CPAP Vets, Please Glance at my First Week...

Hey guys, just finished my first week with the CPAP. As some of you may already know, I'm doing this entirely on my own and not working with a sleep specialist. I've been a heavy snorer and a terrible sleeper for YEARS. Below is my data from ReScan for the past week. Do I appear to be doing alright? Any suggestions as to what I should consider changing? I really wish I knew how to make the numbers bigger and easier to read.




I have most of the symptoms of sleep apnea, but b/c I never underwent a sleep study I do not have an official diagnosis. Based upon the above data is there any way to infer whether or not I do indeed suffer from sleep apnea?

Many thanks to all of you, as this board, and your insights and knowledge, have been a miracle for me.........

jpkman wrote: I really wish I knew how to make the numbers bigger and easier to read.

What operating system is on your computer? How are you getting the screen shots? If you have Vista or Windows 7 you should have the Snipping Tool which would allow you to crop/cut out the excess blank stuff and it should make your image larger. I assume that the report is not this tiny when you try to read it???

From what I can see...things look pretty good except for leak and I now see why you were confused and wondering about it. I would suggest looking at the leak line itself in your situation. Obviously you had some large leaks and this is very common when first using the mask and machine. You obviously had some time with minimal leak..that minimum leak number. To see just how much the leak may have impacted things you really need to look at the individual detailed leak lines. See just how much time was spent over that red line.

5 cm minimum pressure...I can't make out maximum clearly but it is obviously above the 12.7 maximum that is shown. We don't know if that 12.7 maximum was related to excessive leak or not.
You might consider tightening up the range just a little and see if that helps manage the leaks a little better. Technically the 5 cm minimum is doing a decent job with your obstructive apnea quite low but a little increase in the minimum might allow for better leak control. Might also be a bit more comfortable.
Something to think about just based on what I see here which really doesn't tell us a whole lot in any great detail. I prefer to see 3 or 4 nights individual details and graphs to get a clearer picture......especially in regards to leak.

I have never spoken to a Sleep Doctor either. My primary care physician referred me to the study and "a" sleep doctor faxed the results along with a recogmendation to my primary care doctor. That being said, I personally am a little reluctant to respond without a titration study done on you. If you have insurance, why not have a sleep study?

Your 3.7 average AHI is not real bad. I do see that it is an average over a week, so you may have had some nites much higher and some nites much lower. Supposely... a 3.0 AHI is considered very good, with a 5.0, the acceptable max. I would monitor my daily AHI (my puter' at home is busted, so I only get my readings on machine screen). I would also give it another week or two. Then I would possibly bump up my lower pressure setting in .5 increments, and leave it for a week and see what your numbers do, but most of all... see how you feel. Don't get into a habit of chasing numbers. Let "how you feel" be your guide. Be sensitive to your health now and pre-cpap therapy. If you are less sluggish during the day, or less apt to want to take naps, or generally less crappy.... you are on the right path.

Again, your sleep study is the diagnosis of your sleep. Cpap therapy is the cure. It would be hard to cure what you really don't know what's happening in the first place.

Happy Papin'

Sheriff

Thanks Pugs. Is this better:



I also took a shot of last night's graph so you can see the leak line. It looks to me as if the really high peaks of the leak line correspond to moments when the hose became unattached to the mask, but I'm not totally sure. Also, based on this is there any way to tell if I do indeed have sleep apnea and should even be on a CPAP every night?



THANKS!!!

Much better image. That one pressure need to 18 cm along with that little group of events at about 4 AM pretty much indicates OSA. The machine wouldn't go that high unless it has a reason to.

A couple of obvious large leaks probably associated with the hose coming off. Throw those times out the window. Can't rely on that data one way or the other.

If you are wanting confirmation on OSA and need for cpap I would go about it differently just to offer a different viewpoint. We already see that the machine wants to go to 18 cm...maybe for events..maybe for that leak spike at that time that we don't see up close.

With APAP range wide open the machine will try to prevent the events and you see the variations in pressure to prove it. This would be enough proof for me. Normally the machine won't raise the pressure unless it senses the need to. If you didn't have some degree of reduction in flow the machine shouldn't or wouldn't try to increase the pressure.

If you want to do another experiment...tighten the APAP range to 4 minimum and 5 or 6 maximum...see how many events occur because the pressure wasn't sufficient enough to prevent them. Bear in mind that even these minimum pressures do offer therapeutic value so we can't use the machine at anything less than 4 cm so not a true ideal test of what we would be doing without the machine but it is as close as we can get.

