Sleeping but still feel exhausted. Data attached.

riveter wrote:Maybe time to raise pressure a little?

That's what I would do if it were me.
If the hyponeas worsen...then we need to have a talk but crossing our fingers here that all those hyponeas are obstructive in nature and a little more pressure should reduce the number. I am thinking they will reduce.

It's 1030 AM and I'm feeling better than I have in a several days. I may leave it at 15 cm for another night and see how I feel.
Maybe I'll bump it up to 15.5 CM.

Pugsy wrote:

riveter wrote:Maybe time to raise pressure a little?

That's what I would do if it were me.
If the hyponeas worsen...then we need to have a talk but crossing our fingers here that all those hyponeas are obstructive in nature and a little more pressure should reduce the number. I am thinking they will reduce.

Sounds good Pugsy. Maybe I'll try 16 CM for a few days and see how the data looks and how I feel.

riveter wrote:It's 1030 AM and I'm feeling better than I have in a several days. I may leave it at 15 cm for another night and see how I feel.
Maybe I'll bump it up to 15.5 CM.

Glad to hear that. That's why it's a good idea to give the pressure settings a chance before doing more "dial winging".
Last night's "pattern" of events makes me suspicious that they occurred during REM.....along with the fact that you're feeling better. Yeah, the "numbers" aren't where you want to be yet, but you're apparently getting some restful sleep.

Go ahead an bump it up to 16 for a few nights and see which way things go. If the numbers (events) increase, it might give us a clue as to whether they're Central in nature.


Den

.

I raised pressure from 15 to 16. AHI went up from 7.9 to 13.7.
Feeling miserable of course. Will keep it at 16 for a couple of days.

Ouch....I was so hoping that this didn't happen.
Please keep me posted...if after 2 or 3 nights things stay like this....back the pressure down to 15.5.
Don't keep it at 16 long if there is no improvement.

Do you know anyone with a new technology machine that flags centrals that you could borrow?
Not buy at this point...just borrow?

Would you be willing to make a rather odd experiment?...go down in pressure instead of up if those hyponeas don't come down?
Like 13 or 14 cm cpap mode?
If the hyponeas are central in nature then more pressure is going to likely make them worse.
Less pressure should see them reduce if they are related to pressure.
Problem being finding a pressure that takes care of the OAs and doesn't trigger the hyponeas (IF they are central in nature).
Can't be swapping one apnea event for another.
I may be getting ahead of my self here with my concern but I had it the first time I saw your reports.
It looks a lot like past M series reports where people couldn't get control of the hyponeas and they found out that those were centrals.

Pugsy wrote: Do you know anyone with a new technology machine that flags centrals that you could borrow?
Not buy at this point...just borrow?

I don't.

Pugsy wrote:Would you be willing to make a rather odd experiment?...go down in pressure instead of up if those hyponeas don't come down?
Like 13 or 14 cm cpap mode?

I would be willing to set it at 14 cm tonight. I don't want to do another night at 16.

Pugsy wrote:If the hyponeas are central in nature then more pressure is going to likely make them worse.

I need to study up on central apnea. I don't really know the difference.

OK. I Googled central apnea. I means my brain is not sending the right signals to control my breathing.

Watch this video.
https://www.youtube.com/watch?v=CU-XTcf ... e=youtu.be

Central apnea...airway is open but no air moving and if not many obstructive in nature events...called Central Sleep apnea.....I don't think this is your problem because you have a good many obstructive events. Usually found in the diagnostic sleep study.

Complex Sleep Apnea...when there is a mixture of obstructive and central events. Normally brought on by the cpap pressure itself.
So in the diagnostic sleep study...not many centrals noted but with the addition of cpap pressure the breathing becomes unstable and the overshoot/undershoot for Carbon dioxide levels happens and the CO2O levels don't get high enough for the brain to realize it needs to send the signal to breathe. So it isn't so much it forgets....it just doesn't get the signal.

The M series machines do sense centrals and will flag them but they put them in the OSA/Hyponea basket and we have no way to know for sure if what is in there in your situation is obstructive in nature or central in nature. The past M series machine reports that I have seen where the person ended up finding out that there were centrals involved ... the excessive Hyponea accounts were seen on the reports.

Now I am not in any way suggesting that you have Complex sleep apnea issues going on here but I do believe we have a cause for concern. Ideally...a new sleep study using cpap machine is the way to go. Sometimes we can't always do ideally though...if no insurance and no way to pay for one out of pocket. So I have done my due diligence in suggesting it.

The reason I suggested a trial with a machine that has the new technology is to get maybe an idea if those hyponeas are central in nature or not. Even those machines aren't perfect due to some limitations but they do a decent job and would at least give us some idea what might be going on.

Let's see if a pressure reduction helps or not.
Sometimes IF a person has Complex Sleep Apnea there is a fine line where below so and so pressure the centrals will stay away and still have acceptable treatment of the obstructive in nature events.
Meaning that sometimes we might allow a few more obstructive events slip past the defenses if the reduction prevents a truckload of central in nature events.

I'm following your story riveter and I wish you the very best.

Pugsy you are a blessing to us here. (Edit: deleted off topic sentence)

The reason that I haven't brought up ASV yet....not 100% sure if we have Complex Sleep Apnea here and sometimes if it is involved a person can get lucky and find that fine line where we can effectively address the obstructives and not trigger the centrals.
I have seen it happen more than once. Hurts nothing to try a lower pressure just to see what happens before starting to worry about a different (and expensive) machine and a different diagnosis. Cross that bridge only if we need to type of thing.
It's painfully obvious that higher is not the way to go though.
I thought/hoped that maybe with the slight reduction in hyponeas at 15, on a couple of reports, that we might get lucky with a little more pressure being the ticket but this result at 16 along with the other results in APAP mode with higher pressures makes me think we need to look at CompSA as a possibility and try backing off to see if we get lucky.

Thanks for the explanation Pugsy. I watched the video.

I need to find a doctor who understands sleep medicine and I need to get a new sleep study. After I got diagnosed with 'severe sleep apnea with intolerance to CPAP' five years ago, my neurologist never looked at my sleep data after I started CPAP. When I asked for a prescription for an Auto CPAP (because I could not sleep with a regular CPAP blasting at 17 cm), he did not know the Auto CPAP existed. So, not much luck with the doctor. I live near Atlanta, so there must be a good sleep doctor I can see.

My M Series Auto has 13,200 blower hours on it which is every night for about five years. I think the normal replacement period for insurance purposes is five years. I don't have insurance now, but am hoping I can get it when the exchanges open up on Oct. 01. Got turned down by two insurance brokers because of the sleep apnea.

riveter wrote:'severe sleep apnea with intolerance to CPAP'

They knew this back then and didn't do anything about it? The ball sure got dropped on that one.

Try 14 cm or heck even 13 cm with your M series...let's see what happens.
I hesitate to suggest a new machine because you might really need an ASV machine.

I am going to send you a PM....so give me a few minutes to compose it.

I have my machine set for 14 cm for tonight. It's 10 hours till dark. I hate to think of how many wasted days I have spent like this. Too tired to do anything. And part of this curse is being too tired to take a nap.

Just to put my current situation into context, I have not had 'effective treatment' in the five years I have been on CPAP. My AHI average is probably about 10 for the duration of my treatment.

Pugsy wrote:

riveter wrote:'severe sleep apnea with intolerance to CPAP'

They knew this back then and didn't do anything about it? The ball sure got dropped on that one.

Yes. I only slept for about an hour during my sleep study. I laid there awake all night. I slept enough for them to make a diagnosis.