Welcome to Apnea Board !
As a guest, you are limited to certain areas of the board and there are some features you can't use.
To post a message, you must create a free account using a valid email address.
Login or Create an Account
Hi Expat, thank you for your willingness to help. I'm happy to share sleep study results. Please see below and attached.
At-Home Sleep Study
Info from my medical records:
AHI of 4.85 on my side and 11.2 on my back.
Home sleep study results are attached in two separate files.
My comments on the sleep study:
I couldn't get the equipment to stay on properly when sleeping on my side, so I slept on my back quite a bit, which I rarely do.
In-Hospital Sleep Study
Info from my medical records:
AHI of 0.4 with CPAP treatment of 10 cwp.
The patient was started on CPAP of 6 titrated up to 14. The patient essentially cleared with all pressures from 6-14 within a AHI and RDI of less than 5. Patient had minimal desaturations at a pressure of 11 but otherwise O2 sats remained greater than 90%. The patient only achieved REM sleep in the supine position at a pressure of 10. Patient had total sleep time as CPAP of 10 of 106 6 minutes with an RDI of 0.4.
Cardiac rhythym: Normal sinus rhythm
EEG: normal
Periodic limb movements: None
Patient had total time in bed of 404 minutes total sleep time 342 minutes for sleep efficiency 60%. Sleep stage distribution was as follows: Stage I was 6%, stage II was 72%, delta sleep 18% and REM sleep 5%.
Titration results are attached. Apologies for the horrible image quality, but hopefully the above text helps with interpretation.
My comments on the sleep study:
I was under the impression going into the sleep study that I wouldn't be using CPAP. Upon arrival, I was informed that I would be. Wearing it disrupted my sleep significantly (both psychologically, as I was upset about the misunderstanding, and physically, as it caused painful aerophagia).
I used a full face mask for the sleep study.
I felt like the mask was leaking and not fitting properly when I was on my side, so I slept on my back much more than I typically do.
I experienced aerophagia that night (as I always did with the full face mask).
Additional Comments
Both sleep studies were over a year ago. I gave up on CPAP soon afterward.
About a month ago I gave it another try, this time switching to nasal pillows.
With nasal pillows I no longer deal with aerophagia, and I feel like I can breathe much better.
I continue to wake frequently throughout the night and I wake up feeling unrefreshed with tightness in my head, difficulty focusing, lack of energy, etc.
I've been to all sorts of doctors, had nose surgery, etc. Their conclusion is pretty much .
Thanks for all the information on your sleep studies.
On the face of if you have mild sleep apnea from the earlier home study, but with the later hospital study with CPAP, giving only an AHI of only 0.4, and no central apneas.
But as you mentioned, your sleep was considerably disrupted using the machine, and apparent leaking.
Likely this result of only 0.4 AHI is untrustworthy in these conditions.
Looking through your previous graphs, I agree leaks are well within normal limits, but your obstructive apneas are not being controlled. Previous suggestions are spot on, in increasing minimum pressure.
I agree this minimum pressure of 12 would be a good place to start.
I consider the minimum pressure is probably the most important setting of them all, being a basic "guard rail" to catch events before they develop.
Just a note on your graph presentation, we cannot see your flow limitation graph properly. Can you reduce the height of the other graphs slightly so it becomes into view?
With everyone's help I seem to be making progress. I'm attaching the next 2 nights of data:
I dropped EPR to 2 on both notes and am having far fewer centrals. I'm pretty sure the few remaining CAs are junk events from when I was awake.
On the first night I went with a pressure range of 12-15, and on the second night 13-16.
Of note, I'm experiencing more aerophagia with these pressures. Although it is uncomfortable and mildly bothersome, it is not painful and I can cope with it if needed.
How do these charts look? What should I try next to optimize my sleep?
Thank you all for your support and assistance! My medical providers have been pretty much useless on this; it's very discouraging.
Of note, I'm experiencing more aerophagia with these pressures. Although it is uncomfortable and mildly bothersome, it is not painful and I can cope with it if needed.
