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1 week of CPAP; sharing my sleep study
#1
Question 
1 week of CPAP; sharing my sleep study
I'm one week into using CPAP. I've already benefited from all the generous sharing here and some helpful advice. Thank you!

My UserCP info should be correct, except I went back and got a 2nd mask to try as the first irritated my nostrils and facial skin and seemed to get worse each night I wore it. I've done five nights with the listed mask, and one night with a Philips Dreamwear instead of the Nuance. The new mask feels better sitting on my face, but slips around more and seems slightly less effective at aiming air into my nose where it belongs. I may try alternating days between these two masks to see if that relieves the irritation while providing better treatment overall, but it is early days yet.

I've installed SleepyHead and imported five days' data, but will require very specific instructions to share anything with you here as I don't understand most of it yet.

I asked for and received my sleep report from my doctor after reading that advice here. Thanks! My regular doctor (general practitioner) thought to order a home sleep study to check for apnea because I've suffered with chronic illness (primarily pain & fatigue)  for a few years now and neither he nor the specialists I've visited have found definitive serologic results to confirm any specific diagnosis. He's working hard to help me, and a very good primary care physician, but he's not a sleep specialist.

*First question:
Is three pages, including Apnea Analysis, Snoring Analysis, and Oximetry Analysis the complete report, or am I still dealing with a summary?

*Second question:
If 40 of my 103 reported apneas were Central, should I be seriously looking for more analysis and perhaps a sleep study done in a lab by a specialist?

I'm attaching a jpg of the Apnea Analysis portion here. It's a scanned/faxed document, so I can't cut & paste the text.
APNEA ANALYSIS
   

SNORING ANALYSIS
The Snoring Analysis seems less interesting. (Basing this on a comment written therein: "Patient snored infrequently during the recording.")
Snoring index: 22.5.
Type 1: 17%, Type 2: 17%, Type WL: 66%

OXIMETRY ANALYSIS
Oximetry Analysis is easy type up as there's more non-data (normal?) than interesting stuff, so:
In 349 minutes of recording...

Mean O2:    96%.
High O2:     99%
Lowest O2:  87%.
# of desaturations: 58

SpO2 Levels by Time
91% (318 min) at 95-100;
 9% (31 min) at 90-94.
Nothing lower recorded.

SOME ADDITIONAL PERSONAL DETAILS:
I will add a few more personal details because my research since the diagnosis makes me wonder if they are relevant to my questions.

Opioid medication
I do have chronic pain, so I occasionally (10 pills per year?) take opioids. I take synthetic opioids (tramadol) more often (2-3 pills per week?), but I use this drug less often than not. I have observed that either of the former drugs affects my sleep, rendering me tired but unable to rest well (like alcohol--puts me to sleep, but I wake after a few hours unable to sleep further yet still tired.) For this reason, if I need a strong painkiller, I try to take it before dinner in an effort to preserve my sleep quality. I use non-chemical means (heat, rest) before taking drugs as much as I can, and I use a topical NSAID preferentially to avoid taking pills, but ignoring pain has its own ramifications long-term (neurologically) so I walk a tightrope between my wishes and reality.

Benzodiazepine medication
I also occasionally take lorazepam for sleep/anxiety. (It's the lowest dose commercially available of this drug, according to my doctor. I'm out of it right now so I can't check dosage until I get a new Rx.) I got the prescription a few years ago after two occasions of night waking into panic attacks. (I now wonder if those were triggered by apnea events.) I probably used one of these pills before at least the first night of the home sleep study as I found the equipment anxiety-inducing. I also recall taking one the first night with CPAP for a similar reason. I use this medication perhaps once or twice in an average week, not habitually, though more often in clusters when I'm generally unwell/under stress as opposed to spaced evenly throughout my life.

Sleep position
I specifically recall that I slept on my back during the sleep study because I was afraid of all the wires and tubes entangling my neck or coming off such that I'd have to repeat the process. More typically, I prefer to sleep on my stomach or side. I've been pretty successful sleeping in these more comfortable positions with the CPAP mask in place, which was a relief to me. When my arthritis is flaring, however, I sleep in any position that seems to hurt the least, which can include being on my back all night.
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#2
RE: 1 week of CPAP; sharing my sleep study
Your sleep study confirms a strong probability of central or complex apnea. This may not respond to CPAP, and ultimately require bilevel ASV. You should expect a tendency for Central events will increase when using opioids, but it seems your use is infrequent. It would be most useful to see the Sleepyhead daily details. The tutorial for organizing charts is here http://www.apneaboard.com/wiki/index.php...ganization

You apparently figured out how to attach the images. Well done!
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#3
RE: 1 week of CPAP; sharing my sleep study
Okay, I've made screenshots according to the page you referenced. How much data is interesting? Six separate images for all six downloaded nights?

