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Need help understanding first night's data
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SleepEZ Offline

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Posts: 37
Joined: Jul 2013

Machine: ResMed S9 Autoset
Mask Type: Nasal pillows
Mask Make & Model: ResMed Swift FX
Humidifier: ResMed H5i
CPAP Pressure: Autoset (7 - 13)
CPAP Software: SleepyHead

Other Comments: Respironics Premium Chinstrap. Had to buy myself. My DME ignored prescription and many requests.

Sex: Male
Location: Des Plaines, IL

Post: #1
Need help understanding first night's data
Can any of you veterans help me understand why I show so many Centrals? I've attached a screen shot of my Sleepyhead data.

My suspicion is mouth breathing. My DME forgot to order the Respironics Premium Chinstrap I had requested, and it turned out he had only one chinstrap in the his whole office (a Ruby Red--Large) that he gave me to take home while waiting for the original one that he ordered after I picked up the equipment. The substitute chinstrap didn't seem to do the job as well as the one I remembered using at my titration.

I did wake up several times with dry mouth, so am guessing I may have to figure out how to reduce that while waiting for the other chinstrap.

This was my first night, so I felt like I was semi-conscious a good part of the time, but don't feel exhausted this morning. I was up a couple of times ... once to change nasal pillows (Large were causing discomfort but felt like better air movement; Mediums felt much more comfortable, but a little more restrictive ... but only at first). You can see when I got up to change the pillows (about 3:40 am). Also got up to take meds around 5:00 am. Turned off the Ramp feature at that time because I didn't feel the need for it.

Since obstructive events are very low, I assume that's good, but wondering if any of you have any advice other than working on the mouth breathing?

I see the doctor in approximately 4 weeks from now, but would like to figure out how to improve results if possible in the meantime. (Maybe it's just a matter of waiting for that other chinstrap?)

Thanks for any insights or advice.

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08-10-2013 10:04 AM
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zonk Offline

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Posts: 7,908
Joined: Feb 2012

Machine: A10 AutoSet
Mask Type: Nasal mask
Mask Make & Model: Activa LT
Humidifier: Integrated /ClimateLineAir
CPAP Pressure: 9/13
CPAP Software: ResScan

Other Comments: CPAP since Nov 2010

Sex: Male
Location: Australia

Post: #2
RE: Need help understanding first night's data
What medications are you taking? opioids medication can cause central apnea events
There is question mark here as you say ... you was "semi-conscious a good part of the time"

Leak graph indicate some mouth breathing, chinstrap can helps keeps mouth closed and minimize mouth leaks or full face mask ... full face mask allows to breath thru nose or mouth

In the meantime till you see the doctor, try decrease EPR or turn off and see if makes any difference

Gather more data and pay attention to the trends, not to a single night
08-10-2013 03:54 PM
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Sleepster Offline
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Machine: ResMed AirCurve10 VAuto
Mask Type: Full face mask
Mask Make & Model: F&P Simplus
Humidifier: HumidAir and SlimLine Hose
CPAP Pressure: MaxI 13.6 | MinE 5.2 | PS 4.4
CPAP Software: ResScan SleepyHead

Other Comments: Diagnosed Nov 2011. Conquered aerophagia.

Sex: Male
Location: Houston, Texas

Post: #3
RE: Need help understanding first night's data
Did you ever wake up with air hissing out of your mouth? The leak graph spikes up and down, indicating mouth leaks. Try tightening the chin strap a bit.

I doubt this is related to the high CA index.

Both of these issues (mouth-leaking and elevated CA index) are common when first starting CPAP therapy. They should subside after a few nights.

You can look at those central events closer and see how long they last.

You are doing great. You should be happy that you made it through your first night with success. You will notice continued improvement as you progress.

