Brand new cpap user! Some questions regarding my first night

[SarcasticDave94]

Do you have the sleep study report to post? You should get it for your records even if you don't post here. I'd like to ID the apnea events and count. Regardless, I'm seeing actions to take is avoid the CA/clear airway/central apnea events, all those purple flags. Since the charts don't act like attachments, I can't zoom in very well. Here's my suggestion on what I do see, 1. is lower EPR and 2. turn off Ramp. Both increase pressure swings which in turn increase CA. An attribute of CA is that they are consistently inconsistent as in up one night and down the next.

[staceyburke]

I just got the ResMed F30 full face mask, it is much lighter and does not leak for me. It does have the hose come out of the front of the mask. Resmed makes a P30I full face mask that is the hose out of the top. On Nov 24 you had a lot of positional apnea. On the 25 none. Positional is when you cut off your own breath by tucking your chin, many times on your back but you can chin tuck on your side also. As you can see some night you get into a position where your air is cut off - try to find out and stay out of that position. If you can't a collar is the best way to stop.

[Sleeprider]

A couple things. The beginning of therapy where you are using ramp for 45 minutes looks really awful. The breathing flow is inconsistent and rough. Turn off the ramp. Your events are all central. I think you can reduce your minimum pressure to 8.0, but you have to turn down or turn off EPR. I think since you've been using EPR at 3, we should just do a progressive reduction of EPR to evaluate its effect on AHI and your comfort. Reduce minimum pressure to 8.0 and use EPR 2, then we might try EPR 1 depending on what we see.

Ramp OFF
EPR 2
Reduce minimum pressure to 8.0

[xdestry]

Do you have the sleep study report to post? You should get it for your records even if you don't post here. I'd like to ID the apnea events and count. Regardless, I'm seeing actions to take is avoid the CA/clear airway/central apnea events, all those purple flags. Since the charts don't act like attachments, I can't zoom in very well. Here's my suggestion on what I do see, 1. is lower EPR and 2. turn off Ramp. Both increase pressure swings which in turn increase CA. An attribute of CA is that they are consistently inconsistent as in up one night and down the next.

I have asked my doctor for the report but they said they cannot send it to me until they charge the insurance...  I will try changing the settings like you suggested for a few nights and post the results again!  Thank you so much.

I just got the ResMed F30 full face mask, it is much lighter and does not leak for me.  It does have the hose come out of the front of the mask.  Resmed makes a P30I full face mask that is the hose out of the top.  On Nov 24 you had a lot of positional apnea.  On the 25 none.  Positional is when you cut off your own breath by tucking your chin, many times on your back but you can chin tuck on your side also.  As you can see some night you get into a position where your air is cut off - try to find out and stay out of that position.  If you can't a collar is the best way to stop.

Thanks for the reply I will look into positional apnea and a collar!

A couple things. The beginning of therapy where you are using ramp for 45 minutes looks really awful. The breathing flow is inconsistent and rough. Turn off the ramp.  Your events are all central.  I think you can reduce your minimum pressure to 8.0, but you have to turn down or turn off EPR.  I think since you've been using EPR at 3, we should just do a progressive reduction of EPR to evaluate its effect on AHI and your comfort.  Reduce minimum pressure to 8.0 and use EPR 2, then we might try EPR 1 depending on what we see.  

Ramp OFF
EPR 2
Reduce minimum pressure to 8.0

Can you explain what you mean by central?  Is that what CA is in oscar?  I hovered over CA and it just said clear airway.  I will try the new settings, thank you so much!

[Rich66]

4.  What do you guys do about the hose?  I feel like it's always getting in the way, do you guys usually have the machine above your head?  Are there any full face masks with the hose at the back of the head?  

I put the machine on the nightstand -- it is recommended to be lower than the bed.  And then I used to run the hose over the bed covers.  But I found I had to strap the machine to the nightstand or I would end up pulling the machine onto the floor.  Then I figured out how to route the hose up and over using the headboard and have the hose extend out over the pillow by way of a sturdy metal rod, and then down into the useable position.  That solved the problem of possible damage to the machine when it bangs on the floor, and I no longer have a hose to yank on when I'm asleep, and I don't have the hose across my neck.  And since the hose comes right out of the machine and goes vertical for about 12 inches, I think it helps to insure no water gets to the nose piece.  And I no longer need to strap the machine to the nightstand.  The only downfall of the system is I can't sit up fully without taking the mask off.  YouTube has videos of what other people have done.  And I did try sliding a piece of plywood between the mattress and box-spring then strapping the machine to that -- but it often got in the way and just wasn't stable enough.  Like a lot of this -- it takes trial and error.

