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Help is needed - What is wrong with me? (S9 VPAP ADAPT user)
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ebitansky Offline

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Posts: 10
Joined: Apr 2015

Machine: Resmed S9 Vpap Adapt 36037
Mask Type: Full face mask
Mask Make & Model: Resmed Ultra Mirage
Humidifier: H5i
CPAP Pressure: AutoASV max EPAP 15 Min EPAP 8
CPAP Software: ResScan

Other Comments:

Sex: Male
Location:

Post: #1
Help is needed - What is wrong with me? (S9 VPAP ADAPT user)
Hello,
I am new to the forum and learned a lot from previous conversation and by talking to one of the advisers so thanks a lot to all participants

I would like to know if anyone in the forum based on lots of information below and experience can help me figure out what is wrong with my sleeping.
My doctor believes I am just a non compliant patient but you need to know that I really want to be and I tried it too many time on and off
I started again last month and I don't want to break again.

Sorry for so much information, but somehow I think it may be helpful to see the three studies before looking at the daily usage. I also ask some questions in between the studies.

I appreciate any help or advice

First Sleep Study was Dec 2011
BMI 37.3
Sleep Observation:
Monitored Time 432.5
N1 15.8 (Mildly increased)
N2 67.3% (normal)
N3 2.8% (normal)
REM 14.1% (mildly reduced)
Sleep Efficiency is 78.8 (Mildly reduced)
Sleep Onset 20 (mildly delayed)
Rem Onset 252.5 Min (markedly delayed)
Awakening 21 markedly increased
note: Patient Slept on their left and right side and supine

Respiratory Observations:
AHI 40.3 REM 28.8 NREM 42.2 SUPINE 66.8 Non Supine 18.1
Total Number of events :229 Obstructive 166 Central 8 Hypopnea 55
Average Duration 40.3 seconds Longest Apnea 37.1 Longest Hypopnea 98.8
RDI 49.6

Oxygen Saturation
Average 93% Lowest 81% Below 90% 9.6 minutes

Arousal Observations:
Total 287 Index 50.0
Respiratory 227 Index 39.9
Spontaneous 7 Index 1.2
PLM 0 Index 0
RERA/UAR 53 Index 9.3

Snoring was moderate
Arrhythmia observed occasional PVCs
moderate hypoxemia

Recommendation: Return for Positive airway pressure titration study.

Second Study was Dec 20th 2011
BMI 37.3
Sleep Observation:
Monitored Time was 390 minutes Sleep percentage may not be accurate due to decrease sleep time
my note: I guess I was quite anxious first time with cpap

N1: 22.0 (Moderately Increased)
N2 74.1 (mildly Increased)
N3 0.0% Mildly reduced
REM: 3.9 Markedly reduced
Total Sleep time 166 minutes (Markedly reduced)
sleep onset 15.5 (Normal)
REM Onset 264.5 Markedly Delayed
awakening 20 Markedly Increased

Respiratory Observations:
At a pressure of 9 cmH2O using a Mirage Quatro Full Face Mask Medium AHI was 46.6 RDI was 46.6. Central events were at sleep onset
Hypoxemia was resolved with positive airway pressure

Impression:
The positive airway pressure titration was not successfully complete due to residual obstructive events
REM sleep was achieved in the supine position on 8 cmH@O pressure
Sleep efficiency 42.6% (markedly reduced)

Recommendations:
autoCPAP at a pressure of 5-18cmH2o

at this point I got an autoCPAP machine which I couldn't get comply. maximum was able to be on the machine was 30 min.
I never had a problem to fall asleep, always would wake up suddenly, and try to take it off probably because of feeling chocking due to high pressure.

two question though at this point:
Is Central Apnea normal to be observed with Obstructive Apnea Patients that is not due to use of CPAP?
should the results of first and second study show that the patient should go on ASV from the beginning?


