04-02-2017, 04:28 PM
(This post was last modified: 04-02-2017, 04:33 PM by lrob123.)
I just spent my first two nights with a CPAP machine, it is a Philips Respironics Dreamstation Auto (Auto-pap). I have a Resmed Swift Bella nasal pillow mask.
I was recently diagnosed with sleep apnea via a home study (15 AHI) and an in-lab PSG (11 AHI). My sleep doctor (neurologist) said my apnea was mild. However, I was concerned that the sleep tests might not have been too accurate since those nights I hardly slept. The in-lab test was a disaster, I only slept for 20 minutes the whole night. I did not have a CPAP during the tests (I just picked up my CPAP 2 days ago).
Before getting a CPAP machine, based on reading this forum and other internet forums, I ordered a Contec CMS50I oximeter (from ebay). The oximeter data said I have some dips around 85% SPO2. I could see that my worst apnea problems are later in the night (not the first 3 hours of deep sleep) and the problems get worse towards morning, probably during REM periods since I have nightmares and wake often.
I then requested that my doctor prescribe a CPAP machine for me and he did.
He prescribed an APAP pressure range of 4cm to 8cm.
I felt I did OK compared to some other first time users from what I've read, I really didn't like the creepy feeling of trying to exhale into the nasal pillow, but I kept the mask on anyway and the 2nd night was better.
I downloaded SleepyHead software so I can see my data. When I imported my first two nights of data into Sleepyhead, it told me my results were 'horrible' and to talk to my doctor :-<
The sleepyhead screenshot is here (have to put http in front of it because it won't let me post a URL until I've made 4 posts)
The number of AHIs seems worse than the home or lab study said. Do you think I need to ask my doctor to raise my pressure range?
I don't know if the number of central apneas should be of concern, i.e. how does one tell if one really has a problem with central apnea and might need a different type of machine?
One thing that surprised me was that when I woke up in the morning, was wide awake reading, the machine stayed at the high end of the range 8cm (for many minutes, never went down until I turned it off for a while at 9:30am). I knew I was breathing normally so I expected the machine to drop back down to 4cm but it did not. It seemed to flag events and raise the pressure again when I was fully awake (just reading in bed, left it on for curiosity sake) from 9:45-10:48am. Is this to be expected?
I might ask this same question on other apnea forums. I've browsed a few forums but I've never posted to any. I wonder how this forum compares to other sleep apnea forums - is one forum known to be have the most Sleepyhead users for instance? Has anyone started out at a different apnea forum and decided to switch to this one?
I'll post your image here. Your AHI treated is far worse than the mild apnea you were diagnosed with.
I think part of the problem is just adapting, and will improve in time. I think you need to rethink the pressure here. I'd suggest you revise the minimum pressure from 4.0 to 7.0 and set the maximum pressure at 12.0 The machine will only go as high in pressure as needed to address obstructive events. It's pretty obvious that the starting pressure of 4.0 does not work for you. You can see the large amplitude of the flow rate (breath flow) when the pressure is low as you start. This is respiratory effort because you don't feel you're getting enough air. As you relax, you immediately begin to have obstructive apnea until the machine gets near 7-8 pressure, then things seem to quiet down for a bit. As the machine begins to drop pressure towards you minimum events rapidly escalate and you're back to full pressure. At that point the pressure is still not high enough to fully open your airway and the result is hypopnea until you turned the machine off at 06:20, then the whole cycle starts again. The increase of CA in the last half of the session is probably sleep disturbance related.
Both the higher starting pressure and maximum pressure are going to help you to get more comfortable and effective treatment. Fortunately your leak rate is pretty good, an it looks like you should tolerate the higher pressure well. Let us know if you have questions or don't know how to change settings.
It does sound like my pressure needs to be increased.
Do you know if most new CPAP users have quick response from their sleep doctor or RT when it comes to changing their pressure? Or do many people have bad luck and get fed up and just do it themselves? I know it makes perfect sense to do it yourself if you've been using CPAP successfully for years already but just need to adjust because you go a new machine or new mask or moved to a location at a different altitude for example.
Since I've only had my machine for 2 days, I thought I'd try asking the doc or RT first. I'm just wondering if many people have trouble getting changed made. I'm a bit nervous because I love my doctor but his assistant never calls people back (I left 3 messages and never got called back, and she did not return 4 messages from someone at my insurance company company who only needed her to fax info) . But now I have an RT at a DME who can act as my advocate or middleman , so I might get a better response .
