More analysis and tools... (sorry, a bit long)

[Crippiter]

After a month or so, I'm still rather new to CPAP use and data analysis, but I have found this:

I still have generally low leak rates, high pressures, and high AHI's using the Resmed S9 Autoset.

My DME dealer/clinician already downloaded the first set of data, which included this information, and sent it to my sleep doc, and he said, "Just keep using it, come back in early April, we'll talk more."

I've mentioned that in an earlier post, but the engineer in me wanted to dig further on my own.

So, last night I hooked up my webcam with capture software and grabbed several hours of streaming video which I can relate back to the CPAP data as viewed through SleepyHead. I started moving forward to different chunks of a dozen obstructive events and saw that I was sleeping on my back versus the hour or so of good sleep ahead of it. It's an interesting tool to learn more about my sleep, and made it clearer that the "good" sleep I'm getting, as denoted by the CPAP data, may be driven by my sleep position as much as any help the CPAP machine is providing. It at least partially confirms my suspicions-- it struck me as odd that I'd have hours of good sleep interspersed with an hour of dozens of obstructives while the machine was running at full pressure. When I have good nights, is it because the ResMed was working, or just that I happened to be on my side more than my back? Could it be the ResMed is doing more to record the problem than to help resolve it?

It also confirmed that my centrals were indeed central... the video (while not HD) is clear enough to see that I am not making an effort to breathe, and there is no fogging of the mask. I must have been sleep deprived, because my first central last night, lasting 20 seconds, occurred literally *ten breaths* after closing my eyes to go to sleep. The video is also good enough to clearly watch myself struggling to breathe (especially exhale) with 18-20cmH20 in my mask... watching my neck expand with each attempt, watching forced chest movements. To be honest, it was rather troubling.

Here's another thought I'm considering. Has anyone ever set their unit to the lowest setting in pure CPAP mode, not autoadjusting (e.g. 5cmH20 on the ResMed S9) and just watched the results to track events without trying to "fix" them? Why? Well, just to see what the problem is like without CPAP assist... well, *almost* without assist. Again, I'm still uncertain what this unit is doing for me, and until my doc decides to meet with me to look at my data, I'm trying to troubleshoot on my own.

I'd love to hear your thoughts...

Thanks for listening to me ramble...

---

Oh, and I'll add... feel free to reply with feedback like my wife has provided... "Chris calm down, you're getting too worked up about this..." Yeah, maybe I'm being overly involved in this.

[shanzlik]

Generally, sleeping on your back exacerbates the sleep apnea - it seems to help the structures close off even more easily than they do in other positions.

My AHI in my sleep studies was about 50% higher when I was on my back vs my side. I did notice that the one time I purposely went to sleep on my back (for a nap) after I got my CPAP, it was the highest AHI I've had. I don't yet use the autoset feature on my S9, so it couldn't ramp up to compensate. However, the AHI was still far below what it was in my untreated sleep study.

[Steven]

Crippiter's Doctor's attitude IS the reason many seek guidance elsewhere. And then, they get P O ed because we do so.

I have considered doing the video thing myself, but just have not yet gotten around to doing it. No real concerns on my part - just curiousity.

I generally am suspect about "events" rather close to just going to sleep or close to just waking up.

But Crippiter's video seems to support those events.

People may be able to offer more comments if we could see that part of the video with the centrals at the very beginning of your sleep.

Since your pressure is at the 18 - 20 level, using your CPAP at the lowest pressure setting might give you some useful information.
But that is what the Sleep Study was suppossed to do.
Besides, if you need 18 - 20 of pressure & you set it too low, the consequences might be too extreme.
In other words, I am not sure it is worth the risk !

Sleep Studies are video taped.
Since it has only been 1 month or so, see if you can get a copy of that video (at least for the portion without a CPAP).

[iSnooze]

Generally, sleeping on your back exacerbates the sleep apnea - it seems to help the structures close off even more easily than they do in other positions.

I believe shanzlik is correct. When I had my first sleep study done, I was told that I should try to sleep on my back because apnea events happen more often while sleeping on the back.

[Crippiter]

I understand that apnea events are worse when sleeping on the back. I'm not surprised to find that. Maybe I should clarify...

When I started on my ResMed, my numbers were pretty awful. I've had good nights since then, but even within a good night (as judged by the overall AHI) there were stretches of time when there were dozens of events within an hour. So while the average numbers seemed to indicate that the unit was helping more, it struck me as odd that when I *did* have events, they kept happening, even when the unit was pumping out 20cmH20. This begged the question... were my improved numbers really driven by the ResMed, or were there other factors involved, like sleep position.