Sleepster
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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.
08-10-2013 04:14 PM
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Tez62 Offline

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Posts: 837
Joined: Feb 2013

Machine: Resmed S9 Autoset
Mask Type: Full face mask
Mask Make & Model: Resmed Mirage Quattro
Humidifier: Resmed
CPAP Pressure: 5-15
CPAP Software: SleepyHead

Other Comments:

Sex: Male
Location: Melbourne, Australia

Post: #4
RE: Need help understanding first night's data
I agree with Zonk and Sleepster, a couple of other things to add, one night is not a very good sample you need to look at it over a couple of weeks, you are getting some high and frequent leaks so either the chinstrap or try a full face mask and your turning the CPAP off after most of those centrals so something is happening to wake you up which once again could be the leaks. Finally Sleepyhead and Res Scan software is not as accurate as a sleep study they can sometimes pick up movement and things like coughing etc and record them as apnea's so occassionally the figures may be more inflated than they actually are, keep at it.
08-10-2013 04:44 PM
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vsheline Offline

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Posts: 1,907
Joined: Jul 2012

Machine: S9 VPAP Adapt (USA Model# 36007, not better 36037 or 36067)
Mask Type: Full face mask
Mask Make & Model: F10 or SimPlus w/ 2Liners. MirageQuatro & Gecko gel pad
Humidifier: H5i
CPAP Pressure: 15 EPAP, PS 5-10
CPAP Software: ResScan

Other Comments: Marfan Syndrome, chronic bradycardia, occasional Cheyne-Stokes Respiration

Sex: Male
Location: California, USA

Post: #5
RE: Need help understanding first night's data
(08-10-2013 10:04 AM)SleepEZ Wrote:  Can any of you veterans help me understand why I show so many Centrals? I've attached a screen shot of my Sleepyhead data.

My suspicion is mouth breathing.
...
Since obstructive events are very low, I assume that's good, but wondering if any of you have any advice other than working on the mouth breathing?

Hi SleepEZ, welcome to the forum!

For your own records, I recommend getting copies of your full sleep reports for your baseline study and titration study. It will show how many central events occurred and at what pressure. And get/keep a copy of your prescription, of course.

It does not look to me like your centrals are aligned in time with your large leaks, so I doubt mouth leaking has much to do with your centrals. (And, in general, large leaks are more likely to increase obstructive events rather than central events.)

Keep in mind it is fairly common for there to be more centrals during the first weeks/months of therapy, reducing in number as our systems adapt to the pressure.

During titrations the technicians are instructed to have us spend at least some time sleeping flat on our back, since this is usually the worst position for OSA, requiring the highest pressure. If we can be sure we will stay off our back while asleep (for example by wearing a snug teeshirt with a tennis ball in a pocket sewn between the shoulder blades) then our pressure needs will be less, allowing the pressure to be reduced, and reducing the pressure may reduce central events.

Also, using Auto mode instead of fixed CPAP mode will tend to reduce the pressure most of the time and therefore may reduce central events.

Also, although it may be important or you to continue using EPR (at least during the first few days/weeks while getting accustomed to the pressure) eventually you may want to try turning APR down to 1 or zero to see what effect this may have on your AHI and Central Apnea Index. Some report their CAI drops a lot when they turn EPR down or off.

By the way, I think using EPR can hurt our Obstructive Apnea Index if using fixed CPAP mode with a CPAP pressure setting which is too low (although you certainly are not having that problem now), or, on the other hand, using EPR can actually help reduce obstructive events for some people as long as the CPAP fixed pressure setting is not too low.

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.
(This post was last modified: 08-10-2013 05:21 PM by vsheline.)
08-10-2013 04:57 PM
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SleepEZ Offline

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Posts: 37
Joined: Jul 2013

Machine: ResMed S9 Autoset
Mask Type: Nasal pillows
Mask Make & Model: ResMed Swift FX
Humidifier: ResMed H5i
CPAP Pressure: Autoset (7 - 13)
CPAP Software: SleepyHead

Other Comments: Respironics Premium Chinstrap. Had to buy myself. My DME ignored prescription and many requests.

Sex: Male
Location: Des Plaines, IL

Post: #6
RE: Need help understanding first night's data
Thanks zonk, Sleepster, and Tez62. Appreciate your suggestions and encouragement.

I'm real aware that "one night does not a trend make." Smile So will try to be patient as I continue to work on my behaviors. To answer a couple of questions:

Am taking pain meds and a small dose of Lorazepam just before bed ... doctor's orders related to degenerative disc disease. But no opioids at this point. When I said I felt "semi-conscious" it probably would have been more accurate to say I felt like I was in a "shallow sleep state" and woke up easily.

Yes, I did have hissing in my mouth from time to time, so know this is the main obstacle to overcome.

