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

lazer wrote:I honestly can't tell. The face around the dial appears a sort of "off white".

I am pretty sure that is the regular PR S1 machine. If you go into the clinical setup menu I don't think it offers the different temps for hose. Also I just remembered..with the heated hose there are electrical connections in the hose that go to the humidifier swivel thing. Without power there would be no heat so it should be very obvious.

Give SleepyHead a try tomorrow and you will know for sure.

Here is what I got for the first night on the new APAP:

Please help school me on what this all indicates.

Are you okay with the 4 cm minimum pressure? Some people find that low of a pressure rather stifling.
While your numbers are technically acceptable it wouldn't hurt to increase that minimum to say 6 if you find 4 rather suffocating. You don't need much pressure though. That is good news. The little spikes you see in the pressure line...those are test probes and normal for APAP machine.

Check out the SleepyHead tutorial under construction in my signature. It will help explain much of what you see. Sourceforge site is down right now so the Glossary link won't work. I think I have some definitions in there.

For specific things you don't understand...just ask.

Here is something I composed to explain centrals and AHI. Your clear airway events are not numerous and of no real concern but this may help explain things.
A quick word about "centrals" or "clear airway" events...these are cessation of breathing while the airway is open as flagged by the machine. They may or may not be "true" centrals that warrants concern if we saw a lot of them (and it takes more than a central index of 2.0 to cause concern). Centrals are common at sleep onset and sometimes we even hold our breath (that is open airway cessation of breathing) when turning over in bed and don't know it. The machine only has one dimension to work with when sensing and recording open airway cessation of breathing and that is air flow only. In a sleep lab setting the tech has EEG leads to determine sleep stage and thoracic belts to measure thoracic effort. Some of what our machines report would likely be tossed out the window in a sleep lab setting.
People seem to panic when they see "central" apneas but unless there are a large number of them and presenting with associated desats and can't be blamed on sleep onset or whatever...we have to sort of put them aside and try not to worry about them.

We don't treat centrals with an increase in cpap pressure except in those high level machines that are working sort of like ventilators (another story I won't go into now since it is not needed).
So when evaluating your AHI....and how well things are responding to pressure you need to remove any central index from the equation because we don't try to fix them with cpap machines with an increase in pressure anyway.

The AHI has 3 components..
Central index which is NOT an obstructive component because there is no collapse of the airway to cause an obstruction.
Obstructive Apnea Index...this is an obstructive component because there is either a full or partial collapse of the airway causing the measured reduction in air flow to meet the obstructive apnea definition.
Hyponea Index...these is an obstructive component because there is likely a partial collapse of the airway resulting in the measured reduction in flow to meet hyponea definition.

So when evaluating your night by looking at the AHI....mentally remove the central index from the total and evaluate only the obstructive component index. In your case removing the central index significantly lowers the AHI to obstructive components only and well withing acceptable limits and thus no need for any changes to be made (like a pressure change).

What would we do if the central index was higher than we want? We would first look at the actual reports and the event graphs to see when the centrals were being flagged. If in a cluster at sleep onset..do nothing. If in clusters associated with awakenings..do nothing. I once saw a report where the guy had a central index of 10.0...one might think holy crap...he has central sleep apnea or complex sleep apnea (mix of obstructive and central) but when looking at his reports in detail the centrals were all in huge clusters at sleep onset or in the middle of the night when he was waking up and tossing and turning for an hour or more trying to go back to sleep.
All he did was stop the laying in bed tossing and turning for a few nights and the central index plummeted to less than 1. Once we realized that these "centrals" were awake centrals or semi awake sleep onset centrals that were no cause for alarm he could go back to his normal routine of tossing and turning if he wished because we knew that was the cause of the large number of centrals and not some scary diagnosis.

What do we do if we can't explain away large numbers of centrals? That is a question for another time but we look at a lot of things including history and we suggest that their doctor be alerted for sure.

Flow limitations are reductions in flow that are minor and don't meet criteria to be called an apnea or hyponea. Yours aren't excessive but they might be a bit disturbing to sleep quality. A minor increase in the minimum pressure will help reduce their numbers.

Thanks for the explanation Pugsy. What about my "leak rate"? It seemed to spike somewhat as the night wore on. It is a bit ironic as I woke up this morning and glanced at the "readout" on the APAP and it was exactly running at 9.5cm which is what I had finally set my previous CPAP machine at. The 4cm when going to bed did seem a little low as in I didn't feel as comfortable relaxing and breathing normal like I wasn't getting the air I was used to. Since this new DME has been so cooperative with me and all, I'm a little reluctant to change anything on my own or let him know I've also figured out a way to monitor things. I just don't want to cause any kind of a problem with them and not sure how they would react knowing I have the means and interest to muck with anything on my own just yet.

Having a humidifier was really nice. (I used distilled water as instructed). I did feel a bit more comfort with that and even though when I put the mask on how the DME had adjusted it, I was initially concerned with getting a sore nose or "piggy" like discussed here as the pillows seemed a bit more pressure pushing at my nose, I left it be and didn't wake up with any soreness or marks. The top strap was what seemed rather tight but I think I will leave it as is unless it starts getting uncomfortable.

My overall thoughts with this new APAP compared to the 10+ year old CPAP that was donated to me. More comfortable, less "white" noise and overall much more quieter, the humidifier is a nice addition adding to overall comfort, and although I do remember waking up in the wee morning hours for a brief moment, I didn't wake up feeling any "leaks" and having to adjust the nasal pillows at all. I do think my "low end" pressure needs to be higher but like I said, I will go with what the DME has set it per my Doctor for now and if it gets too uncomfortable, I'll call them and discuss and see what they say.

