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+--- Thread: New, very tired, and need help (/Thread-New-very-tired-and-need-help)
RE: New, very tired, and need help - Sleeprider - 11-17-2016
Becky, we finally have the images. Thanks. It is pretty unusual to have such a dramatic increase in both obstructive and clear events after starting CPAP. You are currently using PS 4.0 over 9.0-20 in v auto mode. I don't know that this will work, but please go into your settings and reduce your PS to 3.0. Let's see if that moves things in a positive direction.
Is this the first CPAP/BPAP device you have ever used? Have you previously used other settings?
for future charts, this is the most useful version. You can minimize the monthly calendar by clicking on that triangle next to the date at the top. That will make more useful information visible. Also, in File/Preferences/Appearance, turn off the pie chart of events. Finally size the graphs so the snore and flow limit charts are visible
RE: New, very tired, and need help - beckysmith - 11-17-2016
Thanks so much! I need help because sadly I'm not getting it anywhere else. I will make that change tonight. I finally got the doctor to change it to auto since my machine has that function. He started it at a max of 25 and that about blew my mask off. You can see I have since made changes (on my own), just trying to get some relief. I would love to hear from those with experience and advice.
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RE: New, very tired, and need help - Sleeprider - 11-17-2016
The data suggests complex apnea that may include machine induced centrals. We can try to experiment with some settings to find some relief, but the history you posted shows a number of different settings have not consistently produced adequate results. Did you ever have a sleep study to titrate CPAP? If so, what were the results?
RE: New, very tired, and need help - beckysmith - 11-17-2016
I had an at home study that showed severe sleep apnea and then had one done at the sleep center/hospital. They put the mask on right away. It shows I have both central and obstructive. My AHI was in the low 50's I believe. What other info do you need?
RE: New, very tired, and need help - Sleeprider - 11-17-2016
That is pretty much it. Has your doctor ever spoken to you about complex sleep apnea? The treatment for that will require an ASV machine such as the Resmed Aircurve 10 ASV or Phiiips Respironics Auto SV Advanced. In most cases, insurance requires that you demonstrate the ASV is medically necessary, and this means failing CPAP and BiPAP. It appears you moved to bilevel right off, but I don't think it is the final stop for you. Since you have been at this about a month, you probably have an appointment coming up. While it is admirable to try your best to make the bilevel work, you need to start getting familiar with "complex sleep apnea" and the adaptive servo ventilator machine, in order to have an informed conversation with your doctor about the next step.
RE: New, very tired, and need help - beckysmith - 11-17-2016
I had my follow up appointment 2 weeks ago when he changed it to auto. He hadn't even reviewed any of my sleep studies before I got there and dismissed my concerns, saying it hasn't been long enough. I fall asleep every day at work, driving sometimes, and am always tired. I feel like I should switch doctors.
RE: New, very tired, and need help - Sleeprider - 11-18-2016
Complex apnea often resolves on its own, generally within a month of starting CPAP. So far, I don't see that trend in your data. If you have any details from your sleep study (remove any personal information), we can look at it and maybe understand more of what they saw and why you are under the pressure recommendations you have.
If you can resize the calendar and pie chart so more of the settings data shows up, and include the snore and flow limitation chart in your images, that will help quite a bit. We don't need to see mask pressure. The Organize SleepyHead link in my signature describes how to do that. Also, if you link from Imgur, your attachments won't disappear because you won't have to delete them for space. Your pressures seem to rise pretty quickly at night, and including that information will let us see why. Something I'm thinking about is to limit the maximum pressure and see if that helps with the number of CA events.
RE: New, very tired, and need help - beckysmith - 11-18-2016
Thanks for your help..I did get a copy of my sleep study. However, it is packed due to moving. I requested another copy this morning, so hopefully they can send it electronically to me. Here is last night's data. I kept waking up due to my mask making leaking sounds.
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RE: New, very tired, and need help - Sleeprider - 11-18-2016
Pressure support has no effect given an AHI of 16.8, OAI 4.33 and CAI of 10.63. For the next set of fun and games, let's try limiting max IPAP to 13.0. The hope is that this will not significantly increase OA, but will significantly lower CA. This is pure trial and error, and as you know, is in no way medical advise.
Your machine is setup for a full-face mask, and your profile shows nasal pillows. Please take a look and make any appropriate correction.
RE: New, very tired, and need help - Sleeprider - 11-18-2016
For the next graph, please order the graphs as follows:
Events
Flow
Pressure
Leak
Snore
Flow Limit
The graphs just drag and drop. This way you will only need one graph.
It is interesting that you have a very slow respiration rate, with a median of 8 breaths per minute. Nearly 1.7-seconds inhale, and 5.2 seconds exhale. Tidal volume is good, so you are breathing deeply and slowly. Considering that an apnea is scored when flow is below a threshold for 10 seconds or more, it only takes a span 3-seconds longer than your median breath interval to score an apnea. So if not enough flow occurs during a breath, that can score a CA. Might be interesting to take a closer look at the flow line where those CA events are occurring.