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8 weeks in - a few questions
#1
Hi - I've completed 8 weeks of APAP use now. Thanks to all you experts who've helped me along the way. In the past 10 days my afternoon fatigue (which was my ONLY outward symptom of sleep apnea) is gone. So - good news! But - a few more questions as I reach this milestone:

1. My sleep lab test (31 AHI) showed mostly obstructive apneas with occasional central apneas. Now my AHI results (average about 5 for the last 30 days) typically show about 3 times as many central apneas as obstructive apneas. I suppose that means the APAP is controlling the obstructive apneas - but how do I reduce the central apneas?

2. Does a BIPAP address the central apneas more than my APAP?

3. My AHI index jumps all over the place. One night a 2, the next night a 10. I monitor whether it's affected by having a glass of wine with dinner, or having had a stressful day at work, or getting up to use the bathroom more than once, and I can't find any correlation.

4. I feel like I slept better before I ever started using the APAP. Now every night seems like a really light sleep; I'm always aware of the mask. However, since the afternoon fatigue I had for years has disappeared, I must be sleeping better than I think I am. Anyone else have this experience?

5. I saw my doctor last week, who was not real interested in these particulars. His basic thought was "you're doing fine and come back in 6 months." His opinion is if the AHI stays under 15, don't worry. I - who am much more interested in reducing these apnea events than he is - want to find a way to keep the results under 5.

Thanks for any and all suggestions!



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#2
JaneAM,
Glad you are seeing an improvement in how you feel, but I disagree with your doctor. The goal is to have an AHI under 5. That is considered treated.

I suggest you download SleepyHead software and upload us a screenshot. This way we can see what apnea events you are having and if your pressure is optimal.
http://sleepyhead.jedimark.net/

You can try an outside source to send your screenshots
https://sleep.tnet.com/reference/tips/imgur


OpalRose
Apnea Board Moderator
www.ApneaBoard.com

How to Organize and Post ScreenShots

http://sleep.tnet.com/resources/sleepyhead/shorganize
https://sleep.tnet.com/reference/tips/imgur

INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.




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#3
(07-30-2016, 03:57 PM)JaneAM Wrote: 1. My sleep lab test (31 AHI) showed mostly obstructive apneas with occasional central apneas. Now my AHI results (average about 5 for the last 30 days) typically show about 3 times as many central apneas as obstructive apneas.

That's normal judging by many of the threads I've read here. As long as your AHI remains at or below 5 they are not a concern and should resolve naturally once you get used to the new breathing arrangement.

Quote:3. My AHI index jumps all over the place. One night a 2, the next night a 10.
Again I believe that's fairly normal. If the long term average is at or below five, don't panic. There are comfort adjustments that can be added in to help improve your sleep.

Also your machine is running "wide open" and this is normally a mistake. Start by slowly raising your low pressure to at least 7 (but not all at once, go in steps). Generally you want to have your low end a centimetre or so below the pressure your machine is at or below about 90% of the time.

Quote:4. I feel like I slept better before I ever started using the APAP.

You were probably going to sleep faster because you were more tired, and also didn't have an alien strapped to your fact blowing air into your breathing passages, and you were probably sleeping longer because you needed to because you were choking yourself twice a minute.

Quote:Now every night seems like a really light sleep; I'm always aware of the mask. However, since the afternoon fatigue I had for years has disappeared, I must be sleeping better than I think I am. Anyone else have this experience?

This fact trumps everything. You are feeling better and probably need less sleep because what you do get is better quality.

Quote:5. I saw my doctor last week, who was not real interested in these particulars. His basic thought was "you're doing fine and come back in 6 months." His opinion is if the AHI stays under 15, don't worry. I - who am much more interested in reducing these apnea events than he is - want to find a way to keep the results under 5.

Well, panicking won't help and I think the Doctor felt you needed some reassurance and that's fine. BUT I think you shouldn't be afraid to take control of your therapy. Use SleepyHead to monitor your results if you can, wait and watch and patterns will begin to emerge. Then you can start to adjust your pressures gradually and see what helps, and what hurts. Your doctor may be a great person but can't possibly care as much, or know as much about you as you do.

Ed Seedhouse
VA7SDH

The above is my opinion.  It is just possible that I may, occasionally, be mistaken.

I am neither a Doctor, nor any other kind of medical professional.

