Please Help Me With My Settings.

[shallbreathe]

Thank you so much for your input, everyone. Really appreciated for this newbie who is still completely in the dark about the apnea universe. Places like this where people provide their knowledge and experience have been a major solace during this time...my obstructive apnea really appeared quite suddenly about a month ago and I've been through a month of sheer hell (I'm sure it was progressivng over the course of this year as I kept waking up repeatedly, but it just accelerated only this summer). Those nights at 3am feel so desperate and endless. I really feel for people having been through this for years...it's been the most nightmarish month of my life. Strangely, my "obvious" blocking apnea seems to have gone (even without the CPAP) and this weirdly more subtle central (or transition) seems to have taken its place. Of course I have no idea what it is actually happening behind the scenes, that's just what it feels like right now. Still waiting on a full-face mask, and once I get that I'll post my data for OSCAR.

Incidentally, I do have a question about swapping machines. I have no insurance so just went straight to LOFTA, got the home study and they sent me the CPAP machine. What will it take to get an APAP (or even Bipap) if those would be an improvement? Do I have to do another home study for them to prescribe it? Or do I just stick with this Resmed 11 for another 2 months or so? Can I just flat out ask for the APAP (which of course I understand I'm paying more for.) Not sure what the process is. I did purchase the Lofta care subscription so I can return the machine and keep exchanging masks.

[SarcasticDave94]

You should have APAP, also known an Auto CPAP, now. What settings like pressure are you seeing in the display?

By the way, with an SD card in the slot on the left side, you can pull out detailed sleep data that goes into the free report tool OSCAR. Look at the top of the page for a link, again it's free and a safe program. Lots here use this to see how their therapy is going. That SD needs in before sleeping to capture info. OSCAR goes on your computer.

If you had to pay for your current machine, you might attempt a trade in, or return to Lofta. Take a look at some of our vendors in the list. Also there's DotMed to view what they've got available.

If you'd need to move up to the bilevel ResMed AirCurve 10 VAuto, you can buy used.

And supposing you need to get that VAuto, ask your Primary Care doctor about a script naming VAuto and you supplies too. And assuming you're self paying, then it shouldn't be too big an issue.

[Sterling147]

I used to use a CPAP successfully when lived in New York, at sea level. I moved to high altitudes in Mexico, and had an extremely high number of events. Thanks to a number of people on this board and my doctor, I graduated to an ASV, which has solved my problem. For me, altitude is the difference. I only need a CPAP at sea level, but need an ASV at high altitudes.  Regarding cardiac issues, I believe that you cannot use an ASV if you have congenital heart failure. I have had Afibs, and a heart attack and use an ASV. Both my cardiologist and sleep doctor know about my cardio history, and that I use an ASV, and have no problem with it.

[shallbreathe]

Can someone please help me interpret this? My original AHI was around 48 with some central apnea (home test from a few weeks back).

I've been struggling with sleeping for the past 2 months. Got the CPAP 2-3 weeks ago. Without CPAP: I sleep 2-3 blocks, maybe 4 hours total a night. With CPAP: I can barely go beyond a few minutes before I jerk awake after falling asleep. Maybe half an hour to an hour at most. I end up taking it off. Still trying to get used to it.

I finally sat in front of the TV in bed and just waited until I drifted off with the mask on for an OSCAR report.

This graph shows maybe 30 or so minutes of me sleeping...and this typically is what happens when I have the mask on.

I woke up with my mouth open and a bunch of air whooshing in. I'm waiting on a full face mask (currently using nose pillows.)

I am having a hard time breathing against the pressure so I have the EPR turned on.

I'm not sure what I'm looking at. The CAs all over the graph says "clear airway" but I thought it meant central apnea? I appreciate your intrepretation and suggestions. Obviously the current settings are not working for me? Do I need another machine?

   

   

(Edit: whoops, tried to format everything according to Wiki rules and rettached the data)

[Deborah K.]

