Newbie

I started wearing the mask a little lower and it seems to be helping with the leaks. Not sure that I found the sweet spot but I seem to be getting closer. Thanks to all for your tips.

I am still having problems wearing it; however, especially because I think apnea events are waking me just as I start to doze off. This seems to happen more often if I use the ramp feature instead of starting out at the predefined level of 6. I should be getting the smart card reader early next week and look forward to seeing the data to validate.

Uncle Flapp wrote:I started wearing the mask a little lower and it seems to be helping with the leaks. Not sure that I found the sweet spot but I seem to be getting closer. Thanks to all for your tips.

I am still having problems wearing it; however, especially because I think apnea events are waking me just as I start to doze off. This seems to happen more often if I use the ramp feature instead of starting out at the predefined level of 6. I should be getting the smart card reader early next week and look forward to seeing the data to validate.

Using the ramp means that you go for awhile at a pressure that is lower than what is needed to prevent apnea events. Even if it detects the warning signs for an event, it can't do anything until the ramp is over. If you feel okay skipping the ramp, that would be the best way to go. You would get treatment right from the beginning.

I start to doze and wake abruptly with an overwhelming feeling of claustrophobia and try to catch my breath. I assume it is an event. I'll keep working at it without the ramp.

This CPAP thing sure is a huge pain but understanding the consequences for going untreated, I am dedicated to making it work. Problem is that I am more exhausted now trying to get used to the darn thing than with OSA alone. Forgive me for preaching to the choir.

- Flappy

Uncle Flapp wrote:I start to doze and wake abruptly with an overwhelming feeling of claustrophobia and try to catch my breath. I assume it is an event. I'll keep working at it without the ramp.

This CPAP thing sure is a huge pain but understanding the consequences for going untreated, I am dedicated to making it work. Problem is that I am more exhausted now trying to get used to the darn thing than with OSA alone. Forgive me for preaching to the choir.

- Flappy

It could be an event, or it could be that you feel like you aren't getting enough air circulation. Many people feel that way if the pressure too low. Most people need at least 6. some need higher. I go straight to my starting pressure of 11. I don't know if I could handle 6 or not. I turned off the ramp after nights. 4 was way too low for me.

I am still getting used to the mask and struggling with leaks. If I have the mask lower on the bridge, leakage is minimal but it pinches my nostrils and adds to the feeling of claustrophobia. MId-to high on the bridge, and I get air in the eye (when sleeping on my side). I ordered some liners to see if they help.

In addition, I got the software up and running and am trying to understand the results. My AHI is still fairly high - 9.6%; however, NR (non-resolved apnea) is 0. Is it safe to say that the CPAP is doing it's job? Should the NR be the benchmark or should I be focusing on AHI?

Thanks for your help!

- Flappy

Uncle Flapp wrote:Should the NR be the benchmark or should I be focusing on AHI?

Focus on the AHI.
The Non Responsive Index doesn't mean much..it doesn't mean "centrals" if that is what you were thinking.

What is your average total leak? Do you spend much time up around 90 L/min or over?
What is the breakdown of the AHI?
How much of it is OA and how much of it is hyponeas?
What are your pressure settings??? If using auto mode..what is the minimum and maximum set at?

Are you using the mode that flags Flow Limitations?...only auto mode will flag FLs...if you are using auto mode what do the FLs look like?
Very many snores flagged?

Can you post an image of the detailed nightly report showing the graphs? (don't need the one below the leak graph).
See how to post images here.
viewtopic.php?f=1&t=81072&p=737779#p737779

Pugsy wrote:The Non Responsive Index doesn't mean much..it doesn't mean "centrals" if that is what you were thinking.

My assumption was that a resolved event would likely mean O2 levels would be maintained at a safe(r) level. Getting down to 68% in the sleep study was alarming.

I got a nose bridge liner from my RT and with it, had my most compliant night to date - about three hours but I forgot to put the card back in the machine so I don't have detailed stats.
Night before I did 2 hours.

Minimum pressure is set to 6; maximum 16. Here are the results:

Uncle Flapp wrote:My assumption was that a resolved event would likely mean O2 levels would be maintained at a safe(r) level. Getting down to 68% in the sleep study was alarming.

That's not what the non responsive event index pertains to. A person could still have a truckload of OAs and hyponeas and still have a major O2 problem.
In the past Non responsive events were never something we ever saw a lot of back when we were posting those M series reports.
We used to think maybe they were centrals but I contacted someone in Respironics and was told that centrals got lumped into the OA or Hyponea basket.
Based on past history with all the M series reports I have seen...the non responsive index was not very useful and perhaps that is why it is no longer flagged in the current model machines.
Resolved events are not counted...only events that sneak past the machines defenses in the other categories get counted or flagged.

Do you have a report with a longer time frame that we can look at? 90 minutes isn't much to go on but from this one report...mainly OAs but the machine didn't want to go very high in an effort to better prevent them and starting at 6 cm and sort of stopping at what looks like around 9.0 or so...makes me wonder why it didn't want to go higher. Looks like it stopped at 10 cm which doesn't make sense here with the maximum supposedly set to 16.
Either it simply didn't have time to respond (and it responds to flow limitations and snores...not to the event when it happens) or it was thinking the airway was open and maybe these are centrals dumped into the OA basket...but in the past what we saw most often then centrals were an issue it almost always was hyponeas that were numerous.