It's never a bad idea to include your doctor in a decision. The RT does not have the authority to change a prescription, so they are there to assist you with equipment, fitting and adjusting, but not to change settings. If you don't do anything else, at least increase the minimum pressure from 4 to 6 and leave a message with the doctor's office Monday that you plan to increase pressure. Don't ask permission...leave a message. You will get faster and more positive attention.
I think you will get considerable relief from that small change in minimum pressure. You are starting so far out of therapy pressure that it is just cascading. I suspect you will continue to have hypopnea, but increased minimum pressure may avoid some of the OA. Here is a quick tutorial on settings: http://www.apneaboard.com/dreamstation-c...structions
(04-02-2017, 06:44 PM)lrob123 Wrote: Do you know if most new CPAP users have quick response from their sleep doctor or RT when it comes to changing their pressure?
It varies a great deal. There is no norm.
Quote:Or do many people have bad luck and get fed up and just do it themselves?
Most people quickly realize that they know more than their medical care provider. If I were you I'd follow Sleeprider's advice and change the pressure yourself. You can inform your doctor of what you're doing and why.
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WELCOME! to the forum.!
I agree that your pressure needs to be changed. 4 CmH2O is too low, usually people change it to a higher setting because they don’t think they are getting enough air. Take Sleeprider’s suggestion about the pressure settings and things should look up a bit for you.
I’m proud to say that this is the best sleep apnea forum to come to for lots of great help and support.
I wish you good luck with your CPAP therapy, hang in there for more responses to your post.
(04-02-2017, 06:44 PM)lrob123 Wrote: Do you know if most new CPAP users have quick response from their sleep doctor or RT when it comes to changing their pressure? Or do many people have bad luck and get fed up and just do it themselves? I know it makes perfect sense to do it yourself if you've been using CPAP successfully for years already but just need to adjust because you go a new machine or new mask or moved to a location at a different altitude for example.
I gave my sleep dr a chance at my 3 week follow-up appt. He was uninterested in helping me. It was after that appt that I decided to just adjust my pressure myself... and I've been SO much more comfortable & happy.
When I first began APAP therapy, it did not take me long to figure out that my sleep doctor was not going to be of much help to me during the process. In my opinion, there is more knowledge on this forum than all of the sleep doctors combined. After dealing with a few different doctors, it became painfully obvious that they were there to make money from sleep studies and selling equipment before wanting you out of their lives forever. It's sad but you are sorta forced to become your own physician in many cases. With the guidance of this board and a little trial and error, it's not a problem to change your settings to suit your individual needs.
In agreement with the above. As soon as my doctor could claim victory, they were no longer going to dispense effort to increase my comfort.
The available knowledge related to apnea is people that have mild apnea do not have a higher risk of death than the non-apnea public, while moderate and severe apnea have greater risk by far. The use of CPAP is medically necessary to reduce the risk, and that is the object of their medical task - causing your apnea to fall back into theoretically normal (AHI of 5 or below).
(most of us want more. we recognize that there is a 'rested-ness' piece of this and feel that this is generally gained by reducing to the best of our ability the breathing disturbances to our sleep.) There isn't any proof from documented studies that doing so will lead to a longer life or reduction of risk for categories of illness or disease associated with apnea.
In your case, the cure may be causing more 'countable' apneas, though probably shorter. It may be resolving longer apneas and reducing the level of damage to your body (such as might occur at lower blood oxygen levels). You can employ your oximeter to determine how well the CPAP controls your oxygen level.
If you do not gradually (over the first two weeks of compliance) reach an AHI count of about 5 or less, then you could state that the fix is not what the doctor envisioned, and she needs to help you get at least to her stated goal. By the time most people get to see their doctor again, they have already amassed enough knowledge to be commended by the doctor. If you solve their problem, they won't have to. [as stated above, you usually can control to your desired level which is well beyond their line of 'satisfactory']
Wishing you well,
Dedicated to QALity sleep.
You'll note I am listed as an Advisory Member. I am honored to be listed as such. See the fine print - Advisory Members as a group provide advice and suggestions to Apnea Board administrators and staff concerning Apnea Board operation and administrative policies. 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.
(05-15-2017, 09:01 AM)signal13 Wrote: When I first began APAP therapy, it did not take me long to figure out that my sleep doctor was not going to be of much help to me during the process. In my opinion, there is more knowledge on this forum than all of the sleep doctors combined. After dealing with a few different doctors, it became painfully obvious that they were there to make money from sleep studies and selling equipment before wanting you out of their lives forever. It's sad but you are sorta forced to become your own physician in many cases. With the guidance of this board and a little trial and error, it's not a problem to change your settings to suit your individual needs.
In my humble opinion this post 'hits the nail on the head'.
Thank you signal13!