New to APAP - 50 days in

[Steve.G]

You're not comfortable and not sleeping well. You have persistent flow limitation which is that flattened top on the close-up flow rate graph. Your machine doesn't know if you're coming or going (inhaling or exhaling), so your respiration is chaotic. That is why it persistently reports your expiration time is shorter (1.5 seconds) than your inspiration (2.44 seconds) time. A typical respiration cycle for you is a good start to inspiration as flow rises from the zero-line but then flow flattens out and even acquires a downard slowing flow rate like we see at 04:35;35. This breath cycles out to exhale and quickly shows zero flow (flat across the zero line) or in some cases a brief blip above zero, but not inspiration. This is your machine quitting on exhale relief (Flex) and as you can see, you don't respond well to it.  These persistent reductions in flow represent increased respiratory effort and potential arousals.  In this segment we see a near-hypopnea from flow limitation from 04:35:10 until 04:35:50. It is not flagged because the flow reduction is not more than 50% less than the preceding period, however it's disruptive, and we see a snore.

Four minutes later at 04:40:50,  your next segment has chaotic breathing suggesting an arousal occurred.  Breathing here is about 27 BPM and is not typical of a normal sleep cycle and is irregular. At 04:41:50 your breathing tails off close to apnea range, followed by recovery breathing with higher volumes and flow rate, before becoming much slower at 15 BPM.

So why Airsense 10?  Next post.

Well, the VA got back to me today and I asked explained what is happening. I was asked to check some numbers and their diagnosis was that my low end pressure is too high (I'm currently 9-13), and they asked me to drop that to 6-13 and give it a couple days. So for better or worse, they pay for it so I have to try it (laugh)

Steve

Update: I just got home and checked the "90%" pressure that I didn't have available to me while I was on the phone. I assume that with a 90% of 10 changing the bottom from 9 to 6 probably isn't going to do me much good.

[Sleeprider]

You might as well do as instructed and take the high ground until it is time to say, "I told you so". These guys are mostly accustomed to dealing with plain obstructive apnea and patients that are not engaged in their therapy. Don't be discouraged, but remember that bilevel is only available if you stick with CPAP and fail due to event rate or intolerance. Flow limitations will respond to pressure support, and whether they let you trial a Resmed Autoset or actually go to a full bilevel is just a matter of time an persistence. Your flow limitation is going nowhere with the Philips CPAP.

[Steve.G]

You might as well do as instructed and take the high ground until it is time to say, "I told you so".  These guys are mostly accustomed to dealing with plain obstructive apnea and patients that are not engaged in their therapy.  Don't be discouraged, but remember that bilevel is only available if you stick with CPAP and fail due to event rate or intolerance. Flow limitations will respond to pressure support, and whether they let  you trial a Resmed Autoset or actually go to a full bilevel is just a matter of time an persistence. Your flow limitation is going nowhere with the Philips CPAP.

I went ahead and did what they asked, but I'm also going to call tomorrow and give them the 90% numbers they asked for today while I was at work. The tough part will be clocking the hours for them knowing I'm going to be more tired with it than without. Deliberately causing myself bad sleep runs against my sense of self-preservation. Worse case scenario, I play this game for a couple months and out of pocket a different machine if that's the direction things are still pointing.

[Gideon]

Here is some info about justifying a higher level machine.  I'll have to write one targeting a bi-level so ignore the Central/Complex apnea diagnosis portion and concentrate on symptoms.

http://www.apneaboard.com/wiki/index.php...P_Machines

You have non-restorative Sleep.  What others? 

These are things, indicators, symptoms that doctors look for.  These are reasons for failure at CPAP

Fred

[Steve.G]

Here is some info about justifying a higher level machine.  I'll have to write one targeting a bi-level so ignore the Central/Complex apnea diagnosis portion and concentrate on symptoms.

http://www.apneaboard.com/wiki/index.php...P_Machines

You have non-restorative Sleep.  What others? 

These are things, indicators, symptoms that doctors look for.  These are reasons for failure at CPAP

Fred

My history with sleep issues goes back quite a ways, but to the best of my recollection not as far as a young adult. I'm currently taking medication to go to sleep, without it I wake up a lot. No issues falling asleep, I just can't stay that way. Hypertension, ED, odd weight gains, fatigue that I can force my way though by remaining active (thanks Uncle Sam) but if I physically slow down such as driving my body tries to nod off, morning heachaches, snoring, tinnitus, inconsistent vision, foggy thinking, intermittent short term memory loss, intermittent dull center of the chest aches, the list goes on (My last pulmonary stress test says my heart is fine, btw) Some of it I can attribute to age, but not all. I've been trying to get my VA sleep tech to look at the data from my apap but I've been informed that she doesn't have access to secure email. I have no issues with driving the two hours with my laptop to show her the data IF I can get her to agree to look at it. I have been looking at Craigslist and found a few "gently used" Airsense 10 machines for about $400 if worse comes to worse. I hadn't ever really considered apnea as a possible cause for all this until I started researching, and a sleep study told me it's definitely an issue. On the bright side my sleep tech at the VA has recognized my motivation and willingness to be involved in my own treatment, and seems willing to listen to me. I just need to somehow find a way to get the right data to her.

