[Treatment] Tbrock8905 - Therapy Thread

[Tbrock8905]

Hi all,

I did a sleep study last year as I was told I was snoring every now and then pretty bad. I was feeling a little tired in the afternoon, but not too bad. 

My GP reviewed the results and said they're fine - just to avoid sleeping on my back.
The resmed sleep physician advised for a CPAP first line. (Do they just want business?)

I'm currently 2 weeks into my CPAP trial which has gone.... ok. Feeling worse during the day. I recently got an SD card so will post my OSCAR results here soon. 

I'm not too sure how to interpret the sleep study results properly and my GP and resmed weren't too helpful with this. I have attached my results.

I guess my questions are: should I get a cpap? Is my GP right in saying my results are fine? I don't really know what I am looking at in the graphs. 

Thanks for your help

[Expat31]

Hi, 

Welcome to the board! 

Sleep study 

Your sleep apnea is  categorised at 8.7 as mild. The oxygen desaturation index at 10.3 is just within limits.The desaturation low of 91% does not mean much as now details for how long it lasted - was it just a couple of seconds dip, or longer. No details that I can see from the report are available.

However the doctor's comment on overall of "mild oxygen desaturation" appear reasonable.

The note about supine apnea often quite typical in sledp studios.

Concerning the dental device, this is an option. The only downside I know about is that these devices have a limited adjustment range. The side small braces may need shortening from time to time by a few millimeters so as to pull the chin forwards. Personally after 3 years, the adjustment was maxed out, so went on to CPAP.

As you seem to hava an Airsence11 on test,  and also have downloaded Oscar, it would make sense to  see what the position is currently so as to see what improvements can be made. 

Can you post the following these 6 graphs- Events, Flow Rate, Pressure, Leak Rate, Flow Limitations and Snore 

I have included some explanations of each graph, so quite a lot to browse through when you have some time.

When posting graphs please exclude pie charts and calenders.

EVENTS
This first graph gives us a quick overview of the night's events, and can give us clues, at a glance, where to focus. 
We get a breakdown of the events making up the AHI; obstructive, central and hypopneas, together with leaks, which can really impact the efficiency of the therapy. In addition clustering of events can indicate positional apneas. 

FLOW RATE
This graph shows us the breathing patterns during the night, breath by breath. We see when arousals happen, when we pause breathing, and other disturbances. We can even zoom in to drill down to get greater detail. 

PRESSURE
This obviously shows variation in pressure during the night. Increases in pressure can be caused by the algorithm reacting to a need to open airways due to apnea events. It may also be a reaction to leaks,  or flow limitations (see following graphs below). 
The optimal minimum pressure is or great importance. As a general rule of thumb we recommend an initial minimum pressure of 7 with EPR of 3, but depends on each individual’s needs. 

LEAK RATE
These can be either mask or mouth leaks. These often cause considerable arousals and generally disrupt the therapy. Large leaks are defined for Resmed machines at 24l/m and over. 

FLOW LIMITATIONS 
These are precursors to apnea events, with a narrowing of airways, often accompanied by a resulting pressure increase and an accompanying arousal, and sleep disruption. You will see lots of references in posts to this, and the use of  EPR in the board's Wiki pages.
Ideally the 95% flow limit should be below 0.1.

SNORE 
Just useful to have a look at as has been an issue previously. 

There are of course other graphs that could be useful, the ones above are a good basic starting point.

So just to post your graphs now.. 

[Tbrock8905]

Thanks so much! That's very helpful

I have attached my sleep results from last night. I've been trialling the nasal pillow with not much success - keep waking up for some reason. Maybe due to pain in my nostrils. I will get a larger fit tomorrow to see if that helps.
I changed back to the full face mask around 3am - I seem to tolerate this well.

If anyone could review, help and give guidance that would be great.

I have been waking up feeling not so refreshed and darkness under my eyes. Also getting this constant pressure on the sides of my head. 

Any suggestions on changes? Or is it looking good on paper?

ALso I noticed my PAP mode is: APAP instead of CPAP?

