New CPAP user, help with Dreamstation settings

[IndigoLioness]

Hello all! Totally new to CPAP use and I've had 2 nights with it so far and would love some guidance.

HISTORY: Female, 46 years old, hypothyroid, T2 diabetic, fibromyalgia, chronically light sleeper, history of snoring on my back for the last 20+ years, culminating in daily headaches upon waking and complete lack of energy. 2 years ago I had a sleep study done. It showed many hypopneas and RERAs, but no OSA events because I have trained myself for many years on my own not to sleep on my back due to snoring. I tried a mouth guard for that but it didn't help enough because in addition to the snoring I have UARS. As soon as I start relaxing to fall asleep I feel it closing up in the soft palate/sinus area, so I sleep solely on my side. The study did however show that my oxygen level was dipping below acceptable limits and I had nearly NO (a few minutes I think) restorative sleep stage. Diagnosed with UARS and I think shallow breathing with the flow limitation, maybe you guys can tell me if that tracks with the OSCAR data I will post from the last 2 nights. Sleep doctor said treatment should be CPAP but Medicare won't cover a CPAP for UARS, only OSA. Prescribed an oxygen concentrator instead, which I have been using ever since at 2 LPM. Morning headaches went away but have still always had several hours of groggy every morning and general lack of energy on most days. Some of this due to fibromyalgia but I'm sure effective pap therapy will help. She said if I could get a CPAP at any point on my own she would be able to help me with setting and supplies. 

Fast forward 1 year and another sleep study done. Was urged to try to sleep on my back for the study, which was nearly impossible. As soon as things start closing up I reawaken, then start drifting off again, becoming a cycle of frustrating awakenings and I hardly slept during that study. Results were unhelpful.

Fast forward to now, I have another sleep study coming up on Monday Dec 11th, and a follow-up appointment on Dec 28th. Studies are difficult because I am also a night person, going to sleep at 10pm is unusual for me and this makes them harder. This time she is going to give me ambien and I will try to sleep on my back again to catch OSAs if we can, it would be nice to have coverage for my supplies. 

Last week I was able to purchase a lightly used Dreamstation for a steal. I sanitized everything and started using it 2 nights ago. 

TYPICAL SLEEP: Light sleeper, several awakenings a night to turn over or sometimes pee once, not excessively. Wake groggy and draggy for several hours before being able to tell how I feel each day. Never feel "rested" and haven't in years.

NIGHT 1: APAP 7-12, A-Flex 2, Humidifier 1. Slept 4 hours (insomnia issue not due cpap). Had a small headache at bedtime and it lasted through most of the night. Gear was super comfortable, didn't have a problem with the feeling of airflow since I am used to oxygen shooting up there continually. I felt like I was waking up a LOT more than usual, but couldn't place anything that felt off, may be hypopneas and reras, did feel like it might not have been opening airways enough on inhale. Woke up with slight headache whch came and went throughout the day, but felt more energy yesterday on 4 hours sleep than I have in years. Charts for Day 1 will be attached to this message. The weirdness at 10am on day 1 was me waking up fully to turn over and deciding to try sleeping on my back, which I did. I think I turned back onto my side after a while without waking up. Tonsils, palate and lower sinuses super sore and scratchy all day, decided to up minimum pressure and increase humidifier from 1 to 3 (suuuper dry here), and changed A-Flex from 2 to 3.

NIGHT 2: APAP 8.5-12, A-Flex 3, Humidifier 3. Still comfortable, slept on my sides all night. Break in the chart at 8am was me disconnecting to go to the bathroom. Humidifier 3 was a bad idea, haha. Ended up with a gurgling tube a few time and had to lift it up to drain it back into the tank (will clean today and change that back to 2), which is a shame because my throat etc feels better today than yesterday but still a little sore. Is that is just part of getting used to it? Does that part go away?  Still felt like I consciously woke up a lot more than usual. Feel somewhat better than usual today, but also not. Not having my usual hours of grogginess, energy is somewhat better than usual, but don't feel like I reached a lot of deep sleep. I also did get another morning headache within a few minutes of getting up, which has persisted the last few hours since waking. Charts will be put into a separate post for this day. The break in the chart at 8am was me disconnecting to go pee. Also, the last 2 nights I have woken up sweaty a few times. 


I still feel like from the chart I am not getting fully open airways. The upper limit seems like it's hitting the max that I set of 12, do I need to increase that? Should I also increase the minimum again? I don't know how to fully interpret all the data, so I am hoping you lovely people can give me some guidance on where to go from here. 

Thank you in advance for any and all help!

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Night 2 charts.

NIGHT 2: APAP 8.5-12, A-Flex 3, Humidifier 3. Still comfortable, slept on my sides all night. Break in the chart at 8am was me disconnecting to go to the bathroom. Humidifier 3 was a bad idea, haha. Ended up with a gurgling tube a few time and had to lift it up to drain it back into the tank (will clean today and change that back to 2), which is a shame because my throat etc feels better today than yesterday but still a little sore. Is that is just part of getting used to it? Does that part go away?  Still felt like I consciously woke up a lot more than usual. Feel somewhat better than usual today, but also not. Not having my usual hours of grogginess, energy is somewhat better than usual, but don't feel like I reached a lot of deep sleep. I also did get another morning headache within a few minutes of getting up, which has persisted the last few hours since waking. Charts will be put into a separate post for this day. The break in the chart at 8am was me disconnecting to go pee. Also, the last 2 nights I have woken up sweaty a few times. 