Thank you for the link!

Steve

[Steve.G]

Here is some info about justifying a higher level machine.  I'll have to write one targeting a bi-level so ignore the Central/Complex apnea diagnosis portion and concentrate on symptoms.

Well, long talk with the VA and it was made clear that the Dreamstation is what they're going to give me, and they don't offer any other options. Since I seem to be getting nowhere with the DS I made the decision to bite the bullet and located an essentially new Airsense at an affordable out of pocket price. If it works for me great, if not I can eBay it for what I'm getting it for. Really have my fingers crossed. I didn't take the plunge and go for a sleep study, only to run into a wall on doing something about it.

Steve

[Steve.G]

You might as well do as instructed and take the high ground until it is time to say, "I told you so".  These guys are mostly accustomed to dealing with plain obstructive apnea and patients that are not engaged in their therapy.  Don't be discouraged, but remember that bilevel is only available if you stick with CPAP and fail due to event rate or intolerance. Flow limitations will respond to pressure support, and whether they let  you trial a Resmed Autoset or actually go to a full bilevel is just a matter of time an persistence. Your flow limitation is going nowhere with the Philips CPAP.

Well, just picked up a ResMed Autoset and found the clinical manual. Now to learn how to drive that bus....

[Sleeprider]

Steve, congrats on getting an Airsense 10. We're going to resolve your hypopnea and RERA right now. Here is the quick-guide to clinical settings: https://www.apneaboard.com/resmed-airsen...setup-info The "bus" is pretty easy to drive. Your current Respironics machine was set to 9-13 pressure range. For the Resmed, we're going to open it up just a bit. Use a pressure range of 9 to 16 with EPR set to On at Full Time and Setting 3.

This should feel very good and will actually start your pressure at 9/6 (IPAP./EPAP). I bet you will see an immediate difference. I'm glad you were able to do this.

Tom

[Sleeprider]

Steve, I'm going to post your last chart here and tell you what to expect with the settings above (a prediction).  Your RERA and hypopnea events will be cut in half. The inspiration/Expiration times that are currently 2.44/1.50 will become 1.5-1.8/2.3-2.8, and tidal volume will go to 500 mL. Those snores are going away for the most part.  OA should be lower, but EPR may slightly increase CA events, but I don't expect it to be a problem. Mostly I hope the change is comfortable. Good luck.

[Steve.G]

Steve, congrats on getting an Airsense 10. We're going to resolve your hypopnea and RERA right now.  Here is the quick-guide to clinical settings: https://www.apneaboard.com/resmed-airsen...setup-info The "bus" is pretty easy to drive.  Your current Respironics machine was set to 9-13 pressure range. For the Resmed, we're going to open it up just a bit.  Use a pressure range of 9 to 16 with EPR set to On at Full Time and Setting 3.

This should feel very good and will actually start your pressure at 9/6 (IPAP./EPAP). I bet you will see an immediate difference.  I'm glad you were able to do this.

Tom

Figured out the clinical menu on the ResMed well enough to be confident it wasn't going to go Chucky on me and kill me in my sleep. The chart from Wednesday is the last Phillips chart, after I had gone back to AFlex and tweaked the settings some. I posted two Thursday charts from the ResMed. One is the overview showing that yes, events have gone down from Wednesday night. The second is a closup. My flow rate (to me) still lacks the consistency I was hoping for but for night one overall the events looks better to my layman's eye. I think I'm going to need to tighten my mask straps a little, the hose from the ResmMed (ClimateLine) seems a bit stiffer than the standard hose from my Phillips and I could feel it shift more.  The ResMed didn't have a mask so I used my Phillips Dreamwear full face. The deal I got was the ResMed itself with about 2800 hours on it (A year and a half?), brand new ClimateLineAir, power supply and bag, for $300. I don't think I got hurt on that deal based on used prices around here. Comfortwise I slept most of the way through the night the first night, where it took me close to two months  before I could do that on the Philips. I'm looking forward to you input on my charts.

Thank you again for your help with this.

Steve