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Newbie; the Good the BAD and the Ugly - akasleepyjean - 03-21-2018
Hey Everybody! Total newbie here....
First of all, thanks to all of you who are participating in this forum. I am new to CPAP treatment as of last week) and I have learned so much already from this forum. And I also realize I have SUCH a LONGGG way to go!
Some backstory - I have probably had un-diagnosed OSA for years and maybe over a decade, yikes. Runs in the family. I have also developed a pretty tenacious insomnia patttern since about 2008. (Usually sleep from 10-2 or 3 then awake for a few hours and then back to sleep for a few hours depending on what I time I have clients scheduled for the day). I have tried all herbal and otc sleeping aids like 5HTP, passion flower, melatonin, etc... nothing works. Avoid prescription sleeping pills like the plague since they are so addictive. After reading some of the posts on this site I understand this insomnia may be connected to the OSA. I was diagnosed with moderate OSA.
SLEEP STUDY RESULTS
Low Sp02 83%
AHI 18 hr
PLM 11.8 hr
Sleep efficiency 66.2
Total sleep time 274 min
REM 8.9%
Arousal index 12.9 hr
Awakenings 3.7 hr
I also have a history of SVT and occasional A-fib episodes. I had an ablation for the SVT last October and since then have not had any SVT episodes - YAYY! So for me getting this right is super important as I am pretty sure the a-fib is def related to the OSA.
I am not obese and my neck size is under the
ON TO THE MASKS....
My first mask was Dreamwear with pillows - UGH - couldn't wear more than an hour - the pillows really irritated my nasal passages. Took a few nights off since I did not have another alternative.
Then I bought a Swift FX Nano for her. I wore it one night - the numbers were horrible! (see second attachment below).
Meanwhile I ordered the cushion for the Dreamwear and used that the last two nights and for a daytime nap since I am barely getting any sleep.
My first two reports from Sleepyhead were great on the Dreamwear with cushion! 0 or below 1! Then last night I ended up with tons of clear airway reports. Some of these were def occurring when I was awake. The mask was not leaking and I had all the settings on the machine the same and the fit of the mask was consistent with two previous sessions. I am not a mouth breather and for the last year or so I have been working with the Buteyko breathing technique both while awake and before sleep. I cant even talk with the mask on (it seems like it would be really hard to be a mouth breather with one of these things!) so it doesnt seem like I am mouth breathing while asleep but how can I know for sure??)
You will also see gaps in data - I have not been able to sleep with the mask on all night. Start out with it on then remove for a few hours. Awake at my usual time then put it back on - on for an hour or so before able to go back to sleep.
i am really tired - am considering going to the doc for some kind of anti-depressant like trazadone for sleep temporarily until i can get used to the mask and start sleeping more as I am concerned about my heart.
Help requested!
- What do I need to address that I haven't already?
- Any help interpreting these reports or other suggestions are very much appreciated and welcome!
- Clear airway issue - fine for two days with the Dreamwear then really bad last night.
- Anyone tried anything (such as a low dose anti depressant) to help with insomnia? If so did it effect your results one way or another?
RE: Newbie; the Good the BAD and the Ugly - Sleep2Snore - 03-21-2018
Every time the pressure goes up you have central events, this is not good.
You might need another machine type, I don't know yet.
If you can post a few charts of data with using the same mask then maybe we can see what is going on a bit better.
We should be able to suggest a few things though, but al those clear airway events!
RE: Newbie; the Good the BAD and the Ugly - Sleep2Snore - 03-21-2018
If you want to try see how it goes I would try limiting the machine to 8 or 7.5 just to see if it clear some of these centrals.
Night one gave you the best result. They are very mixed however!
RE: Newbie; the Good the BAD and the Ugly - JesseLee - 03-21-2018
Also, there is a link in my signature below to organize your charts. The amount of central apnea events may cause for you to require CPAP therapy in a different form than your machine will provide. It seems like you have a positive attitude for therapy and that is an excellent way to start the process of getting used to therapy and getting optimized therapy to suit your needs.
