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Can it be this easy?
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mchad Offline

Members-b

Posts: 23
Joined: May 2013

Machine: Resmed S9 Autoset
Mask Type: Nasal pillows
Mask Make & Model: ResMed Swift FX
Humidifier: Integrated
CPAP Pressure: 11-15 (12 avg.)
CPAP Software: SleepyHead

Other Comments:

Sex: Male
Location: New York

Post: #1
Can it be this easy?
Hello all. Brand new member here.

I was recently diagnosed with OSA, with an untreated AHI of 57. After a week of dukeing it out with the DME, I got them to deliver a S9 Autoset, instead of the basic, data-less S9 Escape they originally wanted to give me. It came with a GSM modem for monitoring, which I promptly told my Doctor that I refused to have sitting a foot from my head for the 90 required days of compliance monitoring. (i'm not usually the tin-foil hat type, but if I can reduce the amount of EM radiation passing through my already cooked brain, I'll take it) So they're going to work out another mechanism to get my data on a regular basis.

But, I digress.

The real thing is, I got this device on Wedneday, and have had two nights with it. So far, my first night was a AHI was 1.9, and my second was a .6. I fell asleep in about 45 seconds, and woke only once last night (that I recall). I feel like a million bucks, and barely yawn once during the day, even at the usual 3pm, "holy crap, am I tired" - time... Now I understand that when you start using these devices, you get a "honeymoon" period, that wears off, but hell, after reading the potential difficulties ppl have adjusting the the lifestyle, I am cautiously considering myself lucky.

But learning about this stuff, and doing a little data mining using sleepyhead, I see that last night, I had a "central" apnea. This bothers me. I can understand the obstructive ones, but as I read about it, centrals are when my brain basically "forgets" to breath. That honestly scares the living hell out of me.

Is this something that I need to bring immediatly to my physicians attention? Or is it less concerning? Or am I overreacting and I should relax about it?

Also to note, while the S9 is auto capable, it is currently set in CPAP mode at 15. I am tempted to mess around the clinical settings (set it to auto, basically), but honestly, with those numbers, I probably should leave well enough alone, yes?

Sorry for the long winded post, again, im new and still learning.

Thanks all.
05-17-2013 08:43 AM
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trish6hundred Online

Advisory Members

Posts: 6,431
Joined: May 2012

Machine: Resmed S9 AutoSet for Her
Mask Type: Full face mask
Mask Make & Model: Fisher & Paykel Simplus
Humidifier: H5i Heated Humidifier
CPAP Pressure: 10 - 7-20 Cm H2O
CPAP Software: Not using software

Other Comments: I started CPAP in 2008. Totally blind since birth.

Sex: Female
Location: Missouri, USA

Post: #2
RE: Can it be this easy?
Hi mchad,
WELCOME! to the forum.!
That's good to hear that you are having such GREAT results for the first couple nights.
As far as that one CA, your body is still getting used to this new way of sleeping so I don't think I would be overly worried but hang in there for more answers to your questions.
You have come to the right place for lots of help and information.
Best of luck.
Edit: I wouldn't change any pressure settings for at least a week, preferablely longer so you can see trends in your data. One or two night do not a trend make so it's good to waite for a bit before you mess with pressure settings.

trish6hundred
(This post was last modified: 05-17-2013 09:34 AM by trish6hundred.)
05-17-2013 09:30 AM
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Shastzi Offline

Advisory Members

Posts: 1,174
Joined: Dec 2012

Machine: ResMed S9 Autoset
Mask Type: Full face mask
Mask Make & Model: FitLife Total face mask
Humidifier: F&P HC150 with Hybernite heated hose.
CPAP Pressure: 15cm-20cm H2O (auto)
CPAP Software: SleepyHead Other Software

Other Comments: CMS50-F wearable Oximeter; Software: SPO2 Assistant

Sex: Undisclosed
Location: Florida, USA.

Post: #3
RE: Can it be this easy?
Hi mchad!

