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New Cpap user - strange flow pattern...
#1
Hi all. I'm a new cpap user. The whole story is a long one, but the gist of it for this post is that my first night was good, good AHI of 2.8, and looked pretty great in Sleepyhead. The 5 nights since have been very bad, AHI from 17 to 32 depending on the night. For a couple nights, I had a lot of centrals on my graph, the next few barely any but a lot of other obst. apneas and hypopneas and high AHI. Bottom line is things aren't right, and judging both from legitimate things I'm reading, and from people in forums who seem to be very knowledgable(yes, I take it with a grain of salt) are all saying my readings are pretty strange and not right. What I'm asking about in this post though is the strange waveforms I'm getting in my flow rate at times even when I'm not registering any events. They look very much like Cheyne Stokes patterns(the little I know about it) and very unlike any other charts I've seen unless people are registering centrals. Here's an example where no events are registered but that pattern is strange. I have others that are MUCH more textbook CSR looking, but there are at least a few events in there on those, even if they are often not centrals still. Should I be concerned about this? Why am I breathing like this?



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#2
(09-17-2014, 04:13 AM)zeropoint101 Wrote: Hi all. I'm a new cpap user. The whole story is a long one, but the gist of it for this post is that my first night was good, good AHI of 2.8, and looked pretty great in Sleepyhead. The 5 nights since have been very bad, AHI from 17 to 32 depending on the night. For a couple nights, I had a lot of centrals on my graph, the next few barely any but a lot of other obst. apneas and hypopneas and high AHI. Bottom line is things aren't right, and judging both from legitimate things I'm reading, and from people in forums who seem to be very knowledgable(yes, I take it with a grain of salt) are all saying my readings are pretty strange and not right. What I'm asking about in this post though is the strange waveforms I'm getting in my flow rate at times even when I'm not registering any events. They look very much like Cheyne Stokes patterns(the little I know about it) and very unlike any other charts I've seen unless people are registering centrals. Here's an example where no events are registered but that pattern is strange. I have others that are MUCH more textbook CSR looking, but there are at least a few events in there on those, even if they are often not centrals still. Should I be concerned about this? Why am I breathing like this?

That looks like some variation of Periodic Breathing, sort of a variation of central apnea/CSR. The gaps in breathing may simply not be long enough to get flagged as an apnea.

You may need to do some tinkering with max pressure to see if that reduces it.

Post a more complete screenshot showing pressure and events. You may need to upload it to photobucket or imgur or some other picture sharing site.
Get the free SleepyHead software here.
Useful links.
Click here for information on the main alternative to CPAP.
If it's midnight and a DME tells you it's dark outside, go and check it yourself.
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#3
Hi 0.101 and welcome.

I think you have a problem that should be referred back to your medical practitioner.

If they are markers of CSR that can be indicative of other physiological issues.

On the other hand - it is odd that you had one good night so perhaps the supplier of your machine could be your first stop.

Either way, self diagnosis from text-books/web and a forum (even the best ones) can only help so far.

All the best

David
Disclaimer: The 'Advisory Member' title is a Forum thing that I cannot change. I am not a doctor and my comments are purely my opinion or quote my personal experience. Regardless of my experience other readers mileage may vary.
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#4
Thanks, guys. I will reply back tomorrow with some more pictures and stuff. David, I completely agree, but the problem at this point is every professional I've dealt with so far(my regular doctor, the RT, and one so-called sleep specialist) have all been either ignorant of even the most basic parts of cpap therapy, arrogant and unwilling to do anything but basically tell me to sit down and shutup and do things their way, or they just don't care enough to actually put any thought into it. If you guys know anyone on the forum from the Kansas City area who knows a good sleep doc around here who listens, I'd love a recommendation.
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#5
(09-17-2014, 05:51 AM)zeropoint101 Wrote: If you guys know anyone on the forum from the Kansas City area who knows a good sleep doc around here who listens, I'd love a recommendation.

You might just need to be assertive.

Most docs aren't incompetent, they're just being worked like show-ponies and are worn out..

If you come right out and tell them that you still feel like crap and need to get this fixed, you'll probably get some action.

Terry
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#6
Hi Zero!

My advice is to not over analyze the data when first starting with CPAP. The best thing you can do at this point is to take care of all the basics. When all that is taken out of the equation and problems still remain, then start looking in other areas.

Just because you hear hoof beats doesn't mean it's a stampede of unicorns.

Taking things with a grain of salt can cause water retention.

OK, lets get serious. Here's some basic stuff that you already know but I have to list it in case someone else is reading this.

Consider these things and correct or test as necessary: Sleeping positions, e.g., back, half-back, right side, left side, small pillow, no pillow and any combination of those. No eating or drinking after 5 pm or 5 hours before bedtime. (5-5 rule), use background sound (white noise or whatever) to mask all distractions, treat any nasal congestion (recommend Nasacort), proper mask type and adjustment, proper pressure setting for a beginner (may be much lower than ultimate treatment values), diet and medications,

That'll do for a start. One last tip, in the beginning of your treatment, pay little or no attention to any events flagged while you know for sure or even suspect that you were awake at the time. These machines aren't perfect at data reporting and often report things that are insignificant. Don't let that lead you astray. You can test that theory by holding your breath, swallowing, yawning or coughing. All of those acts can sometimes fool the machine.

Good luck in your quest.

Edit: Forgot to mention that anticipation and anxiety can wreck the whole data mining process. Relax, everything is going to be OK. You'll soon have this glorified blower mastered. Pay no attention to the air flow sounds you may hear (mask them with background sound) and just breathe normally. It's going to be OK, trust me.

Sleep-well
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#7
It is an unusual flow pattern; but, needs to be in context with the other data. By itself, one cannot even guess as to what it may mean.
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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#8
Hi zeropoint101,
WELCOME! to the forum.!
You might tell your doc you are still feeling bad and tell them the problems you are having.
Best of luck getting your CPAP therapy working for you.
Hang in there for more responses to your post.
trish6hundred
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#9
(09-17-2014, 04:13 AM)zeropoint101 Wrote: For a couple nights, I had a lot of centrals on my graph, ....
Did you had centrals in the sleep study and do you take any pain relief medication contain opiate?

From http://www.mayoclinic.org/diseases-condi...n-20030485
Drug-induced apnea. Taking certain medications such as opioids — including morphine sulfate (Ms Contin, Avinza, others), oxycodone (Oxycodone HCL, Oxycontin, others) or codeine sulfate — may cause your breathing to become irregular, to increase and decrease in a regular pattern, or to temporarily stop completely.
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#10
Thank you all for the replies. I was going to respond in more detail with more charts and such, but I've learned about some other possible major health problems and they may be a strong factor in my apnea, so I'm going to put this whole thing aside and figure out and treat those as best I can before coming back to it. Especially considering the machine just makes me feel ten times worse now than before I got it. So until I find a new primary care that I actually trust, and deal with a lot of other stuff, I'm not going to even try and analyze any of this. I just need to get back to basics before I have a clue with this. Thank you all very much though, and I'm sure I'll be back once I have a better starting point and a plan for my health overall.
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