Everything put together sooner or later falls apart.
Your brain is not the boss.
Our forefathers took drugs.
He's no fun he fell right over.
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#4
1. It is very common for the machine to detect what it thinks might be central apneas when you first start therapy. Without being connected to an EEG and chest strap (i.e. being in a sleep lab) there is no way to know if they are real central apneas. Reducing your Flex setting, or turning it off might help. Sometimes changing your pressure down and then back up slowly gets rid of them. But your starting pressure is already likely too low (can't know for sure without seeing some sleepyhead data). I had these too when I started and one night, they just stopped. I think my brain finally realized that all these nighttime changes were OK. At any rate, you don't have many.

2. Yes, a BIPAP machine would address the central apneas more than your APAP if you actually had complex apnea. It does not sound like you do. What you have is "getting used to CPAP temporarily weird breathing" Smile

3. Jumpy AHI numbers is not unusual. Mine eventually settled into a tight band unless I drink too much or have bad allergies or am ill. Your body is an imprecise thing. Relax.

4. Feeling like you have a lighter sleep now could just be that your body is not so exhausted now. Or you might still be adjusting to the therapy. Eight weeks is not that long.

5. Your doctor is going to be a lot less interested in perfecting your therapy than you are. Learn all that you can and take charge yourself. As your doctor says, you are doing OK. There is nothing medically alarming to me in what you reported here. Mind you, I am a software developer not a doctor! Could it be better? Yes! And I encourage you to work towards that goal.
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#5
Jane, you seem to be doing pretty well, and the variability of your treatment will soon settle down. Your doctor's primary concern in your first followup is to document that the machine is effective and you are benefiting from treatment This finding is necessary to ensure you get to keep the device and it is paid for by insurance. He might be more receptive to technical questions in future visits.

A BiPAP does not treat central apnea. It is more comfortable, and has less breathing resistance (pressure) during exhale, so some people tolerate it better for various reasons. Central apnea tends to go away in time and seems to be a common occurrence with new users.

Posting your data as suggested by OpalRose would be a good idea. We can sometimes see if the events are clustered, or occur at particular times of night or at a particular pressure. This kind of analysis can really give you some useful feedback. Finally, I note you have a wide range of pressure 5-15, and I suspect a lot of events are because your minimum pressure is too low, especially since the Dreamstation is slow to increase pressure. Again, looking at the data and charts would help. Here is some information that may help you organize and post the data: https://sleep.tnet.com/reference/tips/imgur
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#6
We really need to see data from sleepyhead. There are so many things that "could" be going on and without the plots there is no way to tell.

centrals could be "real", could be caused by pressure changes, could be caused by unrestful sleeping, could be happening during the time you are going to sleep or waking up (sleep/wake junk).

Personally I would not change any settings until I saw the plots and had some understanding what was going on.

BiLevel could cause more centrals and only ASV machines treat brain stem caused centrals.

Can you get better numbers? yes. Can you get better sleep? yes. get us those plots and we will help
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#7
Doh! Right, ASV is for central apnea.
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#8
[quote='OpalRose' pid='170783' dateline='1469913394']

"I suggest you download SleepyHead software and upload us a screenshot. This way we can see what apnea events you are having and if your pressure is optimal.
http://sleepyhead.jedimark.net/"

THANKS - GOOD ADVICE. IS THERE A GOOD SUMMARY SOMEWHERE ON THIS FORUM ON TIPS FOR DOWNLOADING SLEEPYHEAD? I STARTED THE DOWNLOAD ON MY PC . BEING A COMPUTER IDIOT (I RELY ON THE IT PEOPLE AT WORK TO DO MOST COMPUTER TECHNICAL THINGS FOR ME), I DON'T WANT TO SCREW UP THE DOWNLOAD.

ALREADY RAN INTO A WARNING - "MAKE SURE YOU WRITE PROTECT YOUR SD CARD." NOT SURE WHAT THAT MEANS.

THANKS! JANE
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#9
The cards have a little slide switch on one side, and pictures of an open and closed lock. Just make sure you slide the white plastic tab back to unlock. I know that this made a difference on some older models, not sure it matters anymore-I do it anyway just in case.

just answer yes to everything Smile and you will get the sleepyhead icon on your desktop, double click it to run the program. Make sure you have a card reader slot that accepts the card, the slot should be just big enough to accept the card

By the way, typing in all caps is considered as yelling in forums, unless you are really ticked off you might consider not using the cap locks
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#10
[quote='PoolQ' pid='170869' dateline='1469990617']
"The cards have a little slide switch on one side, and pictures of an open and closed lock. Just make sure you slide the white plastic tab back to unlock."

Thanks! So you mean unlock it again when you put it back into the CPAP - correct? (and thanks for the caps reminder - Smile )





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