If you had a recording pulse oximeter that would offer an additional dimension of data. Might be something to think of down the road. You can get one for around $100 that will work with SleepyHead software...your Autoset will also work with SleepyHead software.

Finally....how do you feel? Do you feel any different with this past week? With the leak issues and hose coming off issues it likely is hard to tell. Anything that disrupts sleep is unwanted because it can mess with sleep and thus how we feel.

Pugsy wrote:If you want to do another experiment...tighten the APAP range to 4 minimum and 5 or 6 maximum...see how many events occur because the pressure wasn't sufficient enough to prevent them. Bear in mind that even these minimum pressures do offer therapeutic value so we can't use the machine at anything less than 4 cm so not a true ideal test of what we would be doing without the machine but it is as close as we can get.

I was thinking of doing this myself, to get a measure of events with minimal, close to no, therapy, compared to what I'm doing presently. I'm going to do it when I don't care so much if I have a really bad night's sleep, like waking up Saturday or Sunday when I can veg-out and stumble about the house, wondering why in the hell I just did that to myself "in the name of science" LOL

Once again, I bow to your knowledge Pugs. Thanks so much for all of your thoughtful insight, and your confirmation of what I expected. I think I found out the issue with my current mask. See this picture?



Well the mask that I have is missing that gray piece that is attached to the swivel. What do you think? Where would be the best place to go to source that part?

THANKS!!!

MaxDarkside wrote:wondering why in the hell I just did that to myself "in the name of science" LOL

I did an experiment with turning my AFlex off last summer. Disastrous night. Won't be doing that again.

I suppose 4 cm straight cpap would be the closest we could get to a "night without cpap" but heck, I would feel totally smothered at 4 cm. Even my sister who had never used cpap squawked within about 30 seconds at 4 cm..."I can't breathe" when I was screening her. I ended up having to use 6 cm on her. She just didn't feel like enough air was moving at anything less.

Without knowing the whole history with OP here, it is kinda hard to base a definite OSA diagnosis solely on the spike to 18 cm that I see here. Limiting the maximum might show more events..might not. Also we have to remember that UARS may be a factor and for that we need a high level of flow limitation scrutiny and someone just starting out on this journey won't have a clue what to look for. UARS might be a factor because it often presents itself with unremarkable AHI. There is more to sleep disordered breathing than simple OSA and apnea events. Using cpap we have one side of things..best we can do sometimes but as we all know, it has its limitations.

Well heck, no wonder the darn thing keeps coming off.

See if this is what you need.
https://www.cpap.com/productpage/resmed ... wivel.html

or this combo
https://www.cpap.com/productpage/resmed ... -mask.html

A local DME might have one. Technically replacement parts don't need a RX but with DMEs you never know.

Pugsy wrote:There is more to sleep disordered breathing than simple OSA and apnea events. Using cpap we have one side of things..best we can do sometimes but as we all know, it has its limitations.

Very much agree. What I'm learning is that sleep and sleep apnea, is a complex, time-based interaction of a myriad of variables and the nature of the effect of those variables depends also greatly on the uniqueness of each person; their physiology, psychology, life history, events experience in the past, internal chemistries and "control loops" and on and on. I sense clusters of types of afflicted, as some people here are not at all like me, but others sound just like me when they post of their malady and experiences. That is to say, it's hard to judge things from a one time professionally done sleep study, even harder when trying a machine for a week, tho it does give some indications.

Based on your previuos post here:

viewtopic.php?f=1&t=73126&st=0&sk=t&sd=a

And this present post I get an impression that you might be suffering from Upper Airway Resistance Syndrome (UAR) which is not a sleep apnea condition but is regarded as Sleep Disorder.

I say it b/c of the following indicators:

Low OSA events (AHI even below 5) , Snoring, Relatively young age, etc.

Please check the following indications associated with UARs:


Although both UARS and sleep apnea are caused by blocked airflow while sleeping, there are many critical differences in the problems they cause:

• Chronic insomnia with frequent awakenings and the inability to fall back asleep tends to be more common in patients with UARS than those with sleep apnea.

• Patients with sleep apnea tend to fall asleep easily during the day (such as when driving), however, patients with UARS are more likely to complain of fatigue than sleepiness.

• Patients with sleep apnea tend to be overweight; however, those with UARS can be any weight.

