First night on CPAP did not go so well :Update- a breakthru!

Pugsy wrote:Your "high" AHI would be considered great for some people. Almost a third of it is clear airway which we don't do anything about in these low of numbers.
I know you are waiting till you get things sorted out with insurance but I really think that once you can raise that minimum pressure a bit you are going to see a rather significant change in your reports.
Did the chin strap make any difference? Who knows. You would need many more nights using it to evaluate a trend if there is one.

Also, your pressure might stabilize more once you have a little more minimum.
Unless the pressure variations are disturbing your sleep there is no need to reduce the maximum because the machine only goes where it needs to go and if it doesn't reach the max it is a moot point. The responses are limited to the pressures it reaches...not the pressures to where it could go.

Hi Pugsy. Yea I realize my "high" AHI would be considered "great" for many others with moderate or severe apnea. I was strictly comparing to myself and my own trend as to if the "chinstrap" was possibly having a negative impact on the therapy for me... Believe me, I've actually felt rather guilty in pursuing this whole process due to my "low" AHI and per hr rate falling out of the normal criteria to indicate benefit with a cpap. I would have never pushed for it if my doctor hadn't been so convinced by all my other symptoms - "daytime tiredness/general fatigue", "sleeping in forever when I have an opportunity on weekends...", "heavy snoring reported by not only myself (waking me up) and/or bed partners", "fighting high cholesterol and triglycerides for years...", "reduced renal function for my age", "generally just very tired and rundown"..., and last but not least "years of depression and anxiety".

Like I mentioned before, my original "In lab" sleep study was roughly 5 years ago and I never went beyond stage 1 sleep according to it. My 2nd and last most recent sleep study was an in-home through Novasom for 3 nights which did indicate heavy continual snoring and lack of REM but of course produced the lower (2.9 avg I recall) AHI. With all that said, my doctor still strongly supported me pursuing CPAP/APAP in hoping to get me better rest and slowly but possibly eliminate some of if not all the complaints/health issues in the last paragraph.

I'll continue to monitor my progress as I've loosened the chinstrap the past couple nights and my AHI has dropped down again to a 1.9 and a .6 I believe. I'm still awaiting the actual word back from the insurance on the DME equipment rental and supplies and I'll proceed from there. One way or another, I already feel enough benefit personally to keep pursuing this even if I have to reach into my own pocket. I am finally dreaming again and have felt a little bit more rested in general looking back pre-cpap.

Thanks...

? Does REM sometimes promote OA events? Because last night I remember waking up right after/during a dream and having to use the bathroom around 3:05 AM. I noticed my pressure reading on the APAP at around 14.8 which is one of the higher levels I've ever seen. Now when reviewing my data, I see the 3 OA events right before awaking which I usually don't see them grouped together so close like that in my case. Any thoughts? Just trying to understand the data and the possible correlation to REM/Dreaming & events...

Actually it is quite common for OSA to be worse in REM stage sleep. Not for everyone but it is common for a lot of people.
They say we don't remember a dream unless we awake during it..so that would stand to reason that if you happen to have a sleep apnea event during REM....it could cause you to wake up and thus remember the dream.

REM stage sleep being worse as far as obstructions...quite common along with supine sleeping but doesn't happen to everyone.
I happen to be much worse in REM sleep. During my sleep study I only had an AHI of 12 during non REM sleep but during REM I had AHI of 53. Sleeping on my back didn't seem to make any difference for me. So I sleep any way I want to.
Over time I easily saw a pattern where my pressures seemed to increase during what was likely REM stage sleep, especially in the wee hours of the morning when we tend to have more frequent REM stages and longer REM stages. I think that sometimes the events just needed more pressure than other times for some reason or another.
I used 10 cm minimum and 20 cm maximum and some night never got above 12 cm and some nights I saw 18 on the reports and almost always in the wee hours of the morning.

So what you are seeing is likely very common and just another reason why APAP mode might be better suited for you.
Otherwise you have to choose if you used cpap mode...use a higher pressure all the time to keep those stubborn events away or use a lower pressure which gets most of the events and allow a few stubborn events just happen.

