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Neophyte Needs A Little Guidance
#1
[attachment=2784]

I've been trying various masks, liners, chin straps, yada yada yada for 4 months now trying to adjust to the 'wonders of being a hosehead'. Not much success. I think I have the leak issues under control, but not sure given my machine. I will try to attach a sleepyhead shot of my status as of last night. I seem to have a lot of periodic breathing episodes. Not sure if this is the primary issue or not.

Trying to understand what Sleepyhead data is trying to tell me but thought some of you experienced folks could further my education.

Will try to send an attachment. (My first time at doing this).
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#2
About those periodic breathing episodes, you should consult your doctor as they can be associated with things like heart arrhythmias (atrial fibrillation) and congestive heart failure (retaining fluids). In my case, I saw periodic breathing, asked the doctor, and was found to be retaining fluid. A mild diuretic and the problem is receding.
"The object in life is not to be on the side of the majority, but to escape finding oneself in the ranks of the insane." -- Marcus Aurelius
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#3
Many thanks, srlevine1.

You provided confirmation into what I have been thinking may be the underlying problem since it was a cardiologist who initially steered me into my first ever sleep study a few months back. So happens I have an upcoming appointment in a few weeks with her.

Again, thanks.
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#4
Hi monkeybusiness,
WELCOME! to the forum.!
Good luck to you with your CPAP therapy and also your upcoming doc appointment.
trish6hundred
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#5
I am a new user of this forum and haven't posted enough times to allow an attachment to be uploaded. So, I'm listing a few statistics here from last night's download of Sleepyhead information in hopes someone can provide me with a better understanding of where I stand when I meet with the sleep doctor in a few weeks. (Original sleep study earlier this year indicated mild sleep apnea of 7.1 and the doctor set me up on a fixed pressure of 17). The study was not very good with my total sleep time under 2 hours I believe.

1. Periodic Breathing: 17.31% - (I do have CHF which may somehow enter into this percentage; however, the PB's mostly don't match up time wise with the CAs, OAs and Hypopneas).
2. Large Leak = 0.00
3. Clear Airway = 0.89
4. Obstructive = 5.70
5. Hypopnea = 1.90
6. AHI = 8.49
7. Leak Rate 14.00
8. Total Leaks 58.00

Total Clear Apneas count = 7
Total Obstr Apneas count = 45
Total Hypopneas count = 15

I don't know how to interpret Sleepyhead's pressure graph. The red line is a nobrainer showing a pressure of 17 across the graph. The blue squiggly pressure line underneath the red line is the unknown. It appears to move up and down between pressure values of roughly 16.00 to 16.33. (I think this is what is known as the EPAP pressure?)

I hope all this makes sense to someone who can provide me with more insight into what I'm facing.

Thanks.









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#6
Hey monkeybusiness and welcome to the forum. Glad you found us!

You could always post a link using IMGUR or other similar site. Good luck with getting your therapy fine tuned. Posting screenshots or links so that others can look at your data may help you in getting your therapy working better for you.
APNEABOARD - A great place to be if you're a hosehead!! Rolleyes

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EVERY ACCOMPLISHMENT BEGINS WITH THE DECISION TO TRY!
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#7
Well, you can attach or link to your data after 4 posts. Meanwhile, the reason the EPAP line is a bit uneven is that Flex is dependent on your expiratory effort for how much pressure reduction occurs. If you exhale forcefully, Flex will provide up to 2 cm of pressure relief. If you exhale softly, the amount of pressure reduction will be less. This contrasts with Resmed's EPR which is constant based on a setting of 1-3.

Your pressure is relatively high and not fully treating your obstructive apnea. It really isn't intended to do anything with centrals or periodic breathing. If you are still in the evaluation phase of your therapy, I like your chances of moving to bilevel treatment. How are you feeling? Is the therapy comfortable / tolerable?
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#8
Thanks for the EPAP line explanation, Sleeprider.

Since starting CPAP therapy in May, the AHI numbers have moved all around from as low as 5.9 (once) to as high as the low 20's. Now that I've settled on a mask and controlling leaks, my AHI's have dropped into the 9-12 range pretty consistently.

I don't have an issue with the pressure of 17 other than the fact it shuts out use of some sort of nasal mask. I've tried nasal masks unsuccessfully and now use a FFM with a chin strap. I've also gotten into the habit of not using the ramp feature, figuring that if the mask will leak at a pressure of 17, I may as well find out now rather than get comfortable and have to re-adjust later.

Most days I don't think I feel any different than before therapy started.

I'll attempt to attach some Sleepyhead screen shots in a few days.

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#9
Your response is perfect. The fact your AHI remains unacceptably high, and you don't feel appreciable benefit from the therapy are good reasons to discuss this with your doctor. At your pressures, you probably should be on bilevel therapy which uses the EPAP pressure to treat OA, and pressure support for a higher IPAP to treat the hypopnea and respiratory related arousals. From the few statistics you posted, I don't think that central apnea is a problem, but high pressure alone is not resolving obstructive apnea, and at this point you are not tolerating it well. With bilevel, you would experience significantly more comfort, higher ventilation rate, and likely better therapy and rest.

The only way that can happen with insurance reimbursement is if your doctor's evaluation is that CPAP is failed after a reasonable trial, and his recommendation is to move to bilevel.
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#10
Welcome!
Any idea why the doc prescribed that high initial pressure? Was there a titration in the sleep study?
(09-07-2016, 12:56 PM)monkeybusiness Wrote: .....................
I'll attempt to attach some Sleepyhead screen shots in a few days.
Good idea! The advice you've gotten so far assumes the events flagged as obstructive apneas really were obstructive. It's a fair assumption from data so far, but from my own experience and reading, it's not necessarily the case. That's why a data display is important. It can supply evidence as to whether an event really is obstructive or, alternatively, an artifact due to cause(s) other than OSA.

-Ron

We are such stuff
As dreams are made on, and our little life
Is rounded with a sleep.
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