My First Night Data With The Resmed S9 Auto Set

[vsheline]

Now I have decided to take the for a few days with the new Machine & the Low AHI and then will wean off slowly once I am caught up with the sleep debt (Hopefully).

Hi Realtor 1,

I think your CAI (average number of central apneas per hour) is more likely caused by the meds than by EPR, and in any case your CAI is less than 1 per hr and is too small to be much concerned about, in my view.

Since easing off the sleep meds will likely be a bear which takes quite some time to tame, you might first want to try optimizing EPR and your minimum pressure.

Some have much better sleep quality when using higher amount of EPR. EPR will do part of the work of breathing for us, helping to reduce our breathing effort.

So, after catching up a little on your sleep debt, I suggest seeing if you feel better with more EPR.

Another thing which helps some people is to raise the minimum pressure a little, to be a little closer to their median pressure. Our median pressure is our 50 percentile pressure, the pressure we were at or below 50% of the time.

I suggest we should vary only one thing at a time and park at each setting for a week or a month to get a good measurement of the average effect of each adjustment.

Take care,
--- Vaughn


ADDED: On the other hand, if the sleep meds are suppressing REM sleep or deep restorative stages of sleep, maybe the earlier you get off the meds the better. I suppose you have googled your sleep meds to find what side effects they have? I have heard that some reduce sleep quality although they increase sleep quantity. But in any case, I think continuing to use the sleep meds is unavoidable in the short term, and seeing if you can catch up on your sleep debt by continuing to use them for a while and then tapering off, is reasonable.

If your sleep meds are of the "time release" type, you may need to avoid cutting or splitting the tablet. It may actually be dangerous to take half of a Time Release tablet, because breaking into two parts may defeat the Time Release mechanism and all of the dosage may take effect at once. New prescriptions for progressively smaller dosages may be required.

.

[Realtor 1]

Thanks for the great advice.

[robysue]

I was on the pill from June Last yr till April of this yr and then I slowly started weaning off and eventually got rid of it.

What sleeping pill were you taking between last June and April? What dose?

And how was tapering being done?

But the sleep got worse & AHI got worse so after 20 days I started taking alternate pills every five days but was pretty much sleeping only on the night I was taking the pills. Was getting some sleep but extremely fragmented Sleep on the nights without the pills.

What do you mean by "I started taking alternate pills every five days"?? Do you mean you were taking two different kinds of pills, switching from "A" to "B" ever five days? Or do you mean you taking a sleeping pill for five days, and then trying to go without one for five days? Or do you mean you tried taking a sleeping pill every other day, but the experiment ended at the end of five days?

Now I have decided to take the for a few days with the new Machine & the Low AHI and then will wean off slowly once I am caught up with the sleep debt (Hopefully).

Yes, this is a workable plan on paper.

You may want to work with your sleep doctor on two things:

1) How to increase the sleep time while you are still taking the sleeping pills. If you are only getting 4-5 hours of sleep with the sleeping pills, you may never pay that sleep debt off.

2) Designing a good strategy for weaning yourself off the pills. Some sleeping medication is more difficult to wean off of than others, and may require a slower tapering.

[Realtor 1]

I was using Zopiclone . Was also prescribed many others but Temazapam was another one that worked & Lorazapem did work too.

At one point I was using as high as 15mg dose but not on daily basis. Started weaning off from 7.5mg to 5 to 3.75 to 2.5 to none.

First 2 nights without the pills were Horrid with no sleep but afterwards I started sleeping a bit but the night without the Meds always felt like I never got any sleep at all.

Sleep doctor is totally useless as they don't listen , gave me 2 minutes of their time after every 2 month and always told me to give it more time till the last time when he put the request for the Auto PAP test.
My regular family doctor tried writing all the tests but in the end just shrugged & told me that she can not help me anymore(She happens to be a good friend of my wife, I have not seen her since January).
A couple of month ago I saw my old family doctor who suggested me to use the existing stock of sleeping pills that I have as needed but preferably after a long gap so I started alternating them after 5 days So on Night 1 I was taking a 5mg Zopiclone, No other prescription pill till the 6th night when I took a Lorazapem .5mg & then No prescription Pill till night 11th when I took 30mg. Tamazapem (Normally get the best Sleep with it , but almost every night with Temazapem I did remove my mask & shut the Machine down without any memory of doing it. But this month the nights without the pills were just terrible and the days were not the greatest with extreme fatigue & terrible Headaches etc.
So far 6 nights with the New APAP & FFM & a part from 1 night I have taken the Pill everynight. Last Night I took Temazapam and it felt like I slep for the whole night but the Data showed that I shut it off at 1:42am put it back again at 3:50am but had no memory of doing it.
Not too sure If I want to take Tamazapem again tonite

[Realtor 1]

Update:
I have fine tuned my Auto settings to 9-14 . My OSA is down to 0 & Hypopnea is also down to zero in last 2 days Centrals are still there and last night i had 6 events & the night before I had 4 events. AHi of still under 1.

I still wake up with terrible headaches & extreme fatigue. Not too sure that these minimal Central Apnea Events are causing these issues.

Advice from the pro's here would be greatly appreciated. Do I need a different machine now to control Central Apneas. There is so little info available about the CA and the Sleep doctor here is just useless.

[retired_guy]

Good job with the ahi results. The quantity of centrals is not a significant number at this point, so I don't think you would be benefited by doing anything further to address them.

Headaches/fatigue can also be caused by mask difficulties. ...and it could help explain why the remaining centrals have not gone away yet.

I suspect we have talked about your mask before, but let's do it again. How tight is it? An overly tight ffm can really stress your body out because of the pressure on your face. That can result in you not really getting the quality of rest you might otherwise.

