First Night with SH Data Please Help.

[BlueMachine]

[attachment=6717]My first Night is not looking good.. Please help me adjust this for a goodnight sleep.. I woke up so many times breathing out of my mouth. Do I need to turn off EPR and go for a full mask?  I never had this high of an AHI or centra apneas in my sleep study.

[Gideon]

The bulk of the events are CA or Clear Airway/ Central Apnea.
Your history is unique for this forum but have you had a Sleep Study?  If so could you please post the detailed results with your personal inf blanked out.  This is to get a confirmation of Central Apnea which requires a different approach than Obstructive Apnea.

Fred

[BlueMachine]

My sleep study shows zero Central Apnea Events.  When I was using the airfit p10 mask I noticed I woke up trying to breathing from my mouth.  Study is dated 4/12/2018. The image is too big for me to upload

[Sleeprider]

At this stage the centrals are not a big problem, but something to watch. The fact your were exhaling from your mouth with nasal therapy really messes with the machine's sensors. We can see the flow rate has an uneven appearance, especially on the expiration half (below zero) on the flow chart. A close-up examination of the flow chart would tell you the extent of the problem. You have virtually no obstructive events happening, but the relatively high flow limitation is driving your pressure higher than needed, and that more than likely is where the CA and mouth exhaling is coming from.

At 6.0 to 15.0 pressure with EPR at 2, your median pressure is only 8.5. If you have a titrated pressure, I'd be curious to see it, meanwhile I think moving the maximum pressure to 10.0 is a good move. You can experiment with EPR while you're awake and I would suggest you use what feels best for now. It is pretty common for CA to be initially high, and a normal progression will be that it drops as you adapt to the new pressure. Changing your maximum pressure to 10 leaves you in the same pressure range as you already experienced, but will ensure it does not run much higher, in response to flow limits and an occasional OA.

[BlueMachine]

At this stage the centrals are not a big problem, but something to watch.  The fact your were exhaling from your mouth with nasal therapy really messes with the machine's sensors.  We can see the flow rate has an uneven appearance, especially on the expiration half (below zero) on the flow chart.  A close-up examination of the flow chart would tell you the extent of the problem.  You have virtually no obstructive events happening, but the relatively high flow limitation is driving your pressure higher than needed, and that more than likely is where the CA and mouth exhaling is coming from.  

At 6.0 to 15.0 pressure with EPR at 2, your median pressure is only 8.5.  If you have a titrated pressure, I'd be curious to see it, meanwhile I think moving the maximum pressure to 10.0 is a good move.   You can experiment with EPR while you're awake and I would suggest you use what feels best for now.  It is pretty common for CA to be initially high, and a normal progression will be that it drops as you adapt to the new pressure.  Changing your maximum pressure to 10 leaves you in the same pressure range as you already experienced, but will ensure it does not run much higher, in response to flow limits and an occasional OA.

Hi Sleeprider,

So do you recommend 6-10 pressure with EPR OFF?  And should I tape my mouth or go for a full mask?  I do not have titrated pressure. My doctor just said to do 4-20 which I know is bad.

[BlueMachine]

    Fred,

Here is the sleep study, I also have another one showing no centrals.

Are we all in agreement to try a pressure of 6-10 with EPR OFF and tape my mouth until i get an F20?

[gwc2795]

Are we all in agreement to try a pressure of 6-10 with EPR OFF and tape my mouth until i get an F20?

The 6 - 10 sounds about right for a start. Post another Sh chart tomorrow please.

Thanks
Gerry

[BlueMachine]

Are we all in agreement to try a pressure of 6-10 with EPR OFF and tape my mouth until i get an F20?

The 6 - 10 sounds about right for a start. Post another Sh chart tomorrow please.

Thanks
Gerry

Thanks Gerry,

I have another question.. Can an At home sleep studies detect Central Sleep Apneas?  I really hope I do not have this.  I am already considering changing my sleep doctor because he said my insurance denied an in Lab sleep study.. I just called the insurance and they said nothing about an in lab sleep study was ever submitted to them.

[ShaunBlake]

Are we all in agreement to try a pressure of 6-10 with EPR OFF and tape my mouth until i get an F20?

The 6 - 10 sounds about right for a start. Post another Sh chart tomorrow please.

Thanks
Gerry

Thanks Gerry,

I have another question.. Can an At home sleep studies detect Central Sleep Apneas?  I really hope I do not have this.  I am already considering changing my sleep doctor because he said my insurance denied an in Lab sleep study.. I just called the insurance and they said nothing about an in lab sleep study was ever submitted to them.

BlueMachine, I've had two different in-lab studies and a pair of at-home studies and I'll always vie for the at-home if it includes heart and oxygen monitoring.  Your doc may be great (though lying to you is really frowned on, and I've dumped my cardiac surgeon for it, but…)  He may have been trying to give you the best shot at getting full benefit from the sleep study.  For example, most folks have a lot of trouble sleeping in the lab in a strange bed, with uncomfortable pillows, wires attached to uncomfortable places, on top of whatever issues or problems put you there.  IMHO, the only advantages to doing it in a lab are two: a) somebody is monitoring you and can come in and stick a probe back on if it falls off; and b) well, 'b' isn't really valid because while they get the data immediately, the PAPs I was given sent the data back via the built-in cell modem.  (They might have waited to get the machine back before downloading the data, but they din't have to.)

So back on point: I'm not trying to talk you into accepting at-home sleep studies; just want to point out that your doctor might be better than he seems (the lying dog!)

Edit: Oops! overlooked your question.  Yes, the at-home study uses sophisticated APAP or Bi-level PAP machines with software that can distinguish CAs.  And in fact, you might be able to download the data from the machine before returning it.  (Depends on the machine and whether it's set up to accommodate that.  e.g., if you got a ResMed AutoSet 10 but it had no SD card, then you couldn't – but that's unlikely because they wouldn't be able to download it either.)

[BlueMachine]

Yes, I am just highly confused as to why I have central sleep apneas. When two at home sleep test basically showed zero. Now with my machine it says I have 10 with basically no obstruction and low rema. My sleepyhead document is at the top of this post.