After almost 2 years of not being compliant I was sent to ASV study (12/9/2013)
BMI at this point was 33.6
Took 0.5 mg xanax prior to the study with authorization of technician
Monitored Time 385 minutes
N1 - 7.3% (normal)
N2 - 71.0% (mildly increased)
N3 - 1.7% (mildly reduced)
REM - 20.0% (normal)
Total Sleep Time 295 min (moderately Reduced)
Sleep efficiency 82.4 (mildly reduced)
Sleep onset 1 min (normal)
REM onset 176.5 min (markedly delayed)
awakening 14 (markedly increased)

Respiratory Observations:
At a pressure of EEP 6 cmH2o Max PS 15 cmH2o and Min PS cmH2O AHI was 1.5 and RDI 1.9
Hypoexmia was resolved with positive airway pressure

Impression:
Positive airway pressure titration was successful
REM sleep was achieved in the supine position on the optimal pressure

Recommendation: ASV at pressure EEP 6cmH2O MAx 15cmH2O min PS 6cmH2O

Doctor prescirbe to me RESEMD S9 VPAP ADAPT
but put the prescription as EPAP 5 PS 3-15

through many periods of times I was able to sleep with the mask for 3 months missing one or two days, but most time was 2-3 hours.
Always woke up with pressure so high that didn't let me go back fall asleep

after reading many threads here I decided on my own to do the following:
1. get climate control and set it to automatic on 72F
2. change the mode to ASV AUTO with default which is: Min EPAP 4.0 Max Ipap 30.0 PS 3-15

then after talking to one of the advisers here on this forum changed the default settings to:
Min EPAP 8 Max Ipap 25 PS 4-10 but somehow still kept it using ASV auto mode

The Adviser after looking at my report suggested I'll go back to my doctor but think I should go for a second opinion.
I am trying to get an appointment in the NY area to a new doctor but waiting time for consultation is a month.

I learned how to use rescan and sleepyhead and imported my data on a daily basis

as you can see in my last 30 days reports (links are below) the last months was like a big roller coaster. seems to me that the machine is trying to kill me. getting to a pressure above 25.
I want to be able to sleep for at least 4 hours a night. so far the most consecutive hours were 2 hours and a bit above 4 hours if I woke up a second time realizing I dont have the mask and put it back on.

Important information
Since I really wanted this period to be succesful I asked my doctor to prescribe anti anxiety medicine for me:
I got prescription for:
Xanax 0.5 mg on April 29th and used it till May 6th
From May 6th to May 11 0.75mg
From May 11th to May 22nd 1mg
after reading that xanax can be bad for me I stopped it on May 23rd and since then I was off the Xanax

Is there something in the report that shows better/worse or optimized level of sleep with the xanax or I am better off try to figure out better way to get compliant?
I realized in my daily reports that although I was awake and just tried to keep the mask on, it reported high hyponea events, high apnea events and pressure in the sky.
Why is my rate of breath below 8, isn't this too low?

links to my cloud drive and the reports:
somehow I couldn't publish this forum with the three links
If anyone is able to assist I could send these report links by email or private message.
(This post was last modified: 05-21-2015 12:11 PM by ebitansky.)
05-21-2015 12:10 PM
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retired_guy Offline

Preferred Members-2

Posts: 2,744
Joined: Jan 2014

Machine: ResMed S9 Autoset
Mask Type: Nasal pillows
Mask Make & Model: Resmed Airfit P10
Humidifier: ResMed
CPAP Pressure: 10.6/14, EPR 3
CPAP Software: ResScan SleepyHead

Other Comments: Is it bedtime yet?

Sex: Male
Location: Beautiful, albeit very wet Oregon Coast

Post: #2
RE: Help is needed - What is wrong with me? (S9 VPAP ADAPT user)
The settings suggested to you by your "adviser" seem much better to me than the original. But I don't know why you're prescribed an ASV machine in the first place. It seems clear that your events are almost completely obstructive in nature.

That makes me think you should look elsewhere for your answer: I would suggest the original Vpap therapy with a minimum pressure of 8 and a max around 14. I would also suggest a different mask, one that you will not end up taking off quite so readily in the night. I think that's the problem. I know I have a rep for always recommending the P10 pillows mask instead of the full face masks, but guess what? I'm going to do that again.

I believe if you were on a pillows mask, with reasonable vpap settings, and sleepyhead to see what your actual results are night after night, you will master this therapy.