Welcome

Sounds like you are doing everything right.
the 'centrals' are more accurately termed clear air apneas.
You will get some every now and then.
Your airway is open but your CPAP does not detect any airflow for 10 seconds or more it scores it as CA.
So, most of the time it's just a normal pause in breathing cycle.

CA's usually arent a problem unless they manifest in tight reoccuring clusters and/or become of long duration (over 30 seconds) .
That's why we have SleepyHead to keep on eye on things with!
If you see weird things starting to happen then it's a good time to check with the doc and show him/her your sleep reports.

Cheers and keep up the good work!

"With ordinary talent and extraordinary perseverance, all things are attainable." - Thomas Foxwell Buxton

Cool
05-17-2013 09:50 AM
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mchad Offline

Members-b

Posts: 23
Joined: May 2013

Machine: Resmed S9 Autoset
Mask Type: Nasal pillows
Mask Make & Model: ResMed Swift FX
Humidifier: Integrated
CPAP Pressure: 11-15 (12 avg.)
CPAP Software: SleepyHead

Other Comments:

Sex: Male
Location: New York

Post: #4
RE: Can it be this easy?
Thanks both for the replies. Interesting re: the CA's. I can see myself "manually" not taking a breath a couple of times while adjusting the mask or removing it slightly to scratch my nose. I wonder if that is being registered as a CA. Maybe I can note the times and see if they match the data.

I'll keep it up.

Also, looking for recommendations on a full face mask for those times a cold may cause a stuffed nose. I bought a quattro FX, to have as a backup and for that reason, but it leaks like a sieve, unless I tighten the hell out of it, and then it's just plain uncomfortable. I should mention, I suppose, that I have a beard. Trimmed quite close, but facial hair nonetheless. I imagine that I'm going to have the same luck with most FF masks...

The mirage FX nasal i'm currently using is pretty close to perfect for me, comfortable and leak-free.

Also to note, I went ahead and ordered a Devilbiss Intellipap autoset. I have a boat that I spend weekends on, and didn't want to carry my primary back and forth. Plus it will be available as a backup in the event of a failure. The Intellipap also has a nice direct 12v input, unlike the S9, which required a up converter to 48v (i think) - which inevitably are energy inefficient. Weekend boating is a very power conscious endeavor. Adding 16 hours of additional power draw made me invest in a 50 watt solar panel, which in direct sun, should give me a nice 3 amp per hour charge to my batteries. Hopefully that'll keep my batteries happy.

I'm so looking forward to boating with this, as is my girlfriend, who before this couldn't sleep in the cabin with my aggressive snoring!

Anyway, again, I write too much....
(This post was last modified: 05-17-2013 10:24 AM by mchad.)
05-17-2013 10:23 AM
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TinyL Offline

Members

Posts: 15
Joined: May 2013

Machine: ResMed S9 AutoSet
Mask Type: Full face mask
Mask Make & Model: ResMed Mirage Quattro
Humidifier: ResMed H5i
CPAP Pressure: 9 Min 13 Max
CPAP Software: ResScan

Other Comments: Type 2 Diabetic

Sex: Male
Location: Arkansas City, KS

Post: #5
RE: Can it be this easy?
Sounds like you took to it well, just been a couple weeks on mine and the thing is great!

Welcome!

Darin aka Tiny...Still Serving and Riding with the ALR...

Support Our Troops, If you can't stand behind them...Please stand in Front of them !!!
05-18-2013 01:44 AM
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Moriarty Offline

Advisory Members

Posts: 270
Joined: Jul 2012

Machine: Respironics REMStar 50 Series Auto
Mask Type: Nasal pillows
Mask Make & Model: Fisher & Pakel Pilairo Q
Humidifier: Respironics System One
CPAP Pressure: 8.5-20 (average 9.4)
CPAP Software: SleepyHead

Other Comments: Image above is my CPAP machine...

