Newbie's charts

[ally1114]

Hello,

I am 51 days into using my Airsense 10 for her with the N30i mask.  

A little bit of background: I am a mom of two children and for the last 5 years have blamed all symptoms (tiredness, brain fog, grumpiness, etc.) on being a new mom.  However, I also snore terribly and have woken up gasping for breath.  I told my primary doctor and completed an at home sleep test - the kind with just a pulse oximeter on your finger.  It showed an AHI of 29.  I am probably 10 lbs overweight and have Hypothyroidsm for which I take medication.

I received my equipment from my DME and have been using it diligently since (apps. 51 days ago).  I have an upcoming appointment with my doctor for follow up in a few weeks.  Overall, I do feel better - I no longer snore (which my husband loves) and I feel overall better.  However, I am still waking up frequently, whether it is to pull off the mask, adjust it etc.  I have noticed the next morning that when I am pulling off the mask or waking up with tons of anxiety in the middle of the night, it is usually after an apnea event - for example last night at 2:15 am.  I still don't feel like I am getting much more "deep" sleep and I am still not dreaming - which I haven't done in years.  

Basically, I am looking for any insights that I might be able to bring to my appointment with my primary doctor.  Should I insist on a sleep doctor? I feel a little in the dark and the only thing that has educated me at all is this group, the reddit group pointing me here and obviously OSCAR.  Thank you all for everything I have read thus far!  Thanks in advance for any help given.  Also, if I didn't follow any of the rules please let me know - I tried to read through all of the requirements.

Thank you!

[staceyburke]

You have a lot of centrals. We need to see your sleep study to see how many you had during the study.  The machine you have does not treat central but you may be able to lessen them. 

I would try a strait Cpap instead of autoset. These are the settings I would try for a night. 

Min8
Max8
EPR0

That will make the machine run at 8 all of the night. I hope you will try it and post tomorrow along with your sleep study (black out all personal info).

[staceyburke]

I reread your post and I understand you did not have a real sleep study. I think that is what you need to get the Dr to order. You have to find out the severity of your centrals. Many times they happen to start with pap therapy but if they are pre therapy they will need to get you a different machine that is made to stop the centrals. 

Even so, give the settings I gave you a night to see how you do.

[SarcasticDave94]

Welcome to Apnea Board,

A few suggestions on the therapy settings, note that the 4-20 is a default not in any way specific to you. You will get much better therapy by specific settings. This Doc didn't do you much favor here.

Most times a sleep doctor will actually be worse as they're typically doctors of other specialties and this sleep doctor work is a "2nd job". You primary doc might be a better choice, in most cases anyway.

Look here for your ResMed AirSense 10 AutoSet For Her setup manual.

https://www.apneaboard.com/adjust-cpap-p...tup-manual

You'll need to access the PAP Clinical Menu by pushing and holding both the Home button and the Dial in for about 5 seconds. You'll enter the setup menu to adjust your settings. I fully encourage you to do this ASAP. You will not break the PAP or upset insurance.

Upon accessing the menu, you should edit pressure from 4-20 to 7-15 for now. I would also suggest to turn off Ramp.

EPR is set to 3, this is Exhale Pressure Relief and makes it easier to exhale. But you default 4 pressure Min cancels EPR effectiveness because any PAP can only drop to 4, this is why you need to edit pressure Min to 7 so EPR will actually work.

Get OSCAR, a free report tool for PAP therapy. You'll download that to your PC, create data charts, and you can attach them to posts. It helps us see how therapy is working.

Go through these corrective measures and it'll start improving how much better it will treat you.

Keep asking questions and we'll answer them.

[unidee]

It may take a few months before you really feel rested if you have had sleeping apnea long time before starting treatment. Not for one or two nights.

[Gideon]

Welcome to the forum.
Your charts, shrink the leak and pressure charts and include the Flow Limit chart NEXT time. Flow Limits are a pressure driver on ResMed so they are important. Your Flow Limits do not appear to be a problem.

Central Apnea, your second screenshot with its central events approaching 5 is higher than I, or anyone else here, likes it is likely the result of the consistent aspect of central apnea, that is that CA events are consistently inconsistent, that is they jump all over the place. This is why Stacey is suggesting the Fixed at 8 pressure, to manage your central.

Your Settings are 4-20, the Min and Max value your machine is capable of. I suspect this is because your doctor (falsely) believes that this is an auto machine and thus will automatically find and settle on your optimum pressure, it will not. Additionally, your EPR is set to 3 which doesn't work well with machine minimums. EPR is not just a comfort feature as I'm sure your doctor believes, but an effective therapeutic tool capable of delivering excellent treatment for hypopneas, flow limits, RERAs, and UARS, but it needs room to work. Setting min pressure to 4 + EPR, 7 in your case, accomplishes this.

Pulling off your mask, anxiety, feeling "air-starved" or breathing through a straw are all symptoms that you need your min pressure increased. Another reason to boost it to 7, it may need to go higher.

[ally1114]

Hello,
Thank you for all of your suggestions.  Based on the feedback I followed the suggestions of changing min pressure to 7, max pressure to 15, and turned off ramp.  I have done this change for 3 days and am attaching my charts for those three days.  I was also suggested in this thread to do min - 8, max 8 and EPR 0 and can try that as well.  I have noticed I adjust the nose mask on and off throughout the night.  Are the central apneas "real" or is it me just adjusting the mask? I don't really understand how it understands when apneas happen.  Please consider my updated charts with my new APAP configurations.  

Thank you!

[ally1114]

I am also attaching my at home sleep study - which was a pulse oximeter test only.

[SarcasticDave94]

The Central Apnea are real, but do realize these CA can be various flavors.

I'm not saying which of these you have, but helping to define the flavors.

First is the most common CA.
Treatment emergent CA are due to using a PAP which increases CO2 content bring flushed out. This is due to a PAP making your breathing more efficient, and more than prior and the body has adjusted to the less efficient Apnea breathing before. Now things are closer to normal, and your breath controls are needing to catch up.

Second is the pre-existing condition Central Apnea. To diagnose this, either a lab diagnostic sleep study or an at home version with effort belt is required.
This type of Central will show on the diagnostic data before the PAP and mask are introduced. This type CA can be for a lot of various medical reasons. We can't say you have this type as that type test was not done. You may need to have this though.

OK a suggestion on new current actions, edit your pressures to straight 7 or 8, means both Min and Max are identical. I would also lower your EPR to either 1 or maybe off for now. Ramp pressure to add comfort but to minimize CA effects, set Ramp to 1 below your normal straight pressure above and minimize time to 10-15 minutes.