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Nate, when you have time take a look at Alex's thread. It is long and it meanders a bit but I think you might see a portion of his story that hits home to you. His doctor wouldn't even return his phone calls. Nor the DME. He decided to become very proactive with his own therapy and had amazing results.

viewtopic.php?f=1&t=60761&st=0&sk=t&sd=a&hilit=Alex

Don't know how much 2 hours of sleep will show if you are worse in REM but it is a start. May not have much REM...but then again, gotta start somewhere.

I read the whole thread a few days ago, it was pretty inspirational. As far as the 2 hours, its more of a comfort trial than anything. If I can't sleep with 7 then I will try 6 in the morning after work. Good night!

natethegreat wrote:Gonna be trying 7 cmH2o for a couple hours before I go to work tonight, hopefully the data looks better

When I called the clinic they basically blew me off saying that I needed to give the therapy time to work, and to call my DME to go over the operation of the machine and fitting of the mask blah, blah When I persisted, I was asked how I knew I needed more pressure. I told them that the machine has a minimum of 4 cmH2O and my RX was 5. Basically, the machine is running at min setting, along with the fact that I am waking up and noticing that I am not breathing. The response: Well, he's out of office until the 7th

I would schedule a meeting with another doctor today and bring along all the results I have - the sleep study full data too.
I would ask my PCP for a pulse oximeter test at home.

And, while waiting to meet the other doctor, if I knew I had no other medical problems, I'd set my machine on Auto, with the upper pressure at 10, and then I'd observe the following:
Which pressure it goes up to
How the pressure change affects the AHI
How the pressure change affects the length of time in each apnea.

Ozij, would you do anything about lowering the EPR or would that just confuse the issue now?

Dori,
Nate isn't using any EPR right now. Even though script mentioned it, EPR wasn't turned on now. He was originally using 5 cm with 2 EPR but has since turned it off to see if it helps.

Perhaps the scritpt is backwards... 15 cm with a ramp of 5 minutes?

Wow, Hose Crusher,that wouldn't be the first time an error like that could happen, i.e-lab errors, pharmacy errors,scribbled notes transcribed incorrectly,etc. Nate, I'm sure you'll follow up on this, sounds plausible, the RX doesn't?

I think initial sleep study happened to catch Nate on a good night.
Documented worse in REM but Nate reported in his first post that the sleep study AI was 9.6 I think it was. His reports now show that to be either unchanged or worse.
So either he had minimal REM during sleep study (this happens often) or it may have been a rather mild REM event night.
How they came up with 5 cm pressure is beyond me. Maybe they used a ouji board. Maybe it is a clerical error.
Whatever the reasoning it needs to be improved upon and an increase in pressure is needed. He may need APAP range if REM or he may need just a higher straight cpap. Personally if it were me, I would probably try what Ozij said and watch those centrals. But Nate is taking a big step just increasing the cpap pressure and then seeing what happens.
As he gets more comfortable with the machine, his therapy and seeing the results, he can make the decision how he wants to proceed. Who knows, he might get lucky and 7 cm do the miracle thing. I had similar experience just from changing 8 cm to 10 cm.

Sorry it took so long to check back in, my wife has had 2 of her grandparents die in the last 2 weeks so my schedule is pretty fluid right now.

I do have some good news though




This is just one session, but I like it AHI for 3/29 : 1.1

A huge thanks to all on this board for taking the time to lend me a hand. Looking forward to actually getting better now instead of wearing the gear and feeling the same

natethegreat wrote:I do have some good news though

I am doing the happy dance for you. Sometimes such a seemingly small change can actually make a huge difference.

So sorry to hear your other bad news though. Sending a virtual hug to your wife and you in this time of loss.

Nate, this is such a beautiful thing! My best to your wife and family.

Pugsy wrote:Basically the pressure of 5 is not enough to address the events. If this were my report I would increase the pressure use by small amount and watch those centrals.

+1
I'd up the pressure one cm and wait a week. If I saw an average decrease, but still not below 2.0, I'd up it again using the same process. Sometimes all it takes is a small amount of change to make a drastic reduction in AHI. Sometimes it also takes your body adjusting to the new way of breathing while you sleep. When you get to the point that higher pressure induces aerophagia or centrals, it's time to back off the pressure a little.

Your Large Leak rate is not bad if your 95th percentile is that low.

Edit: I should have read further. It looks like you're on the right track. Welcome!

Leaks, leaks, leaks, leaks, leaks...

The learning curve is coming into effect again

natethegreat wrote:Leaks, leaks, leaks, leaks, leaks...

The learning curve is coming into effect again

Ahh, bad leak again. That last report you posted looked great and minimal leak.
Again, hardest part of this whole thing (once pressure is correct), is the mask, leaks and comfort....Always something.

Back again with another update:



It seems like hypopneas are my main issue now. Not sure if they are being caused by my allergies or just more noticeable now that most of the apneas are gone. I suspect I might be having a slight issue with aerophagia as I have woke up a few times with some uncomfortable pressure in my abdomen. Hopefully both of these issues go away with my allergies soon.

Cpap machine and mask have been pretty easy to use for the most part and I usually don't have much problems dozing off with the equipment on. Sleep quality still doesn't feel much better than it was before, but I have only been on the equipment for a couple weeks now. I hope everyone else is doing well!

-NTG