Can you post a redacted copy of your sleep study? If there are not too many CAs then your CAs are treatment-emergent and will lessen on their own as time passes. If there are a large number of them, then you may need different therapy. If you don't have a copy ask your doctor's office for one. By law, they have to provide it if you request it.

[shallbreathe]

Thank you very much Deborah! The original report was:

Obstructive Sleep Apnea (G47.33) - Severe based on pAHI=46.8 and O2 nadir of 79%
Central Sleep Apnea (G47.31) - Mild based on pAHIc=9.9

What is interesting is that shortly after the sleep study, before I even got the CPAP I found myself not waking up from choking at all. At least the "obvious" signs of choking went away. Not sure what I was doing differently other than doing numerous tongue exercises. This seemed like it was replaced by a ton of transitional apnea, where everytime I would start falling asleep, I'd feel myself stop breathing and jerk awake. Again, this is without the machine even. I wonder what a new sleep study would show.

O2 Saturation Min 79
O2 Saturation Mean 92
O2 Saturation Max 98
Oxygen Saturation      < 90%      < 88%      < 85%       < 80%      < 70%
Your Sleep Minutes       14.8           4.2           0.1              0.0 0         .0
Oxygen Desaturation             4-9%           10-20%           > 20%
Your Number of Events           243                7                     0



I'm very new to the CPAP world, but to me that seems like a shockingly large number of central apnea events. What concerns me is that I'm also experiencing this without the CPAP machine on...just got an oximeter today so perhaps I'll be able to confirm this somehow.

If anybody has some recommendations for me on pressure or changes I can make, please let me know. I'm going to try taping my mouth a bit to see if this helps. I also don't know what all those CAs on my report actually mean in terms of what my body is doing. Is my breathing just stopping each time?

Like a lot of people here I am absolutely exhausted and struggling daily. I appreciate all of your input so much, especially since it's the weekend and won't be talking to the sleep therapist until Monday.

[Deborah K.]

It will help us help you if you download Oscar, our free apnea reporting program that provides great charts to help us help one another.  We need to have visual data to offer our best help.

[SarcasticDave94]

You have a moderate tendency to have Central Apnea before CPAP therapy, in part as I recall due to higher altitude. You might not get approval for ASV, but maybe get the doctor to switch you to ResMed AirCurve 10 VAuto.

Second option is supplemental oxygen.

[shallbreathe]

So after the upteenth night of struggling with CPAP, I did get a little less than hour of "sleep". Not sure what I'm looking at on this graph, and would appreciate any interpretation.

What happened throughout the night:

* I was using nasal pillows and mouth tape (small hole in the middle just in case).
* I spent hours fiddling around with different settings. So everything from about 12:00 am to about 2:07am was me trying different settings and just breathing in and out while I read a book.
* Finally fell asleep without jerking awake around 2:07am with pressure settings that seemed like they worked. I did have to use RAMP to fall asleep.
* Woke up in little less than an hour. My mouth was INCREDIBLY dry and uncomfortable, maybe I had been exhaling through the hole in the mouth tape, not sure.
* I don't have any oxygen data, but my oximeter should arrive in a few days.

   

Questions:

1. Was I actually sleeping until I woke up? Is that what that dense narrow black pattern past 2:25 signfies? (or is it more like I'm barely breathing?! It looks like my flow rate is under 17...whatever that means but it seems quite small.)
2. Was the leak towards the end why I ended waking up? Could I leak occur because I was opening my mouth and air was getting through the tape?
3. Do you have recommendations going forward? This might be the first stretch of sleep on CPAP I've had that wasn't littered with Central Apnea events.

Grateful for your help.

[shallbreathe]

Also, if anybody knows...not sure what happened at the tail end of this session. Something caused me to wake up, and these were the last few seconds (close up.) Why would the flow rate go higher here right before I was jolted awake? Appreciate any insight.