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Need help please! High events per hour
#1
Need help please! High events per hour
Hello everyone, I am new to this forum and this is my first post.

I am a nearly 70-year old male, about 20 pounds overweight and I'm working hard to lose this weight. I have, what I understand to be, moderate sleep apnea and I snore a lot - my snoring is loud and apparently disgusting. I had two sleep studies done in 2016 and 2017. The following are summaries of the study, excerpted directly from the reports: 

2016 Sleep Study on 7/1/2016

SLEEP SUMMARY:
Total sleep time 266 minutes
Sleep efficiency 65%
Sleep latency 52 min
Rem Latency 125 min
Sleep stage 1-15  2-66  3-1
REM -18%

Central apnea 0, obstructive apnea 34, hypopnea 16

IMPRESSION:

1. Positional sleep apnea G47.33
2. Periodic limb movement with arousal index 7.2 events per sleep hour
3. Abnormal sleep architecture
4. Snoring noted
5. No significant arrhythmia noted

2017 Sleep Study on 5/22/2017

PROCEDURE:

Polysomnographic parameters monitored. EOG, Submental EMG, EEG C3-C4, EEG 01-02, airflow, effort with abdominal and thoracic belts, snoring sensor, ECG, tibialis, EMG and oximetry.

Sleep architecture
Total sleep time 315.5 minutes
Latency to sleep onset 41 minutes
Latency to REM 98 minutes
Sleep efficiency 82%
CPAP titration 
CPAP was initiated at 5 cm of water pressure and incrementally increased to a max pressure of 12 cm of water pressure. At 12 cm of WP, the patient had increase in respiratory events. Most effective pressure was 9 cm of WP with pressure of 10, 11 and 12. There were central apneas. Cardiac monitoring revealed sinus rhythm. No evidence of restless leg syndrome or periodic limb movement disorders of sleep.
Cardiac monitoring. 
Sinus Rhythm. 


SUGGESTIONS:
The patient should be fitted with a Resmed Quattro FX Full Face Mask size M. CPAP should be initiated at 9 cm of water pressure with EPR 3 using humidification. 

After the study, I was given a Resmed Quattro FX Full Face Mask, which I used for a little while (can't recall how long), but then I stopped using it because it became uncomfortable. After a while, I changed to another sleep doctor and he said I should rather use a Resmed P10 nasal pillows mask at a setting of 10, and he wrote a prescription for that. I tried the P10 for a while, it didn't seem to be helping me. I became disillusioned and then stopped the CPAP therapy completely. I went back to the same doctor recently and he said that since I do not seem to be comfortable using a CPAP machine, I should try going to a dentist who specializes in sleep apnea and have a mouth device custom made to stop my snoring. I did this and as the cost was going to be quite exorbitant, I abandoned that idea. 

Fast forward to November 2019. I am now in a brand new relationship with a lovely lady, but we cannot sleep together in the same bed as my loud snoring keeps her awake. Sad My new relationship and the fact that we cannot sleep together, was definitely a wake up call to take immediate action! I researched for quick solutions and immediately started taping my mouth with 3M micropore tape. I got used to the tape very quickly and felt rested the following days, as I was breathing only through my nose. We did some test runs sleeping together in the same bed, but alas - I was still snoring unbearably with the tape and she couldn't sleep. I had to move back to another room. I then started extensive research on this forum, looking for answers what to do. I have a Resmed Airsense 10 autoset and I know how to access the settings. I also currently have 3 masks in my possession:
Resmed Airfit F20 full face mask; Resmed Mirage FX nasal mask; Resmed P10 nasal pillows mask. 

I've had the F20 full face mask for about 3 years. It seemed to work when I got it originally, and if memory serves, the best number at that time, was down to 7. But then I became uncomfortable using it - felt I couldn't breather properly. I've tried using it again during the past 2-3 weeks and I still feel that I'm suffocating in it- the numbers on it are high. I'm also getting high AHI numbers with the The Mirage FX. The P10 is the most comfortable mask, but I am also struggling to breathe in it - it's possible that this is on the exhale because the vents may be occluded, despite extensive cleaning with a tooth brush and warm soapy water. I've tried many different settings on the CPAP machine. I initiate at 6 cm and it ramps up to 9m as suggested in the sleep study recommendation. I've set it to 10, 11, 12 and even 6-16. Nothing is working. I'm getting readings on my Resmed Airsense machine of 25 - 40 events per hour. On many nights, I have to remove whatever mask I'm wearing because I feel that I'm struggling to breathe. A few nights ago, the reading went down to 15 events per hour with the F20 mask set at 6 to 9 cm of WP, -the lowest it's been for a long time, but last night it was back up at near 40. I tried adjusting the settings during the night looking for the sweet spot, but nothing worked. I like the P10 mask the most because it's so light to use. I've tried using it with my mount taped and un-taped, but cannot get proper sleep or lower numbers with this mask or the Mirage FX. 

