Starting Down the Yellow Brick Road

[Bigstates]

Hello all and thank you for providing this space to document my journey and hopefully get advice and encouragement as the process progresses.

Here is a bit of background. About 10 years ago I was told I had hypertension and needed to start BP medications. This was the diagnosis from fatigue, headaches, sinus and allergy issues, and seeing a trend in rising BP. As the time moved forward, I was checked by a cardiologist and went through numerous tests to be told all was good. Went to an ENT and testing showed that there were no structural abnormalities. Ongoing visits to my PCP with nothing seeming to help.  I also track my sleep with an Apple Watch and a Withing Sleep Mat.

Extreme fatigue, headaches, congestion, and brain fog continued to get worse until about a month ago. I was looking at my sleep data and while I was averaging 8hrs of sleep a night with minimal snoring I started to notice that my restorative sleep was moving lower and lower with almost no deep sleep. The sleep mat also shows breathing disturbances, and they were now at the top of the high chart.

That’s when the light bulb moment arrived. I spoke with my PCP and decided to order an in-home sleep study with a WatchPat device. Oddly enough, the night of my study I slept better than I had in months and the sleep mat showed disturbances just above moderate. The study results came back and are in a screenshot below. The indication was of mild sleep apnea with a pAHI of 6.3 and pRDI of 9.9. I was also given a prescription for an APAP device set at 4-20 cm.
I spoke with my PCP and then an advisor at the company that did the sleep study. I indicated that I was willing to try a machine but that due to my sinus and allergy issues and on the advice of my PCP I would rather try a BiPap machine if it would ultimately work better. I did not want to purchase two machines. My out-of-pocket deductible wouldn’t have been reached either way and I would need to purchase it outright.  They agreed to let me purchase this type of machine.
I ordered a Resmed Aircurve 11 Vauto and two masks (F40 and N30i).

The machine and masks have arrived, and I tried a short stint the first night and then 8 hours last night.  The first night I had over an hour of deep sleep and felt better than I have in a long, long time. Last night wasn’t as good and I struggled off and on all night.

I have just downloaded OSCAR and still need to figure out how to set it up and post screens. I will elaborate in future posts as I am still trying to navigate all of this.

I you have made it this far Thank You! If anyone has advice or suggestions for this or posts in the future, I would greatly appreciate them.

         

[PeaceLoveAndPizza]

Thanks for the thoughtful information and questions. Some comments…

First, put an SD card in your machine to capture the detailed data and read the links in my signature on “Formatting OSCAR charts”. After a few days of data, post some properly formatted charts. Also go to the link above “CPAP Setup Manuals” and find the clinicians manual for your machine. Ask any question you have and folks will be happy to help.

In the meantime, try the following.

Mode VPAPauto
EPAP min 6
IPAP max 15
PS 3
No ramp

That should be enough to get you started. Also watch some YouTube videos from LankyLefty27 on proper sizing and fitting of your masks. That will save you much angst at the beginning.

[Bigstates]

Thank you PeaceLoveAndPizza for the reply and comments.

I have been watching YouTube videos especially from LankyLefty and that was one of the reasons for opting for the F40. It seems to fit fairly well, and the seal seems good, from a Newby’s point of view. That is until I get fidgety. The first night will show not a very good seal as I was trying to figure out how to sleep with a new appendage.  I also purchased a N30I but will wait to try it until I get acclimated.

I had already been lurking on this site for a week or so awaiting my supplies. I requested, received and have started to go through the clinician’s manual. It was sent via email last night.

The machine came with an SD card, and I downloaded OSCAR and uploaded the data to it. I think I have the pages formatted correctly but we shall see.

I will post the first short night and then last night’s data below.

I also wanted to mention that I have been waking up 6 or 7 times a night with a full bladder feeling only to realize that it wasn’t full at all. Also have been waking up more exhausted than when I go to sleep. I sleep on both sides and stomach. Very rarely will I sleep on my back as it is uncomfortable.

I think the machine data will be visible on the screenshots, but the Resmed 11 Vauto came set at
Mode Vauto
Max IPAP 25
Min EPAP 6
PS 4
Ramp at 5 minutes but I already turned it off from the get go

I realize that I should give it some time but figured I should begin to post so I am more comfortable and that the charts are formatted correctly. The first night gave me my first taste of nasty Aerophagia with last night being much better. It does feel that when I am finished inhaling that the machine will continue with the inspiration and puff my cheeks. I normally breath through my nose but speculate that my mouth does open. When my allergies are bad, which is quite often I know I do breathe through my nose and mouth.
 
Should I still make your recommended changes to the machine or give it a few more days?

         

[PeaceLoveAndPizza]

It may be too much PS for you at this point in your therapy. Give the settings I suggested a try and let’s see how it goes. 

The one bit of advice I think may help is to learn to breathe with the machine, not against it. Relax, don’t fight it. Okay, that’s two bits of advice, but you get the point.

[Bigstates]

Thank you!  I will change the settings and give it a go. I am sitting here chuckling, I am trying to focus on breathing with the machine and relaxing. I guess it’s easier said than done but with practice I know I will get it.

I will give a few days and post with how it goes.

[PeaceLoveAndPizza]

Relaxation is key. If you focus on it, you will overcompensate and likely get aerophagia. Try letting your mind wander. Don’t think about the machine, mask, or anything else. Maybe find some good meditation, relaxing music, ASMR, whatever works. Take a breath and count to zen.

[Bigstates]

Thanks, if all else fails I think I will try playing Joe Diffie’s Third Rock from the Sun.

[Bigstates]

Peace Love and Pizza, I made the changes as you suggested above and have two days of results. The pressure support drop and trying to relax have seemed to help tremendously with the issues I described. Thank you!

It is getting easier every day and my restorative sleep, if accurate on my tracking devices, is going up to levels I haven’t seen in a long time. This morning, I actually didn’t have a headache upon waking and my brain fog and moodiness was greatly reduced.

A question I do have is regarding the CA’s. If I am reading my sleep study correctly the were at 7 events per night, the pAHIc event line, correct? My CA’s are making up the majority of events per night and wondering if that is something that is seen when people start treatment and/or if it related to mask leaks?  They seem far more prevalent later in the night and leaks also seem higher during that time.  I am so exhausted when I go to sleep that I don’t think I am moving around much if at all. Later in the night I seem to wake more often and move from one side to another frequently.  At some point I have a N30i mask that I would like to try and ordered mouth tape today but think it might be best to get more acclimated to one mask setup in the begin.

I will attach the last two nights of OSCAR charts for reference and comment and suggestions are welcomed.

       

[PeaceLoveAndPizza]

Glad it was of help. It is a journey to find the best you can do with CPAP too many travel alone. We are only too happy to help as we have buggered it up on ourselves many times, so glad to share what we have learned.

For new users we see quite a few with treatment emergent central apnoea’s and also centrals that come from pressure support being too high. Most are in the former, not latter category.

Let’s see what the trigger settings does regarding the centrals. Note we could also try reducing your pressure support more, but I would like to see how getting a more responsive trigger will help. I also think bumping up TImax a bit will feel better.

So, try the following:

Mode VPAPauto
EPAP min 8
IPAP max 14
PS 3
No ramp
Trigger high
TIMax 2.5s

Depending on how that goes, we can try it with either trigger “very high” or leaving it on high and reducing PS. Let us know after a day or two.

[Bigstates]

Thanks, 

Machine setting changed. Will update in a few days.