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Help reviewing data?
#1
I could use some help. I'm beyond exhausted, so please excuse any rambling. I'm going to put an overview of the background in the quote box. Read if you want context. Skip down past it if you just want the relevant stuff for the past couple of weeks.

Case history Wrote:I've been on CPAP for over 15 years. My required pressure kept going up, so when it hit 24, I had UPP surgery. (They removed everything from the airway that they possibly could.) They said there was a good chance I'd never need CPAP again after that, but I was sleeping so poorly that I started using the machine again before my throat had fully healed. It did lower the pressure I needed to about 12, though. Since then, the requirement has been slowly creeping up again. Last year, I was on BiPAP of 15/10. Around June, I was feeling exhaustion creep up on me again and my AHI was slightly elevated. I called the doctor, but she didn't get back to me. So I turned the pressure up to 16/11 myself, and felt better.

The thing with me is that I've got a bunch of other sleeping disorders. Mostly fibromyalgia, but I'm also diabetic and have a thyroid disorder, both of which can interfere with sleep quality. I'm also totally insensitive to light cues, which has put me on a "non-24" or "free running" schedule. I may have some other issues for which they don't yet have names. Basically, I can't remember feeling well rested in my adult life. I need a baseline of 9 hours a night, and if I don't get it I'm usually exhausted for the next two days. It doesn't take much to put me into the kind of sleep deprivation that has me talking out loud to myself with no memory of what I was trying to say by the time I get to the end of the sentence.

With all that, I'm very sensitive to changes in my apnea. AHI has to be around 2. If it's over 2.5, I can feel the difference without even looking at the machine. If it's under 1.5, it's usually an indication that, for some reason, I wasn't sleeping deeply enough to even trigger the apnea. I realize that sounds far-fetched, but I promise you it's held true over long experience, and I assess how I feel before looking at the numbers.

That's the starting point. Last November, I took a turn for the worse. I'd racked up a sleep debt in early October, and expected to take a couple of weeks to recover, but... Well, it's hard to remember with any clarity, but I know I spent about half of November locked in my room, unable to tolerate having another human being in physical proximity and often too woozy from lack of sleep to even sit up. I've had my ups and downs since, but suffice it to say I've been in exceptionally bad shape for the last few months.

I finally managed to see the sleep doctor, and managed to talk him into doing a sleep study. The machine was still reporting AHI around 1.5-2, but clearly something was very wrong. We started with CPAP at 12 (turns out the new sleep doctor didn't have it in his records that I'd been on BiPAP for years) and worked up from there. The report said I had an average AHI of 31 until the tech turned the pressure up to 19. So I've been on 19/15 for the last several nights.

I can't tell yet whether it's making any difference. So I pulled the memory card and took a look at the graphs. I still can't make heads or tails of it. It doesn't look to be making a difference, but I'm too tired to think straight. I put together before and after graphs and just added the data from last night. I do feel like there's a change in my sleep, in that I'm maybe sleeping more deeply at times but I'm also waking up fully more often and having more trouble falling asleep. I don't really know if that's progress. Last night, I got 8 hours and just couldn't get back to sleep. I've already got a headache.

I'm using a nasal mask. Leak is negligible. I did try using a chinstrap for a while, just in case I was somehow suddenly opening my mouth at night despite not having done so for the last 15 years. But I was desperate to try anything that might help. Not sure if it made a difference. I stopped using it two nights ago because, as much as I loosened it, it just wasn't very comfortable.

The graphs are attached. Can you make anything of the data? Any other ideas/suggestions?


Attached Files Thumbnail(s)
           
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#2
Prima facie, the new pressure data looks better.
Hard to tell as it would be better to display flow, pressure, events, and perhaps leaks.
From what you've posted, one cannot review what the machine is doing when an event is flagged.

Again, at first glance, you appear to have mixed apnea. Both Central and Obstructive.
IMHO: Based on limited data, you should have been titrated for an ASV machine.

Edit: And please post which S9 machine you have in your profile.
You can find the name just above the start button.
You edit your profile in your user control panel.
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.
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#3
The machine is not programmed to adjust the pressure after an event. I tried auto titration, but it actually made things worse. I'll see if I can find a way to post extended charts. Is there a better method than lining up screenshots?

I'll take a look at the machine to get more specifics and update my profile later today.

I'd never heard of ASV before. I'll mention it at my next appointment.