[Sleeprider]

Xdestry, a CA is a central apnea or clear airway event where breathing stops or is reduced by at least 80%, which is the event scoring criteria. The cause can vary between individuals, but at these relatively low frequency levels, we consider them "idiopathic" or without specific cause. Individuals new to CPAP and bilevel often experience therapy onset central events. The are most commonly the result of an increased ventilation rate (higher tidal volume and minute vent), which reduces CO2 in the blood stream. Technically this is referred to as the "apneic threshold". CO2, or more accurately bicarbonate in the blood, is directly responsible for respiratory drive in a sleeping person. When CO2 is reduced, the respiratory sensors in the body perceive the respiratory needs are met and reduce the signal "to breathe". As breathing rate or volume diminishes, the CO2/bicarbonate levels will increase causing deeper respiration or even hyperventilation. All of this occurs without our awareness, but the point is to understand, that respiration is a balancing act that the body orchestrates naturally.

When you added higher pressure and EPR at 3, you created the conditions for deeper ventilation. EPR in particular makes respiration easier to the extent you might trigger the apneic threshold. This can be seen as an oscillating respiratory flow rate or even central apnea (CA) events. My observation of your posted chart is that your pressure does not rise significantly from the minimum pressure, and that you have very few, if any obstructive events. My recommendation is based on a reduced pressure overall and a reduced EPR in particular, to help you better balance respiration and reduce the CA events, while still treating your obstructive apnea. This explanation is intended to be simple, but I realize it is a complex subject, so ask any question you may have.

[xdestry]

4.  What do you guys do about the hose?  I feel like it's always getting in the way, do you guys usually have the machine above your head?  Are there any full face masks with the hose at the back of the head?  

I put the machine on the nightstand -- it is recommended to be lower than the bed.  And then I used to run the hose over the bed covers.  But I found I had to strap the machine to the nightstand or I would end up pulling the machine onto the floor.  Then I figured out how to route the hose up and over using the headboard and have the hose extend out over the pillow by way of a sturdy metal rod, and then down into the useable position.  That solved the problem of possible damage to the machine when it bangs on the floor, and I no longer have a hose to yank on when I'm asleep, and I don't have the hose across my neck.  And since the hose comes right out of the machine and goes vertical for about 12 inches, I think it helps to insure no water gets to the nose piece.  And I no longer need to strap the machine to the nightstand.  The only downfall of the system is I can't sit up fully without taking the mask off.  YouTube has videos of what other people have done.  And I did try sliding a piece of plywood between the mattress and box-spring then strapping the machine to that -- but it often got in the way and just wasn't stable enough.  Like a lot of this -- it takes trial and error.

Thanks Rich, that seems to be a good solution to keep it out of the way.  Seems like i'll need a new bed frame though haha.

Xdestry, a CA is a central apnea or clear airway event where breathing stops or is reduced by at least 80%, which is the event scoring criteria.  The cause can vary between individuals, but at these relatively low frequency levels, we consider them "idiopathic" or without specific cause.  Individuals new to CPAP and bilevel often experience therapy onset central events. The are most commonly the result of an increased ventilation rate (higher tidal volume and minute vent), which reduces CO2 in the blood stream.  Technically this is referred to as the "apneic threshold".  CO2, or more accurately bicarbonate in the blood, is directly responsible for respiratory drive in a sleeping person. When CO2 is reduced, the respiratory sensors in the body perceive the respiratory needs are met and reduce the signal "to breathe".  As breathing rate or volume diminishes, the CO2/bicarbonate levels will increase causing deeper respiration or even hyperventilation.  All of this occurs without our awareness, but the point is to understand, that respiration is a balancing act that the body orchestrates naturally.  

When you added higher pressure and EPR at 3, you created the conditions for deeper ventilation.  EPR in particular makes respiration easier to the extent you might trigger the apneic threshold.  This can be seen as an oscillating respiratory flow rate or even central apnea (CA) events.  My observation of your posted chart is that your pressure does not rise significantly from the minimum pressure, and that you have very few, if any obstructive events.  My recommendation is based on a reduced pressure overall and a reduced EPR in particular, to help you better balance respiration and reduce the CA events, while still treating your obstructive apnea.  This explanation is intended to be simple, but I realize it is a complex subject, so ask any question you may have.

Thanks for the explanation.  I used to snore a lot and I thought my apnea was mainly obstructive, but it seems that the cpap has pretty much completely gotten rid of my obstructive apneas.  I changed the pressure last night to 9 minimum and the EPR to 2 since the night before it was at 8 and I ended up ripping it off because I felt like I was not getting enough air.  Here's the graph from last night.  It looks like I still have mainly all CAs , the pressure only really went up past 11 for a bit though.  I ended up taking the mask off halfway through the night.. don't really remember why.. and put it back on around 6.  I'll try another night tonight at 9 for more data.  I appreciate your time, thank you.

[SarcasticDave94]

Just figured I'd mention it, I'm not so sure HIPAA law allows the stipulation of we the doc give you a copy of your sleep study after insurance pays. Maybe request it again and mention HIPAA Law.

[xdestry]

Last night.. The CAs at the beginning were just me being awake and getting used to breathing.  EPR is at 2 now with no ramp.  Min at 8 and max set at 13.  Trying to remember why I took off the mask but it's not coming... I do feel pretty good today though, wasn't so tired in the afternoon.  Thanks again for everyone's help. 

[SarcasticDave94]

OK the CA are dropping some. Keep at it as is is my suggestion.