Also, pay attention to your sleep situation. With the high obstructives you experience it is important that the head of your bed is elevated considerably. Ok, not so much that you slide off in the night, but enough so if you were to look you could see your toes. I would advise you to stay off your back as well, and indeed that might be of help to you, but it is nice that you can sleep on your back and on your side. So maybe think on the stay off your back thing for awhile.
05-21-2015 12:32 PM
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ebitansky Offline

Members

Posts: 10
Joined: Apr 2015

Machine: Resmed S9 Vpap Adapt 36037
Mask Type: Full face mask
Mask Make & Model: Resmed Ultra Mirage
Humidifier: H5i
CPAP Pressure: AutoASV max EPAP 15 Min EPAP 8
CPAP Software: ResScan

Other Comments:

Sex: Male
Location:

Post: #3
RE: Help is needed - What is wrong with me? (S9 VPAP ADAPT user)
Thanks for replying and your advice about the mask.
The reason why I am having a full face, was due to high season allergy I found it hard to breath from my nose. when I am treated with nasal spray situation gets better so I can try it again.
about the ASV, I don't know why I was prescribed but the first study had 8 central events and the second one had the following observation:
At a pressure of 9 cmH2O using a Mirage Quatro Full Face Mask Medium AHI was 46.6 RDI was 46.6. Central events were at sleep onset

I always thought that it means I have both obstructive and central and that most of the central ones are a cause of the cpap usage.

could you please explain why you believe this is not the case?

Thanks
ebitansky


(05-21-2015 12:32 PM)retired_guy Wrote:  The settings suggested to you by your "adviser" seem much better to me than the original. But I don't know why you're prescribed an ASV machine in the first place. It seems clear that your events are almost completely obstructive in nature.

That makes me think you should look elsewhere for your answer: I would suggest the original Vpap therapy with a minimum pressure of 8 and a max around 14. I would also suggest a different mask, one that you will not end up taking off quite so readily in the night. I think that's the problem. I know I have a rep for always recommending the P10 pillows mask instead of the full face masks, but guess what? I'm going to do that again.

I believe if you were on a pillows mask, with reasonable vpap settings, and sleepyhead to see what your actual results are night after night, you will master this therapy.

Also, pay attention to your sleep situation. With the high obstructives you experience it is important that the head of your bed is elevated considerably. Ok, not so much that you slide off in the night, but enough so if you were to look you could see your toes. I would advise you to stay off your back as well, and indeed that might be of help to you, but it is nice that you can sleep on your back and on your side. So maybe think on the stay off your back thing for awhile.
05-21-2015 12:43 PM
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retired_guy Offline

Preferred Members-2

Posts: 2,744
Joined: Jan 2014

Machine: ResMed S9 Autoset
Mask Type: Nasal pillows
Mask Make & Model: Resmed Airfit P10
Humidifier: ResMed
CPAP Pressure: 10.6/14, EPR 3
CPAP Software: ResScan SleepyHead

Other Comments: Is it bedtime yet?

Sex: Male
Location: Beautiful, albeit very wet Oregon Coast

Post: #4
RE: Help is needed - What is wrong with me? (S9 VPAP ADAPT user)
(05-21-2015 12:43 PM)ebitansky Wrote:  Thanks for replying and your advice about the mask.
The reason why I am having a full face, was due to high season allergy I found it hard to breath from my nose. when I am treated with nasal spray situation gets better so I can try it again.
about the ASV, I don't know why I was prescribed but the first study had 8 central events and the second one had the following observation:
At a pressure of 9 cmH2O using a Mirage Quatro Full Face Mask Medium AHI was 46.6 RDI was 46.6. Central events were at sleep onset

I always thought that it means I have both obstructive and central and that most of the central ones are a cause of the cpap usage.

could you please explain why you believe this is not the case?

Thanks
ebitansky

"Total Number of events :229 Obstructive 166 Central 8 Hypopnea 55"

... we all have some centrals, especially when we do something new.
... it mentioned the centrals were found at "sleep onset." Perhaps I would think they were more significant if they had occurred all night. Also, I believe you mentioned you took some Xanax before sleep?
... Ok, so 229 events of which 8 were central. Let's get rid of the 221 others and see if the central are still there.

As to the sinus thing? Nothing on earth works better to keep snarly sinuses open and doing what they're supposed to do all night long than a steady stream of warm, moist air coming from your cute little pillows mask. I have always had nose breathing challenges. But if I didn't need cpap for apnea, I might actually elect to keep using it for the benefit to my nasal breathing at night. I do not use any nasal sprays or treatments other than the nice warm moist air provided by my S9.

