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[CPAP] Where do I start (my first night on cpap + sleepyhead)
#1
Where do I start?

1. On Tuesday they gave me a wristwatch-fingercuff to wear overnight.
2. On Wednesday they told me my "Polysomnogram Report" had a "Apnea/Hypopnea Index" of 91.8/hour and a Minimum oxygen saturation of 76%.
3. On Thursday they gave me a loaner Philips Respironics "REMstar Auto A-Flex" set to, I think they told me, 10 to 20 cm of water (and a nasal mask F&P Eson).
4. On Friday I downloaded sleepyhead software for Windows and have a PDF of the results
5. In a week I'm supposed to go back to them with the loaner machine where they will read the results.

But I want to get an idea of where I stand now so that I have questions for them next week.
What do I do now?

Page 1 of sleepyhead report: i.cubeupload.com/yvDGXt.jpg
Page 2 of sleepyhead report: i.cubeupload.com/IDHidA.jpg
Page 3 of sleepyhead report: i.cubeupload.com/mXcUea.jpg

What is the first thing that I look for in the first night results above?
#2
Hi verbatim1,
WELCOME! to the forum.!
Hang in there for answers to your questions about your SleepyHead report and much success to you with your CPAP therapy.
trish6hundred
#3
You lowered your AHI from 91.8 to 0.88 and you managed to sleep with the machine on, so that's awesome.

I don't like those spikes in your leak rate graph. They indicate that when you fall asleep your mouth is dropping open and the pressurized air is hissing out of your mouth. That ruins the machine's effectiveness. Call your equipment provider and get a chin strap. If that doesn't work you may have to switch from a nasal mask to a full face mask. In fact, just switching to a full face mask may make things easier for you.

When you do go back and exchange the loaner do not let them screw you over by selling you a machine that won't record data. See the following for machine recommendations:

http://www.apneaboard.com/wiki/index.php...ne_Choices
Sleepster
Apnea Board Moderator
www.ApneaBoard.com


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.


#4
Welcome to the forum. You have moved forward really fast and are doing the right things. Your data shows you're getting very good results at this point. Your sweet spot for pressure is narrowing into about 12 to 14 cmH2O. I wouldn't do a thing until you have your appointment. About the only thing I could suggest is that the minimum pressure might come up 1-2 cm to prevent some of the snores and obstructive events. People usually take some time to fully adapt to the use of PAP, but you've done quite well and should continue to see improvements.
#5
Hi verbatim. Welcome to Apnea Board. Looks like you are doing terrific!

I have two comments.

1. Find out if whoever will be writing the prescription for your xPAP machine intends to give you an auto-adjusting machine like you're using now, or if they plan to give you a CPAP (can only do one fixed pressure).

If your health insurance is covering this, they typically reimburse the same amount whether you get an auto machine or a CPAP. Auto machines cost more, so that can mean that the place that's supplying your machine would prefer that you get a CPAP machine. (This is a separate issue from the machine being data-capable.)

I did not know this when I did my sleep study, and I ended up with a CPAP machine. I need about 13.0 cm pressure to control my middle-of-the night sleep, and about 9.0 for the sleep before and after that. I have compromised on 11.0 at the moment. (I'll probably be at 13.0 eventually; I'm just not up for dealing with the mask leaks, etc., that I was getting at that pressure and am taking a break from struggling with that.)

You should be able to look at your nightly graphs in SleepyHead and see if you're showing a similar variable pressure requirement.

2. Mask. I had a nasal mask for the first six months. I just switched to a nasal pillows mask. After using it for just two nights, I really like it much better than the nasal mask. If you are going to get a non-full-face mask, I would highly recommend trying a nasal pillows mask.

I can sort of see why a nasal mask might be used for a week-long titration study like you're doing, since the nasal pillows can make the tip of the nostrils sore at first.

If you do end up with a nasal mask to start with, no harm done. It doesn't sound like you're having any problems with claustrophobia. And you may end up with a recommendation for a full-face mask if there are lots of mouth leaks in your week's data.

It's terrific that you're off to such a good (and quick) start. like
#6
(05-21-2016, 10:53 PM)Sleepster Wrote: You lowered your AHI from 91.8 to 0.88 and you managed to sleep with the machine on, so that's awesome.
[quote='Sleepster' pid='162902' dateline='1463889222']

Thank you for that encouragement.
I think what you are saying is that the AHI is the most important figure?

It seems to be the number of times I stopped (A) or almost stopped (H) breathing, is that correct?

I'm not sure what "almost stopped" (H) means, but I watched a bunch of youtube videos which show a person lying down and the back of the tongue falling back partially, which must be the "almost stopped" (H) part.