There is no significat difference between 12 and 13 cm. But you had more leaks on the 13; also, because of your aerophagia, you want to stay on the 12. Also, your CAs should clear up spontaneously with time because they were absent in your sleep report. Hence, from time to time, you want to experiment with EPR=3 to cope with your aerophagia
Agree you should leave it on 12 minimum for the moment.
As you may know, their are advantages and disadvantages with EPR
On one hand it is a comfort feature and can reduce flow limitations for those who have flow limitation issues.
On the other hand, using EPR can encourage the appearance of central apneas due to CO2 washout, tricking the body to stop breathing, as no need to continue breathing djring the event.
However, a potential positive of reducing/eliminating EPR, is that better therapy control canbeachieved.
It's a balancing act, and depends on each person.
You will know which is best for you by trial and error.
I am personally a full EPR person after much trial and error.
However, for information, here are some videos discussing the "negative side" of EPR :-
A point on your graphs, I think best not to use zoom unless we request this from you.
With zoom we cannot see the whole night. The latter is really useful in helping to understand the total situation.
Thank you Expat and G Szabo for your input! Last night I went with 12-16 and EPR 3. How do things look?
Expat: If what you meant by zoom is the selection length, I did that intentionally on the 2 previous graphs because they included afternoon naps followed by many hours before my overnight sleep. I thought the long gap of inactivity between the nap and overnight sleep would make it harder to view the "real" data. Let me know if there's a better way I should approach it. Of note, that's not an issue on last night's chart as I only used the machine overnight. Thank you!
Your flow limit is excellent.
With the current EPR=3, your CAs should disappear within a month or two. So, just use this setting for a while and observe.
Increasing the minimum pressure might reduce the remaining OAs, but 13 cm was not too much help. Increasing it to 14 depends on your tolerance.
I see two distinct posibilities on your therapy, both in my opinion, of equal merit:-
1. Leave the settings as they are for the moment to let things settle a bit to see where it leads. Centrals could certainly reduce over time, as this often happens.
2. Or increase minimum again.... I know you had aerophagia before when you were on EPR 2, but hopefully now you are on EPR 3, it may OK.
The reason for this is that I have found that central apneas can be false positives, and increasing minimum pressure can help. This is from personal experience. I should note that centrals can be encouraged by certain medicines, for example pain killers or sleep aids; It depends on each.person.
I looked again at your leak statistics, but whilst the results look acceptable, the graph is a bit "choppy". This may be nothing, but these variations could be causing micro awakenings. It depends on each individual. I am really sensitive to this sort of evironment.
I however found a potential fIx. As a user of a pillows mask, (Breveda) and a terrible mouth leaker, I use tape, BUT before affixing it, I tuck my lower lip just under the top lip, and for me I get a sort of double seal. Works a dream for me, but perhaps worth a try.
Concerning unwanted sessions, yes there is a bettter way to approach it.
If you have a periode or "session", you can disactive a session you don't want to display, for example an afternoon nap, testing a new mask for an hour or so, etc so etc...
You can either clic on the coloured zones at the bottom of the left hand pane,(click again to show it ifb you wish, or do this in "session information".
Yes, ignore the CAs entirely. They are treatment-emergent and will lessen on their own as time passes. EPR 3 is your friend. It makes breathing more comfortable and lowers flow limits, which are short-lived apneas that we want to keep low. You are doing well.
08-27-2024, 06:04 AM (This post was last modified: 08-27-2024, 06:07 AM by weepingwillow.)
RE: Leak rate question
Hi folks, you've all been really helpful so I'm back for more advice. I'm attaching my last few nights. A few things to note:
I experienced bad aerophagia on August 24 and was up a bit in the night. However, I woke up in the morning feeling unusually good! I'd like to wake feeling that way more often.
I've kept my settings at 12.0-16.0 with EPR 3.
I'm still taping my mouth and it's working well.
I've been taking Gas-X (simethicone) before bed. Going forward, I'm going to also take it when I wake up in the night, as my doctor noted it's only effective for a few hours.
Do you recommend any changes? How can I get more nights like August 24?
Thanks again, everyone's been so helpful!
EDIT: I've reached my attachment quota so apparently I can only share 2 additional nights.
.