...and I really don't think use of Xanax or other such things is in your long term interests.
(This post was last modified: 05-21-2015 01:08 PM by retired_guy.)
05-21-2015 01:07 PM
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trish6hundred Offline

Advisory Members

Posts: 6,450
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: #5
RE: Help is needed - What is wrong with me? (S9 VPAP ADAPT user)
Hi ebitansky,
WELCOME! to the forum.!
Hang in there for more responses to your post and much success to you in getting your CPAP therapy needs met and straightened out.

trish6hundred
05-21-2015 03:13 PM
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ebitansky Offline

Members

Posts: 10
Joined: Apr 2015

Machine: Resmed S9 Vpap Adapt 36037
Mask Type: Full face mask
Mask Make & Model: Resmed Ultra Mirage
Humidifier: H5i
CPAP Pressure: AutoASV max EPAP 15 Min EPAP 8
CPAP Software: ResScan

Other Comments:

Sex: Male
Location:

Post: #6
RE: Help is needed - What is wrong with me? (S9 VPAP ADAPT user)
Hi again,
I am afraid that in my previous response I did not explain that in my first sleep study (no xanax , no cpap, just sleeping)
I had 8 central events (out of 229) yes.

in my second study that was only cpap (again no xanax) there was no count of events just that "central events where at sleep onset" without any other explanation.

Xanax was taken only in third study which used ASV.
So my question is still in effect, if with CPAP study it was important enough to show that I had Central events, should I assume that since they recommended CPAP and not an ASV that these events were insignificant?
Could it be that the ASV is hurting me more than helping in this case?
should I move it out of ASV mode to CPAP mode?

About the mask, you convinced me. I am going to give it a try.
I think I may still have one from sleep study where they tried it prior to the full mask.




(05-21-2015 01:07 PM)retired_guy Wrote:  
(05-21-2015 12:43 PM)ebitansky Wrote:  Thanks for replying and your advice about the mask.
The reason why I am having a full face, was due to high season allergy I found it hard to breath from my nose. when I am treated with nasal spray situation gets better so I can try it again.
about the ASV, I don't know why I was prescribed but the first study had 8 central events and the second one had the following observation:
At a pressure of 9 cmH2O using a Mirage Quatro Full Face Mask Medium AHI was 46.6 RDI was 46.6. Central events were at sleep onset

I always thought that it means I have both obstructive and central and that most of the central ones are a cause of the cpap usage.

could you please explain why you believe this is not the case?

Thanks
ebitansky

"Total Number of events :229 Obstructive 166 Central 8 Hypopnea 55"

... we all have some centrals, especially when we do something new.
... it mentioned the centrals were found at "sleep onset." Perhaps I would think they were more significant if they had occurred all night. Also, I believe you mentioned you took some Xanax before sleep?
... Ok, so 229 events of which 8 were central. Let's get rid of the 221 others and see if the central are still there.

As to the sinus thing? Nothing on earth works better to keep snarly sinuses open and doing what they're supposed to do all night long than a steady stream of warm, moist air coming from your cute little pillows mask. I have always had nose breathing challenges. But if I didn't need cpap for apnea, I might actually elect to keep using it for the benefit to my nasal breathing at night. I do not use any nasal sprays or treatments other than the nice warm moist air provided by my S9.

...and I really don't think use of Xanax or other such things is in your long term interests.
05-21-2015 03:44 PM
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PaytonA Offline
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Posts: 3,014
Joined: Dec 2013

Machine: ResMed S9 VPAP Auto
Mask Type: Full face mask
Mask Make & Model: Resmed Mirage Quattro
Humidifier: H5i(distilled-top up)
CPAP Pressure: VAuto MinE14.0 MaxI 20.6 PS4.0
CPAP Software: ResScan SleepyHead

Other Comments:

Sex: Male
Location: Orange County,California

Post: #7
RE: Help is needed - What is wrong with me? (S9 VPAP ADAPT user)
(05-21-2015 12:32 PM)retired_guy Wrote:  ........I know I have a rep for always recommending the P10 pillows mask instead of the full face masks, but guess what? I'm going to do that again.

I believe if you were on a pillows mask, with reasonable vpap settings, and sleepyhead to see what your actual results are night after night, you will master this therapy.

And guess what R_G, I wholeheartedly agree with your P10 mask recommendation as well as the rest of your recommendations. Coffee

Best Regards,

PaytonA
05-21-2015 04:03 PM
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trailrider Offline

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Posts: 304
Joined: Feb 2015

Machine: A10 Autoset for Her
Mask Type: Nasal mask
Mask Make & Model: Eson or P10
Humidifier: autoset
CPAP Pressure: 6-12 DME, 7-13 me
CPAP Software: SleepyHead

Other Comments: engineer. EPR at 3, unheated hose, humidity at 2. Routine hose entanglement.