As for "managing" the machine, they told me that I would be claustrophobic but I wasn't. In fact, the mask was so loose I thought it would fall off.
[quote='Sleepster' pid='162902' dateline='1463889222']
I don't like those spikes in your leak rate graph.
Now we're getting somewhere, because the question I have i spades is how to INTERPRET the data!

(05-21-2016, 10:53 PM)Sleepster Wrote: They indicate that when you fall asleep your mouth is dropping open and the pressurized air is hissing out of your mouth.

Ooooooh. Interesting. The sleep tech asked me if I breathed through my nose or mouth and I said "how would I know?". So she gave me the nose-only mask and she said that everyone usually is a "nose breather".

(05-21-2016, 10:53 PM)Sleepster Wrote: That ruins the machine's effectiveness. Call your equipment provider and get a chin strap. If that doesn't work you may have to switch from a nasal mask to a full face mask. In fact, just switching to a full face mask may make things easier for you.
That is interesting information, since I am unaware of HOW I breathe when I sleep.

Is there a way to prove or doublecheck that I breathe with my mouth from the charts? (She said most people breathe with the nose.)

(05-21-2016, 10:53 PM)Sleepster Wrote: When you do go back and exchange the loaner do not let them screw you over by selling you a machine that won't record data. See the following for machine recommendations:

apneaboard.com/wiki/index.php?title=Archangle:Machine_Choices

Thank you for that recommendation. I will ask for the same kind of machine that they gave me which is a gray Philips one with a recorder.

I asked if they will assign me a bipap or cpap and the sleep tech said it was up to the doctor. I would prefer the "better" machine, but which one is better?

CPAP?
BIPAP?

I presume that bipap can do cpap so it seems "better" to me to prove to them that I need bipap but I don't know how to do that if that is true.

It would be good to find the encore software on line so I am looking for that also but the sleepy head software works well so maybe I don't need/want encore?

Thank you for your advice.



#7
(05-22-2016, 11:29 AM)verbatim1 Wrote: Ooooooh. Interesting. The sleep tech asked me if I breathed through my nose or mouth and I said "how would I know?". So she gave me the nose-only mask and she said that everyone usually is a "nose breather".

The issue is the choice between a full face mask and a nasal mask. Nasal masks pressurize only the nose, full face masks pressurize both the nose and the mouth.

Full face masks have a reputation of leaking more and therefore being harder to fit. Medical equipment suppliers (DME) therefore try to fit you with a nasal mask first unless you are known to be a mouth-breather.

But in my opinion mask materials and designs have improved significantly in recent years and so the reputation they have for leaking more and being harder to fit is not as well-deserved as it used to be.

Quote:Is there a way to prove or doublecheck that I breathe with my mouth from the charts?

We're talking about mouth-leaking, not mouth-breathing. Mouth-breathing is something you do when your nasal passages get blocked. Mouth-leaking is something you do when you're hooked up to a CPAP machine, you fall asleep and the jaw-closing muscles relax, the mouth falls open, and the pressurized CPAP air escapes out your mouth.

The way we confirm mouth-leaking is by looking at the extended chunks of elevated leak rate on the graph and seeing how they change when we apply a chin strap or a full face mask.

I would wake up with air hissing out my mouth, which was my first clue. That's not happening to you, but perhaps your sleeping partner, if you have one, has noticed. Some people have modified video cameras to work in the dark and recorded themselves sleeping. I don't think any of this is as reliable as the method I described in the paragraph before this one.
Sleepster
Apnea Board Moderator
www.ApneaBoard.com


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.
#8

(05-22-2016, 11:42 AM)Sleepster Wrote: The issue is the choice between a full face mask and a nasal mask. Nasal masks pressurize only the nose, full face masks pressurize both the nose and the mouth.
Thanks for that advice. I'm fine with the nose mask if that's what works for me.
(05-22-2016, 11:42 AM)Sleepster Wrote: Full face masks have a reputation of leaking more and therefore being harder to fit. Medical equipment suppliers (DME) therefore try to fit you with a nasal mask first unless you are known to be a mouth-breather.
I have no idea what kind of breather I am, but they did fit me with a nose mask only. The only choice they had was small or large.
(05-22-2016, 11:42 AM)Sleepster Wrote: But in my opinion mask materials and designs have improved significantly in recent years and so the reputation they have for leaking more and being harder to fit is not as well-deserved as it used to be.
I don't have a lot of money so I prefer the cheapest mask that works.
(05-22-2016, 11:42 AM)Sleepster Wrote: We're talking about mouth-leaking, not mouth-breathing. Mouth-breathing is something you do when your nasal passages get blocked. Mouth-leaking is something you do when you're hooked up to a CPAP machine, you fall asleep and the jaw-closing muscles relax, the mouth falls open, and the pressurized CPAP air escapes out your mouth.
Oh,. I misinterpreted that initially. My fault.
Thank you for explaining.
So the air goes in my nose and out my mouth in spikes between 5:30 and 6:30 am. I wonder why just the last hour of sleep.
(05-22-2016, 11:42 AM)Sleepster Wrote: The way we confirm mouth-leaking is by looking at the extended chunks of elevated leak rate on the graph and seeing how they change when we apply a chin strap or a full face mask.
That is interesting. It doesn't look like I have a chin strap or full face mask, so, I won't be able to tell if it's leaking. I have more graphs for last night so I will try to show them (but I can't upload pictures yet).