The "substitute" chinstrap I got to tide me over till my Respironics Premium arrives is a one-size-fits-all, so I couldn't tighten it as I would have liked to.

Not discouraged, just wanting to be pro-active as possible. Hoping for improvements tonight. Thanks again
08-10-2013 05:14 PM
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SleepEZ Offline

Preferred Members

Posts: 37
Joined: Jul 2013

Machine: ResMed S9 Autoset
Mask Type: Nasal pillows
Mask Make & Model: ResMed Swift FX
Humidifier: ResMed H5i
CPAP Pressure: Autoset (7 - 13)
CPAP Software: SleepyHead

Other Comments: Respironics Premium Chinstrap. Had to buy myself. My DME ignored prescription and many requests.

Sex: Male
Location: Des Plaines, IL

Post: #7
RE: Need help understanding first night's data
Vaughn,

Thanks. Appreciate your insights.

I actually changed my EPR from 3 to 2 during the night last night, and am not opposed to turning it off tonight. I turned Ramp off too, because after getting up I didn't want to go through the 30-minute process of getting back up to pressure. All to say, I feel I tolerate the CPAP pressure pretty well.

I do have my full sleep study report, and in my original results I only had 6 central apneas, so that's why I was somewhat surprised by last night. My original AHI was 46.7 and it dropped to 1.1 at my titration, using the same nasal pillows and an adjustable chinstrap. My titration results recorded no centrals or apneas, but only one hypopnea.

Also, my entire titration was done on my back because, with my low-back problem I must sleep on my back in an adjustable bed. Last night was entirely on my back too, so that will effectively take away the option of side sleeping.

I'm excited to finally be on my machine, so I'm ready to hang in there for the long haul.

Will post updates as I am able.

Thanks again.

(08-10-2013 04:57 PM)vsheline Wrote:  
(08-10-2013 10:04 AM)SleepEZ Wrote:  Can any of you veterans help me understand why I show so many Centrals? I've attached a screen shot of my Sleepyhead data.

My suspicion is mouth breathing.
...
Since obstructive events are very low, I assume that's good, but wondering if any of you have any advice other than working on the mouth breathing?

Hi SleepEZ, welcome to the forum!

For your own records, I recommend getting copies of your full sleep reports for your baseline study and titration study. It will show how many central events occurred and at what pressure.

It does not look to me like your centrals are aligned in time with your large leaks, so I doubt mouth leaking has much to do with your centrals. (And, in general, large leaks are more likely to increase obstructive events rather than central events.)

Keep in mind it is fairly common for there to be more centrals during the first weeks/months of therapy, reducing in number as our systems adapt to the pressure.

During titrations the technicians are instructed to have us spend at least some time sleeping flat on our back, since this is usually the worst position for OSA, requiring the highest pressure. If we can be sure we will stay off our back while asleep (for example by wearing a snug teeshirt with a tennis ball in a pocket sewn between the shoulder blades) then our pressure needs will be less, allowing the pressure to be reduced, and reducing the pressure may reduce central events.

Also, using Auto mode instead of fixed CPAP mode will tend to reduce the pressure most of the time and therefore may reduce central events.

Also, although it may be important or you to continue using EPR (at least during the first few days/weeks while getting accustomed to the pressure) eventually you may want to try turning APR down to 1 or zero to see what effect this may have on your AHI and Central Apnea Index. Some report their CAI drops a lot when they turn EPR down or off.

By the way, I think EPR can hurt our Obstructive Apnea Index if using fixed CPAP mode with a CPAP pressure setting which is too low (although you certainly are not having that problem now), or, on the other hand, can actually help reduce obstructive events for some people as long as the CPAP fixed pressure setting is not too low.

Take care,
--- Vaughn
08-10-2013 05:36 PM
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Paptillian Offline

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Posts: 474
Joined: Jun 2013

Machine: S9 AutoSet
Mask Type: Nasal pillows
Mask Make & Model: Swift FX
Humidifier: H5i
CPAP Pressure: 4 - 10, EPR x2
CPAP Software: ResScan SleepyHead

Other Comments:

Sex: Male
Location: Pennsylvania, USA

Post: #8
RE: Need help understanding first night's data
I had lots of mouth leaks in the beginning but not as much anymore. The number one thing people point to (aside from using a chinstrap) is humidification settings. However for me personally, the thing that did the trick was to learn how to stop the airflow from coming out of my mouth. You can learn to do this voluntarily and after a few nights it just kind of happens on its own. Now when I open my mouth the air doesn't hiss out, and I can talk almost normally with the nasal pillows and airflow on.

