Intro............in search of sleep

[lonigan]

Howdy,


Thought I’d stick around for a bit and try and learn a few things if that's OK.


I was diagnosed at an AHI of 29 I think last sept from a home sleep test and started therapy. My numbers went down to the 10ish range pretty much all centrals and some hypopneas. Still exhausted/sleepy during the day. At my 6 month recert the therapist ordered an in lab test. That was done in late apr. Their recommendation was a fixed pressure of 7 and 0 EPR to try and get the centrals down. They said 7 worked better than 5 for me so that’s where we started.


My numbers haven’t changed much since then and the therapist has ordered and echocardiagram and another in lab test to see if a different machine would work better. In the meantime I started reading up. I inserted and SD card in mid May so can attach some screen shots.


I’ve learned tons here and on the OSCAR page thanks to all. Flow chart is pretty much all over the place most nights seems like.


Guess I’ll just dive right in.


Here is a snippet of my decent sleep periods, far as I can tell its pretty periodic but the negative flow rates are about 3/4ths to double the positive flow rate and the shape of my breathing pattern almost looks like a couple examples of palatal prolapse but I am not sure.


   


Periodic breathing patterns or arousals and sleep wake junk? I get these periods pretty much every night.


   


I get these marked CSR events every 2nd or 3rd night once or twice a night. Can some of these and the CA’s be false positives due to arousals?


   


I didn’t include the flow limit chart because there doesn’t seem much going on and the pressure chart because its fixed at 7. Not a lot of large leaks or snores.


I have lots of questions…………………most I usually find answers to I just seem to go down a lot of rabbit holes.


thanks for looking


tim

I can add full nights charts if needed

[Deborah K.]

Full night charts are the best to start with, then charts like you showed if asked for.  Also, do include the Flow Limits.  We need to see those.  Did you have a lot of CAs in your sleep study?  If so, you may need a different type of machine.  If not, they could be what we call treatment-emergent.  If that's the case they will lessen as time goes by.  

[SarcasticDave94]

The other machine needing an echocardiogram is ASV. That is the treatment machine for Central Apnea. It sounds like you're headed there soon. If the medical person is already mentioning and planning that, your sleep study report will have shown these Central Apnea, and likely lots.

For now, I would have you try your best to wean yourself off the Ramp of 4 cmH2O for 15 minutes. Ramp and CA don't like each other much.

Static pressure like this is to help avoid some CA, but as you see it's not doing very well with the avoidance. Get that echocardiogram and ASV as soon as you can. Your gold star answer for CA is ResMed AirCurve 10 ASV, nothing less.

[lonigan]

Thank you both.

Right now I am on steady pressure of 7, EPR 0 and no ramp, for a week or 2 I think. My numbers have not changed significantly.

The sleep lab did both 5 and 7 and said I did best on 7 with fewer centrals. They couldn't do an ASV check back then without the echocardiagram so it was a basic study. I have almost all centrals and some hypopneas. My night starts on my back and I fall asleep within minutes I believe and about an hour to 90 minutes in, wake and turn on a side and then go from side to side for the rest of the night seemingly every hr or so from what I recall. Been like that for as long as I remember.

I agree that I am most likely heading towards an ASV as I have been using this machine for going on 7 months now with not much improvement. Should have adjusted by now I guess. I seem to tolerate the machine just fine with no issues and was also kind of wondering if the graph would show any false positives for those apneas due to arousals and noises and such during the night. We have a family member night owl and I didn't know if that could influence some of these readings or if the flagged events are strictly physical. My lab study was pretty similar so I guess that is my answer for that last part.

The study also reported a periodic leg movement index of 84, probably pretty high. Ferretin level was low so I am trying to work on that as well. All this works together I imagine. I don't have a diagnosis as yet for PLMD or RLS, probably coming.

last night


   

and here is part of the summary of my sleep study, I understand some of it.


   

I don't understand the flow limit chart very well and can't find it in the oscar wiki.

tim

[PeaceLoveAndPizza]

Curious if you have tried higher pressures? Maybe 9 or 11?

[SarcasticDave94]

Just a guess, lonigan would discover the results pretty quick, however the trend won't manifest for a few days. CA being stubborn, they'll be like a bad neighbor, showing up frequently when you least expect and making your life terrible.

[lonigan]

From what I remember my pressures were anywhere from just under 11 to 8.5 or so on a nightly average and centrals have been in the 6ish to 15 range depending on the night. OA’s since I started therapy are always less than 0.04 or so. I do not know what the breakdown was from the results of the home sleep study just the AHI of 28.


I talked to the nice VA folks after about 3 months and they said a lower pressure may be better in my case and would review at the 6 month time. Thats when they ordered the in lab study I posted a summary of above.


I can ask about trying a higher pressure while I wait for the other study, only have time I guess. So far I’ve been hesitant to do any tinkering on my own just not knowing enough. My sleep therapists and the lab tech both mentioned that the resmed algorithim (?) is pretty aggressive and said that the lower fixed pressure was my best bet. Been on fixed pressure of 7 with EPR off since may 10th.


Last night was rough. The data is pretty much the same but my brain just started racing at 4:30 and I didn’t want to lie in bed listening to myself breath so just got up. The times on my chart are an hour off I must have checked a wrong box or something DST maybe. Usually sleep from 1120ish to 6ish on a good night.


………….This part is kinda hard to bring up (I’ve typed and deleted 3 times) but do sleep disorders typically lead to mental health issues and external stressors or is it the other way around. I am working on the first part – slowly – haven’t asked about the latter. Just depends, I suppose everyone’s different.


Fingers crossed I’ll get to a day that I can read a book or magazine again without drowsing off and remembering what I read



   

[SarcasticDave94]

I'll try to help convince you to get your CPAP Setup Manual HERE.

This is for your benefit on therapy, to give you necessary knowledge to set your CPAP yourself. Even if you get the high level ASV, your can do it. I was able to with my ASV, the DME RT told me she didn't know how to set the ASV they were issuing me. Apnea Board to the rescue. The 2 years I was on ASV, I was on my own with settings. My insurance didn't care as long as I used it. DME and doctor didn't like because there's less money with Dave setting it himself, says I non-sarcastically.

[lonigan]

Thurs night, last one at 7cm continuous

   

I decided on 7-9cm to start, not expecting much change tho. Is 4 nights enough to get an idea before changing settings again?

last night full night

   

in this one is the flow limit and shallow breathing due to the leak rate?

   

planning on a range of 9-11 in a few days if nothing has changed much.

standard response setting rather than soft

tim

[SarcasticDave94]

Just my opinion, I think this is the start to make a case for ASV, or at the very minimum a VAuto with high trigger. I really don't think it'll be successful either for you because of the higher consistent concentration of CA. Most of your events are CA, you're not able to avoid them with the settings