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New Guy, Central Sleep Apnea, wrong machine?
#1
New Guy, Central Sleep Apnea, wrong machine?
Hey all, I'm a new user. I was diagnosed with Central and Obstructive sleep apnea a few months ago and started the ResMed Airsense 10 vAuto 2 months ago. In the beginning it seemed like things were getting better, but the last 3 weeks have been pretty rough, especially the last 72 hours. I have really intense transitions into to falling asleep where I gasp awake. That's how i was originally diagnosed, I kept waking up gasping for air and totally freaked myself out. I ended up in the hospital, I didn't know what was going on and had never heard of apnea, outside of snoring etc. I'm 31, 6'0", and 165lbs, even my sleep doctor told me it was all in my head and there's no way I had apnea. Well, turns out...boom. Apnea. Last night was just under 30 AHI, and i'm back to feeling like complete garbage again. My pressure is 10 / 4, which I think is really low for a bi-pap. I thought the bippap was for people who needed higher pressure settings to be able to tolerate. (sorry for my rambling and confusion, i haven't slept right in a few days...we also have a newborn  Smile      .  Anyway, my ResMed machine doesn't have one of those backup/timer things, which i really feel like is the whole point of having this machine. Sometimes i pause my breaths for as long as 47 seconds at a time. It's insane. The bi-pap pressure is obviously there, but if it doesn't fire on it's own (which i know this particular model won't do...i just learned that today, which is why I'm here, because i thought this whole ""thing"" was behind me lol...man...am I an idiot lol)   I went to the cardiologist back a year ago and other than a trace mitral regurgitation, everything is tip top shape, so i feel like that would put me as a good candidate for ASV, which is what i feel like i need. or at least the backup pressure setting thing on the Bi-pap. I don't mind the pressure, but Im a side sleeper (nose mask, not pillows). The problem with side sleeping for me is a tend to tuck my chin down, so there's no way for me to get the proper pressure, and i end up swallowing air like crazy, and wake up with the whole aerophagia deal, unbelievable stomach pains, farting for 10 minutes. It's awful, so I'm forced to sleep on my back. Not a huge deal, but sucks, especially with the restless legs. 

Recently i've started doing yoga every day, working out again, and meditating. I almost feel like the meditating is making my apnea worse. It sounds nuts, but if I'm slowing down my breathing that much, and i'm good at it, I feel like that would set me up for failure with the central apnea. There's not much out there on yoga / meditation and Central, but I'm literally willing to try anything.  

As I mentioned before my wife and I have a newborn, a beautiful baby boy, no issues at all. The little monster even sleeps 6-9 hours a night, at 3 months old! SO WHY AM I THE ONE WITH THE SLEEPING ISSUES!!!???


I remember back in 2008 having these wake/sleep transition issues. That's just what I remember. But my whole life I've had issues waking up, school as a kid, etc. Never felt rested my entire life, except a few times here and there that stick out in my mind growing up. It's weird. 

So weekends are obviously the bane of the existence, can't call any drs, etc, but Im calling first thing on monday to figure out why the hell i have a machine that literally doesn't help me through the 99% of apnea type that i have. I have my first actual checkup in 10 days, but I'll be hanging from the rafters by then. There's no way I can wait that long. I've even considered just buying a used bipap, same make / model but making sure it has the timed backup etc.   I don't really blame my sleep doctor though, in their defense, the sleep tech struggled with me for pressure for 2 hours, then i finally drifted off to sleep for the last 50 minutes of my titration test with no issues....but after today, looking at the data from Sleepyhead for the first time, which i didn't know you could do, I realized that I still do that most nights...the first 1-2 hours is the most apneas, then I go into a deep sleep and have little issues for an hour, then more etc.  

I'm so absolutely miserable that I can't focus on anything. My business partner and I are opening up our business and it's been insanely stressful, obviously the newborn, my wife goes back to work in a week and we can't afford daycare or anything.  I'm less concerned about my business and more concerned about my ability to take care of my son. I'm so tired that I can't even see straight. My wife is super duper supportive, totally understands everything that's going on and does everything that she can to help. If I can get a good nights sleep, my anxiety levels can get under control, I can eat normal, feel normal etc. 

I don't take any medications, I try to eat right, take breaks from the computer, etc. 

Again, so sorry for the crazy ramble, I'm an anxious and excited person who is just trying to get my junk together. I've been using the machine every day, no compliance issues other than gas.

IDK if this timeline seems crazy, but i feel like it all took insanely too long at every step.:  
               June 26, 2017 - hospital for gasping, did the sleep/wake transition thing for 48 hours. Unbelievably awful.
               June 29 - primary dr, to refer to sleep dr
               July 13 -  sleep doctor appointment
               July 22    1st Sleep study  
               Aug 10    Titration/Mask study
               Sep 20     received the Bipap in home. 
        Help me Obi Wan Kenobis, y'all'er my only hopes.
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#2
RE: New Guy, Central Sleep Apnea, wrong machine?
If it were me I'd raise the EPAP to 6cm and Drop the IPAP to 9cm maybe 8cm. It won't fix everything but it should lessen the Centrals your having.

You should download SleepyHead so you can post your data here. It helps everyone here to follow along and give advice.

The links are just below.

Good Luck.
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5
Advisory Members serve as an "Advisory Committee" to help shape Apnea Board's rules & policies.

Membership in the Advisory Members group does not imply medical expertise or qualification for advising Sleep Apnea patients concerning their treatment.



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#3
RE: New Guy, Central Sleep Apnea, wrong machine?
Hey Boodmaster, to get best advice folks her will want to see Sleepyhead charts.

