Sleep apnea monitors without cPAP

[LVH115]

me: age 63, M, 6'1" 188 lbs, type 2 diabetic, well regulated via diet and metformin.  Arthritis in both shoulders due to old injuries.   
sleep study: indicated an AHI of 30.0 with O2 dropping to 72% 
equipment: resmed airsense 11, have tried four different masks
additional info: active sleeper but cannot sleep for long on side due to numbness developing in fingers, apnea seems worse when sleeping in supine position, have never slept in prone position.

     I was diagnosed with obstructive sleep apnea via in-hospital sleep study in 1999.  I don't recall the actual results, but the sleep specialist explained to me I was waking up many times during the night.  "I suggest," he told me, "that you get more sleep."  That was it - no other recommendations.  (I am not making this up.)  

     Things seemed to get better over the next few years but my wife would tell me I often stopped breathing in my sleep.  Sometimes I would dream I was drowning or being strangled and I would fight to wake up and then found myself gasping.  Was often tired but thought it was due to my busy and active lifestyle - at one point I was participating in 100 km races.

  In 2011 at age 51 I was diagnosed with type 2 diabetes, despite having no family history and having a BMI of 25.  Now, I wonder if sleep apnea was a predisposing cause.

     Last year daytime sleepiness got so bad I had another sleep study done.  (I had fallen asleep in a dentist chair (without sedatives) and at traffic lights.  Study showed AHI of 30 and a SPO2 as low as 72%.  Sleep specialist immediately recommended cPAP - Resmed Airsense 11.  No further diagnostics, no discussion of other therapies - just start it.  Received a unit through a "rent to buy" program from a supplier.  Technical support was non-existent, and so bad that I returned the unit at a loss of several hundred dollars to myself.  I then paid about $1000 out of pocket for the same machine from another supplier.

     I STRUGGLED to use the cPAP for four months.  Just could not get used to it.  Tried four different mask designs from nasal only to mouth and partial nasal to full face.  The experience was so discomforting that around 11 PM or 11:30 PM every night I would get anxious just knowing I was going to have to put it on - and I am not a person prone to anxiety.  Again, technical support was of little benefit.  Example - "You have a large leak.  Fix it."  No suggestions.  They played with ramp and pressure settings, but nothing worked.  Straps caused irritation to my scalp, movement against hair woke me up.  Sometimes there would be episodes where I could not exhale against the pressure and that woke me up.  Leaked despite using several types of masks and getting the message that the seal was good when I checked after putting it on.  Could not fall asleep with the mask on - sometimes lay awake for over an hour.  Would be awakened by sensation of mask.  If I had to get up in the middle of the night, when replacing the mask I found I could not fall asleep again.  Tubing would wake me up when I moved.  Sometimes I would awake to find I had removed the mask during the night, other times the sensation of the mask was so irritating that I would consciously remove it.  Almost never had it on for more than 4 hours.  Numbers did not improve, not surprisingly.  If I slept without it, I thought my sleep quality better but I was still tired.

I am frustrated that for the amount of money spent in this country on healthcare, and the amount my health insurance costs me ($1100 a month for $7000 deductible) the system is such a poor value.  Sleep specialist does not seem to address my concerns, and support has been terrible.  Veterinarians take more time with patients, listen more closely to their clients, provide more information, and answer questions more fully than the pulmonologist and sleep technicians I have been in contact with.  

I have given up on cPAP.  Am not ready to consider Inspire surgery.  I am looking into an oral appliance.  Sometimes, when awake but resting in supine position, I will notice a constriction of my airway, especially if my neck is flexed downward.  If I move my lower jaw forward, I notice an improvement and less resistance to airflow.  I asked my dentist about this and he suggested that before going forward, get a sleep apnea monitor to establish a baseline, then use it afterwards to see if the oral appliance is helping.

So that brings me to my question:  What home sleep monitors have people used?  Are there ones which measure more than just SpO2 and heart rate?  Can any of them determine the AHI?

Also - cervical collar tried, rubbing and irritation often wakes me up - any suggestions for along those lines?

[BoxcarPete]

My best advice to you is to see an ENT who cross-specializes in sleep medicine. Don't forget that OSA is not a disease, it is a syndrome. That means there's no information in your sleep study as to why exactly you stop breathing at night, just that it's happening. An ENT will be able to take a look at the structures of your airway and have a little more of an idea why.