Sex: Male
Location: Toowoomba - Qld - Australia

Post: #6
RE: Can it be this easy?
These data reporrting machines are very clever but they do not have a neuro-sensory connection and so they CANNOT report Central Apneas. As was said earlier the correct term is Clear-airway Apnea. These may or may not be true central apneas or they may be an incorrectly identified Hypopnea..
Examination of the breathing wavefotm in SleepyHead will be very informative.
(This post was last modified: 05-19-2013 03:49 AM by Moriarty.)
05-19-2013 12:18 AM
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vsheline Offline

Advisory Members

Posts: 1,907
Joined: Jul 2012

Machine: S9 VPAP Adapt (USA Model# 36007, not better 36037 or 36067)
Mask Type: Full face mask
Mask Make & Model: F10 or SimPlus w/ 2Liners. MirageQuatro & Gecko gel pad
Humidifier: H5i
CPAP Pressure: 15 EPAP, PS 5-10
CPAP Software: ResScan

Other Comments: Marfan Syndrome, chronic bradycardia, occasional Cheyne-Stokes Respiration

Sex: Male
Location: California, USA

Post: #7
RE: Can it be this easy?
(05-17-2013 08:43 AM)mchad Wrote:  I got this device on Wednesday, and have had two nights with it. So far, my first night was a AHI was 1.9, and my second was a .6.
...
I see that last night, I had a "central" apnea. This bothers me. I can understand the obstructive ones, but as I read about it, centrals are when my brain basically "forgets" to breath. That honestly scares the living hell out of me.

Is this something that I need to bring immediatly to my physicians attention? Or is it less concerning? Or am I overreacting and I should relax about it?

Also to note, while the S9 is auto capable, it is currently set in CPAP mode at 15. I am tempted to mess around the clinical settings (set it to auto, basically), but honestly, with those numbers, I probably should leave well enough alone, yes?

Hi mchad, welcome to the forum!

Everything is going well, so I suggest not touching your settings on your own until after the 90 day compliance period. Except for maybe the EPR setting, if it has been enabled. (If it hasn't been enabled, you could ask that it be enabled.)

I suggest you ask your doctor why CPAP mode has been prescribed instead of APAP mode. (For example, perhaps the doctor has some reason in mind why he does not want the machine in APAP mode with Min Pressure of less than 15 and/or Max Pressure higher than 15.)

If you haven't already done so, you should obtain and keep a copy of your full sleep report and your CPAP prescription, for your personal files. For example, I think you would need a copy of your prescription to use your machine on an airplane, in which case it would be allowed free (meaning, in addition to your normal luggage limits).

It is fairly common for a few centrals to occur when we first start CPAP therapy and to slowly disappear during the first few months, as our systems adapt to the therapy.

Also, it is pretty common to have a few centrals as we are falling asleep. Since we were not yet asleep, we should subtract those from the total CA events before dividing by total hours, to get the CAI. (By looking at the time waveform of the Minute Volume, we can usually see pretty easily when we fell asleep.)

To be eligible for US Medicare or a private insurance company to pay for an upgrade to an ASV class machine, I think the CAI may need to be larger than the OAI and I think the CAI (all by itself) would need to be higher than 5.0.

Since your AHI is small, unless some of the CA events are lasting a very long time (in event duration), or unless your blood oxygen were dropping a lot (as shown by a recording Pulse Oximeter like the ones available from Supplier #19 on Supplier List), I doubt you or your doctor should be overly concerned. But of course talk to him about it on your next doctor visit.

Take care,
--- Vaughn

Membership in the Advisory Member group should not be understood as in any way implying medical expertise or qualification for advising Sleep Apnea patients concerning their treatment. The Advisory Member group provides advice and suggestions to Apnea Board administrators and staff on matters concerning Apnea Board operation and administrative policies - not on matters concerning treatment for Sleep Apnea. I think it is now too late to change the name of the group but I think Voting Member group would perhaps have been a more descriptive name for the group.
(This post was last modified: 05-20-2013 12:29 AM by vsheline.)
05-20-2013 12:23 AM
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iSnooze Offline
Apnea Board Proofreader
Advisory Members

Posts: 239
Joined: Feb 2012

Machine: Respironics PR System One C-Flex+
Mask Type: Nasal mask
Mask Make & Model: Resmed Mirage Micro
Humidifier: System One Heated Humidifier
CPAP Pressure: 11
CPAP Software: SleepyHead

Other Comments: also use a Comfort Gel Full Mask by Respironics

Sex: Female
Location: Indiana

Post: #8
RE: Can it be this easy?
(05-17-2013 08:43 AM)mchad Wrote:  After a week of dukeing it out with the DME, I got them to deliver a S9 Autoset, instead of the basic, data-less S9 Escape they originally wanted to give me. It came with a GSM modem for monitoring, which I promptly told my Doctor that I refused to have sitting a foot from my head for the 90 required days of compliance monitoring. ... So they're going to work out another mechanism to get my data on a regular basis.