• About 50 percent of those with UARS are women, while only 8 percent of those with sleep apnea are female.

• Upper airway resistance syndrome is often accompanied by a spastic colon and low blood pressure with lightheadedness on standing while sleep apnea is usually associated with high blood pressure.

• People with UARS usually have cold hands and feet and other symptoms of hypothyroidism and a brainwave pattern called alpha intrusion into Delta sleep, which often occurs in CFS and fibromyalgia.


But, even if you have UAR the treatment is still with a CPAP.

Notice: I am a not a doctor! But most Sleep Clinics do not check for UAR condition.

MaxDarkside wrote:it's hard to judge things from a one time professionally done sleep study, even harder when trying a machine for a week, tho it does give some indications.

Yep, it is difficult sometimes even under the best of circumstances in a sleep lab with a good tech.
Even harder when going it alone with one dimension of data but not impossible.

You know when I screen my sister that was about 2 years ago. Zero apnea events of any kind and the pressure never stirred above 6 cm (I used 6 min and 10 max) yet she said she felt better those 3 nights she used the machine than she had felt in a long time. I suppose it is possible that she happened to be one of those lucky people who are very well treated with their apneas with a low pressure. She sure had all the other classic symptoms but now that UARS is more widely known...she may be one of those. So far she has avoided my suggestion of doing another screening or her using the machine for a couple of weeks just to see how she feels. I sent her UARS stuff and she blew it off. They don't have the money for any co pays for a real sleep study. No money for even an overnight pulse ox and I don't push it because if it is UARS she likely doesn't desat much anyway.

Hey now Pugs, thanks for finding that part for me. You sure are quick and resourceful for sure!!! I ordered just the gray attachment as per your first link.

I have never heard of UARS before and had to Google it to find out what it meant. As far as symptoms of UARS:

• Chronic insomnia with frequent awakenings and the inability to fall back asleep tends to be more common in patients with UARS than those with sleep apnea. I fall back to sleep fairly easy

• Patients with sleep apnea tend to fall asleep easily during the day (such as when driving), however, patients with UARS are more likely to complain of fatigue than sleepiness. I definitely suffer from fatigue way more than sleepiness

• Patients with sleep apnea tend to be overweight; however, those with UARS can be any weight. While I am not obese I am certainly overweight and the heaviest I have ever been

• About 50 percent of those with UARS are women, while only 8 percent of those with sleep apnea are female. N/A, I'm male

• Upper airway resistance syndrome is often accompanied by a spastic colon and low blood pressure with lightheadedness on standing while sleep apnea is usually associated with high blood pressure. No spastic colon, and I actually have high BP

• People with UARS usually have cold hands and feet and other symptoms of hypothyroidism and a brainwave pattern called alpha intrusion into Delta sleep, which often occurs in CFS and fibromyalgia. Can't say that I have cold hands or feet

So it appears that I only have one of the symptoms of UARS. Based upon my answers above do I need to investigate UARS any further or am I good?

THANKS!!!

jpkman wrote:Based upon my answers above do I need to investigate UARS any further or am I good?

Probably not. Do you know what the most usual therapy for UARS is? Cpap machine...Yep.
Problem is with UARS often they don't see a clear indication as to what the pressure needs to be.
There is no easily seen and scored apnea events to go by.

For now you have enough to learn and since you seem to be having enough apnea events to warrant therapy...use the machine for some time and see how you feel.

You know just because a person doesn't have an earth shattering number of apnea events doesn't mean there isn't a problem. You have the machine...get that part for the mask...evaluate how you feel after you have the mask sorted out and hopefully have had some good sleep.

You have read the other stuff. Even under the best ideal circumstances we don't always see improvement right away.

If fatigue is your number one complaint...while you are giving the cpap machine a good trial you might want to look at the other stuff that messes with how we feel during the day.
The usual....meds....hours of sleep...fragmented sleep...pain...etc.

Thanks yet again Pugs. I hope you are out there today b/c I want to let you know that I went home last night and looked in the S9 travel case, pulled out the original hose, and guess what? I found the piece that attaches to the swivel.

If you look at my leak from last night, it is MUCH improved. However, my AHI is the worst that is has ever been. Isn't that weird? Also, since I have not gotten the FX yet I'm still using the LT, and I have a kind of like sore on my nose between my nostrils and my upper lip. It actually got so uncomfortable last night that I had to ditch the mask.

Take a look:






Thanks again everyone!!!!