Thanks Pugsy, I'm starting to wonder if that is when my events mainly occur (in REM) and why the 1st in-lab sleep study was worthless for me years back when it indicated I didn't go beyond Stage 1 or 2...

I plan to have the DME increase my low pressure again in the near future. I can't wait till I can feel ok with changing the damn settings myself. Still waiting on the DME to send all the data, ect... in to the insurance.

lazer wrote:Thanks Pugsy, I'm starting to wonder if that is when my events mainly occur (in REM) and why the 1st in-lab sleep study was worthless for me years back when it indicated I didn't go beyond Stage 1 or 2...

It is very possible that is why first study didn't show anything exciting. I ran into similar thing with my diagnostic study.
Criteria for a spit study was 15 events within an hour. I didn't meet that with my 12 AHI in non REM and everytime I would get to REM sleep events would cause an arousal and I would have to start the sleep cycle all over again so we ran out of time by the time I hit enough REM to get and idea what was going on. I did have desats to 73% during non REM so my events were of long duration (even though not many of them) but just not enough of them to meet their standard criteria initially.

Another little setback the past couple nights. Been waking up to a very sore nose - mainly the part on the center inside of the nostrils very red, swollen, and sore - especially on the left side. I'm thinking the mask straps are too tight now with wearing the headband although I did already adjust them some. Loosened them a little more last night but still having issues. Thinking now that I might end up having to try a different type of mask. I had bought a used "Mirage Quattro mask size medium" off of STLMark I believe a few weeks ago which I have yet to try but might give it a go. I've been using the Lanisoh or whatever it's called but its up in the inside of my nose where the soreness is so not sure that is real helpful.

Edited to correct username and mask name.

What the heck happened at 12:30 AM last night? I've never seen a max out at the "high" pressure before Nor have I ever seen a "Snore" go so high in the 20s like that. Is that in decibels or what measurement is that?



On a side note, just an update on my situation. The DME has sent the first data report to the doctor. Now they have decided to just go after getting the "supplies" and possible 1-month loaner paid for by the insurance but have decided due to my low AHI from the sleep studies that they aren't going to be able to get the insurance to pay for on an ongoing basis at this point so the doctor has decided along with the DME's cooperation that I will keep the current "loaner" and continue usage for the next 2-3 months then the doctor is going to have me wear something on my head (?) to do another in-home type sleep study without the APAP to see if I have enough events to then qualify for a permanent solution. The DME won't charge me anything for the APAP usage during this time, just for the supplies in the event the insurance doesn't pay.

Snores increased and the machine responded to the snores with more pressure.
Why at some times and not at others? Probably related to sleep position...might be REM stage sleep related but my first suspect would be sleep position. That or aliens paid you a visit last night and they have been known to do that.

I go back to my original thoughts that your minimum pressure is not quite sufficient for preventing some of your snores.

I don't think the unit of measurement of snores is decibels....I think it is just number of snores.

Pugsy wrote:Snores increased and the machine responded to the snores with more pressure.
Why at some times and not at others? Probably related to sleep position...might be REM stage sleep related but my first suspect would be sleep position. That or aliens paid you a visit last night and they have been known to do that.

I go back to my original thoughts that your minimum pressure is not quite sufficient for preventing some of your snores.

I don't think the unit of measurement of snores is decibels....I think it is just number of snores.

Thanks for the reply Pugsy, I can't remember waking up or anything during that time of the increased snore, the data just seemed very weird. At this point, I'm really considering just adjusting the low pressure up myself to 8 or 9. I'm pretty much realizing I'm approaching the point eventually anyhow where I'll be doing this on my own which is fine. I don't really expect the insurance to pay on an ongoing basis from what I'm hearing. Very glad now that I am getting that S8 Vantage so I'll be able to continue therapy when the time comes to hand in my Resperonics back to the DME.

For sure get some time with the minimum pressure increased so that you can properly evaluate the response to snores while you have a machine that will give you snore data. Even if you had the software and card reader for the Vantage it doesn't record snores at all so no way to evaluate.