I wore the mask 8 hours on night one, then 5.5, then only about 3. The pain/irritation was making me remove it and it got a bit worse each day. I tried it both at the beginning of the night and then for the second half of the night as I'd read issues were common during REM sleep (latter half of the night) so I figured what the hell. Dont-know  That might be clear if there are time stamps. My hours in bed are fairly consistent, roughly 10 pm to 7 am, though insomnia is an issue within that window.

Here are Nights 1 and 2.
   
   
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#4
RE: 1 week of CPAP; sharing my sleep study
Night 3
   

Night 4
   
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#5
RE: 1 week of CPAP; sharing my sleep study
Night 5
   

Night 6
   
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#6
RE: 1 week of CPAP; sharing my sleep study
Good job on the charts. Your AHI has varied from 1 to 5 at consistently low pressure less than 8 cm. These results are considered "treated" and I doubt your doctor will propose a change in treatment. You have essentially no obstructive apnea, and all events are central and hypopnea. From this, I can say you could do at least as well with fixed pressure at 5.0, or auto pressure of 5-7 cm. Your events are nearly all central, and most likely central hypopnea, and some flow limitation. Your machine cannot be set or optimized to resolve this, and your best results have been with lower median pressure. It appears some form of CFlex or AFlex is on, and I suggest you try the machine with Flex off to see if it feels okay and perhaps improves results. Flex does not generally work well with someone with central apnea.

The only way to address the flow limits, hypopnea and RERA would be with a bilevel machine, and bilevel pressure (different inhale and exhale pressures) would likely increase central apnea requiring ASV. Since your CPAP is working well enough, that is not going to be an option.
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#7
RE: 1 week of CPAP; sharing my sleep study
First, sorry, but what’s a RERA? (Something you say I should address?)

I suppose my interest is in understanding the underlying mechanism of what’s going on with my diagnosis when possible, probably at least as much as how to treat it. That’s my nature (for better or for worse.) I’ve already changed my diet, lifestyle factors, etc., all in an effort to know what’s going on with my pain/fatigue. I want to understand my health if I can.

It seems like Central Sleep Apnea (CSA) is a very different beast from OSA, with which I’ve been officially diagnosed. I will definitely follow up with my doctor! I don’t need him to change my Rx, but I want to Dx to be as correct as possible, if only for the records and for my own peace of mind. You never know what treatments will appear in the future either.

40/103 = 39% of my Apneas on the initial test were central.

Can you specify which data you reference from my SleepyHead charts to share with my doctor with regards to the CPAP data? What do you see that says “central apnea and hypopnea” as opposed to OSA? Please point me to the red flags if possible.

I may want to adjust my central- apnea- inducing medications based upon this information, so it is very important to me. I hate the idea of antidepressants (for pain relief), but I hate the idea of dying young(ish) even more. (insert sarcastic grin here)

Then again, I’m not taking a lot of medicine even though I have it on hand, so most of this may be my brain’s failure. That does feel very important. Correctly stating the facts of what is happening right now should help me to evaluate options as they arise.

Thanks again,
—willo
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#8
RE: 1 week of CPAP; sharing my sleep study
In this chart you have 2.84 CA per hour, 0.4 OA, 2.03 H .  Clear Airway are non obstructive, or central apnea.  The proportions of events are similar to your diagnostic test, but you are clearly benefiting from CPAP, as the event rate is much lower.  Our Wiki has a list of acronyms we commonly use http://www.apneaboard.com/wiki/index.php?title=Acronyms and RERA is [url=http://www.apneaboard.com/wiki/index.php?title=Respiratory_disturbance_index_(RDI)]respiratory effort-related arousal.[/url] 


[Image: attachment.php?aid=9139]