That will guide your next steps if you've given CPAP an honest try and it's not working out for you. It's the first line of treatment for OSA because many people adapt to it pretty well and it resolves the symptoms of the majority of OSA patients. It's not the only option, and neither are inspire or MAD the only alternatives. As my ENT told me, "If you want more space, you can either make the room bigger or make the furniture smaller. I can make the furniture smaller." I'm now recovering from my triple-surgery on my nose, deviated septum, enlarged turbinates, and swollen adenoids were all taking up excessive space in my nasal cavity. It's already easier to breathe, and I'm still spitting up bloody phlegm from the procedure. Your situation is probably different, not everyone can get space back where the adenoids are because they usually shrivel up and go away by age 12, but for me I'm looking forward to restful sleep. Other options are maxillary expansion through orthodontia and surgical procedures as well as a few more, but getting a camera shoved up your nose is the first step on a path to getting the best option for YOUR situation, in my opinion.

[Sleeprider]

Download OSCAR and post a chart. Tutorials are linked in my signature. Sometimes the hacks on this forum find solutions you won't get from someone that makes boat payments out of their advise. Give us a try.

[SarcasticDave94]

Possibly the CPAP isn't set properly. We can help with this, if you download the free OSCAR app that will allow you to see the CPAP data on your computer. That is if your 11 Series CPAP has an SD card slot with SD in it to capture the data.

The SD card can be from any brand, 2-32 GB capacity. You would physically remove the SD card from the CPAP and use your computer SD card reader to import the file into OSCAR. Lastly, you'll post here, comment about the therapy and attach OSCAR screenshots.

From there, we can help best with the data. Your issue and run circumstance from doctors is typical. They've got money from the test.

[PeaceLoveAndPizza]

For the soft cervical collar, take a look at the Caldera Releaf. It is soft and smooth, so it should not irritate your skin, but is still firm enough to keep your neck aligned and help keep your mouth closed.

[Gideon]

Welcome to Apneaboard.

At least Give us a chance..
Post screen shot of your daily charts, we prefer OSCAR as it is easier to read than Rescan.

It is most likely that your settings are incorrect for your apnea.

On your not being able to breathe against the pressure, is it pressure or flow that is causing the issue

An easy practical demonstration of the pressures involved.

Get a tall glass of water and a straw. Now simply with the straw near the bottom, just blow bubbles.

Assuming the straw is 8 inches deep you just exhaled against the maximum pressure your CPAP can produce.

It is possible, though uncommon, that you do have a condition such as palatal prolapse which we can tell by looking at your charts.

There is very little we can do to help you without seeing your detailed data.

[TechieHippie]

I empathize!! But I agree with others that you should keep trying to figure out the CPAP using the advice here, which is extremely helpful. At least you'll know more about what is going on and how to optimize your settings. It's a hassle and almost another job to track, but it's worth it.

That 72% oxygen could be quite worrying. At some point you might consider getting a SleepU (<$150) or CheckMe oxygen monitor. They have a buzzing alarm. For me, I'd rather be woken up than stay asleep without oxygen. More than several minutes under 90% and I'm a mess. I tried restricting sleep positions, mouth tape, tongue suctioning...but finally got a CPAP and it's a big difference.

You might not be tolerating the CPAP because your oxygen gets really low. If the oxygen deprivation is severe your doctor might consider external oxygen going in through the CPAP. My dad had diabetes, COPD and heart failure (probably all sequential to severe apnea), and got much improvement with a BiPap and supplemental oxygen, monitored with the SleepU - I didn't know about Oscar then plus we were monitoring oxygen while awake also.

Lisa

[SarcasticDave94]

I had totally forgot the oxygen issue. That by itself is cause to get something working. Due to me having COPD and a heart condition called PVCs, either of which may diminish my SPO2, I can detect a level of 92% or less fairly accurate.

[TechieHippie]

Regarding sleep position, I find that a very plump pillow behind my back allows me to sleep on my side without falling forward and cutting circulation off to my arm. I also have a  pillow between my knees and a fluffy one in front of me to either wrap my arms around or stuff into places I need support. 

My soft cervical collar arrived today but it's too smelly to use yet, so I've been using a stuffed animal under my chin as someone else had suggested on another thread.

Lisa

[LVH115]

<< Don't forget that OSA is not a disease, it is a syndrome. >>

Exactly.  Which is why I was frustrated when the pulmonologist showed no interest in trying to determine the etiology - just get started with cPAP.

<<Download O and post a chart

Will I have to go back and use the cPAP for a night or two, or can it analyze old data stored in the unit?

<<physically remove the SD card from the CPAP and use your computer SD card reader to import the file into OSCAR.

Sounds like old data might be usable.

<<we can help best with the data. Your issue and run circumstance from doctors is typical.

I have more helpful information from just one post here than four months of dealing with two tech "support" departments and a board certified pulmonologist.

<<There is very little we can do to help you without seeing your detailed data.

Absolutely.  Will get to work on using OSCAR.

<<take a look at the Caldera Releaf.

THANK YOU for the recommendations