#9
Here's a link to the section of Roby Sue's Beginner's Guide to SleepyHead wiki that shows a graph of breathing flow rate with different events going on (snoring, expiratory mouth breathing, etc.) The whole Wiki is excellent for learning to understand SleepyHead.

You're correct about the apnea and hypopneas. They are usually expressed as an "index", which is number of events per hour. If you look at your daily SleepyHead data, you can see apnea and hypopnea events in the Events graph. There is also a graph for AHI (apnea-hypopnea index) that is an hourly average of events.

SleepyHead also shows something called RERA (respiratory effort-related arousal) which are the events in yellow on the events graph.

If you have a question about definitions, you can usually find them in the SleepyHead wiki, or you can just do a web search for the term. (Ditto for CPAP, APAP, and BiPAP (and VPAP). You probably want to read about C-Flex and A-Flex, too, which are Philips Respironics terms for expiratory pressure relief (EPR).

If you go into the Setup menu on your machine and look at the settings, you will find the A-Flex or C-Flex setting. It may be on or off. It it's on, it will have a value of 1-3. (You can do a search to read more about this setting.) 1, 2, or 3 all give you in the neighborhood of a 2 cm drop in exhalation pressure.

A BiPAP machine basically lets you set the exhalation pressure independently of the inhalation pressure. Some people have problems exhaling against pressure and need a wider gap between their set inhale and exhale pressure than typical. If they don't have it, they will swallow air, have the feeling that they can't exhale, etc.

BiPAP machines come in fixed pressure or auto-adjusting. With fixed pressure BiPAP, you might set your inhale pressure at 13.0 cm and your exhale pressure at 9.0 cm.

Auto-adjusting BiPAP would be like the APAP that you're using now, but with the ability to set a fixed difference between inhale and exhale pressure.

If you want to know how you breathe while you're asleep, I think looking at the breathing flow rate graph is the most helpful. If you click repeatedly on it, you can zoom in so that you can see individual breaths.

When the sleep tech said that most people are nose breathers, maybe she meant that they primarily inhale through their nose. When you are wearing a mask that doesn't cover the mouth, you keep air from escaping from your mouth by blocking your airway with your tongue. When we get into really deep sleep, sometimes our muscles relax and this tongue "block" may let air escape.

That can vary from just a tiny bit escaping from time to time (which I believe will look like the "expiratory mouth breathing" graph) to letting so much air rush out of our mouth that it shows up as a large leak. You may want to do a search about what large leaks of air from your mouth do to the effectiveness of your therapy.

If you wake up with a very dry mouth, that's a sign that you're probably doing quite a bit of mouth breathing.

I'm not clear about whether some people also inhale through their mouths all the time (unless there's lots of nasal congestion).

A "full face" mask covers your mouth as well as your nose, so if you exhale through your mouth, the air doesn't leave the pressurized system of the xPAP machine, tubing, mask, and you. (Full face mask doesn't mean it covers your eyes.)

Another interesting graph is the pressure graph. You can look at events and see how the machine's algorithm varies the pressure in response. (You'll want to look at the flow limitation graph in addition to the events graph if you're doing this.)

If this is confusing, blame my writing style. Plus, there are several definitions to learn. PLUS, the different machine manufacturers (primarily Philips Respironics and Resmed machine users on this board) use different terminology, so you have to learn more than one term for (approximately but not exactly) the same thing, like expiratory pressure/pressure relief being called EPR, C-Flex, A-Flex, pressure support, etc.

I've tried to be accurate in what I've written here, but there may be errors. If so, someone will probably say so.


(05-22-2016, 11:29 AM)verbatim1 Wrote: The sleep tech asked me if I breathed through my nose or mouth and I said "how would I know?". So she gave me the nose-only mask and she said that everyone usually is a "nose breather".

