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Here are my first night results
#1
Here are my first night results
I just completed my first night using a cpap. I am eager for feedback from the experienced members.

First of all, my sleep study revealed an AHI of 46.

My AHI for last night was 10.8
- Clear Airway = 5.53
- Obstructive = 1.11
- Hypopnea = 4.18

I feel as though going from 46 to around 11 should be celebrated, yet I'm still well above 5 so I'm discouraged as well. I'm not really sure what adjustments I should be making to my machine/mask to improve my results.

My machine: Philips Respironics Dream Station Auto w/humidifier
My Mask: Philips Respironics Dreamwear Gel Pillow Mask
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#2
RE: Here are my first night results
Hi Croweater.  First of all, DO NOT get discouraged.  The people on this board are nothing short of amazing!!  They have helped me so much with getting my Apnea under control.  Keep plugging away and asking questions.  It's all soooooooo much to take in and the people here are very understanding and VERY helpful.  I was getting discouraged too, then found this board.  
    Go to the software support section and the top thread is about how to post your Oscar charts and how to organize them.  I'm assuming you have either Sleepyhead or Oscar.  If not you can get a copy of it there too.  Did I mention it's free too?  Oscar is just the "newer" Sleepyhead, due to the developer of sleepyhead not supporting it any longer.  Post those charts and these wonderful people will more than help you out.  
     Good luck with your therapy, and remember, DO NOT get discouraged!!  Your first night is not the end all and be all of your journey.  These people here are amazing!!!
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#3
RE: Here are my first night results
Hang in there, Rome wasn't built in a day and you can't expect your body to instantly acclimate to CPAP your first night. It takes many of us weeks or even a few months to get fully comfortable with the new arrangement.

To get more help from the forum, please look into installing OSCAR and downloading your data so you can post charts. Also we need to know what mode and pressure settings your machine is set to, including the flex settings.

Good luck!
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#4
RE: Here are my first night results
Hey Croweater and welcome to the forum where you will find abundant help in your journey. Go ahead and get your profile up to date, download Oscar and collect some data. Then you can post some data that will allow members to provide you with help. Sounds like you are already getting somewhat of a handle on things. Also, if you haven't already done so get copies of your sleep study report and of your prescription and hang on to them for future use. You should soon be getting some specifics from other forum members.

Wishing you well, Stan
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Advisory Members serve as an "Advisory Committee" to help shape Apnea Board's rules & policies. Monitors are also Advisory Members, just with Extra Work assigned.
Membership in the Advisory Members group does not imply medical expertise or qualification for advising Sleep Apnea patients concerning their treatment.
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#5
RE: Here are my first night results
Croweater, if you had a comfortable first night, then you are well on your way to success and your attitude sounds great. The first thing we're going to do is throw out the CA events. Since they are not obstructive, that is not a part of the therapy we can target anyway, and it's common for new users to experience this level of CA events as sleep disruption or sleep stage transitions occur. Your OA index is just over 1 per hour, and the hypopnea at 4/hour is something that needs improvement.

You are using a Philips Respironics Dreamstation auto, and without the data we don't know the settings, pressure delivered, or how events were distributed through the night. We really do better when we can look at OSCAR data. My "guess" is that you were issued a Dreamstation with fairly open settings like 4.0 minimum to 20.0 maximum. The Philips is a fine CPAP, but it is poor at increasing pressure before events occur and needs to be setup with a higher minimum pressure. If you look at the machine sleep report record, you can pull up the average and 90% pressure, and somewhere in there is what your minimum needs to be.

Congrats on your first night on therapy, and best of luck with your journey. If you want specific recommendations, give us the data; meanwhile, consider increasing your machines minimum pressure setting by 1-cm until obstructive and hypopnea events are less than 2/hour.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

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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
RE: Here are my first night results
Thank You. I am working on setting up OSCAR today. I also found my APAP did not come with an SD card so I am rectifying that as well. My goal is to have OSCAR data available to share by tomorrow.

I know that the machine is setup with a pressure range of 6-20. But it has a 15 minute ramp that starts as low as 4. Once I have OSCAR data I'm sure you smart guys can help me dial that in.
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#7
RE: Here are my first night results
   

Here are my results from last night. They are much worse than my first night (but the truth is I took a sleeping pill on my first night so I should probably ignore those results)

Any suggestions?
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#8
RE: Here are my first night results
Compared to your first night AHI of 10.5, the second night is clearly a move in the wrong direction at over 26. Your CAI was over 50% which is a concern, but we are going to deal with this as obstructive sleep apnea rather than assume complex apnea for a while longer, however the lack of obstructive snoring and flow limitation combined with a high rate of central apnea events is more suggestive of therapy onset complex apnea. Since you are self-titrating on an auto CPAP rather than working from a clinical titration, I think you should consider requesting a clinical titration evaluation if this high rate of apnea continues. It would be helpful to see more details of your original sleep study, specifically if central apnea was present prior to CPAP therapy.
Quote:Treatment-emergent central sleep apnea. Some people with obstructive sleep apnea develop central sleep apnea while using continuous positive airway pressure (CPAP) for their sleep apnea treatment. This condition is known as treatment-emergent central sleep apnea and is a combination of obstructive and central sleep apneas.
The clustering of events suggests a potential positional apnea problem, and a soft cervical collar is an inexpensive and effective way to eliminate that possibility. This Wiki article offers a good understanding of the condition, and some examples from from other forum members that experienced similar AHI, and shows how the use of a soft cervical collar resulted in near-elimination of the apnea. http://www.apneaboard.com/wiki/index.php...onal_Apnea

