No titration until June. Need help dialing in.

[Aeolus]

Hi All - here's my story. Let me know what you think! Thanks!

I am a lifelong snorer, and I've been told I "stop breathing when you sleep" in the past. I even went into a specialist 15 years ago, but because I didn't demonstrate fatigue and other indications, he said it probably wasn't anything to worry about. Skip to last year, and I'm starting to drag like ALL the time, and my wife (who says she isn't bothered by the snoring) says "no seriously you need to get checked out - it's scaring me." I started trying to make appointments towards the end of January, and ended up taking a home sleep study. 

Let's skip to the sleep study. Holy cow. AHI 84, ODI 95, Low Sa02 58%. 
58%. I must have been unknowingly strangling myself every night for years. 

Ahh well. Onward and upward. Having pre-educated myself, I knew this was pretty bad, but the PA going over my report with me impressed upon me just how bad it was. Immediate prescription for APAP, 5-20, titrate when possible, may need high pressure and/ or Bi-Level PAP due to severity down the road. I have Cigna/ Carecentrix/ Apria, so instead of going across the hall and picking up the machine, I have to massage the bureaucracy. I had thoughts about buying my own machine, having heard some of the long drawn out stories on this board, but fortunately I had a machine through insurance 5 days after my prescription. I had gird my loins for battle when I went in to Apria, but apart from reminding them that the prescription included a heated tube it was a super easy appointment with them. The scrip included FFM, so that's what I got. Apria didn't even ask for a credit card!

My first night wasn't bad, but the pressure was distracting. I woke up with my face farting, so recalling to mind the holy writ laid down in the Mask primer, I readjusted and was able to sleep through the night. I've used CPAP every one of the last seven nights. No miraculous moments, but the monkey on my back feels a little lighter. The AHI numbers look pretty good, but my sleep doesn't feel as restful as I would like. It feels like the pressure differentials keep waking me up. 

I only have sleepyhead graphs for the last four days because I didn't realize my machine didn't come with an SD card. 

Some info about me: 42, 6 feet tall, way overweight. 450mg Wellbutrin, 40mg Adderall. I have the Resmed P10s on order. I didn't bother going through the DME since they were only $55 online. 

Let me know if the graphs are OK. Looks like the flow limits got cut off a little bit. Is it preferred to show as pics, or as a link?

[Hydrangea]

Good for you! You're doing it well!!!! You got a machine, and you're having at it. Fantastic!!!!!

You'll get great info and feedback here. (I'm not an expert in that area, so I'll leave that feedback for others.)

And at this point - upon receiving an auto machine, and using it - I don't comprehend why you would even continue with a titration sleep study. I mean, IMHO, your data from your machine should give the dr what he/she needs.

[Aeolus]

Thanks Hydrangea! I haven't heard a peep from insurance or doctor since I got my machine, so that may be what ends up happening. Then again it could be that insurance preapproval is just slow.

[chill]

Welcome!  That first specialist 15 years ago was a real keeper.   I had a similar experience that I am still a bit bitter about.

I'd start by increasing your minimum from 5 to 13 or 15.  You seem to be tolerating that pressure most of the time anyway and that should be the machine a better idea about where to keep the pressure.  Your pressure is pretty high, so I would not be surprised to see a BiPAP in your future.  You might find that more comfortable.

An AHI of 3-5 is not likely going to leave you feeling rested. For me < 2, preferably less than 1 is best.  But it does take time to adjust to the therapy and start feeling better.  Give yourself time.  Think of the damage you have to undo.  You seem to have a great attitude towards this which is most of the battle.  Or is that finding the right mask?  This could be a long debate.

[ajack]

as chill said, I'd raise my minimum to around 13 or 15 minimum, if that was my chart too, I'm running 15min-20max

[Gideon]

I am a little more conservative in my suggested adjustments, I like to take it in steps, so I'm not as aggressive as those above me are, and I could easily end up at those levels.

First, in THIS case, because you don't have significant CA events you do not need a sleep study.  What you have done is demonstrate that you need xPAP treatment.  
Your min pressure would be set at your Med Pressure (11) if I had no other data.  On the more conservative side your charts show considerable time at just over 9 cm, thus you could change your min to 9 without changing your treatment at all.  Your last 2 nights say 14 for a med pressure.  I would set my min to 11 for tonight and see what happens for a few nights and use 9 as a fall back value.  

Keep in mind that the medical community says that you are treated (AHI < 5)

Your EPR is set at 2cm, this means that your exhale pressure is set to drop to 2 cm below the current inhale pressure.  This is considered a "comfort" setting.  I'll suggest that you try setting it at 3 cm but not untill you see the impact of raising your min pressure


FYI per titration protocol consistent pressures over 15 indicate a consideration for BiPAP.

[Aeolus]

Your EPR is set at 2cm, this means that your exhale pressure is set to drop to 2 cm below the current inhale pressure.  This is considered a "comfort" setting.  I'll suggest that you try setting it at 3 cm but not untill you see the impact of raising your min pressure

I did forget to mention that after a few days I "hacked" in and changed my EPR to 2 because it was feeling like a lot of effort to breathe when I woke up at higher pressures. 

As for pressures, I'll start cranking up the minimum, and I'll be back in a week. Thanks to all who commented!

[Sleeprider]

I'm with Fred on this one. The Resmed machine is pretty responsive, so a minimum pressure of 10 - 11 will put you in the range necessary to prevent the obstructive events. Considering your machine is not optimized at all, you're getting pretty darn good treatment. Your EPR at 2 seems to be working fine, and you are not showing any centrals, so if you need more exhale pressure relief, you still can move to a setting of 3. Your leak rate is excellent, and well done on starting off on therapy so strongly!

[Aeolus]

Thanks for the feedback everybody. Here's another week down. I've switched to the P10 nasal pillows. I think I'm tolerating them pretty well, but I keep waking up and having to adjust the headgear. Seems better than the FFM even through my nostrils are getting a little sore (have been using lanolin last 4 days), but I'm not sure the graphs tell the same tale. Any thoughts? Looks like I can bump up the minimum a little more maybe...

      

[ajack]

I just kept increasing the minimum pressure till the OA/H were under control. I still think chill first suggestion is going to be around the pressure you finish up at. If it was my chart. I'd have the minimum 13 and leave max on 20 for a week and see if the OA come down enough.