First night on autopap (central apneas)

[Sleeprider]

I think any form of EPR is bad for you.  The end of the night at fixed pressure of 8 was fine, and that is where we left off on 2/23.  I don't really know why you'd not stick with this.  

[JohnnyGobbs]

I think any form of EPR is bad for you.  The end of the night at fixed pressure of 8 was fine, and that is where we left off on 2/23.  I don't really know why you'd not stick with this.  

Sleeprider,

Yea but on Sunday I had auto and epr 1 and it was even better (my 2nd post today)

The 8 with no epr was good too. A couple apneas and centrals though. I guess I can stay with it a few more nights and keep checking. My bad nights are when theres lots of centrals I just feel wired and I'm still not sure why they occur.

[JohnnyGobbs]

Had a terrible night last night. Trying to figure out what it means if anyone can help. Started half the night with fixed pressure 8min/8max and epr 0 then halfway through the night switched to auto with epr 2 just to see what happens and I thought it felt more comfortable at the time. Some notes, I had bad acid reflux last night and ate and drank too much. Also, Have a little sinus thing/cold thing going on too. My mouth was super dry the many times that I woke up. What's with all the hyponeas all at 10 secs? is the snoring accurate? all the centrals were crazy too (probably many were onsets in the beginning). I would fall asleep then startle awake. what do you make of this? thx.  


http://imgur.com/a/AF8BU

[Sleeprider]

The ideal of using 8 cm fixed with no EPR was to see if that could reduce or eliminate the centrals. At this point, I think you have shown it does not, and it's hard to avoid that this could be a mild complex apnea. You are almost a month into the therapy, and by now should be adapted enough that what we're seeingis not just the sleep disruption junk, but that remains a possibility since you say you eating, drinking and reflux were factors. I don't think the severity will be enough to move you into a covered ASV type machine, so the idea is to get comfortable and minimize events to the extent possible.

Would you be willing to try APAP mode with a minimum of 5, maximum 8 and EPR at 1 or 2? You don't need the higher pressures, and you have never required over 8 cm to control obstructive events. I think 4 is too low on IPAP, and your APAP session last night was mainly in the 7-8 pressure range for IPAP. Variable pressure seems to be more comfortable for you, but it would still be beneficial to limit the range.

[JohnnyGobbs]

Let me just note that many of these nights I've posted have all had lots of different variables. Stress/anxiety, Benzos/stimulants (all prescribed but inconsistently used), alcohol, I've slept in 3 different locations since starting therapy and none at home, a lot of different bedtimes all over the clock, there's been lots of variables and chaos. Could say, anxiety, be causing me to be extra sensitive to pressure changes some nights and trigger the central apneas or something? Or do the sleepyhead graphs not lie?
I'm just trying to figure this out cause my life has been very hectic and inconsistent since starting therapy.

I am willing to try whatever man! Keep sending in the recommendations.

what's the benefit of limiting the range to 8 vs 18 when I never go over 10? Just curious. Does the machine switch pressure more smoothly with a smaller range? (A couple nights it went to 10 max btw fyi). The ramp is always at 4. I started at min 5 and you said to go to 6. So now back to 5?


Also, I don't understand those hyponeas. Could they be from my stuffy nose last night or anxiety from intentionally mouth breathing a dozen times or so (which I kept doing intentionally).

Thx again for your help man.

[Sleeprider]

When you look at the Events tab in daily details, you will see the duration of the events. Are most of them 10 to 15 seconds? If so, those are relatively inconsequential nuisance events. CA events and even H are pretty typical to see in disrupted sleep, and even tossing and turning. Short events, spaced through the night do not cause a problem with oxygen levels. Keep in mind, an event rate under 5 is considered medically treated and acceptable. Don't let this become a point of anxiety. No one is keeping score or giving you a grade. The whole idea is to get the most comfortable and rested you can. It beats being untreated.

[Mark71]

Keep in mind that it takes a few days to get used to any changes you make. When you change settings half way through the night, it is not really reliable data there to compare. Make a change,(one thing) then stick with it for a few days (at least) then you may be able to see a pattern develop. If you change something everyday or even twice during the night, you never have a chance to settle in and get used to a particular setting.

Take any advice I give with a grain of salt as I am new to this too. Just trying to share opinions/ ideas that I have learned in my short time here.
Thanks

[Sleepster]

Had a terrible night last night.

That can happen regardless of machine settings. I'm just 5 years into this now, and I still notice this type of variation. I can still say, though, that I continue to improve. The frequency of bad nights continues to decline.

[PaytonA]

JohnnyGobbs,

Last night you slept very poorly if at all during about the first half of the night. That is the area where over half of the events occurred including most of the CAs. I am almost sure that this is sleep/wake junk and can be ignored. Try calculating your AHI without the first half of the night and I will bet that you come up with an AHI about 2.0. That ain't bad, and that is only considering the time after you switched to APAP. If you consider the whole night (excluding the events before you switched to APAP) the AHI is more like 1.2.

Why did you switch from CPAP to APAP in the middle of the night? You really need to settle on a good starting point and let it run for 4-5 days or more. Sleeprider's recommendation is probably a good place to start. Then let it run for a while before you make any changes even if you have a bad night or 2.

Your constant changing, either good, bad, or indifferent is making it much harder for Sleeprider to help you. I know that you are anxious to get this working well for you but it may end up taking twice as long this way.

I am doing well with my therapy and if I am not feeling well, it definitely affects my AHI and often makes my CAs go up from next to nothing. Also, if I just do not sleep well, my AHI will go up. i am an inveterate tinkerer and still in the 5 years that I have been on CPAP, I have only changed my pressure once. I did get a good prescription based on the recommendation from my titration, so I had a good starting point.

Please do not think that I am trying to be hyper-critical, I am just trying to point out where you need to be in order to be successful in a timely manner.

Best Regards,

PaytonA

[JohnnyGobbs]

Guys thanks for all the feedback. Last night was definitely not a normal night. I would fall asleep, dream for a second, gasp for air and pull my mask off etc. Definitely lots of panic/adrenaline going on.

Sleeprider,

The events were all 10-15 secs.

The reason I switched to apap after was because I was thinking maybe the fixed pressure was messing me up (the other night my ears felt clogged etc but not sure if that was sinus/cold related) and my mouth was super dry last night (could've just been dehydrated though). I don't think the apap setting had anything to do with a better second half of the night. I think my anxiety just finally subsided. My best night ever though was with apap 6min 18max pressure and epr 1 so that's why I switched. The fixed 8 pressure zero epr also has worked well too.

I was doing pretty good overall so to see all those centrals and hyponeas kind of freaked me out. Sleepyhead data is a blessing and a curse. I'm a bit of a perfectionist so I'm trying to get the perfect settings/chart and will probably go mad in the process, lol.