Still trying to get used to this, need some thoughts

Thanks. I was thinking of getting one anyway (oximeter). Im curious about what it says when i wake up with these headaches. Any recommendations?

And you guys.....I think I slept or 1 or 1.5 hours last night with it! I know that is nothing, but considering I have gotten no sleep with it, this is huge! I am getting some nasal leakage when pressure rises so I'm gonna get some panty hose today for the modifications, lol. It's 6:00 am so gonna put it on and try for another hour or so.

Well, I got some readings but not much. Did I have leaks? It looks like no apneas but some AHI? I still don't fully understand what AHI is other than partial closure. In my study, I had relatively low apneas but high AHI. Can you all explain what thy means to me.







At least I finally fell asleep with it, right?

Your leak numbers looks good. It's better to see the individual detailed leak line to know for sure but with your maximum hitting 14 L/min that means the rest of the night you were probably below the leak number to avoid and that is 24 L/min.

I wouldn't put too much worry into the AHI number right now because you aren't feeling like you are sleeping much. You think you are spending a lot of time awake on the machine and the machine can and will flag awake breathing irregularities as some sort of apnea event...most commonly clear airway (centrals) events...and that goes along with your AHI from last night.

AHI...that's just an overall hourly average of the 3 different event categories.

Apnea events...there are 2 kinds....obstructive apnea which is a tissue collapse and central which is an open airway cessation of breathing.
Hyponea..that would be partial collapse event

The green apnea column or band...you won't ever see much being reported there because that section is for unknown apneas...where the machine didn't know what to call them. On ResScan reports those are yellow colored.
Mainly we see the darker Blue for Hyponea...the light Blue for the obstructive apneas and the purple for the centrals.

If you can show the events graph that show up on the right side of the detailed page...that would be more helpful than the summary graphs you are showing.
This would be the events graph that are at the upper right on the same report that you got the pie chart from.

If you can show the events graph that show up on the right side of the detailed page...

No data there.

It's very odd because I don't even know if I am having apnea episodes. Since it says no data, I am guessing no. BUT, if you remember I have been complaining of the pressure rising very high the moment I fall asleep. So if I don't have an event, why does the pressure rise? But if I AM having an event, why does it not record? I'll have to keep trying to sleep with it and see if I can make any sense of anything. You would have thought something would be there under events since I did sleep for an hour and a half finally and I did wake up with the pressure on 10.

I have also lost over 40 pounds since I originally had my sleep study (half of what I need to lose) and my snoring has completey stopped. So maybe the apnea had as well. BUT, I still wake up with awful headaches.

There should be some sort of events graph available because the event pie graph stuff is showing 10 clear airway events per hour.

Mirrasi wrote:BUT, if you remember I have been complaining of the pressure rising very high the moment I fall asleep. So if I don't have an event, why does the pressure rise?

The machine won't increase the pressure unless it is sensing some sort of collapse of the airway. They won't respond to clear airway events at all.
Also it doesn't go from minimal pressure to high pressure with the blink of an eye. It doesn't take half an hour but it does take more than 30 seconds for the pressures to increase.
It responds to event warning signs...like flow limitations and snores.

Mirrasi wrote:But if I AM having an event, why does it not record?

I just thought of something...do you know how to go to the clinical setup menu?
The default setting is for "usage" under Sleep Quality setting....go in and see if Sleep Quality is set for "usage" and if it is...change it to "On".
If Sleep Quality is set to usage the machine won't write the detailed data (and that is what you are missing) to the SD card and if it isn't on the SD card than SleepyHead can't report it.

How to get to the clinical setup menu in case you don't know how.
http://www.apneaboard.com/resmed-s9-cpap-setup

Yes it was set to usage, so I turmed it on. I think I love you! LOL I also turned the ramp off permanently and set the minimum pressure to 7 (so a range of 7 to 12). That way it will help the suffocation feeling. Quite frankly, I am most comfortable with the 8 setting. Do you think it would hurt me if I set that to a minimum? I think I read if it's too high it can signal CSAs? The doctor really has no idea what my pressure should be because I left the titration and they got nothing. The original plan was for me to have a "loaner" APAP, use it for 3 months, and then he would get the pressure from that and order me a CPAP.

Instead, since my insurance was crap anyway, I just bought the APAP out of pocket based on reviews. Once I can get used to the machine and get a good amount of data, I plan to go back to the doc (though I want a different clinic). So I just don't want to do anything dangerous in the meantime.

Hopefully I will get some data now so we can look at it. I really can't thank you enough.

Hi - don't worry about centrals if you move from 7 to 8... the people who need to worry are those moving e.g. from 15 to 20 and leaving it there indefinitely (the ones who really should have a bipap or vpap machine to begin with). Plus you'd see a gradual increase, it wouldn't happen all at once and then be irreversible. It also seems to me that so many of us are around the 10 mark (i.e. I'm set from 9 to 13 but 90% of my AHI's are 10 through 11+. Very boring .

This "fear" of centrals and pressure doesn't have to be a fear.

