01-30-2019, 08:41 PM
Struggling to become compliant - Suggestions needed
I apologize in advance for the length of this post. This has been a 12 year journey and I hope a bit of the background may be helpful.
I’m a 51 year old male, 5’6”, 150 lbs. My weight has been near the same since first diagnosed with sleep apnea. I’m fairly active, with a daytime job that requires a fair bit of walking. The only medication I take is for high blood pressure – which has been the same dosage for the past 7+ years and very well controlled. I do not drink alcohol regularly or excessively.
In January 2007 (then 39 years old) I had a sleep study done, was diagnosed with mild OSA and was prescribed a CPAP machine set to 8 cm of H20 and a full face mask. (Note: I have summary reports of my initial sleep study and PAP-NAP, but not the detailed report). The machine was a ResMed S8 Escape that did not have EPR, nor any data recording. I tried to become compliant with the setup for several months, but gave up since the machine usage made my sleep worse than without it. My complaints were: too much pressure on exhale, mask made me feel claustrophobic and leaked if I slept in any position other than on my back.
In late 2014 I revisited the sleep doctor. He suggested a PAP-NAP to find a new mask. Out of the PAP-NAP, I settled on ResMed AirFit P10 (nasal pillow) and a chin strap (since I’m a mouth breather). During the PAP-NAP, they used a ResMed S9 in Auto Mode with a heated hose. I tried my new equipment (mask, chin strap and Hybernite heated hose) on my original S8 Escape, but continued to have compliance issues. I tried adjusting my pressure down (in the 5-7 cmH20 range), but without data collection, I didn’t know what the therapy results were …. Just that I still couldn’t stand the setup. Complaints were that I still seemed to have to work to exhale, never felt rested after using.
Based on my PAP-NAP experience, I started to look for used ResMed S9 machines on the “grey” market (since my health insurance is more like “catastrophic coverage”, where most everything is out of pocket until you reach a max deductible). I wanted a machine that had full data recording capability, so I could import into SleepHead, and an integrated heated hose.
In early 2017, I found a ResMed S9 VPAP Auto that was virtually unused. With my very limited knowledge of the difference in therapy of the machine models, I assumed I could get similar operation from the VPAP Auto as an AutoSet with EPR….this may have been a bad assumption.
I have always used the new machine in VAuto mode. Ti Max, Ti Min, Trigger and cycle are default values (2 sec/ 0.3 sec/Med/Med respectively). Ramp is off. I have kept the Min EPAP + PS set to around my original 8 cm H20 prescription (4+4, 5+3, 6+2) and a couple of times to around 7. Results all seem to be about the same. I consistently awake about 1 hour after going to bed/falling asleep. I’m not sure if this is a natural occurrence for most people. However, when this happens, I struggle to fall back asleep with the mask and generally remove it. Out of my 30+ days total usage of the new machine (over the course of 3 years), SleepHead has only shown 4 OSA occurrences and 1 Hypopnea occurrence. Every other occurrence has been a Central. I have tried to keep the PS at 2 (or occasionally 3) based on Sleeprider’s comment that a larger PS can cause central apnea due to wash-out of CO2.
I estimate that I get 3-4 hours of sleep a night without using the machine, however, I don’t believe that it is restful/restorative/deep sleep. I have many awakenings throughout the night. My spouse indicates that I snore, stop breathing and generally thrash about the bed. I believe I have “learned” to live with the lack of good sleep, but I know that it impairs my cognitive skills, it definitely affects my mood. I only have a handful of really “bad” days during the year, where I feel completely “whacked out”… like I haven’t slept at all during the night. During the last year, I’ve noticed that when I get out of bed in the morning my calves are very tight.
OK….so here are my questions:
Is the arousal/wake up after one hour normal? Is there anything I can try to break this cycle? (I would like to get more than 1 hour of machine data)
Why mostly Centrals? Do I have the wrong settings or possibly the wrong machine? BTW, I have no knowledge of experiencing a Central while awake. Also, it seems the machine usage is causing the centrals. I start to fall asleep, then realize I’m not breathing and wake up (this doesn’t happen when not using the machine). I also notice when the machine starts cycling pressure (Forced Oscillation) to determine airway patency – this sometimes wakes me up.
Should I be concerned with the shape of the Flow Rate?…..specifically the exhale. It seems to be shallow for a long time.
Should I be concerned with my Respiratory Rate? It seems low. Is there a “normal” range?
Older data from last year. Largest PS (4) tried.
