy, that was relief. I am happy with what I got and look forward to starting on it tonight. I had him set the ramp starting at 6cm instead of 4cm, but I may just change that myself. When he started talking about getting into the menus that set the pressure, and that only they could do that, I interrupted him by saying, "What, you mean pressing the down and right arrows at the same time?" He laughed, but only after I promised not to mess with the pressure settings (except maybe the ramp).

So, I'm sorry that so many of you had horrible experiences with your insurance and DMEs, but for me, it couldn't have been easier. My copay ended up being only $168 and change, which leaves me money for accessories like the card reader, software and maybe a hose hanger. My wife is going to sew me a fleece hose cover to prevent rainout, since our room gets very cool at night.

I'll keep you guys updated on my progress! If you have any questions, or you want any of the data from my two sleep studies, feel free to ask and I'll post it here. Thanks again to all of you, without whom I would have festered unduly in my own anxiety.

[roster]

........... He said, "No problem, man, we'll get a machine you want." He even offered to look into getting me the card reader and software since they might be able to get a better price. He knew all about CPAP.com and says he visits the site regularly.

...........

Good man!

Do you mean he visits cpaptalk.com?

[TSSleepy]

Thanks for taking time to post your story Kenny! I eagerly await hearing how things turn out for you. I'm still waiting for my equipment, but it's very reassuring to read about other people going through the process.

And thanks to the people who are answering Kenny's questions! This thread answered questions I didn't even know to ask yet.