Your leak rate for the last part of the night while it did increase and probably could use some work..is acceptable. Respironics say they can compensate for leaks up to large leak territory and my past experience with large leak flags is that they don't occur until right around 90 L/min.

Which mask were you using last night? The new Swift FX? I suspect the nasal pillows got a little slippery from facial oils and/or movement around in the bed. The leak line itself actually looks worse than it use due to the scale of the graph. Your maximum leak was less than 40 and thus the graph is making mountains out of mole hills.

Remember Respironics machine report total leak with is the mask intentional vent rate plus any excess leak.
Don't try to compare your leak numbers to a ResMed machine user's leak numbers..ResMed machines subtract the vent rate prior to reporting leak rate so all we see is excess leak.

Call the DME and tell him about the 4 cm feeling uncomfortable...he shouldn't care if you increase it to 6 cm. He will understand. You won't be the first to complain about it. Tell him you know how to change the pressure.

Thanks Pugsy, I will call the DME and tell him that it seemed like I wasn't getting quite enough air to feel comfortable at first and also that when I woke up, it was running at 9.5 and that I don't have a problem changing the setting if he says it's ok to do.

Moved the Humidifier setting from 2 to 3. Had a really good night last night. Went to bed between 9 and 10pm and fell asleep pretty quickly. Woke up around 2:20 AM after a seemingly lengthy dream (which I haven't had pre-cpap in a very long time) and felt really refreshed but hungry so had a light snack and got right back asleep. Woke up this morning at the alarm around 7:30 feeling pretty decent. Pretty pleased at the quality of my sleep lately and it seems to improve each day on this latest APAP even though my AHI is rather low both pre-cpap and current so not sure what it is but this is certainly helpful for me.

Last night's chart:

It's a long journey, need patience and peserverence. It gets better and better over time. And before you know it, you won't be able to sleep without it!

Keep it up and good luck

Lazer,

Glad to hear of the continuing forward progress.

lazer wrote:Pretty pleased at the quality of my sleep lately and it seems to improve each day on this latest APAP even though my AHI is rather low both pre-cpap and current so not sure what it is but this is certainly helpful for me.

As I recall, "loud persistent snoring" was a major part of your diagnostic results. And snoring all by itself can lead to badly fragmented sleep. The SleepyHead numbers seem to indicate the machine is taking care of the snoring---the median snore = 0.0 and 95% snore = 1.0 both indicate the machine is not detecting any snoring for most of the night. My guess is that if you look at your snore graphs, they are typically flat and at or near 0.0 except for very short lived periods of time. And my guess is that getting rid of the snoring is playing a critical role in why you're starting to feel some improvements!

robysue wrote:Lazer,

Glad to hear of the continuing forward progress.

lazer wrote:Pretty pleased at the quality of my sleep lately and it seems to improve each day on this latest APAP even though my AHI is rather low both pre-cpap and current so not sure what it is but this is certainly helpful for me.

As I recall, "loud persistent snoring" was a major part of your diagnostic results. And snoring all by itself can lead to badly fragmented sleep. The SleepyHead numbers seem to indicate the machine is taking care of the snoring---the median snore = 0.0 and 95% snore = 1.0 both indicate the machine is not detecting any snoring for most of the night. My guess is that if you look at your snore graphs, they are typically flat and at or near 0.0 except for very short lived periods of time. And my guess is that getting rid of the snoring is playing a critical role in why you're starting to feel some improvements!

That makes sense And not having the fragmented sleep would be giving me a better chance at reaching REM, correct? Thus the dreams and the starting to feel more energetic and rested then before?

lazer wrote:That makes sense And not having the fragmented sleep would be giving me a better chance at reaching REM, correct? Thus the dreams and the starting to feel more energetic and rested then before?

Correct.

Anything that messes with normal sleep cycles messes with how we feel.

So I loosened the top strap on the Swift FX last night thinking it felt a little tight and also based on one of the guides in (can't remember who's signature now...). Didn't wake up feeling quite as good this morning. In fact it was like I was back to my "old self" = not wanting to get out of bed... Also noticed waking up to a lot of air rushing out of the pillows onto my face.



Any thoughts?

Looks like a night with lots of leaks that probably caused you to wake often and a couple of times it looks like the machine may have been chasing the leaks which makes things worse. If you remember waking a lot with leaks...remember anything that causes fragmented sleep messes with how we feel. With the leaking and pressure changes you probably did not rest well. Not surprised you don't feel so great.
I suspect a little too much loosening of that top strap made the mask a little unstable with movement during the night.
Sometimes a real fine line between too loose and too tight. Make tiny adjustments.

Pugsy wrote:Looks like a night with lots of leaks that probably caused you to wake often and a couple of times it looks like the machine may have been chasing the leaks which makes things worse. If you remember waking a lot with leaks...remember anything that causes fragmented sleep messes with how we feel. With the leaking and pressure changes you probably did not rest well. Not surprised you don't feel so great.
I suspect a little too much loosening of that top strap made the mask a little unstable with movement during the night.
Sometimes a real fine line between too loose and too tight. Make tiny adjustments.

Thanks Pugsy. I remember only moving the top one notch back so I'll just put it back to where it was. The thing is when I made the adjustment, the mask felt better and as if it was easier to breath with the nasal pillows being slightly less compressed if that makes any sense. But I have been noticing a problem as I have been trying to sleep on my sides instead of my back and when the mask pushes into the pillow it sometimes dislodges the seal. I did notice the leak line considerably higher than normal on last night's graph. I guess it can be a "fine line" between comfort and avoiding leaks... Funny thing is I don't remember the leaks during the night waking me up BUT last night was one of the first nights in awhile that I don't remember any dreams again. When I mentioned waking up to a lot of air rushing out onto my face, that was in the morning when the alarm went off.