Number one...centrals can happen at a pressure of 5...it isn't just with "higher" pressures. They can pop up at any pressure if the conditions are right. I know people with centrals showing up immediately at 5 or 6 cm pressure.
There are people use straight cpap pressures of 18 and above and they don't have anymore than a normal random central every now and then.
High(er) pressures don't automatically trigger the production of centrals or complex sleep apnea.

Number two...the chance of having centrals pop up as a response to cpap therapy (remember at any pressure) is really not nearly as high as people think. I think I read a while back that only about 15 % of the people who start cpap therapy develop centrals and complex sleep apnea.

Number three...even if it happens there are things that can be done to fix it....if it even happens. It isn't the end of the world.
Might be a little trickier to treat and require a little more work but it can be treated.

I routinely saw pressures pushing 20 cm during my night (probably at least 3 nights out of 7) from my starting pressure of 10 when I was on an APAP machine...and some nights I didn't have any centrals at all.
Higher pressure needs don't automatically equal the production of central apneas.

One thing we do know for sure is that the obstructive apneas need to be addressed and comfortable breathing is paramount to good quality sleep. We need both to stand a chance of achieving what we all yearn for....improvement in how we feel. Let's face it...we don't really like going through all this work and sleeping with the alien stuck on our face every night without a chance of feeling better. We can give speeches all day long about using the machine as a preventative measure and of course it is true BUT we also want to actually feel better. Myself included. We all want the "miracle" that we read that others achieve quickly and seemingly easily.

So don't panic over centrals...they may or may not even be a factor. If they happen..then they happen and then we deal with it.

Okay, let's try this again! I got some readings this time. I only slept for 2 hours, but still, at least that's two days in a row I fell asleep. I wish I could just fall back asleep but I always wake so panicky. I'm sure that will get better over time. I really have no idea what I am supposed to be looking at, can you make sense of it? I see no apneas and one hypopnea. (Is hypopnea different than AHI? The hypopnea is what I had a lot of at the sleep study)

Looks pretty good for those 2 hours.

CA...that is clear airway event..central...an apnea event where the airway is still open. Mostly like in your situation you were awake. Nothing to worry about. Hold your breath for 10 seconds...that's an open airway cessation of breathing.
The clustering pattern really points to most likely you were awake during the time frame (or semi awake). The machine doesn't know if you are awake or asleep...it just calls them like it sees them. It's common for us to pause our breathing while awake and not realize what we are doing. Your report pretty much looks like I expected it to look. Those CAs will go away as you sleep longer and better on the machine. It's normal to have a few anyway.

OA...that would be the obstructive apnea events where the tissues collapse a lot and block the airway.

Hyponea...that would be a smaller version of the OA...a reduction in air flow but maybe not bad enough to be classified as a full grown obstructive apnea (OA)

Your leak line looks good. No worries there.

Your main thing to work on would be getting to sleep and staying asleep on the machine. Gotta get the hours of sleep first before the mask and machine can work their magic. With time and experience the time on the machine will get longer.
Just have to keep working at it and trying to fix whatever is causing the panic feelings so that you can get 7 or so hours of sleep while using the machine. Don't get discouraged. Even an hour on the machine is better than no hours on the machine.

Really an excellent report considering what you have been going through.

I hope you don't mind me showing you one more. I skipped a couple nights due to rough days at work and tried again last night. I didn't sleep long again, but I still slept longer than the previous. I am starting to think I will eventually adapt if I keep plugging away at it. I'm off Saturday and Sunday so plan to give it a really good run this weekend.

Could you help me understand the readings a bit better? I can see the apnea events so I am saddened to know that they haven't gone away with weight loss like the snoring did. I think I slept from around 9:30 to midnight is when my husband said I woke up and took off the mask. It looks like I woke up in the middle and turned the machine off? I don't really remember but I might have if the pressure was really high. I am vaguely remembering doing something like that. Anyway, here is the pic....



Can you see how high the pressure got and was it high for long? The doc has it maxed at 12 since we don't really know what I need (left the titration before any readings). In the original sleep study (3 years ago now) the apnea was mild on my sides and moderate on my back with mostly hypopneas. So the doc didn't think I would need anything close to the max 12 he set.

Anyway, I know the biggest thing right now is to adapt and try to sleep longer. But I'd like to understand what I'm reading better. Thanks!


ETA: Also, is it just me or does that seem like an awful lot of apnea events for only 2.5 hours of sleep??

Mirrasi wrote: Can you see how high the pressure got and was it high for long?

You don't show the real pressure line but you are showing the AHI graph and the mask pressure line...those really aren't needed.
You can turn them off and make sure that your pressure line graph is turned on. This would be done in the Preferences/graphs tab...click on File upper left to see Preferences.