Practice holding your tongue up against the roof of your mouth just behind your teeth. Try to use the back of your tongue to block the airflow into your mouth.

For the first 2-3 nights while learning to do this I applied some olive oil around my mouth and tongue. That helped to prevent dry mouth and to keep my mouth shut.

Oh, and I agree with Vaughn about using AutoSet. This technique is going to be harder to learn with a constant blast of 11 cmH2O. It's easier to train at 4 cmH2O when you first put the mask on and have yet to fall asleep.

Hope this helps.
(This post was last modified: 08-10-2013 06:10 PM by Paptillian.)
08-10-2013 06:03 PM
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zonk Offline

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Posts: 7,908
Joined: Feb 2012

Machine: A10 AutoSet
Mask Type: Nasal mask
Mask Make & Model: Activa LT
Humidifier: Integrated /ClimateLineAir
CPAP Pressure: 9/13
CPAP Software: ResScan

Other Comments: CPAP since Nov 2010

Sex: Male
Location: Australia

Post: #9
RE: Need help understanding first night's data
Tell your sleep doctor about taking Lorazepam, Lorazepm works by depressing the central nervous system
08-10-2013 06:16 PM
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vsheline Offline

Advisory Members

Posts: 1,907
Joined: Jul 2012

Machine: S9 VPAP Adapt (USA Model# 36007, not better 36037 or 36067)
Mask Type: Full face mask
Mask Make & Model: F10 or SimPlus w/ 2Liners. MirageQuatro & Gecko gel pad
Humidifier: H5i
CPAP Pressure: 15 EPAP, PS 5-10
CPAP Software: ResScan

Other Comments: Marfan Syndrome, chronic bradycardia, occasional Cheyne-Stokes Respiration

Sex: Male
Location: California, USA

Post: #10
RE: Need help understanding first night's data
(08-10-2013 05:36 PM)SleepEZ Wrote:  I actually changed my EPR from 3 to 2 during the night last night, and am not opposed to turning it off tonight. I turned Ramp off too, because after getting up I didn't want to go through the 30-minute process of getting back up to pressure. All to say, I feel I tolerate the CPAP pressure pretty well.

I do have my full sleep study report, and in my original results I only had 6 central apneas, so that's why I was somewhat surprised by last night. My original AHI was 46.7 and it dropped to 1.1 at my titration, using the same nasal pillows and an adjustable chinstrap. My titration results recorded no centrals or apneas, but only one hypopnea.

The Ramp period is adjustable, so it can be reduced to 5 minutes, for example. But I think it is easier to check mask fit if not using Ramp feature.

Reducing EPR to 1 may be more comfortable than zero.

Were you taking the same meds (and at same times during the day) at the time of the titration study when there were no central events? Also, alcohol and other nonprescription drugs can cause/worsen centrals. If the centrals do not get a lot better in a few weeks, you may want to discuss with your doctor(s) alternative pain meds. Personally, I'm not familiar with which ones may be better in that regard.

If the central apneas last only 20 seconds they might not be causing much oxygen desaturation. Zooming in closely on the Flow plot would let you see how long the centrals are lasting. A Pulse-Oximeter would let you know how low your oxygen is going.

I use a wrist-mounted Pulse-Ox, which I think is far more comfortable than finger-mounted ones which can make the finger sore if worn all night. I think Supplier #19 sells a good selection and offers good customer support.

If your Central Apnea Index (CAI is average number of central apneas per hour) stays above 5 and accounts for more than half of your total AHI, some health insurance plans will cover an ASV titration and an Adaptive Servo Ventilator class of CPAP machine, which can treat central apneas as well as obstructive apneas. But a sleep tech told me some insurance companies will not reimburse for an ASV titration (and machine) unless the CAI with your existing CPAP machine is at least 15.

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.
(This post was last modified: 08-10-2013 06:52 PM by vsheline.)
08-10-2013 06:22 PM
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