Sex: Female
Location: Ontario

Post: #8
RE: Help is needed - What is wrong with me? (S9 VPAP ADAPT user)
To answer your question Ebitansky, I think there is nothing wrong with you! You are a perfectly normal human being whose body and brain are not at all amused with this confounded apparatus you insist on wrapping yourself up in. It covers your face, it tries to strangle you with a hose, and then it tries to push air that is not normal room air down your throat while you are sleeping. Of course you will wake up in distress and throw the evil thing away! It's what any self-protective human would do.

So yeah, no wonder it's not working out.

Take the time to unravel all the bits that are not working and distressing you. And we'll help you deal with them one at a time. R_Gs P10 recommendation is good. (I'm a convert.) So order them online (cheaper). While you wait for them to arrive, let's get you used to this mask and machine monster. Start by wearing your mask for an hour or so reading, not sleeping. An hour will give you time to see if there is something bothersome happening.
-air temperature, humidity, ramp setting, etc. Each of us has own own preferences for comfort. So give that a try tonight or tomorrow and tell us how it feels and what you don't like.

As for the pressure settings, we'll help you get there.
05-21-2015 08:23 PM
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ebitansky Offline

Members

Posts: 10
Joined: Apr 2015

Machine: Resmed S9 Vpap Adapt 36037
Mask Type: Full face mask
Mask Make & Model: Resmed Ultra Mirage
Humidifier: H5i
CPAP Pressure: AutoASV max EPAP 15 Min EPAP 8
CPAP Software: ResScan

Other Comments:

Sex: Male
Location:

Post: #9
RE: Help is needed - What is wrong with me? (S9 VPAP ADAPT user)
Thanks for the good words.
Apparently (according to the mask manual ) this mask is not compatible with VPAP adapt SV machines.

I can easily be awake for two hours with the mask. Problem is that it raises the pressure while awake to high pressure.
My starting pressure is 8 and I am fine sitting and watching tv until it
Gets to much higher number.

Previous replies suggest I may be using a machine for something I may not have.
Maybe this is the problem Sad


(05-21-2015 08:23 PM)trailrider Wrote:  To answer your question Ebitansky, I think there is nothing wrong with you! You are a perfectly normal human being whose body and brain are not at all amused with this confounded apparatus you insist on wrapping yourself up in. It covers your face, it tries to strangle you with a hose, and then it tries to push air that is not normal room air down your throat while you are sleeping. Of course you will wake up in distress and throw the evil thing away! It's what any self-protective human would do.

So yeah, no wonder it's not working out.

Take the time to unravel all the bits that are not working and distressing you. And we'll help you deal with them one at a time. R_Gs P10 recommendation is good. (I'm a convert.) So order them online (cheaper). While you wait for them to arrive, let's get you used to this mask and machine monster. Start by wearing your mask for an hour or so reading, not sleeping. An hour will give you time to see if there is something bothersome happening.
-air temperature, humidity, ramp setting, etc. Each of us has own own preferences for comfort. So give that a try tonight or tomorrow and tell us how it feels and what you don't like.

As for the pressure settings, we'll help you get there.
05-21-2015 08:37 PM
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trailrider Offline

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Posts: 304
Joined: Feb 2015

Machine: A10 Autoset for Her
Mask Type: Nasal mask
Mask Make & Model: Eson or P10
Humidifier: autoset
CPAP Pressure: 6-12 DME, 7-13 me
CPAP Software: SleepyHead

Other Comments: engineer. EPR at 3, unheated hose, humidity at 2. Routine hose entanglement.

Sex: Female
Location: Ontario

Post: #10
RE: Help is needed - What is wrong with me? (S9 VPAP ADAPT user)
I don't use and ASV and I'm not familiar with the pressure settings as described. Your sleep stats look like normal AutoPAP fix to me. I'll go do some reading. This looks like a good primer:

http://www.carolinasleepsociety.org/docu...of_asv.pdf

Do you have a DME or RT you can talk to who gave you the device? Something seems off.
(This post was last modified: 05-21-2015 09:03 PM by trailrider.)
05-21-2015 08:59 PM
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