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New Member but not new to CPAP
#1
Hi All,
        Not sure why I never found these forums before. I am not new to CPAP but am back after a brief trial off after significant weight loss. I was diagnosed as severe sleep apnea in 2008. First machine was a ResMed S8 and it served me well over the years. I had bariatric surgery (sleeve gastrectomy) in December of 2015. I knew I would have to have pressures adjusted during the weight loss in the first year to 18 months post op as it is usually pretty dramatic. I worked with my sleep doc during this time and had the pressures adjusted several times. I did get my latest machine, ResMed AirSense 10 AutoSet and love it (I can finally download results). My pressures were lowered 3 times 9/12 in April 2016, 8/11 in September 2016, and most frequently 7/9 in March 2017. I did a trial of no CPAP from October 2016 to February 2017. A follow up sleep study was done and I still am classified as severe sleep apnea (30 events/hour) but the weird part was I had zero symptoms. My O2 sats didn't drop below 92% during the study but as a preventative measure I am back on CPAP. I have decided to do a bit of experimentation of sorts and am presently looking at how different pillows affect the results in Sleepy Head and what my machine reports. Only 4 days in and I see a difference with a pillow change I did 2 nights ago for the better. It is a small sample set so I will not declare results as of yet but it is looking good. I am a side sleeper and use nasal pillows for my mask but even that the first pillow I was using I had a high leak rate. Changed to a contoured memory foam pillow and my leak rate was cut in half. Looking forward to contributing where I can and getting questions answered from the other CPAP veterans out here.
Sleep-well
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#2
Welcome to the board, GPLarge.
                                                                                                                                                                                  
Please organize your SleeyHead screenshots like this.
I'm an epidemiologist, not a medical provider. 
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#3
Welcome!  I also enjoy comparing and contrasting different aspect related to CPAP treatment.
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#4
Welcome to Apnea Board! The fact that you were having 30 episodes per hour but didn't have an o2 desat is wild.
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#5
(03-11-2017, 07:29 AM)C0mbe Wrote: Welcome to Apnea Board!  The fact that you were having 30 episodes per hour but didn't have an o2 desat is wild.

Yeah it is weird. My initial study in 2008 had my sats dropping below 75% with the same amount of events/hour. That was the start of CPAP treatment and it has worked great over the years.
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#6
Welcome to Apnea Board!

(03-10-2017, 10:43 PM)GPLarge Wrote: A follow up sleep study was done and I still am classified as severe sleep apnea (30 events/hour) but the weird part was I had zero symptoms. My O2 sats didn't drop below 92% during the study but as a preventative measure I am back on CPAP.

I think that some people don't have O2 drops because they wake up and breathe before the O2 level can drop very far. That will prevent you from getting the sleep you need to live a full life. You may be so used to living with this malady that you don't notice it. That was the case for me. Being tired all the time was just a way of life for me that crept up on me so slowly that it just became my new normal.

Quote:I have decided to do a bit of experimentation of sorts and am presently looking at how different pillows affect the results in Sleepy Head and what my machine reports. Only 4 days in and I see a difference with a pillow change I did 2 nights ago for the better. It is a small sample set so I will not declare results as of yet but it is looking good.

You are wise to be cautious about results from such a small sample set. AHI can change from night to night even if you don't change pillows.

Quote:I am a side sleeper and use nasal pillows for my mask but even that the first pillow I was using I had a high leak rate. Changed to a contoured memory foam pillow and my leak rate was cut in half.

Paying close attention to the leak rate graph when evaluating different pillows is a good idea. The leak rate graph should be steady. If it's going up and down that's a red a flag. A sign that you may need a chin strap or a full face mask.
Sleepster
Apnea Board Moderator
www.ApneaBoard.com


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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#7
I agree with you on getting great sleep. The strange part is that I was asymptomatic. With my original sleep study I had all the classic symptoms. During the trial off CPAP (with the blessing from my sleep doctor) I was sleeping great. I felt well rested, not waking with headaches, not drowsy during the day, and no bruises from my wife's elbow for snoring LOL. My blood pressure has been fantastic and have been off meds for a year now. I am apparently not the only patient of my sleep doc with similar results after significant weight loss.

The most important thing to pass on is to stay informed, keep all you providers (regular doc, sleep doc, etc) informed of what the others are doing and share the test results with them. It helps with ALL aspects of your health and treatment. Most importantly, be your own advocate, educate yourself on you health conditions, and ask questions.
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#8
(03-11-2017, 10:18 AM)GPLarge Wrote: IDuring the trial off CPAP (with the blessing from my sleep doctor) I was sleeping great. I felt well rested, not waking with headaches, not drowsy during the day, and no bruises from my wife's elbow for snoring LOL. My blood pressure has been fantastic and have been off meds for a year now. I am apparently not the only patient of my sleep doc with similar results after significant weight loss.

Okay, so the subsequent sleep study showed an AHI of 30. You should be able to use the data from your CPAP machine to confirm that you d indeed need CPAP therapy.

Your pressure range is 7-9. Do you spend all night at or near 7? Is your AHI low? Is it dominated by any one or two of the three indices (CA, OA, or H)?
Sleepster
Apnea Board Moderator
www.ApneaBoard.com


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
I only have 4 nights worth of data to work wit right now but here they are

AHI 2.72
OI 0.00
HI 0.33
Clear Airway Index 2.14

Average Pressure 7.33
Min Pressure 7.0
Max Pressure 8.9
90% pressure 7.78
Average EPAP 4.37
Min EPAP 4.02

Seems to be dialed in right for now but need more data to get t just right. May want to see if I can drop the low pressure to 6 and see how it does but I will talk with my doc about it once I have some more data to get the averages.
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#10
Looks great, and a few CA events when starting out are pretty normal, and are more a reflection of sleep disruption than a problem. Your ideal of using a minimum pressure of 6 looks like it will work fine. Go for comfort, whatever that is for you. Reading between the lines, your EPR level is at 3, so keep in mind the minimum pressure for the machine is 4.0 cm. As you reduce minimum pressure, you will also be reducing EPR at the low end of that setting. So if your minimum pressure is 6.0, your delivered pressures with EPR at 3 are 6/4, 7/4, 8/5. I recommend that if you select a minimum pressure of 6.0 that you also reduce EPR to 2.0 so it remains constant if your pressure need increase. It is the exhale pressure (EPAP) that resolves OA, and as you can see, at these low pressures EPAP will lag pressure increases.
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