Thoughts after less than a week, and questions

[SkySleep]

I found this forum while searching around for CPAP information, and I found it somewhat intimidating, with all that discussion of pressure settings, OSCAR analyses, followups with physicians, and so on.

Oddly, or maybe not (how would I know?), after less than a week with my machine, none of that stuff seems to apply to me. Perhaps readers here will be interested in my very different perspective. If not, sorry for wasting your time.

My problem was very heavy snoring, much worse in the past few months (but always bad), to the point where my partner and I were thinking we could never vacation together, as separate rooms would be prohibitively expensive.

We guessed that sleep apnea might be the root of my problem, so I contacted a local sleep center and got an initial virtual appointment for two months hence. Way too close to a European river cruise we'd already booked, so that probably wasn't going to work.

Instead, I went to a website that offers an at-home sleep study for $189 (not on the Supplier List) and they sent me a WatchPAT One. I put it on that night and within a day they reported that I had severe sleep apnea (AHI 42.1). I took this as great news because (1) maybe sleep apnea really was the cause of my snoring, and (2) I could get a prescription for a CPAP machine.

While I had been waking up one or two times a night, I really wasn't suffering from poor sleep. Good energy, alert, and not especially tired until bedtime, which was usually about 11 - 11:30 PM. (I'm 76.) My deal was snoring, not fatigue.

I went ahead and ordered some equipment, not even delaying long enough to contact my insurance provider.

So, my AirSense 11 and a full-face mask arrived (ResMed F20) and I tried the machine out. Unfortunately, in my haste I had ordered a too-small mask, so it didn't fit comfortably and I had a lot of trouble going to sleep with it. Probably any mask would have kept me up, since this was all new. Not a good night of sleep at all.

But, the SnoreLab app reported no snoring! Success! Problem solved.

(It is possible that this online site is completely bogus that that my sleep study is a total fabrication, although the people there seem very professional and the extensive sleep study looked real enough. But none of that actually matters, since the machine and the mask are genuine and they work.)

If I could get a good night's sleep and maybe deal with my sleep apnea (dangerous!) things would be even better, but I was happy because this huge problem had been magically solved.

But now some experimentation was in order. Instead of getting a properly-sized F20, I got a P30i because based on what I had read, pillows were likely to be much more comfortable. What I didn't know was whether I was a mouth breather and whether pillows would also arrest my snoring.

They did! And, indeed, the mask was very comfortable.

Now I've slept with the machine for exactly 6 nights (4 with the P30i) and am rapidly getting used to the mask. And, sleeping better, too. (Still no snoring.)

I don't feel any different during the day, but that doesn't bother me because I didn't feel bad even with untreated sleep apnea.

Here are some words of advice based on less that a week of experience:

1. If you can swing it, get a highly automated machine like the AirSense 11. I don't have to mess around with pressure. The machine apparently figures out what's needed on the fly. I turned off ramping because I like the initial flow of fresh air into my nostrils.

2. I don't know how a person like me is supposed to find the right mask, since for me each experiment costs around $90 - $150. I have no actual sleep doctor (just that website) and no clinic to go to to try stuff out and maybe provide me with something to try at home. Maybe others have this; if so, it sounds like a good idea.

3. A very nice thing about the P30i is that it comes with small, medium, and large pillows, so you can find out which one is best. Actually, while I use the medium, I think the small and large would also work, so I plan to use them when my medium needs replacing, since I already have them.

4. For about $30 you can get an N30i cradle cushion that will fit onto your P30i, so that particular experiment will only cost me that much. It comes on Tuesday.

5. The air flow around my head might be noisy, but I'm very hard of hearing, so I hear nothing.

I wonder how common my situation is. Do people here usually try the do-it-yourself route, with no physician or sleep clinic involved? I read an opinion piece where the writer thought that the hassle of arranging for a sleep study was causing sleep apnea to go mostly untreated, and that people should just try an automated machine (available over-the-counter in this writer's imagination) which essentially does a sleep study in real time. I totally understand this point of view.

And, a more important question: Is there some unforeseen (by me) problem I'm setting myself up for by being ignorantly self-guided? Now that my snoring is gone and my sleep is probably better, should I still spend lots of money by going to a seep doctor?

Is there any reason why I should put an SD card into my AirSense 11 so I can start to peruse OSCAR reports like so many others here? Or, should I just treat it like a magic box that needs watering?

[Deborah K.]

 

You would definitely do better using Oscar.  Folks here can give you lots of advice to make your sleep the best it can be.  Even if you are comfortable now, you might be able to feel and sleep even better.  I found help months after I had started, and found that with the help offered here, I felt better and better.  

[SarcasticDave94]

Personally I don't recommend operating equipment without being able to monitor what it's doing. You don't have to be super involved, just enough to tune the machine a bit. Your situation seems well enough that you'll not need to spend weeks or months looking at charts and changing the settings.

Welcome to Apnea Board

[HalfAsleep]

From my experience with ApneaBoard, the general crowd in the universe of CPAP users (especially failed CPAP users; my DME says 30% return their machines) believes that xPAP is plug and play. Unfortunately, DME's and hospital sleep departments reinforce that notion. I guess it keeps them in business.

Most people who get help here are past that assumption and know there's something off.

And sleep is a very individual thing. There's no one who can really tell you how to sleep, what sleep is, or exactly what sleep you should be striving for, or what sleep feels like. All of that info is statistical, not individual. So, it's up to the individual to get their sleep the best it can be.

But I also believe there can be assistance in this. Three levels of assistance. 1. Help with dialing in data, so it matches your individual sleep profile for the night. 2. Experiential assistance with the "softer" aspects, e.g. masks. 3. Supportive assistance with the experience of adjusting to xPAP.