I think if it were me I (and assuming other reports from other nights with longer duration look like this one) then I think I would consider maybe 7.5 or 8.0 minimum pressure to see if the base pressure will hold the airway open better and prevent those OAs from sneaking past the defenses.
If at 8.0 the OAs actually increase...time to back off and get with the doctor about maybe getting a machine that actually detects and flags centrals just in case these are open airway events and not closed airway events.
If open airway events and they increase in numbers with more pressure then we get to have a different discussion.

Are you nights always like this? Short hours on the machine? If so why? The claustraphobia ...can't breath thing that you though might be an apnea event? With this little clusters it might have been and the fix would be again more minimum pressure.
I don't see the need to bother fiddling with the maximum...the machine doesn't ever seem to want to go very far.

Thanks for the advice, Pugsy. I am averaging only a couple hours on the machine and just started collecting data. The new nose bridge pad seems to help with the leakage but prior to that, I would wake from air in the eye and/or shortness of breath accompanied with a strong sensation to yank the mask off. I was considering bumping the low-end to 8 if for no other reason than to see if it would help alleviate that suffocation feeling.

Thanks again for all your help. I will post more data as it is collected. The card is back in the machine.

- Flappy

Uncle Flapp wrote:I was considering bumping the low-end to 8 if for no other reason than to see if it would help alleviate that suffocation feeling.

I would give that a try then. At the lower pressures it just seems to feel like we aren't getting enough air for some people. I know we won't suffocate but it sure feels like it.
Maybe that would help you keep the mask on longer and sleep longer and better just from comfort itself.
We need longer times on the machine to be better able to evaluate the reports.

Another two hours on CPAP and awake again. Instead of going back to sleep without the mask, I decided to take a break - get up, do a little web surfing, then start all over. Tomorrow night I may take a sleeping pill to see if it will help me get through the night.

Starting to think I shouldn't look at the stats in 2 hour blocks because what I see is disturbing. Lots of events despite the pressure. Should I get a new machine that can provide more detailed data? My insurance will cover 2/3 the cost. I am using the old M series just because I have one. Here is what happened during those two hours:



Well, back to bed and time to try again.

- Flappy

Looks like the OA clusters woke you up again.
Or maybe it was the pressure change when the machine was trying to prevent them that caused the wake up.
Some people are sensitive to pressure changes like that and the change in pressure disturbs sleep.
Did you get back to sleep with the machine on again after this segment? If so, what does it show?

Thew newer technology machine would add central (clear airway) flags and RERA flags. I don't know how critical that need would be at this moment.
I am leaning towards wanting it for peace of mind to make sure some of those OAs aren't CAs getting dumped in that OA basket.
The M series isn't supposed to increase pressure in response to centrals...normally it uses snores and flow limitations as pressure increase triggers and we aren't seeing either on what little graphs we have. Only 1 little snore right at the end of the night right before the last OA cluster.

What is your normal sleeping position? On your back by any chance? Or maybe go to sleep and wake up on your back?
It's fairly common to have higher pressure needs when sleeping on our backs. REM stage sleep also sometimes will cause higher pressure needs but you seem to be having the pressure needs increase long before we would assume to be seeing REM stage sleep.
Normally the first REM stage doesn't happen until about 90 minutes after sleep onset.
Last night I see the first break in therapy and pressure increase about 30 minutes after turning the machine on.

I am thinking maybe a different pressure strategy before going down the new machine road.
Maybe try a pressure with less chance of pressure changes causing the wake up and maybe prevent the OA cluster at the same time.
Small range of pressure...10 minimum and 12 maximum.

More of the same. I adjusted the pressure as suggested - minimum of 10cm, max of 12cm. I slept only 45 minutes before the first arousal but after a break went back to sleep and lasted another 3 hours. Oddly, the statistics for the last 2 of the 3 hours did not show in the data. I am perplexed as to why that is. Maybe I turned off the machine in my sleep? Anyway, what I do see is that the AHI remains high. Here are the two graphs from last night's sessions:




Oh - and I sleep on my side.

Perhaps the smart card wasn't seated just right during the missing 3 hours of data. It has to be just perfect we get no detailed data.
Always listen for the beep to tell you it is in place.
Oh...and sometimes the M series would just having little "fits" it seems where we would have big blanks for a night's usage despite knowing for sure it was inserted correctly. It's something that we used to laugh about back when these were used by lots of people.
Normally just 1 night but sometimes more than 1 in a row.

Okay...tonight try 11 min and 14 max.

Oh...I forgot to ask some usual questions.
Mainly do you take any meds RX or OTC? and if so what are they? Dosage strength and time you take it?

No meds that should impact this.... I just started taking Flonase at bedtime to help with congestion. I do take a statin (Crestor) every morning for my high cholesterol.
As I mentioned earlier in my post, I did have a UPPP around 7 years ago.