Thanks for the help.
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#4
You have a pretty long list of things that could affect your health and fatigue level. Have you checked T?
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#5
(01-17-2016, 03:15 PM)pgw78 Wrote: Is there a better method than lining up screenshots?

Rearrange the display order of graphs in rescan such that flow, pressure, and events are grouped together.

(01-17-2016, 03:37 PM)Sleeprider Wrote: You have a pretty long list of things that could affect your health and fatigue level. Have you checked T?
And Blood Glucose and Thyroid...
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.
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#6
Hi pgw78,

Goodness gracious, your background section shows terrible suffering.

Hang in there. Don't give up.

What is your height, and on the Statistics tab of ResScan, what are your median values for Tidal Volume (amount of air inhaled or exhaled per breath) and Minute Volume (volume of air inhaled or exhaled per minute)?

Most of your apnea events have been clear airway events, but the number per hour is less than 5 and therefore too low to qualify in the USA for insurance coverage for an ASV machine, which is what I suspect you need.

An ASV is a type of bilevel which can treat (prevent) both your obstructive and central apneas, as well as your RERAs (Respiratory Effort Related Arousal). RERAs are not recorded by the S9 machines, but just like Apneas and Hypopneas, RERAs can prevent us from achieving restorative sleep, leading to daytime fatigue/exhaustion.

An ASV machine allows a large amount of Pressure Support (the difference between inhale and exhale pressures) to be used without causing central apneas. Larger values of PS do for us more of the work of breathing, tending to eliminate RERAs, and also tending to increase our average Tidal Volume and average Minute Volume. If our TV and Minute Vent are too low for our body size, I think this would also interfere with achieving restorative sleep.

If you now are using an S9 VPAP S or an S9 VPAP Auto, you can try increasing EPAP and decreasing PS. Increasing EPAP would tend to decrease Obstructve Apneas, and decreasing PS typically tends to decrease the number of centrals we get, but decreasing PS typically increases the number of RERAs we get, so only trial and error would show which approach (less PS or more PS) may be best in your case.

If decreasing PS seems to make things worse, try increasing PS. Increasing the PS will sometimes increase the number of centrals we get but may give us better sleep by eliminating RERAs.

Also, if increasing the PS increases the number of centrals, this might give you at least 5 per hour which you would likely need for insurance coverage of an ASV titration and an ASV machine.

If you would be able to purchase a machine out of pocket, I would suggest a used S9 VPAP Adapt from Supplier #2, which often are out of stock but when in stock may be priced as low as $1,250. http://www.apneaboard.com/forums/Thread-...plier-List

Good luck and 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.
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#7
Have now updated machine info in my profile.

I've had every blood test you can name, and seen more specialists than I can remember. Testosterone levels are normal, and I keep up regularly with my endocrinologist on diabetes, thyroid, and other maintenance.

I'll take another shot at ResScan tomorrow. Used up brainpower for the day.

Will definitely look into ASV when I get the chance.

Thanks again for all the help.
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#8
The ResMed VPAP Auto S9 can certainly run in auto mode. Same machine I have.
VPAP is ResMed's name for BiPAP. The ResMed VPAP Auto can run in 3 modes:
Fixed pressure CPAP, or S mode BiPAP, or Auto BiPAP.

vsheline is correct. I just counted your events for several nights with the new pressure.
You are sleeping about 8 hours and having about 16 events; that's an AHI of 2.
Clinically speaking, your therapy would be considered effective by the doctor.

Seems like other things may be coming into play. Or the combination of all things is making you feel bad.
Likely you are on some meds -- and their side effects can also zap a person.

Rhetorical questions: (Don't actually answer them on the forum --- just in your mind.)
How long have you been diabetic?
How well is you control as indicated by your HgA1C ?
Do you use insulin?
Do you have neuropathy or retinopathy?

Long term diabetes that is not well controlled can lead to systemic neuropathy.
And, that's bad.
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.
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#9
As I said, the auto setting made things worse. Not uncommon, I'm told by my doctor. It only adjusts the pressure when things are already bad, and the change itself can be disruptive.

My diabetes is well managed, thank you. And I'm very well aware of things like complications. Even so, if my blood sugar gets out of range on a given night, it can interfere with my sleep. (You also seem to be assuming I'm type II, but most of my health issues are autoimmune.)
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