That is interesting information, since I am unaware of HOW I breathe when I sleep.

Is there a way to prove or doublecheck that I breathe with my mouth from the charts? (She said most people breathe with the nose.)



#10
(05-22-2016, 10:06 AM)green wings Wrote: Hi verbatim. Welcome to Apnea Board. Looks like you are doing terrific!
Thanks. My AHI went from 0.88 to 1.71 last night but that's still below 5, which I think is the aiming point.

(05-22-2016, 10:06 AM)green wings Wrote: 1. Find out if whoever will be writing the prescription for your xPAP machine intends to give you an auto-adjusting machine like you're using now, or if they plan to give you a CPAP (can only do one fixed pressure).
Thank you for that advice.
I will ask them for an 'xpap", which, I gather, is a "dynamic" automatic adjusting pressure versus a static pressure.

Would you suggest me asking for 'bipap" also?

(05-22-2016, 10:06 AM)green wings Wrote: If your health insurance is covering this, they typically reimburse the same amount whether you get an auto machine or a CPAP. Auto machines cost more, so that can mean that the place that's supplying your machine would prefer that you get a CPAP machine. (This is a separate issue from the machine being data-capable.)
The insurance covers the machine, although I don't know how THEY decide what to cover. I assume they cover whatever the MD prescribes so my goal would be to make sure the MD prescribes me the best they can for me, which sometimes means I have to tell them what I want.

(05-22-2016, 10:06 AM)green wings Wrote: I did not know this when I did my sleep study, and I ended up with a CPAP machine. I need about 13.0 cm pressure to control my middle-of-the night sleep, and about 9.0 for the sleep before and after that. I have compromised on 11.0 at the moment. (I'll probably be at 13.0 eventually; I'm just not up for dealing with the mask leaks, etc., that I was getting at that pressure and am taking a break from struggling with that.)
Thank you for that advice to ask for the self-adjusting machine!
I only know the one kind of machine that I have so it is GREAT that you tell me what to ask for.

I don't know if they LISTEN, but at least I can ASK intelligently, so thank you for that advice of:

1. self adjusting
2. data capable
What about
3. Bipap?

(05-22-2016, 10:06 AM)green wings Wrote: You should be able to look at your nightly graphs in SleepyHead and see if you're showing a similar variable pressure requirement.
Here are the sleepyhead statistics over the past two days:
Average Pressure 12.34 12.36
Min Pressure 10.00 10.00
Max Pressure 17.80 17.80
90% Pressure 15.30 15.20

So it looks like I go from the minimum they have the machine set to, to almost 18 cm of water, with my average around 12 cm of water.

I'm not sure how to tell from the graphs though, whether this is like your situation since those are just static numbers.

Here is a screenshot of the graph of last night for example:
i.share.pho.to/5b361854_l.png

(05-22-2016, 10:06 AM)green wings Wrote: 2. Mask. I had a nasal mask for the first six months. I just switched to a nasal pillows mask. After using it for just two nights, I really like it much better than the nasal mask. If you are going to get a non-full-face mask, I would highly recommend trying a nasal pillows mask.
Thanks for the "pillow mask" suggestion. I'll look up what that means. OH. OK. They go INSIDE your nose. Thanks for that suggestion.
(05-22-2016, 10:06 AM)green wings Wrote: I can sort of see why a nasal mask might be used for a week-long titration study like you're doing, since the nasal pillows can make the tip of the nostrils sore at first.

If you do end up with a nasal mask to start with, no harm done. It doesn't sound like you're having any problems with claustrophobia. And you may end up with a recommendation for a full-face mask if there are lots of mouth leaks in your week's data.
I don't have a problem ever with claustrophobia, and I scuba dive and I go caving and I mountain climb and I've jumped out of airplanes, etc., so, I can't imagine putting a silly looking rubbery plastic mask on my face giving me claustrophobia. Smile (It's more embarrassing than anything else.)
(05-22-2016, 10:06 AM)green wings Wrote: It's terrific that you're off to such a good (and quick) start. like
I like that they said come down immediately when they saw my numbers.
They seem like they're already going to give me a machine, even though I didn't "prove" anything to them with the loaner yet (the tech said the machine would be there waiting for me so that's why I want to ask questions ahead of time).

I'm working on getting clearer screenshots but here is the sleepy head results for last night (which got twice as bad as the first night):

Page 1. i.share.pho.to/d5dce325_l.png
Page 2. i.share.pho.to/4b5d345b_l.png
Page 3. i.share.pho.to/89d1a9d9_l.png



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