Have I given you the pitch to move to a pillows mask yet? I know, I know,,, I can't use them because of this or that or the other. I know that because I was the chief proponent for not using pillows masks because I could not possibly breath with them. But I was wrong. They are by far more comfortable and effective for me than the full face masks or the nasal masks. You can seize my lands, pillage my villages, rape my sheep, but you will have to pry my pillows masks out of my cold dead hands.

[Realtor 1]

3rd Night did not go s planned. Did not Fiddle with the EPR but decided not to take the Sleeping Pill. took 2 hrs to fall asleep but woke up 20 minutes later. Hardly got any sleep all night. AHI was 0.3 with 2 CA's & 1 OSA But the great numbers are deceiving as the Sleep was terribly Fragmented . Had Bad Headaches in the morning & terribly Fatigued.
I think I should try to get 4-5 good nights sleep with good AHI before doing any changes so will be going bak tonite with the Sleeping pill.

Can you try breaking the sleeping pill in half? Just a thought to help you come off them, halves then quarters. How long have your been on them?
If it has been a while they are not going to let you get rid of them without a fight, so nice and easy does it.
Good luck.

Good job with the ahi results. The quantity of centrals is not a significant number at this point, so I don't think you would be benefited by doing anything further to address them.

Headaches/fatigue can also be caused by mask difficulties. ...and it could help explain why the remaining centrals have not gone away yet.

I suspect we have talked about your mask before, but let's do it again. How tight is it? An overly tight ffm can really stress your body out because of the pressure on your face. That can result in you not really getting the quality of rest you might otherwise.

Have I given you the pitch to move to a pillows mask yet? I know, I know,,, I can't use them because of this or that or the other. I know that because I was the chief proponent for not using pillows masks because I could not possibly breath with them. But I was wrong. They are by far more comfortable and effective for me than the full face masks or the nasal masks. You can seize my lands, pillage my villages, rape my sheep, but you will have to pry my pillows masks out of my cold dead hands.

Ok my mask history is that I started with Fisher & Paykel Pilario Nasal Pillows Mask & also got a F& P Zest NAsal Mask as a Back up last year when I started my therapy. I got comfortable with my Pilario afte 2 days and it worked great for a while till I got a nasal soreness, so i used the zest till it got better for 2 weeks. My Pilario was the old style with the loose single strip but it broke after a few months (So when I went to buy the replacement DME told me that F & P has got a way better New Style Head gear which supports it better & is lot sturdy too. Any how I purchased it and just went down from there. I just start getting nose infections after every 2 days of using it. Adjusted it to the loosest strap setting but nothing worked. Switched to a Hybrid mask with the Pillows but the leaks were tremendous. Went for an ENT check & found out that I have got a Deviated Septum & possibly that was the reason behind my struggles with the Pillows. (Strangely with the old strap , I had no major issues with the Pillows & deviated Septum). My Mouth was popping open a lot so I purchase a Chin Strap & used it for months along with the Zest.
Just switched to F10 & With the Auto set and I m loving it. It is way more comfortable then any other mask I have used. It does leak when I put it on at night but with a little fiddling around it has virtually gone leak free. Last 2 nights , my leaks were at zero.(Unbelieveable).
My knowledge base about Central Apneas is Zero. Fisher & PAykel was not even capable of seeing central Apneas so possibly it used to record the as Hypnopneas.

[retired_guy]

Ok, I remember now....

I think your cpap therapy is going great. I also think you're remaining problem with the sleeping pills, and the elimination thereof, is probably causing your failure to feel like you are well rested, and have a headache, and all that sort of stuff.

So at this point I would recommend you leave your cpap therapy right where it is, which is pretty darn good by the way, and focus on the drug thing. For that, I think you need to work closely with your Doc....

[vsheline]

My knowledge base about Central Apneas is Zero. Fisher & PAykel was not even capable of seeing central Apneas so possibly it used to record the as Hypnopneas.

Hi Realtor 1,

How many seconds do each of your centrals last? If longer than about 45 seconds or a minute, I think that may be especially alarming. If shorter than about 20 or 30 seconds, I think that would be far less concerning.

I think a 30 second central apnea would be less stressful on the body than a 30 second obstructive apnea, because the 30 second central apnea would have ended as soon as we again tried to breathe, but the 30 second obstructive apnea would not have ended until after struggle and perhaps a jolt of adrenalin, causing extra stress on the body.

I suggest investing in a recording Pulse Oximeter to monitor your blood oxygen levels. I bought one from Supplier #19. (Link to Supplier List is at top of all forum pages.) The wrist mounted ones with separate finger sensor are far more comfortable to wear all night, or if wearing for multiple nights. This would tell you how low your oxygen level is dropping during your apneas and hypopneas. Also, if your average oxygen level is low this may point to anemia which would need treatment. Ideal target range for SpO2 (saturation percentage of oxygen) is 94-96, or perhaps lower during sleep. Less than about 90 is a little too low, even if asleep. Too high can also be bad.

Also, in your case I would suggest total avoidance of stimulants such as caffein.

Yours is an extreme case (feeling horrible, even though you have achieved low AHI), and you need to keep searching for a better doctor who will be able to help you more than the doctors you have been seeing.

Take care,
--- Vaughn

[Realtor 1]

Thanks,

The Centrals are between 15 to 25 sec. 9I believe the #'s next to them are representing the duration of the event).

I will look into an Oximetre.
I stayed away from Caffenie for almost a yr but have started drinking Tea in the morning & coffee in the afternoon. Just don't take any after 4pm.
I have honestly given up on the doctors especially of the Sleep Variety. They give me 2 minutes and even then they are not listening at all. Dme was very sneaky initially because I was extremely green when I first walke in there with the Prescription but were always polite yet clueless(All they want is to sell you stuff) they are conveniently located within a walking distance from the Sleep doctors clinic.