Home Sleep Study - Low AHI but significant desat

[ArcherNeedsSleep]

Wow - that's a vicious cycle with the red blood cells.  I used to give blood all the time so the idea of using that as a treatment option doesn't sound horrible.  But still....I would rather not 

[ArcherNeedsSleep]

I talked to the doc today.  She wrote a prescription for the APAP.  

She said that I could probably get it covered by insurance if I go to a pulmonologist who uses the desats as justification for coverage rather than trying to argue about the low AHI.  But the referral appointment will take a few months so I'm going ahead and starting with the PAP out of pocket and will revisit the insurance thing after the fact.  Maybe it will be cost effective to let them cover some recurring supplies, but based on my research I suspect I'll do better on my own for the long term.  

I'm going with the Autoset for Her and the P10 nasal pillows.  I'll definitely be posting some data as soon as it arrives and I get to sleep with it.

I have hope that this is the right solution, and that by the time I see the pulmonologist I'll have real progress on the nighttime oxygen levels.  (Yes, I'm very averse to nighttime oxygen and my doc felt similarly.  But she said the pulmonologist will be the better resource to make the decision.)

[Sleeprider]

Keep us posted on your use of the machine and any oximeter results. I would encourage you to experiment with both lower and higher minimum pressure ranges to evaluate if higher pressure is indeed effective in improving your SpO2 saturation.

[ArcherNeedsSleep]

The Autoset for Her arrived today!

It's funny - the instruction manual and description on the website all said that every new machine ships with an SD card, but there wasn't one in the box or in the machine.  I'll have to go back and look for fine print that says something like, "only if we remember to include it as we're boxing up the machine, and only on days that don't end in "day"".  
Good thing I'm a nerd who loves electronics and I ordered an SD card separately.  Now I'm keeping my fingers crossed that Amazon delivers it today as-promised.

Based on reading as many "Help the Newbie" threads* as I could find, I've picked up that a reasonable starting setup is:

Min Pressure: 7
Max Pressure: 14
EPR: 3 full time
Ramp: off (or should I start with a short ramp period until I'm used to the pressure?)
Humidity ~4  (thinking about going auto on this one, since Colorado is really dry and I'm not really sure where to set it)

I think I found the right size pillows to start with.  I ran the mask fit and was in awe of people who can use the machine at that maximum pressure setting!  

I'm going to forego the pulse oximeter for a few nights until I get the hang of the machine itself....I think I'll have enough to adjust to without something bulky on my finger along with something new on my face. 

Anything I'm missing?


*I fully understand and embrace my status as a Newbie, and am looking forward to learning the ins and outs of the machine and the data 

[OpalRose]

Your pressure settings look good to start, but keep the ramp off. A minimum pressure of 7cm is low enough to that you shouldn't need ramp.

I would leave the pulse ox off too. Too many new things could make for a bad night.

Good luck!

[ArcherNeedsSleep]

Thank you!  Appreciate the feedback.

I'll keep the ramp off, and won't do the pulse ox ring until I'm a settled a bit.

[ArcherNeedsSleep]

First night was.....interesting.

I've attached an Oscar screen shot.  Hopefully I set it up right.

The CAs are probably 90% junk.  They correspond with the times that I was awake, trying to keep calm, telling myself that I wasn't suffocating and all I had to do was relax and breathe.  I did eventually find a nice rhythm and fall asleep.  

Had a couple of wake-ups with a few rounds of telling myself to relax and breathe.  It also appears that I had a couple blocks of time where I was leaking significantly, but I didn't wake up during those.  Guess I was tired.

A couple of things I need to work through, beside the panic/calm/just breathe sessions:

1) Mask straps.  I have very long hair and the straps don't seem to settle in the right place.  Leaving the strap on top of my hair causes the entire rig to slip off my head as I sleep.  I put the bottom strap underneath my hair but it seems to pull the pillows downward toward my mouth and that rubbed my nose raw.  I think that was the cause of the leaks, too.  I'll work it out, but it definitely seems that it wasn't designed to work with long hair.

2) Swallowing air.  I know my pressure isn't very high and I shouldn't be swallowing air, but every time I reflexively swallow I end up gulping down a bit of extra air with it.  I'm assuming this is something that my body will figure out and it won't continue to be a problem.  But I did notice it every time I woke up, and am feeling it this morning.

3) My bed pillow isn't right for using the CPAP.  It's too firm to lay in the middle of it without knocking the mask out of alignment.  And it's too wide, so while sleeping on my side, I can't hang my face/mask off the end without bumping into my husband's head or his pillow.  I'll mull over the options on that, too.

Otherwise, I think it went ok.  I feel about the same as before, but I didn't expect an immediate improvement, so that's fine.
Since I didn't have many obstructive events in my sleep study, I'm not expecting to see a whole lot of exciting events in the Oscar data.  I'm betting that once I get used to the machine and stop panic-breathing and solve the leaks, there won't be anything exciting in the data at all. The real results will hopefully show up in the Wellue ring when I add it back into the data stream.

If you see anything that I should consider or change, please let me know.  Otherwise I'll stick with these settings for a bit and add the Wellue ring back in over the weekend to start checking for progress on the desats.

[Gideon]

Increasing pressure may help you to feel calmer because it feels like you have more air. Personally, I need about a 10 min for that reason.
Try increasing your pressure by 1

[ArcherNeedsSleep]

Increasing pressure may help you to feel calmer because it feels like you have more air.  Personally, I need about a 10 min for that reason.
Try increasing your pressure by 1

I was kind of wondering about that, but figured it was just me overthinking the situation.  
I'll bump the min to 8 and see if it improves things.  Thank you!

[Gideon]

Comfort is so very important.