[Deborah K.]

I suggest that you turn off ramp.  It offers virtually no therapy.  Also you would benefit from raising your minimum-pressure setting to 7.  Both of these should contribute to better therapy and comfort.  Apap mode is best for most people as it gives your machine a little leeway in pressure. Best of luck!

[SarcasticDave94]

APAP is the auto CPAP mode also called AutoSet.

To permit EPR 3 to work more fully, consider increasing min pressure to 7.

Note your sleep study indicates 4 Central Apnea, no Obstructive, then 39 Hypopnea. It appears the AutoSet has addressed the Hypopnea but not the Central Apnea. Not surprising as the AutoSet isn't intended to treat CA.

As for whether to treat this with CPAP, I think it depends on how you feel. Do you think you can benefit from CPAP? Yes, the AHI and RDI are pretty low at 8.7, in all likelihood it'll get worse later. It may be easier to get used to CPAP treatment now while therapy demand is less, but it's your choice.

[Tbrock8905]

Thanks very much to our both

Will turn off ramp and increase minimum to 7. Will post results tomorrow

Is it possible I'm feeling worse in the morning after CPAP because my CAs have increased?. Not sure why I feel worse when my AHI is reduced to 1.9 from baseline of 8.7?

[DancesWithCats]

If it needs to be ripped off and changed at 3AM, it's not a good mask for you...

If the nasal mask doesn't work well for you and you tolerate the full face mask well, use the full face mask (be sure the machine is set for the mask type and hose size being used.) While there's a pretty strong nasal mask majority among users here, (I'm not one, though I am a very biased "top of the head connection hybrid full-face" for my personal use, because it works for me) there isn't one mask to fit them all, and the mask you tolerate well is the better mask for you. IMHO.

Likewise, I personally don't tolerate a min pressure of 7 well, and it didn't improve my numbers when I trialed it, so I run less than 7 with EPR3 - it seems to work better for me. EPR is, of course, less than 3 when pressure is less than 7, but better sleep counts.

[Expat31]

Hi, 

I can't really add much to the pretty good advice you have already received in the last few preceding posts! 

Just a few additional points :-

You had 14 central apneas which means at least 14 arousals that have contributed to poor quality sleep. 

These centrals could be treatment emergent, and hopefully will reduce over time as you get used to the machine. 

As mentioned in a previous post, they, were not particularly significant in your original sleep study with only 4 events. 

It is always possible that these centrals are "false positives" and increasing pressure can sometimes solve this, but too early to say at the moment. Give the suggested settings time to work through. 

Concerning your graphs, in future graph postings, can you display the top part of the left hand pane, so we can see the total AHI, sleep time and summary machine settings? This can be achieved by moving the slider up a bit.
See Oscar chart organisation

Regarding your pillows mask issues, and sore nostrils, with my Breveda pillows mask I had the same problem. 

I found personally two solutions, loosen tightness a little, or/and use a small amount of lip salve to eliminate friction-not too much to avoid mask sliding all over the place. 
You may want to read the mask primer here. 

[Tbrock8905]

With the changed settings, woke up feeling much better this morning! Thanks all
Hope it continues
I have attached my OSCAR results from last night

Any other changes recommended?

I didn't think raising the minimum pressure by 1 and turning off ramp would have a major effect but I definitely did feel it. It took me a while to fall asleep.
I guess my question is it worth turning off ramp? I thought having it set to auto means it will get to minimum pressure when I fall asleep. Do I need treatment before I fall asleep?
Or does it start ramping again whenever I wake up which contributes to poor treatment?

[SarcasticDave94]

The ResMed Ramp will be governed by your settings, if Auto it attempts to sense sleep breath patterns to handoff to normal therapy settings. Otherwise, it's timed and will supply a static pressure. Either Auto or not affects time duration only. And a Ramp set to on with ResMed happens every time you start a therapy session.

As for the chart, it looks better, cleaner. If you liked the results, go a few days and see how it is. Feel free to look at charts anytime, and post results with questions. But myself, I think it's headed better than where you started with the little edit already paying off.