When I first started out (including my sleep study and initial titration attempt) sleeping on my back. Largely this was because the wires and mask made mobility while sleeping rather difficult. I've since gotten used to side sleeping with a mask on... and interestingly my numbers have gotten better.

Anyway, the video was simply to understand whether those stretches of "better" times and "worse" times were more a product of my sleep position. After all, if the only improvement is coming from that-- why bother with a CPAP pumping 20cmH20 in my face and wearing a mask that has irritated the bridge of my nose for the last month?

The results of the video seem to indicate that 1) the numbers did get uglier when I was on my back, even with a CPAP trying to help, and 2) I have centrals even with low pressure. Both of those items tell me a ResMed S9, alone, isn't doing all that I need. That's admittedly the opinion of someone perfectly unqualified to make such a call.

And again, the question about running at 5cmH20 was just a thought about how one might use their CPAP unit expressly to "monitor" apneas without trying to resolve them... that is, to see what my AHI is in a *nearly* non-CPAP environment, using the most diagnostic tool I have handy. And Steven, I'm not worried about extreme consequences... after all, I lived with apnea for many years without any CPAP, so I don't think it's a risk really.

Thanks for everyone's feedback.

[PaulaO2]

If you are having Central apnea events, perhaps you need the VPAP vs the CPAP. VPAP is the general tool for treating CSA. CPAP does diddly for central events.

What did the report say from your sleep study? Did it show central events?

You said your numbers were 'dozens of events within an hour'. But what is the actual AHI (the number of apneas and hypopneas added together then divided by the number of hours slept)?

We've had people freak before over their numbers then we find out their numbers are actually very good. Could be better, but certainly not freak worthy. Not that you are confused or freaking over nothing, but for us to know the numbers helps. We can either help calm you down or stress the importance.

[Crippiter]

Hey Paula... I'm not freaking out, no worries. My AHI has dropped a bit recently, but has typically been in the mid- to high teens lately. I was at 22 or so during my first two weeks with my unit, though I was back sleeping more then.

My DME clinician suggested a VPAP as well, but my doc ignored that and said, "Just stick with the CPAP for awhile, let's see what happens..."

My sleep study report didn't mention anything beyond apnea and hypopnea. I didn't know enough to ask about it at the time.

And I will my breathing gets very slow and weak even when sitting and resting. Before ever talking with my doc about apnea, I noticed times I'd be sitting and resting then suddenly *inhale* real hard. Pretty sure now those were some kind of waking central events (in my completely unqualified opinion! ). As I posted separately, I recently took video to go with a night's sleep on my ResMed and saw times where there was suddenly no breathing motion, no fog on the face mask... I just stopped... then started again twenty or more seconds later. Watching yourself do that is kind of surreal... and hard to explain to non-apneacs.

[PaulaO2]

Your AHI was in the teens to low twenties and he said "stick with CPAP for a while"?

Change docs.

[Netskier]

Here's another thought I'm considering. Has anyone ever set their unit to the lowest setting in pure CPAP mode, not autoadjusting (e.g. 5cmH20 on the ResMed S9) and just watched the results to track events without trying to "fix" them? Why? Well, just to see what the problem is like without CPAP assist... well, *almost* without assist. Again, I'm still uncertain what this unit is doing for me, and until my doc decides to meet with me to look at my data, I'm trying to troubleshoot on my own.

I'd love to hear your thoughts...

Thanks for listening to me ramble...

---

Oh, and I'll add... feel free to reply with feedback like my wife has provided... "Chris calm down, you're getting too worked up about this..." Yeah, maybe I'm being overly involved in this.

Crippiter,

Thanks for this fascinating post. I suggest doing your experiments while in the APAP mode, so the device can rescue you if you drop into obstructive apnea. I realize you survived sleeping in the past without PAP support, so did I, but we are a few days older now, and now might have a stroke or heart attack during OSA (obstructive sleep apnea). I think of blood vessels as being like balloons; they pop more easily as they age, so I suggest caution, and to use the APAP mode. My Autoset seems to get me out of OSA within 5-10 seconds, which I like.

For your first experiment, I suggest systematically varying your minimum pressure while closing monitoring your event count in SleepyHead, Daily, Events. It would be interesting to see how your events decreased as you increased your minimum pressure 1cm/h20 per day, and then back down.

While you are there, be sure to go into Notes to record your daily body weight, and get your free calculation of your Body Mass Index, which you can then relate to your Zombiness rating, plus everything else.

HTH.