My Story (so far)

[Stemwinder]

I've been a member of this forum for 18 months, this is actually my second post, my first was a few minutes ago in the software forum. 

I was diagnosed in April 2017 and started on CPAP. My AHI averaged 34 but was told that when sleeping on my back it went up to a whooping 127. Thank goodness I rarely sleep on my back, I can thank a persistent wife and a sharp elbow for that. 

My first attempt at treatment failed miserably, I gave it an honest try but discontinued after 7 months. I started with a Dreamwear mask which I soon changed to a full face mask because I could not keep my mouth closed. In retrospect I should have kept the Dreamwear and worked on the mouth breathing problem because I fought with the full face mask the entire time I used it.  

My sleep clinic tried to help me but I saw little relief from their adjustment which was to change from a fixed pressure of 12 to auto pressures of 4 to 17, I changed that to 8 to 17. They were my DME supplier and they gave no help with mask issues. The issue they were not able to solve was a feeling of suffocation that would wake me most nights, many a night my mask would fly across the room only to stop when the hose ran out. Their response to this problem was that I would adjust. After a very tense confrontation with a nurse practitioner at the clinic I swore to never return there.

I am a stubborn soul but after almost a year I decided to give it another go. The issues related to my apnea cannot be ignored any longer, I have been back on my machine for a little over a month. I have purchased another mask, this time a Dreamwear mask with nasal pillows and I love it. I also purchased a heated hose, with these two my sinus issues are not the problem they were before.  I am not yet where I want to be but I am optimistic, I have even made another appointment with the sleep center, I did ask to be assigned to a different NP.

I am planning to post some graphs and I am wondering which ones would be the best to include.

[Melman]

Good that your willing to try again and wish you success. Hopefully we can help you. See the link below for organizing your graphs.It includes which ones should be posted.

[Gideon]

Welcome to the Apnea forum.

Data is what helps us help you and there are two types of data, the first is detailed data from your machine.  We can look at the data on a breath by breath basis if necessary. The second is how you feel which is much of what you are talking about above.  

The "Organize" portion of the guide (see my signature) is very important because some graphs are more important than others and that link lists which those are.  We will and do ask for others at times when they are needed.

In addition please post full (redacted) copies of your Sleep Studies, the summaries are often misleading.
If you are still having issues with the mask try reading, playing games, watching **** movies (that is good movies) anything to help get your body used to having a trunk to carry around.  It is really different and a lot of people have issues adapting to it.

The links in my signature are all good reading and who knows, you might even learn something.

If there is something you don't understand or question just ask, we will answer.
Finally keep all you posts about your therapy in one thread, that way there will be a history that is easy to follow.

Fred

[Stemwinder]

Thank you Melman, 

I am attaching a chart from last night, hopefully I have it formatted correctly.

The things that stand out to me about this chart as an untrained observer is the number of central apneas , they number more than obstructive apneas. I also notice the amount of vibratory snore events they appear to be an almost constant thing.

[Stemwinder]

Thank You Fred, Unfortunately I did not ask for my sleep study print outs, I have an appointment in a few weeks and will ask for them. I am happy with my current mask and feel i am on the right track

[Sleeprider]

You have what I think are typical Philips Dreamstation results for people that don't respond well to CPAP or slow CPAP Auto response. Your CA and OA are about evenly mixed, some considerable flow limitation and a bit of hypopnea.  You can turn off VS2 as it's not something we're concerned with.  Notice how the Dreamstation simply fails to respond to any of this and pressure stays nearly constant. It records inspiration time longer than expiration (I guarantee it's an error), and so is improperly timing the changes in pressure from inhale to exhale.  The best solution is a Resmed Autoset which would anticipate these events with changes in pressure and afford a better inhale/exhale pressure channel that properly follows your actual respiration. 

The only option the Dreamstation gives us is to increase minimum pressure, and that's my recommendation here.  I think increasing minimum pressure in 0.5 increments until events are less than 2 should work. It looks like you might do better on the bilevel-like pressures the Resmed offers with EPR, and this is just a classic example of why I don't like the Philips Dreamstation. It is just too limiting on how we can adjust therapy for comfort and efficacy. Something we will keep an eye on is the possibility of positional apnea. Your OA events are clustered a bit and that may indicate chin tuck.

[Stemwinder]

Thanks Sleeprider. One thing I have picked up on in some nights reports is central apneas, in last night graph they we almost equal to obstructive but at times they far out number them, at times almost 2 to 1. It is a scary thought that I may be at times not even trying to breathe.

I will go with your suggestion and raise my lower pressure from 9.5 to 10.

[Stemwinder]

One more question please about C-Flex settings, I am currently have C-Flex  turned on with a setting of 3, is this a reasonable setting.

[Sleeprider]

Definitely reduce Cflex to 2 or 1. CFlex was simply awful for me personally, and few people benefit from higher levels. It is unlike EPR in that Cflex is predictive and is apparently the main reason the Philips machines commonly miss expiration time. Cflex does not follow your breathing, it anticipates it, and returns IPAP/CPAP pressure well before expiration is completed. This can make it feel like exhale is cutoff, but in some individual it creates hypopnea by not enabling a full exhale (tidal volume). Higher setting just amplify this error. If there is a reason a person should not get a Philips machine it is Cflex.

[Stemwinder]

The CFlex setting was one that I made myself. I thought it would help exhale. It was originally set to off. I have no problem returning it to off.