Central Sleep Apnea (CSA) is a very different beast from OSA, but it is not uncommon for a diagnosis to state OSA even when events are predominately central.  I don't know why this is so common, but feel free to ask the doctor.  Nearly everyone is started on CPAP regardless of whether apnea is obstructive or central.  This is partially an insurance requirement that endeavors to use the lowest cost, effective therapy.  The fact is 15 to 20% of central apnea patients will be effectively treated by CPAP, many others will quit in frustration due to very uncomfortable therapy caused by numerous central apnea and hypopnea. A few will eventually have a trial on bilevel, which they generally don't tolerate, before being provided with bilevel ASV, which is the therapy designed to treat complex apnea and hypopnea. You will actually see a disproportionate share of forum members using ASV, because very few get there without support and understanding the problem and process to acquire treatment. So far, you tolerate, and do pretty well with CPAP.

40/103 = 39% of my Apneas on the initial test were central.
The rest wewe hypopnea which may be central or obstructive. In any event, this mixture is often called Complex Apnea https://www.google.com/search?q=complex+...e&ie=UTF-8

Can you specify which data you reference from my SleepyHead charts to share with my doctor with regards to the CPAP data? What do you see that says “central apnea and hypopnea” as opposed to OSA? Please point me to the red flags if possible.
It's still early in your therapy, and so far, you are doing well. For me, the clues come from the fact you are on very low pressure, and events are nearly all central or hypopnea. People with obstructive apnea do not normally achieve good treatment with low pressure. I'm pretty certain that if your pressure was set at a minimum of 8.0 which is typical for OSA you would increase central events. Other hints that your doctor won' probably care about is that your tidal volume is on the low side, but may be normal for you. Your inspiration time and expiration time appear to be poorly detected by your machine. This is very comm with Philips machines,and it is likely your inhale is shorter in duration than exhale, rather than the 2.64/1.54 we see here. Sleepyhead will let you zoom in on the flow rate graph to see each breath clearly. This wiki can help younunderstand what you're looking at http://www.apneaboard.com/wiki/index.php...ailed_look

I think that is enough, or too much for now.
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#9
RE: 1 week of CPAP; sharing my sleep study
(11-19-2018, 01:58 PM)Sleeprider Wrote: ...  You have essentially no obstructive apnea, and all events are central and hypopnea.  ...you could do at least as well with fixed pressure at 5.0, or auto pressure of 5-7 cm.  ... your best results have been with lower median pressure.  ...

The only way to address the flow limits, hypopnea and RERA would be with a bilevel machine, and bilevel pressure (different inhale and exhale pressures) would likely increase central apnea requiring ASV.  Since your CPAP is working well enough, that is not going to be an option.

I'm going to adjust my settings today for the first time. I think i will try the fixed pressure of 5 first. Most often, if the machine wakes me up in an irritating way, it is because it is blowing like crazy and I feel like I'm fighting with it, so this seems like a good adjustment to try. I think I will sleep best with fewer external changes in my environment, but it's just an educated guess.

So, specifically for the DreamStation, have I got this right:
1) I'm going to turn off Flex in the regular, MySetup menu.
2) I go into Clinician Setup, choose Mode, then select "CPAP" instead of "Auto" (which should be selected now?) At that point I should see the option to choose "5" for the pressure?

I'll post the Overview screenshot for the full 20 days of therapy I've used, but my naive reading suggests the data looks similar to that first week. (Mostly hypopnea, then CAs, then OAs.) I'm stuffed up again thanks to my germy children, and saw more OAs the past 2 nights as I did with my first stuffy nose incident. My ability to wear the mask for more of the night seems to be growing as usage hours reflects.
   

I did have a night-waking panic attack once last week (the 3rd of my life; I posted about it http://www.apneaboard.com/forums/Thread-...ck-in-data.) If there's any chance higher CPAP pressure triggered this event, I'll do almost anything to avoid another. (Hence, my pressure choice of Fixed 5 vs. Auto 5-7 to try first.)

Anyone want more details to advise me? Eat-popcorn
--willo
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#10
RE: 1 week of CPAP; sharing my sleep study
[quote pid='279228' dateline='1543774171']
So, specifically for the DreamStation, have I got this right:
1) I'm going to turn off Flex in the regular, MySetup menu.
2) I go into Clinician Setup, choose Mode, then select "CPAP" instead of "Auto" (which should be selected now?) At that point I should see the option to choose "5" for the pressure?
[/quote]

Never mind these questions. I found both settings in the Provider menu area.
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