Until you can implement a soft collar, I'd like you to think about your sleep position and anything that might cause chin tucking like tall firm pillows. I'd like to see the minimum CPAP pressure moved to 9.0 which is equal to your median pressure, and change AFlex to 1 or 2 but not 3. We often see higher CAI with higher flex in some members. Your median respiration rate of 10.8 is on the low side, but fluctuates a great deal suggesting a pretty disturbed sleep architecture. Be patient for your results to stabilize, but if these kind of results continue, your will need to involve your doctor in reevaluating your therapy.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files

How To Deal With Equipment Supplier


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
RE: Here are my first night results
Thank you for that response. I did have a very significant amount of CA in my sleep study. Six timers as many CA as OA.

What follows is the main part of my sleep study:

Protocol: This sleep study included the recording and monitoring of frontal, central, and occipital EEG, EOG, EMG, ECG, respiratory effort and flow, snoring, pulse oximetry, and position. Video recordings were obtained as needed. A qualified technician continually monitored patient throughout the night. Data was digitally stored and tabulated using Alice 5 software. Sleep staging and respiratory events were scored manually using AASM standards.

Sleep Latency: The patient’s sleep onset latency after lights out was 22.5 minutes. The Stage R sleep latency from sleep onset was 110.0 minutes. Total Sleep Time: The total time in bed was 376.0 minutes with a total sleep time of 244.5 minutes. Sleep efficiency was 65.0 %.

Sleep Architecture: The patient had 41.0 minutes of Stage R for 16.8% of TST, 37.0 minutes of Stage N1 for 15.1% of TST, 166.5 minutes of Stage N2 for 68.1% of TST, and 0.0 minutes of Stage N3 for 0.0% of TST. The arousal index was 5.4 per hour of sleep.

Respiratory: The patient was observed to have had a total number of 188 apneas and hypopneas with an AHI index of 46.1 per hour during total sleep time. The Stage R AHI index was 55.6. The normal AHI index is less than 5 per hour. There were 10 obstructive apneas, 0 mixed apneas, 60 central apneas, 118 hypopneas (4% desaturation or greater), 0 central hypopneas, 0 obstructive hypopneas and 5 RERA’s. The total RDI (A/H + RERA’s) was 47.4. Mild snoring was noted for 28.6% of TST. A split-night was not conducted due to physician order stating PSG.

Oxygenation: The patient had an average oxygen saturation of 95%. The minimum oxygen level was 83%. *Masimo Pulse Oximeters are accurate to a low SpO2 of 70% (+,-3).

Cardiac: The average heart rate was 55.6 beats per minute. The patient had a normal sinus rhythm with no arrhythmias noted.

Other/EMG: Patient had evidence of periodic leg movements during sleep. Patient had a total of 93 PLM’s with a PLM index of 22.8 and a total of 14 PLM arousals with a PLM arousal index of 3.4 per hour of sleep.

Diagnosis: Severe obstructive sleep apnea (G47.33) with an overall AHI of 46. Nocturnal hypoxia (G47.36). Abnormal sleep architecture with evidence of reduced of delta sleep. Patient did not qualify for split night (CPAP trial) protocol. There were significant periodic limb movements (G47.61) with a PLM index of 23.

Recommendations: Treatment for Obstructive Sleep Apnea is indicated to prevent cardiovascular morbidity and effects on daytime performance. Treatment options include CPAP/BiPAP, dental sleep appliances, upper airway surgery and neuro-stimulation. Until successful treatment has been established patient should be advised of the risk of driving or operating heavy machinery. Conservative therapy may also be helpful including weight loss, avoiding alcohol or sedatives prior to sleep, cool and totally dark bedroom, and trying to maintain a regular sleep pattern. Patient should return for a full night CPAP/BiPAP titration to optimize pressure settings if patient elects to have PAP therapy. Auto-PAP device set at 6-20 cwp should be considered while awaiting definitive titration or as an alternative to CPAP. Further evaluation and treatment of Periodic Limb Movements should be considered if they continue to cause arousals despite successful treatment of the obstructive component of the patients sleep disorder.
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#10
RE: Here are my first night results
it boggles the mind, the inefficiency of diagnosing oa when you had 6 times more ca. something similar happened to me too. I understand we have to fail cpap/apap first but do they tell us that? and does it really make sense when you have psg numbers like yours? you have every reason to return to ask for a more appropriate treatment modality. but they'll probably still make you wait up to 90 days to disprove treatment emergent / pressure induced ca. also, don't discount the periodic limb movements. they tend to cause a lot of arousals we are unaware of.
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