That said...mask pressure will equal regular pressure. The highest it ever got was up by the 12 cm line. Roughly at 19:50 to 20:00. So roughly 10 minutes.
See that little cluster of OAs at 19:50? That's likely caused the pressure increase. The stuff you see at 19:30 to 19:50 (especially the centrals) I wonder if these were sleep transition or sleep onset events. I don't think you went to sleep straight away. I think it took you a little while but I have no way to prove it.
The rest of the night things were fine...pressure stayed fairly low, didn't want to increase all that much. Around 21:00 it got up to near 9. Events were minimal.
Your AHI wouldn't be high if it wasn't for that first large cluster. If you weren't asleep we have to discount them anyway.
The machine can and will flag awake/semi awake breathing irregularities as some sort of event.

You just need to work on getting to sleep and staying asleep (on the machine) longer.

I agree I was awake for that. I generally fall asleep in like 2 minutes But when I put the mask on it takes me longer because I still feel suffocated at first. I suppose you can see that at the start with all the activity. After I have it on for 5 minutes or so, I relax and then am fine. Ive also noticed..and I have NO idea why I do this (with or without the machine) is that when I am laying there reading, I will just stop breathing and then all of a sudden realise it and take a huge breath. It's like my brain just stops for whatever reason. I have never noticed myself doing this during the day, only when I am realxed and focused on a book or something. I'm never aware until I'm suddenly breathing again. So I am guessing that's what the central stuff is at first. I know I am awake there so not too concerned.

Your description makes me feel better too about the apneas while asleep. At least it wasn't that bad for those 2 hours.

I hope you don't mind reading those for me. It helps me understand what I'm looking at. Friday night I plan to give it a harder try. When I took the mask off last night, I actually felt like I could have put it back on and done more. But I kept it off since I had work today. I was almost missing the air a bit. So that tells me I will slowly get used to this.

I will turn off those things you said.

Thanks!


ETA: One of the questions I will have, once I can sleep better with it, is whetehr the 12 max setting is really enough. The doc had to guess the 6-12 range tp start and said he didn't think I would ever go up to the 12.

None of us here on the forum mind when reports get posted for review and thoughts.
Everyone gets a chance to learn.

Mirrasi wrote:So I got the hybrid mask and it's comfortable. I'm still having a hard time doing this mentally I think. I might have to go back to using it when watching tv. When I have it on, I'm VERY aware and I think it's making me hyperventilate. It starts at 6 and I feel like I can't get enough oxygen. I feel like the air is there, it's the lack of oxygen. So I start taking bigger breaths and get dizzy.

If I read a book and get my mind off of it, it stops. Which tells me it's all mental I think. But what's odd is that I find when I'm not thinking about it, while AWAKE, I stop breathing. Period. And then suddenly I'm aware I'm not taking any breaths and then start. Do you ever just forget to breath with your mask on? Lol

Hi Mirrasi,

I am one who also tends to hyperventilate when using CPAP and during the first few minutes the tendency for me is quite great. Indeed the first several minutes of "getting to sleep" I often spend several minutes using techniques to get the breathing rates and volumes down to a place much more metabolically appropriate for the intended relaxed and at rest on my bed that I am.

The technique I most often use is simply to insert a pause between exhale and inhale (or simply to very much slow down exhale). So I start counting – two counts for inhale – two counts for exhale – two counts pause. Or – two counts for inhale – four counts for exhale. As I develop a rhythm I start to reduce the volume of air used (control at inhale) and also to slow the counting process. I know I am doing it right when I feel my feet get warmer and my relaxation becomes obvious. It becomes quite easy and natural to breath less as I should be.

Late summer and early winter last year I proved Pugsy statement that this tendency to hyperventilate while using CPAP can occur at any pressure. In my new town I am under a lot less stress and started loosing weight consistently and faster probably partly to do with the hills. I noticed my tendency for my breathing to become unstable (times of high air use, periodic breathing, some apparent hypocapnic central apneas) was getting to the place I could no longer control it with lifestyle. With less weight to push back the CPAP pressure the pressure was getting hard for me to handle. I also had a lot of trouble finding good doctors in my new town. So I started to reduce pressure (drop a cm/H2O and observe for 7 to 10 days). At about 12 cm/H2O the unstable breathing issues ceased. I did not see signs of apnea and hypopnea until I tried 7 cm/H2O and settled for 8 cm/H2O. I started using 8 cm/H2O October 1st.

But stress appears to change things!

The anniversary of a traumatic assault and robbery upon me is in November. During November I was having trouble keeping my breathing rates down during the daytime. And indeed unstable breathing reared its ugly head as I used my CPAP much lower pressure notwithstanding. I ended up using EERS[1] during this season as I did last year with success finding it even more effective this year.

For study Google Scholar "sleep apnea CO2 reserve" "hypocapnic central apnea" "sleep apnea ventilatory instability".

Have a great week!

Todzo

[1] :
Gilmartin G, McGeehan B, Vigneault K, Daly RW, Manento M, Weiss JW, Thomas RJ.
Treatment of positive airway pressure treatment-associated respiratory instability with enhanced expiratory rebreathing space (EERS).
Source: J Clin Sleep Med. 2010 Dec 15;6(6):529-38. Division of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
Link: http://www.ncbi.nlm.nih.gov/pubmed/21206741