Many of us don't have a machine with a modem. To make sure we're compliant, i.e. using our machine at least 4 hours a night, the DME or Doctor's office usually sends us a new data card in the mail and we mail the old one back to them. My DME was nice enough to even email me copies of the reports when I asked them. I have SleepyHead software so I didn't need their reports but I wanted to see what they see.

As others said, I wouldn't change the settings for quite a while. To measure how effect your cpap therapy is you need several days/weeks of data. A few nights might be good, one or two nights bad, etc. It's the averages over time that show how effective treatment is.

Good luck finding the right full face mask for your beard. FFMs tend to leak more than nasal masks. Even if your beard is cut short, the mask isn't sitting flush with your skin. A few people have had luck with a total face mask. These cover the enter face include the eye area. Google them and check the reviews to see if they work for people with beards.

It sounds like you're off to a great start. Keep us posted on your improvements and how well your therapy works on the boat.
05-26-2013 05:11 AM
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mchad Offline

Members-b

Posts: 23
Joined: May 2013

Machine: Resmed S9 Autoset
Mask Type: Nasal pillows
Mask Make & Model: ResMed Swift FX
Humidifier: Integrated
CPAP Pressure: 11-15 (12 avg.)
CPAP Software: SleepyHead

Other Comments:

Sex: Male
Location: New York

Post: #9
RE: Can it be this easy?
Approaching 2 week update: AHI remains under 3, was 2.1 last night, 1.8 the night before. Sleeping like i did 25 years ago in the Corps, after a day of "strenuous activity"... Been trying out several masks (at my expense) but still come back to the Mirage FX. The Wisp is a very close second, but I'm still not sure. Using the measurements I record using the included tool, indicates I should be using a small cushion, however it's just not comfortable. I breathe just fine, but it just feels tight. So I use the large, which feels a *bit* too large. Both seal fine though. Ive also got the quattro fx adjusted to its passes the mask leak test (still a little tight, but tolerable) so i'll live with it the few nights i may ever need to use it. So that's that.

I did go ahead and set the unit to auto set mode three days ago, 10-15 range. The data reports it stays around 10.9 all night, never approaching the cpap 15 I was ordered. I find the lower pressure is much more comfortable. I suppose I should tell my Dr, but I don't want to get reprimanded for changing the settings... Thoughts on that?

In either case, I also purchased a less expensive devillbiss intellipap auto for use on my boat. I don't want to carry my S9 back and forth. I'll be using it prob 1-2 nights a week, fri and sat, or just sat. I think I will still meet compliance requirements for my insurance purchased S9 with 5 or 6 nights of 7+ hours of nightly usage, you think?

Anyway, I feel great, am sleeping like a rock, and barely move at night. My girlfriend is particularly thrilled at the thought of a quiet cabin on my boat this summer!

Another run-on post...
05-26-2013 09:07 AM
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OMyMyOHellYes Offline

Advisory Members

Posts: 915
Joined: Mar 2013

Machine: Respironics 560 Auto
Mask Type: Nasal mask
Mask Make & Model: Resmed Mirage FX
Humidifier: Respironics System One (no heated hose)
CPAP Pressure: 08.0-15.0 cm/H2O
CPAP Software: EncoreBasic

Other Comments:

Sex: Male
Location: Texas

Post: #10
RE: Can it be this easy?
I found the S9 AutoSet to make my sleeping MUCH more easy.

OMyMyOHellYes
Post #5 towards getting enough posts under my belt to post a link. 3 more to go!
05-26-2013 10:29 AM
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