You don't have a dog sleeping in bed with you that snores do you?
I do....for the longest time I couldn't figure out why I had snores show up like this one below then I realized that I got those snores flagged when my little Pug slept up by my head. He likes to rest his chin on my shoulders. Look at that band of snores....

Pugsy wrote:For sure get some time with the minimum pressure increased so that you can properly evaluate the response to snores while you have a machine that will give you snore data. Even if you had the software and card reader for the Vantage it doesn't record snores at all so no way to evaluate.

You don't have a dog sleeping in bed with you that snores do you?
I do....for the longest time I couldn't figure out why I had snores show up like this one below then I realized that I got those snores flagged when my little Pug slept up by my head. He likes to rest his chin on my shoulders. Look at that band of snores....

Lol! I do in fact have three Chihuahua/Toy Fox Terriers that sleep with me. They are usually down under the covers though.

Crap! I didn't realize that the S8 wouldn't be able to track snores... That's my main enemy it seems and wish I could keep that data. Oh well, Maybe as things progress, I'll be able to afford an APAP eventually that will track that data.

/Offtopic: How is that baby crow doing? I just grew my pet society one more this past weekend and purchased a juvenile "bearded dragon"...

The baby crow is doing well. Hopefully in the next week or so he will be able to be set free. He just now seems to understand pecking to get his food...mainly he is lazy and likes me to hand feed him. Quite tame with me but is terrified of my husband (home only on weekends) and last weekend my husband got up early and bird was hungry but wouldn't have anything to do with my husband. For me he just walks out of the cage and stands there with mouth open squawking.
He has grown a lot in the 3 1/2 weeks I have had him. Not quite stable yet with his flying.

None of the S8 machines recorded snoring. That was one of the reasons why I elected for the M series Respironics machines back 3 years ago when I first started therapy. Of course now the S9 machines do record snoring (though it is presented visually different on the reports).

If you end up looking on the secondary market for APAP (that does include snores) let me know and I will see what I can stir up. Never know what deals might be out there. Someone got a PR S1 BiPap Auto for $275 with minimal hours on it a while back. Not that you need BiPap but just use it as example of deals out there. Deals are out there..just have to be patient and be able to put the hammer down when you find a good deal. So rat hole some extra money....just in case.

Edit: The S8 machines didn't record Flow Limitations either...another con and another reason I opted for Respironics.
Of course now the S9 machines do record Flow Limitations so that is no longer an issue.

Tried out the Mirage Quattro (Med) last night and didn't feel any leaks. Got it to fit good I think. This was my first time ever with this type of mask. I do see where my pressure stayed up quite a bit more during the night. Woke up briefly around 4:30 AM and had to take it off for a couple minutes to scratch/itch my face...

Just a point of clarification for those who might be wondering about that leak line graph.
SleepyHead is making mountains out of mole hills.
Leaks are really minimal. The increase that is seen directly correlates to an increase in pressure and with pressure increases we have the expected increase in the normal intentional vent/leak rate. We would expect more venting.
Due to the scale offered on the graph the detail is really zoomed in and it is making the leaks look a lot larger than they really are.

I think today is the day to release the crow.
Your last night report is a good report. Again my usual comment about the minimum pressure needs and those snores You know...when you finally do increase that minimum just a bit you may find out that the pressures stabilize and don't go roaming around all over the place so much. Not that what you are seeing is bad...it is just the machine at work.

Thanks Pugsy,

I do think I need more minimum pressure with the Quattro as opposed to the nasal pillows though. It seemed a bit more discomforting laying there before sleep set in like I was used to feeling more air if that makes sense? The change in wearing that type of mask didn't really seem to bother me though like I thought it might and I even still have my goatee and could feel no leaks whatsoever. I'm debating on using it tonight again as I'm feeling some major congestion with this damn cold OR going back to the Swift FX until I'm not chicken shit scared to mess with the DME's machine and/or acquire my own.

Hey, Did you release the crow and if so how did it go?