Arousals/Awakenings with CPAP

[chrisiscitrus]

Hi everyone,

I just got the results from a titration study.  I'm guessing I'll be talking to a DME about devices this week.  When I had my full sleep study, my arousal & awakening total was around 15 an hour and with the CPAP, it was about the same.  I don't think that those numbers show up on OSCAR with a full data device, but I'm wondering if for those who have gotten multiple full studies over a long period of time, if the amount of arousals and awakenings usually go down with treatment.  I'm asking because my AHI wasn't actually that high during the study (6 per hour), so I'm thinking my arousals and awakenings have a large part to do with my fatigue.

Thanks in advance,

Chris

[BB63]

Hi Chris,

I'm not an expert, but I lived for 15 years with a CPAP that did not have the ability to do some datalogging and produce data plots as OSCAR software does.

DON'T let them talk you into a CPAP that does not produce raw data that you can see yourself-that's like archery practice while blindfolded!

My sleep has improved significantly since I got my new (datalogging) CPAP, and I've only had it for 10 days now!

GL

AB

[Gideon]

Chris,
Step #1. Get a full copy ofyour Sleep Study, not just the summary, including all the charts and tables.
Step #2. Post a redacted copy here for review.

That will give you your talking points.

On machines, I can almost guarantee they will suggest a CPAP which may or may not be the correct machine for you. We need to see the breakdown on all the events that were logged, including what occurred near them.

[Sleeprider]

No one has said it yet. You will be issued some flavor of CPAP. Make sure it is a Resmed Aircsense 10 Autoset or Autoset for her. Both offer full data and the most sophisticated pressure delivery and obstructive sleep apnea algorithm of anything on the market. Don't accept substitutes. Ask for it by name and model and refuse anything else. If the supplier won't provide it, change suppliers.

[chrisiscitrus]

Thanks for your help, everyone.  I've attached redacted versions of both my initial study and my more recent titration study (these were about 5 months apart).  As you can see, my arousals and awakenings are very similar with the cpap as without.  I will say that the sleep tech made my head feel like it was in a vice grip with how tight he made my mask, and I should've asked for him to loosen it, but I didn't, so I guess that may have impacted the titration results. I was still somehow able to get to sleep under those conditions (blame it on the apnea, I guess!). 

I am definitely planning on insisting on getting an Airset Autoset 10.  I've talked with a few DME's, and the one I plan on going to say that have it in stock and that it shouldn't be a problem getting it for me, though they tried to provide themselves some leeway with saying they might have to give another device, based upon the prescription.  I've done my due diligence reading this forum though and know that a "CPAP" order (which is what is written on the prescription) can be used to get an Auto CPAP, and therefore shouldn't preclude me from a receving an Airsense 10 Autoset. 

This forum has been a lifesaver.  
 
Chris

[Gideon]

SR a typo above. You said "AirCurve 10 AutoSet" when you meant ".AirSense 10 AutoSet"

To Chris, "AirSense 10" is a line of CPAPs, "AirCurve 10" is a line of BiLevel xPAPs, the next level up, which depending on model, can treat quite a variety of conditions.

[Sleeprider]

Thanks Fred, fixed it. I think I was using my phone at the time.

Chris, you raised an important an insightful point: "As you can see, my arousals and awakenings are very similar with the cpap as without". There is a tendency for people starting on CPAP to assign blame for every arousal, discomfort and general fatigue to the CPAP therapy, when the problems are usually external to the therapy, pre-existing or due to other health and lifestyle problems. You would be surprised how many times CPAP is blamed for someone's fatigue when they only use the machine for 6 hours or less each night. Our objective in coaching people is to teach them to take responsibility for their therapy, with an emphasis on making it comfortable as well as effective. We can help with selection of the best equipment, and explain how different settings or aids can overcome the problems we see and have come to understand. The rest requires some work on the part of the user to pay attention to the problem identification and solving process and a realistic expectation of what the therapy can and cannot do. You seem to be well on your way to success.

[chrisiscitrus]

Thanks! Yeah, when I have a follow up with my referring pulmonologist (I still haven't spoken to or met the sleep study doctor), I'll definitely ask about the awakenings. I feel like I'm in good shape (I eat well, get cardio daily, am only 32 and don't have any other pre-existing conditions of note), so I'd be interested to see what his take is on why I'm waking so much and whether any further investigation is warranted. All things considered, I'm very fortunate to have received the diagnosis at such a "mild" level before age allows the condition gets worse, if it does. I'm hoping I'll be a success story and can shake my daytime sleepiness and fatigue.

One more question, are we allowed to change our CPAP settings while going through the compliance period of the insurance process or do people generally stick with prescribed levels for awhile? I want to make sure that nobody gets mad at me and that it won't mess up the data, if I decide to try it on auto mode.

Chris

[Sleeprider]

Another good question. Apnea Board provides clinical setup manuals to help members make changes to their machines, and there is a useful discussion (perhaps biased) to introduce our position on patients controlling their own therapy https://www.apneaboard.com/adjust-cpap-p...tup-manual

There is no law, regulation or medical precedence that should prohibit a patient from adjusting settings as needed. Compliance is simply your use of the machine as required by insurance so they don't pay for something that gets put on a shelf. Compliance is usually defined as use of the machine for at least 4-hours per day for at least 21 days in a 30 day period. I have never seen compliance include any language regarding settings, however I have seen some P*ssed off respiratory therapists that are by regulation limited to setting a CPAP according to a prescription. We will never guide you to a bad decision.

To avoid problems, the best approach is to request that your doctor prescribe the Resmed Airsense 10 Autoset and "self-titration". This means you have control of all settings and optimization.

[chrisiscitrus]

Thanks again for the info and the tips!