Soon to start CPAP - Question on dehydration

[Sleeprider]

The sleep efficiency at 6.0 cm is because the test was very short, but you actually slept the whole time they were testing at this pressure. I think that has some significance and in my opinion they rushed you out of the lower pressure when you had some hypopnea early in the sleep cycle. The higher they took you, the worse your sleep and apnea got. It takes time to figure out what is going on in a sleep study, and as Fred and I both said, the study had some problems.

My PCP does all my CPAP/BPAP prescriptions, and could make any referrals I might request. Your PCP can certainly make a referral, or he/she can consult with an associate, including your DME or Sleep Test physician and technician to make recommendations. Your sleep study clearly indicates you qualify for supplemental oxygen under Medicare guidelines. With your doctor's prescription, that is all you need. Getting some pulse oximeter data just reinforces your need. Setting oxygen is really easy. i wrote a Wiki on it that includes some technical details. http://www.apneaboard.com/wiki/index.php..._with_CPAP In your case, probably 2 or 3 liters per minute with CPAP is going to keep you above 96% SpO2. Just use the oximeter to confirm.

[picante]

The sleep efficiency at 6.0 cm is because the test was very short, but you actually slept the whole time they were testing at this pressure. I think that has some significance and in my opinion they rushed you out of the lower pressure when you had some hypopnea early in the sleep cycle.  The higher they took you, the worse your sleep and apnea got. It takes time to figure out what is going on in a sleep study, and as Fred and I both said, the study had some problems.

So sleep efficiency represents the %age of the 16 minutes I was asleep? If so, that's believable. That percentage was pretty darn low overall for both sleep studies. 36.3% for the first study and 41% for the titration study.

And speaking of that, it's near-impossible for me to sleep there because of the misery of being dessicated, with or without CPAP. Parched mouth, super-constricted sinuses, and parched bronchials that stay irritated for a couple of days afterwards. When she woke me up at 5:45 and said, "you're done", my reply was a groan and "thank god".

Your sleep study clearly indicates you qualify for supplemental oxygen under Medicare guidelines. With your doctor's prescription, that is all you need. Getting some pulse oximeter data just reinforces your need. 

So if  I can avoid another sleep study, that would be ideal. Not to mention yet another hospital deductible in January!!!

[Sleeprider]

If we can get you comfortable at low pressure, and keep AHI at this level, our work is done. If needed, add oxygen and you should really feel some healing. I can actually see where we might go lower in pressure rather than higher. In any event, your AHI is now reasonable, with events of short duration. Your discomfort from aerophagia should diminish, and your ability to eat should improve. I just want to see you put together a restful night of good sleep.

[picante]

I just want to see you put together a restful night of good sleep.

Thank you, Sleeprider. I'm not sure when I've ever had that.

[picante]

Aw, for cryin' out loud. The weirdest part is I feel less brain-fogged than yesterday.  My oximeter just arrived!
[attachment=9460]          [attachment=9461]

First session AHI: 4.47
Second session: 30.90
I got up to pee, eat and drink at midnight (last chance before my SIBO test). Then I could not get the mask to stop leaking. I kept reseating & adjusting the straps from 12:23 until after 1:00. Then all those OAs when I fell asleep, good grief!!

Shut it down at 3:11 and did a sinus rinse.
GERD perhaps? I had fat: almond butter and coconut oil, to hold me through the fast for the test. Maybe 3-4 teaspoons total, plus grapefruit juice & aloe gel. Today I have gut bloatation, but it's probably from the lactulose I had to drink for the test. It's not the pain I get from aerophagia.

Mask pressure looks lower than yesterday's.

[Sleeprider]

Are you using a soft cervical collar or anything to protect against positional apnea? I think we will look at this pressure a little longer and then decide if we want to go up. What this tells us is that just like your test, your events can be unpredictable and inconsistent. We know that sleeping on your back (supine) results in much higher obstructive apnea, so I'm guessing you were not on your right side during this second session.

[picante]

You're right: the first session was on my right side, the second I turned to my left side. I don't think I was supine, but ... I was asleep, and woke up at 3:00 without noticing.

Nope, I don't have a cervical collar (yet). I need one for a very long, very skinny neck.

Inconsistency is the name of the game. I hope I get the oximeter hooked up tonight; maybe then we'll see a direct correlation between how I feel and the oximeter data. 'Cuz it sure isn't direct between how I feel and my apnea data.

[Sleeprider]

It might be good if you started including the snore chart. That may be an indicator of the need for a cervical collar or wedge. Hopefully there will be some suggestions because I think the right neck support might be a key.

[Gideon]

Julie, that session before midnight was near perfect.  See how smooth your flow chart is there?  That is a good sign that you are getting really good rest then.
The 2 clusters of OA events are a very strong sign of positional apnea, most frequently resulting from the tucking of the chin down to the chest.  This is often corrected with a soft cervical collar or ab anti-snoring collar (no foam on the back).  

We look past the clusters of OA events and we see a very "rough" flow rate chart. This is an indication that you are becoming more uncomfortable and are likely "tossing" around and changing sleep position.  Also note how your Tidal Flow follows what I indicated.

Look for something that you can handle to keep your chin from tucking.  And be mindful, which I know you are, of your sleep position.

Let's keep you at 6.0 for a while longer.  Looking forward to seeing your O2 SATs from your meter.

Fred

[picante]

It might be good if you started including the snore chart. That may be an indicator of the need for a cervical collar or wedge.  Hopefully there will be some suggestions because I think the right neck support might be a key.

My snore graphs have been amazingly empty. Are there instructions here somewhere on how to select just one graph to post? I've been overly reliant on F12 screenshots.

Julie, that session before midnight was near perfect.  See how smooth your flow chart is there?  That is a good sign that you are getting really good rest then.
The 2 clusters of OA events are a very strong sign of positional apnea, most frequently resulting from the tucking of the chin down to the chest.  This is often corrected with a soft cervical collar or ab anti-snoring collar (no foam on the back).  

Yes, I'm thinking that I'm more prone to chin-tucking on my L side than my R.  I think that's happening more than me collapsing to prone. I've got a pillow in back and one in front to stabilize me.

We look past the clusters of OA events and we see a very "rough" flow rate chart. This is an indication that you are becoming more uncomfortable and are likely "tossing" around and changing sleep position.  Also note how your Tidal Flow follows what I indicated.

I tried my R side first, then switched to the L. It was equally leaky. I was confused and thought it might be because of my constricted sinuses. That doesn't really make sense, though.
I usually put the mask back on sitting up, hook up the hose again and wait for it to inflate partway. Then I lie on my back and fiddle with the straps. When it's all inflated, I reseat it. 
But I just kept getting a whisper of air above my nose last night, and I kept on tightening, especially the upper straps. This morning they were the tightest I've ever seen them by far, more than 1/2" tighter! 

Look for something that you can handle to keep your chin from tucking.  And be mindful, which I know you are, of your sleep position.

OK.

Let's keep you at 6.0 for a while longer.  Looking forward to seeing your O2 SATs from your meter.

I just plugged it in to charge, so I guess I won't be using it tonight. It's a Contec CMS 50F. Should I bother installing the software that came with it, or just go straight to the oximeter wizard in Sleepyhead after my first session?