Welcome to Apnea Board!
RE: Newbie; the Good the BAD and the Ugly - Crimson Nape - 03-21-2018
Hi akasleepyjean -
To aid in providing us a more complete display of your data, please read the topic, SleepyHead Chart Organization, in my signature below.
Good luck!
RE: Newbie; the Good the BAD and the Ugly - Sleeprider - 03-21-2018
akasleepyjean, your events are all central, so if your sleep test show obstructive apnea, you got that resolved at low pressure, now we need to optimize for the CA events. This is going to be easy. change exhale pressure relief (EPR) settings from 3, to either 1, or off. You can lower your pressure to run between 5 and 9 cm pressure.
These settings are in the clinical settings area that are accessed by pressing the control knob and home button at the same time. I will guess this change alone will reduce your CA events by 60-70%. Give it a try and let's see where that takes us. Do you have a breakdown of your AHI from the sleep test in terms of OA, CA and H events? Were you ever provided with a titration test for a pressure prescription?
RE: Newbie; the Good the BAD and the Ugly - Walla Walla - 03-21-2018
I recommend dropping your EPR from 3cm to 1cm and see if that clears up the CA events your getting.
OK sleeprider posted same time as me. So ditto on what he says. I'd still try EPR of 1cm first.
RE: Newbie; the Good the BAD and the Ugly - akasleepyjean - 03-21-2018
@walla walla - thank you for the suggestion! I will give that a try for sure!
@sleeprider - I will def try to set it to 1 first then go down to zero if necessary. "You can lower your pressure to run between 5 and 9 cm pressure. " Are these the limits that I have currently set from 6 -12? I have already been in the clinical settings part of the machine and i know how to change these thanks to a great youtube video
. Do you have a breakdown of your AHI from the sleep test in terms of OA, CA and H events? Were you ever provided with a titration test for a pressure prescription?
No to the titration test.
Yes to results - see below:
CA events: 0
OA events: 40
MA events: 0
H total: 42
A and H total: 82
RERA total 12
@Crimson Nape thank you! I will see if i can get the images better next time - am on a mac...will try to get more data showing...
@JesseLee thanks! I am really trying hard to make this work. Its either that or have a heart attack or stroke...not great alternatives! LOL! There is not a lot of data yet since i have barely used the device but I will keep at it! Thanks for your warm welcome.
@Sleep2Snore - thank you - I will change the settings...seems to be a consensus here! I will repost the two charts with the Dreamwear cushion since that is my mask of choice for now at least. Plus the data seems to be most conflicting - from really good (zero and below 1 vs really bad!)
To all - sorry if my reply is funky. I hit reply and it doesn't seem like I am replying to any one individual. Still have to learn some basics here on the board - my apologies in advance!
Oh - one last question! Does anyone know if for the Dreamwear cushion the setting should be PILLOW or NASAL? I think I read something on this forum that manufacturer of the mask does not have any real answer to this question. Wondering if this could also be contributing to the CA events...
RE: Newbie; the Good the BAD and the Ugly - Sleeprider - 03-21-2018
I'm confident that reducing EPR will resolve most of this. You have a bit of complex apnea from the CPAP treatment, and most of that is likely related to EPR. In time that may pass completely, but for now turning down EPR should work. Since you are turning down EPR and the machine won't be dropping pressure on exhale, you can still use the lower pressures of 5-9 I suggested and get the same OA and H results. You can use the Nasal Pillows setting for Dreamwear.
Hope you have a comfortable sleep tonight!
RE: Newbie; the Good the BAD and the Ugly - Sleep2Snore - 03-21-2018
I would turn on the EPR as Sleeprider suggests as well, I didn't notice you didn't have it turned on.
This might help with smother breathing and help with centrals.