[attachment=10072]
More recent data. PS set to 2
[attachment=10073]
Abnormal data. A slew of Centrals
[attachment=10074]
Last nights data. Changed from VAuto to CPAP. Pressure set to 8, EPR set to 2
[attachment=10075]
I’m a 51 year old male, 5’6”, 150 lbs. My weight has been near the same since first diagnosed with sleep apnea. I’m fairly active, with a daytime job that requires a fair bit of walking. The only medication I take is for high blood pressure – which has been the same dosage for the past 7+ years and very well controlled. I do not drink alcohol regularly or excessively.
In January 2007 (then 39 years old) I had a sleep study done, was diagnosed with mild OSA and was prescribed a CPAP machine set to 8 cm of H20 and a full face mask. (Note: I have summary reports of my initial sleep study and PAP-NAP, but not the detailed report). The machine was a ResMed S8 Escape that did not have EPR, nor any data recording. I tried to become compliant with the setup for several months, but gave up since the machine usage made my sleep worse than without it. My complaints were: too much pressure on exhale, mask made me feel claustrophobic and leaked if I slept in any position other than on my back.
In late 2014 I revisited the sleep doctor. He suggested a PAP-NAP to find a new mask. Out of the PAP-NAP, I settled on ResMed AirFit P10 (nasal pillow) and a chin strap (since I’m a mouth breather). During the PAP-NAP, they used a ResMed S9 in Auto Mode with a heated hose. I tried my new equipment (mask, chin strap and Hybernite heated hose) on my original S8 Escape, but continued to have compliance issues. I tried adjusting my pressure down (in the 5-7 cmH20 range), but without data collection, I didn’t know what the therapy results were …. Just that I still couldn’t stand the setup. Complaints were that I still seemed to have to work to exhale, never felt rested after using.
Based on my PAP-NAP experience, I started to look for used ResMed S9 machines on the “grey” market (since my health insurance is more like “catastrophic coverage”, where most everything is out of pocket until you reach a max deductible). I wanted a machine that had full data recording capability, so I could import into SleepHead, and an integrated heated hose.
In early 2017, I found a ResMed S9 VPAP Auto that was virtually unused. With my very limited knowledge of the difference in therapy of the machine models, I assumed I could get similar operation from the VPAP Auto as an AutoSet with EPR….this may have been a bad assumption.
I have always used the new machine in VAuto mode. Ti Max, Ti Min, Trigger and cycle are default values (2 sec/ 0.3 sec/Med/Med respectively). Ramp is off. I have kept the Min EPAP + PS set to around my original 8 cm H20 prescription (4+4, 5+3, 6+2) and a couple of times to around 7. Results all seem to be about the same. I consistently awake about 1 hour after going to bed/falling asleep. I’m not sure if this is a natural occurrence for most people. However, when this happens, I struggle to fall back asleep with the mask and generally remove it. Out of my 30+ days total usage of the new machine (over the course of 3 years), SleepHead has only shown 4 OSA occurrences and 1 Hypopnea occurrence. Every other occurrence has been a Central. I have tried to keep the PS at 2 (or occasionally 3) based on Sleeprider’s comment that a larger PS can cause central apnea due to wash-out of CO2.
I estimate that I get 3-4 hours of sleep a night without using the machine, however, I don’t believe that it is restful/restorative/deep sleep. I have many awakenings throughout the night. My spouse indicates that I snore, stop breathing and generally thrash about the bed. I believe I have “learned” to live with the lack of good sleep, but I know that it impairs my cognitive skills, it definitely affects my mood. I only have a handful of really “bad” days during the year, where I feel completely “whacked out”… like I haven’t slept at all during the night. During the last year, I’ve noticed that when I get out of bed in the morning my calves are very tight.
OK….so here are my questions:
Is the arousal/wake up after one hour normal? Is there anything I can try to break this cycle? (I would like to get more than 1 hour of machine data)
Why mostly Centrals? Do I have the wrong settings or possibly the wrong machine? BTW, I have no knowledge of experiencing a Central while awake. Also, it seems the machine usage is causing the centrals. I start to fall asleep, then realize I’m not breathing and wake up (this doesn’t happen when not using the machine). I also notice when the machine starts cycling pressure (Forced Oscillation) to determine airway patency – this sometimes wakes me up.
Should I be concerned with the shape of the Flow Rate?…..specifically the exhale. It seems to be shallow for a long time.
Should I be concerned with my Respiratory Rate? It seems low. Is there a “normal” range?
Older data from last year. Largest PS (4) tried.
[attachment=10072]
More recent data. PS set to 2
[attachment=10073]
Abnormal data. A slew of Centrals
[attachment=10074]
Last nights data. Changed from VAuto to CPAP. Pressure set to 8, EPR set to 2
[attachment=10075]
Hopefully Fred has my back here.
I have found the UF1 settings that Fred referred to and reprocessed my data. Is there a specific night(s) of data you would like to see the 2 minute plots for?