Sorry for the long rant, but I just wanted to bring you up to speed. As so many have stated, getting help from a sleep doctor is virtually mission impossible. They are all so busy, you are just another sheep in the never ending flow of people in and out of their office, where you get 10 minutes with them max. I'm hoping to see a CPAP supplier next week to get another mask, but am not sure which mask I should go for now - the P10 in general seems to have issues with venting based on the extensive discussions on this forum. Mine is more than a year and a half old, so the vents could be blocked up. Should I buy a Waterpick to try and unblock it or get a new P10? Or maybe another make of nasal pillow?

I would like to request the kind assistance of members of this forum with some basic questions - what am I doing wrong? What should I do next? Does it seem that I have a problem with my settings, the machine itself or the mask? I have not downloaded any software like Sleepyhead, to read whats going on at night. Should I do so now? 

I am very hopeful and confidant that I will be steered in the right direction on this forum! To any member who responds to this post, I thank you very much in advance!
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#2
RE: Need help please! High events per hour
Wow. At the beginning of reading your saga, I was thinking you just need the right mask and the right pressure.

But after finishing reading what you wrote, I am curious if this would be the supposed failure of CPAP therapy, indicating you should move toward ASV. *Please note that I do not have any idea about this, as I have no experience with it. Rather, I've observed here on the board that some people who have unresolvable problems with CPAP/APAP often need to move on to the other various machines.*
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#3
RE: Need help please! High events per hour
Hi Arnold,
Please download OSCAR software. Be sure there is an SD card in your machine.
Once you have a full nights data on the card, insert the card into your computer.

Use the links in my signature line to guide you in taking a screenshot of the daily page in OSCAR and post it here.

Your pressure settings may be incorrect, but once we see some data, we can advise.

As far as the mask goes, it’s an individual preference. Wear the mask that feels most comfortable.

Your second sleep test states you had some centrals. Do you know the numbers?
Total AHI, and breakdown like Obstructives, Hypopnea's and Centrals?

If you have a copy of the latest study, you can use the attachment feature and post it here for review. Not just the summary, but all of it.
OpalRose
Apnea Board Administrator
www.ApneaBoard.com

OSCAR Chart Organization


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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#4
RE: Need help please! High events per hour
That is some story.  We are here to help.  The key to that is a daily report from OSCAR.  The charts will say a lot about what is going on.  So follow the given instructions and post the chart please.

Another old almost 70 YO male.
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter

Download OSCAR
New to Apnea? Helpful tips to ensure success
Soft Cervical Collar
Mask Primer
Dealing with a DME
Organize Charts
Optimizing Therapy
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#5
RE: Need help please! High events per hour

.pdf   extracted_LG Sleep Study[169].pdf (Size: 948.36 KB / Downloads: 20) Thank you very much for the responses so far! I sincerely appreciate it! I am attaching the full May, 2017 sleep study. I will now proceed to download the Oscar software and report back to you in a few days. In the meantime, based on what I have written in my original post and the sleep study, could you please recommend what pressure settings I should use on my CPAP machine so that I can at least get a few night's sleep with the P10 mask? In this way, I will have some useful information for members of this forum to review? 

Thank you again!
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#6
RE: Need help please! High events per hour
I would use, for 1 night,

EPR=3 full time
Min pressure =7
Max Pressure =15
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter

Download OSCAR
New to Apnea? Helpful tips to ensure success
Soft Cervical Collar
Mask Primer
Dealing with a DME
Organize Charts
Optimizing Therapy
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#7
RE: Need help please! High events per hour
Thank you very much Fred (Bonjour)! I will proceed to change my settings as you suggested and see how it works tonight! I have downloaded OSCAR. I need to get a memory card adapter!
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#8
RE: Need help please! High events per hour
The real experts here can help you to get things dialed in. There was one comment in your saga that caught my eye. You used an F20 (3 years ago) and initially had good success, and then had a tough time breathing.

Companies are trying to make venting less intrusive than years gone by. I’m just wondering if something happened with the vent or ??? Usually people can’t adjust to a FFM, but if you can it eliminates a lot of the extra gyrations needed if you are a mouth breather. It just seems odd for it to work well for you and then fall off the cliff.

John
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#9
RE: Need help please! High events per hour
Arnold, thanks for posting the sleep study.
Bonjour’s pressure recommendations are a good starting point. When you can post data, more precise advice can be given.

The study showed a few centrals, so we would want to watch if that shows up in your charts.
If you experience a lot of central Apneas, then we may have to tune down the EPR setting, but wait and see how it goes.

And good luck with your mask. Comfort and a good fitting mask is a priority.
OpalRose
Apnea Board Administrator
www.ApneaBoard.com

OSCAR Chart Organization


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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#10
RE: Need help please! High events per hour
The experts will start giving you good help with your settings once you post a daily chart.

You should use whatever mask is comfortable on your unique face. If you want to take up again with the P10, the one you have is probably fine, but for your peace of mind, I’d suggest you get a new one instead of messing around with a Waterpick. At least at the beginning, you might want to use some tape to help avoid mouth leaks.

I just switched from a P10 to an Aloha pillow mask, which I’m liking enough to get serious about. But I have to say the venting of the P10 is far superior, due to the diffusing characteristics of the mesh. It will really help you to avoid inadvertently blowing a stream of cold air onto your bed partner.
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