I need some guidance [TennisTom's therapy thread]

[TennisTom]

Hello!  I'm new to the forum and new to CPAP.

[Gideon]

Welcome to the forum. We can and will help you but do tell us what is going on. I'm feeling fine is not a good answer unless you actually are

Please post, attach, your daily screenshot, use f12 to take the screenshot, as that will tell us a lot.

[TennisTom]

   

   

I guess I need LOTS of guidance.  I must have pushed post prematurely. 

I've been on cpap for about a month, using a Resmed Airsense 11 cpap model.  My sleep study showed an AHI of 7.7 and they prescribed a pressure of 10 which supposedly "eliminated all AHIs" in my study.  I had a FFM for the sleep study, but hated it, so I'm experimenting with masks, currently using a Dreamwear "hybrid" FFM (like a nasal pillow but with the mouth covered).  Eventually I want to move to a straight nasal mask but haven't mastered the "no mouth breathing" yet.

Very quickly I complained of feeling I needed more air, so the doc raised the pressure to 12.  Then a few days ago on the first follow up visit, he raised it to 15 saying "there are too many events, we have to get this lowered".

Attached is my OSCAR data from last night and a zoom in of a series of apneas about 12:30am that have me a little worried.  I don't pretend to know how to read all the data, so I'm looking for guidance.  Also, this is the first night's data where there were more apneas than hypopneas.  Usually, almost all hypopneas.  

One other note, I used an Resmed Airfit F10 mask last night until 4am, then switched to the dreamwear FFM 'cause I just couldn't stand it anymore.  I was hoping for a "no leaks" review (I know I get some leakage with the dreamwear) but obviously that didn't work, either. 

Any and all input would be appreciated!

Thanks!

Tom

[Gideon]

Welcome to the forum Tom.

I'm going to answer your questions then I'm going to have a moderator move your thread to the main forum which is for therapy help.  This forum, The Software forum, is for things like your are having issues with OSCAR or an oximeter and not therapy based questions.

Observations. You are having clusters of mostly UA events near the power on and falling asleep phase of your sleep.  Clusters tend to say positional (head/neck alignment) but when they fall near the start of a session we immediately think sleep awake breathing where a lot of events occur.  We call these SWJ or Sleep Wake Junk and those we tend to ignore.  
The zoomed example show a very brief sample of wake breathing, st the start of the zoomed view, see how irregular/ragged that series of breaths is.  The 1st 3 UAs are tossing and holding your breath.  The last cluster of breaths is a classic form of CA induced by your CO2 levels going low indicating that you do not need to breathe. The 3 breath clusters before that show aspects of both obstructive and central apneas.


Addressing the positional nature of this, tell me about your pillow arrangement, 1 or 2 pillows, firm or flat, do they force your head to tilt, are you a side or back sleeper, etc.

Set your EPR=2, fulltime and let's see if that helps.

I'd like to see more examples as well as a period of normal sleep so I can get a feel of your normal breathing pattern, a 3-5 minute segment please.

[pholynyk]

I see that your AirSense 11 is the CPAP model, one of the first reported here. Please tell me what model number is it is. That will be on the sticker on the backs side, or it is displayed at the bottom of the Statistics Page of OSCAR, in the Settings Changes. It should be a number like 394??.

Looking at your zoomed in display, it looks like your apneas are long enough that we should have seen the extra squiggles that are how ResMed detects central apneas in the more advanced models - the Elite, and Autoset. Perhaps this is left out of the CPAP model - I can't find my Clinicians manual to check.

In any event, I suspect that these are Central or Clear Airway events, and raising the pressure usually makes them worse. The good news is that they may be treatment emergent, and will go away after 3 or 4 weeks if you turn down the pressure. On the other hand, if the central apneas showed up in your original sleep test, Then perhaps you have the wrong machine.

In any event, the CPAP model is the lowest value AirSense 11, and the Autoset the best value, and - depending on your insurance - the cost to you is the same. I'm sure others will comment some more.

[Gideon]

Phil, I was just sitting down to call your attention to this AS11 CPAP version. you got it.

[TennisTom]

Thank you both for the input.  I'm encouraged that there is this type of support, makes me optimistic that I'll get it leveled off and feel better.

The serial number of the Resmed Airsense 11 is 39421.  Its a cpap only model.  It was all that was offered to me.

I'll try lowering the EPR to 2 and repost tomorrow.

In the meantime, Gideon asked for a 3 to 5 minute segment of normal sleep.  I'm assuming that would mean 5 minutes with no AHIs?  If so, here is a segment from last night:

   

If that's the wrong assumption, let me know.  

I'm mostly a side sleeper, or at least I start that way.  I often find myself on my back when I awake.

I sleep on a single memory foam pillow that is fairly firm.  Its not a cpap piller per se, but it is similar in that the edges of the pillow end abruptly, so I can easily hang my mask out beyond the edge and still be supported by the pillow.

Here is another OSCAR screen, just a random sample from this past week, for comparison.  I was on a pressure of 10 this night.

   

This is a 5 minute segment from that same night, pressure of 10

   

I'll send more tomorrow morning, including the recommended mods.

Thank you both!

Tom

[Gideon]

I want to see more of the wave form, I can see that that is not normal, possibly mouth breathing. See my avatar, the waveform in the OSCAR logo represents a perfect breath, but no one is perfect. The example you presented is significantly restricted on the exhale side with most of the breath missing, exhaled thru the mouth.

[TennisTom]

Hi Gideon,  I think you are asking me to send you a version of my breathing that looks perfect?  I don't think I have any.  I've gone through each days data over my first month, and I either have apnea looking patterns, or I have some variation on what I sent you, which I now see is not consistent sine-wave type pattern.  They all tend to run horizontal on the inspiration and drop down quickly on expiration.  But I am sure I'm not always mouth breathing, at least while awake, and I can't find better examples even looking at the beginning of therapy, when I'm obviosly awake.

This is as close I as I can find to "normal" breathing:

   

Tom

[Gideon]

Thanks, this segment is a fair representation of normal. As I said no one has " perfect " waveforms.

I thought you may have been breathing a bit heavy before, this kind of confirms that. This is the kind of breathing we are trying to get most of the time.