1 and 2 on this board are facilitated by the use of Oscar. Charts are evaluated via data and for "softer" issues like positional apnea. This is how the apparatus is "finessed" to optimize the sleeping experience for the individual. Guidance is provided if it looks like positional apnea is a factor or the mask is leaking.

#3 is community experience and understanding.
*****

Since you've experienced the effect of good sleep before xPAP treatment, as well as after, without looking at data like that on Oscar charts, you'd have no way to know whether your apnea is being treated. You also have no way to know if your mask leaks. The happy face report on the Resmed units is almost adorational with its happiness when it comes to leaks; they can substantially affect your therapy, and the smiley face beams away. It's also very encouraging when it comes to AHI. <5 is a compliance figure. After reading a few charts from various posters, I believe you'll find it doesn't come close to aspirational.
In other words, you don't know what you don't know, and the recording device in the xPAP is the best way to find out what you're missing. That's what Oscar reads.

****
FWIW neither Oscar nor your unit will be accurate in reporting snores, simply because they don't have ears. They can, though, record apnea, which might just save your life.
I've never looked into the SnoreLab app, but unless the app has ears, how can it pick up your sleep sounds at all accurately? It seems very unlikely that an app can do that. On a phone? How does it tell the difference between snoring and yelling at your dog to get off your feet? Or smacking your face or night partner? And how will you know the conditions under which you snore? When you turn over? When your neck is kinked? These are conditions that are impossible to guess at: they are extrapolated from data charts.
Though your personal goal might be to eliminate your snoring, the more important goal might be to survive the night. Easiest way to analyze that is Oscar.
But you may not wish to do that: it's YOUR sleep.

I'm personally aware that your unit can't pick up snoring. Mine says I snore all night every night. I'm a veritable snore machine. But, in fact, I'm not a snorer. But the machine also doesn't have ears, as is obvious. It must be recording from vibrations, and perhaps not yelling at my dog in every sleeping moment (humorously, it might even pick up my dog's snoring in error if it had ears), but the vibration in a nostril divider in my mask or a minor leak. Oscar also leads me to that conclusion, when I look closely. To all intents and purposes, though, my biPAP fully believes I'm an all-night snorer, with every breath, at some points.

[brokensleep57]

I don't know how common your experience is, but it sounds like you got accustomed to CPAP pretty quickly which is good.  

I didn't have your foresight to think on my own I had sleep apnea. I snored and thought nothing of it.  Truthfully, I had no real awareness of sleep apnea or CPAP. It was a doctor (ENT) who I sought out for benign positional vertigo issues who examined me and said, on the first visit, "I think you have sleep apnea."  I was like what's that?     She explained it to me, but I brushed it off at first since I felt ok and wasn't tired. It was only because of her harping on me did I finally agree to see a specialist and get tested.  

She was correct of course.  It's a good thing I listened to her because my vertigo issues have dramatically improved since beginning treatment. I still get them at times, but nowhere near as often as I used to.  Also, my blood pressure/resting pulse have dropped to normal levels since being on CPAP.  Sleep apnea can do much more to your body than just feeling tired.  

I don't think I would treat myself for sleep apnea or any other medical condition; however I understand that it isn't easy, depending on where you live, to find a good sleep doctor and receive good treatment.  So, folks decide to go it alone.   I got lucky with a decent doctor.     

Even with a pretty good sleep doctor, forums like this one and OSCAR has been helpful in tweaking my treatment to be as optimal as possible.

[HalfAsleep]

Personally, though I adapted to xPAP well, it took long term finesse to approximate the right course of action. We are still in medias res.

[SkySleep]

[quote pid='521558' dateline='1720316990']

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I've never looked into the SnoreLab app, but unless the app has ears, how can it pick up your sleep sounds at all accurately?

About SnoreLab: It shows an audio histogram of the night, with an indication of volume. (The phone has a microphone.) You can easily distinguish the background noise of the CPAP machine. You can't tell from looking at an irregular pattern whether it's snoring or something else, but you can touch on a point and hear the recording, and that is a true indication. Also, if your snoring was historically so loud as to wake and keep awake your sleeping partner, you can ask them in the morning how it went.

Surely you are right about not knowing about sleep apnea without further analysis (I put an SD card in my machine for tonight), but there is no question about the machine's positive effect on my snoring.

As you say, SnoreLab provides no insight as to cause. It only records the effect.

I look forward to seeing the OSCAR report in the morning and perhaps posting it here to find out what the experts think. (From some of the replies, it seems that people are assuming I'm somehow opposed to OSCAR. That isn't the case at all... I was only asking a question.)
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[PeaceLoveAndPizza]

Beware the illusion of knowledge.

You are in the honeymoon phase. When reality settles in folks will be here to help.

[joeblough]

question for the experts though, is the AirSense 11 really fully automatic? i assume it has some pre-set pressure range that OP doesn't know about...

as for the skepticism about snorelab, etc... well, your phone does have ears in the form of several microphones. and these apps automatically record sounds above some threshold and then use a variety of methods to classify them. the one i use (pillow) saves the recordings so you can go back and listen in case the automatic classifications are wrong. but it is mostly right in my experience. computers are nowadays very powerful in data analysis especially with all the machine learning stuff over the last 5 years.

[Crimson Nape]

. . . the AirSense 11 . . . i assume it has some pre-set pressure range that OP doesn't know about...

Would you care to elaborate further on your assumption? The absolute pressure range is 4 to 20 cm. It can be only programmed to any value within that range. The only time that it will increase in pressure, assuming it is not in the static CPAP mode, it when it detects flow limitation (i.e.: breathing restriction).
- Red