[Gideon]

First, and most important. Has your dreamstation had its foam replaced? Were the 2 FDA Class 1 (the worst kind) recalls processed? Read this post and a few that follow it. https://www.apneaboard.com/forums/Thread...-ONE-USERS Every CPAP system they made before the recall was involved
This is why Dreamstations are available at a steal. (Foam particles being inhaled and cancerogenic fumes off-gassing and being inhaled.)

Additionally, for UARS you want a machine that does an excellent job of managing flow limitations. Dreamstations do not. A BiLevel does and in the CPAP scope ResMed AutoSet is arguably the best.

Watch the fill level on the humidifier, try 3/4 full. At least make sure you are not overfilling it. Or put a command strip on the wall above your CPAP so the hose is vertical for about the first foot. Some put the CPAP on the floor for this purpose.

[IndigoLioness]

Thank you I am aware of that. It is however the machine that I have and would like to know what if any settings i should change from what I have because I am unable to get another machine at this time.

[IndigoLioness]

After night 2 I had a headache all day yesterday, it was horrific. 

Changed humidifier from 3 to 2, no more water in the tube and throat feels great. Tweaked a few numbers, changed range from 8.5-12 to 9-20 and reduced flex to 1. My reasoning was a higher low limit with lower flex number might keep the airways open more during both inhale/exhale to prevent as many flow limitations. Upper limit set to 20 because the previous nights were nearly hitting the upper limit so I wanted to see how high it would go if given the space. I feel like I slept much better than the previous nights. I feel better this morning than yesterday, throat not sore at all and don't have my usual mucus and irritation around the lower nasal/upper palate area up in there. Noticed the leak rate, I think I know what that was from, headgear issue that can be easily fixed.

I have no idea if I'm going in the right direction. Anyone?

[UnicornRider]

Sounds good, get those leaks under control.

Can you give a zoom view of the three OA just before and at 10:00am?

Try to capture about a 6 minute time frame with each OA,

That may enable us to get a better understanding of your needs.

[IndigoLioness]

Absolutely, here are all three. Let me know if you need the lower graphs for each and I can redo.

[IndigoLioness]

I am also adding this one from 11:15 because it is the longest period of not breathing recorded yet at 18 seconds. 

Looking at last night, the first half looking great and the second half worse I am wondering if it is partially postural. Chronic pain makes me more sore so i tend to shift position more the longer I am asleep and being a predominantly side sleeper, I may be also bending my head slighty forward. I will also keep an eye on this and if it seems to be the case try a soft collar and see if that makes a difference.

[UnicornRider]

If you have a sleep test scheduled for monday you need to prove to them that you have tried all that the Philips Dreamstation could offer. and you still had the headaches, grogginess, brain fog, trouble connecting thoughts, irritability besides still feeling the need for additional sleep, day time sleepiness. 

    The Variable Breathing (VB), bottom line of the Events field at the top of the display, you are hitting it quit often. you will notice the DreamStation provides no corrective action while you have the Pink shadow of the VB flowing down the report. That is part of the algorithm Philips has programed in.  

       You can  read about it here: https://www.apneaboard.com/wiki/index.ph..._Breathing

    So in order to show you have tried all that the DreamStation can offer, you will need to use A-Flex 3, but in order to keep your pressure up to the support level to maintain your air way open, you would need to set pressure min to at least 11, possibly 12 cmH2O. 

    Then you could tell the Sleep Tech who is conducting the study, that you have tried all that the DreamStation can offer. You want a ResMed AirCurve 10 Vauto or better if you have additional specialized needs. 

    I used to be a Philips die-hard fan. Since I shifted over to the ResMed last year, there is no going back. The algorithms of ResMed are more aggressive than Philips, the ResMed AirCurve 10 Vauto has more Modes of operation, more special features for timing and tuning the therapy to your specific needs.

      I find as I go through allergy season, or catch a respiratory infection whether it is a head cold, chest cold or flu. I can adjust my ResMed AirCurve 10 Vauto to meet my needs. Then I can resort to my normal needed therapy after I recover.

       I have found as I age I need to change eyeglass prescription and my PAP therapy needs change also. It is part of ageing. The ResMed has plenty of room for my future needs.

      So between now and Monday you need to practice sleeping on your back, snoring, gasping, snorting and going quite as you slip into OA or UA ... Let them know how bad it really is, so you qualify for the machine you need. 

     Post back, I will be here to give what support I can.

   



...

[UnicornRider]

Here is another thread I would like you to read before Monday.

https://www.apneaboard.com/forums/Thread...to-Bilevel

I think there is some valuable information to be gained.

[IndigoLioness]

Thank you for all the information! I had done a lot of research on UARS and was aware that a resmed bilevel would be better but was unable to find one that I could afford. That will be something for the future, as my income is from disability. In the mean time I got this one for less than $200 with only 1250 hours on it, knowing that it might not be perfect but better than just my oxygen machine trying to blow a tiny stream of oxygen past all the events.

I took your advice and last night changed the min to 11, A-Flex 3. I did however forget to fill the humidifier, oops. I woke up a few times in the later half of the night with my mouth open, which is NOT ever a normal thing for me. Do you think that accounts for the leaks? I can fix that if it is. I fixed the headgear issue so I can't think of what else it could be.

As for how I feel today... I happy cried. My mornings are usually take morning meds, crawl out of bed and have several hours of groggy/low energy and pain. Today I got up, did my morning chores, got coffee and felt great. Then I looked at my meds and realized I hadn't taken them yet and felt fantastic. Over 7 hours later and I still feel amazing compared to my normal for so many years.

Here are the charts for last night. Do you think 11 is good or should I go to 12 tonight and tape my mouth shut?