That said, AHIs of 30 with mostly Centrals? I was wrecked with far lower scores myself. ASV has been a god-send for me.

I don't think from what you've posted that tinkering around with a Bi-level will be your solution.

Bill
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#4
RE: New Guy, Central Sleep Apnea, wrong machine?
Firstly I feel for you, it reminds me a bit of me at the start wondering why I have a machine and a mask that was not working for me without cutting the hell out of my noose.
Firstly, if you thing it took a long time where you are, you should try the UK, it can take months between appointments!

I do believe you can get collars to prevent you from tucking your chin in.  If you have a Nasal Mask, think about changing to Nasal Pillows, they are far better for side sleeping, I have the Swift FX soft pillows and they are very good for me, the headgear itself could be designed a bit better, but if it were not for the stupid hose I could forget I had them on.
I can't comment on the type of machine they have given you as I have not seen you and I am no doctor.
I also don't know how they set the machine up, but it does not appear to be working for you, I would be straight onto the phone first thing Monday and get some advice form the doctor.
The chin cushions are just a lump of foam that stops you tucking your chin down, in fact a travel cushion turned round the wrong way will help until you get a proper on, though it will not be quite so effective.  They are just a half circle of foam with a cover, though it is quite a stiff foam, they have a strap that goes round the back of the neck for adjustment.
Got on the phone first thing Monday and get them to see you urgently.
I am NOT a doctor.  I try to help, but do not take what I say as medical advice.


Every journey, however large or small starts with the first step.

Sleep-well
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#5
RE: New Guy, Central Sleep Apnea, wrong machine?
Thanks for the advice. I’m not too worried about the position sleeping just yet, I can deal with the nasal mask until I get a machine that works for me. I’ve been looking into ASV’s. I’m at my wits end. It’s crazy how insanely horrible I feel day to day. Last night was the first night that I consciously had the apnea’s wake me up since the first night I went to the hospital, pre-machine days. So that was troubling. I’ll try to add some screen shots, I thought I did before but it didnt seem to take. I agree with the statement about changing pressures. It frankly doesn’t appear that that would work. If the pressure of any kind was different, how would that prevent me from stopping breathing? I don’t understand the cm’ changing at all. I only know about the in/out pressure, obviously I haven’t booted in settings mode, just consumer/patient mode, high humidity and cold tube!

first shot
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#6
RE: New Guy, Central Sleep Apnea, wrong machine?
last night's snapshot
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#7
RE: New Guy, Central Sleep Apnea, wrong machine?
To enter the clinic menu push the big knob on the front at same time push the home button which has the house painted on it. In 3 seconds or so the clinic menu will pop up on the screen. You can request the clinic manual by going to the private files section on this site.
Download SleepyHead
Organize your Sleepyhead Charts
Posting Charts
Beginner's Guide to SleepyHead
Mask Primer
5
Advisory Members serve as an "Advisory Committee" to help shape Apnea Board's rules & policies.

Membership in the Advisory Members group does not imply medical expertise or qualification for advising Sleep Apnea patients concerning their treatment.



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#8
RE: New Guy, Central Sleep Apnea, wrong machine?
There is a sudden surge of this same problem on the forum...I just replied to Sleepykiddo here: http://www.apneaboard.com/forums/Thread-...#pid233017

You are using EPAP 4 and IPAP 10 which is a pressure support of 6 cm. This can cause central apnea due to wash-out of CO2. I'm in agreement with Walla on this one, and would like to see you try 9/6 (EPAP 6, IPAP 9). I'm sure this will reduce your central apnea. Alternatively, you can swiched from VPAP s mode to Vauto mode. In Vauto mode, I recommend EPAP min 5, EPAP max 7, IPAP max 12 and PS 3. Vauto mode will give you automatic adjusting exhale pressure to prevent OA and the more reasonable pressure support of 3 cm.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

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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.
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#9
RE: New Guy, Central Sleep Apnea, wrong machine?
Just keep an eye on your median tidal ventilation, breath per minute and minute vent, if your drop PS, It could help with CA, but there may be a reason the doctor set PS:6.

I don't know about philips, but resmed PS:6 is the max the ASV will go to for base tidal volume minute vent support, it doesn't leave you any room to increase minimum PS. It will adjust PS to keep recent minute vent numbers, but will follow bad minute vent right down. Before I laid out my money on an ASV, I would want to know it would meet my needs.
mask fit http://www.apneaboard.com/wiki/index.php...ask_Primer
For auto-cpap, from machine data or software. You can set the min pressure 1 or 2cm below 95%. Or clinicians commonly use the maximum or 95% pressure for fixed pressure CPAP, this can also be used for min pressure.
https://aasm.org/resources/practiceparam...rating.pdf
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#10
RE: New Guy, Central Sleep Apnea, wrong machine?
I sincerely appreciate your feedback, but I have to apologize, I'm following you as best I can. I've been having the central episodes for years. I'm not sure that the machine itself would be causing it? I mean, y'all see this more and deal with far more people and their experiences than I have, so absolutely correct me if I'm wrong. I get these episodes even just being on the couch, zoning out, or in front of the computer where I'll have to force myself to breathe, which usually causes the panic, vicious cycle.  But you're saying that adjusting the pressure to a 'less difference' = cm, which is what I'm picking up,  would relieve central apneas? (or i should say *could*).  Again, I really appreciate how active you guys are in this forum, I wish i would have known about it sooner. I just want to make sure I understand. Even with no machines or anything I registered a 20 ahi on my sleep study, with no titration.
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