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New User - not sure it's working for me
#1
New User - not sure it's working for me
Thanks for all the useful info here. It’s great to have an option like Oscar to see just what’s going on overnight.

I’ve been using my Philips Dreamstation for about 6 weeks, and I’m just not sure it’s really doing anything for me. I was feeling tired with low energy, and a doctor suggested a home sleep study. It showed mild sleep apnea, with both obstructive and central apneas, the central ones sometimes occurring with low pulse rate (my pulse is often in the upper 40’s when I exercise regularly). My sleep doctor prescribed a pressure range of 5-12, but I felt uncomfortable from the pressure at first, and decided that I’d max out very low at the beginning (6) and every few days raise the max pressure to adjust. Now I’m at 9.5.

I’m not the best user. I often fall asleep watching TV and will get to bed at 2am and turn the machine on for only about 4 hours (clearly some room for basic improvement here). A problem, though, is that I just don’t believe the machine accurately identifies my issues or has the right solutions. The machine has only one tool - adjusting pressure. For obstructive apneas, sure, that can help. But what, exactly, does that due for central apneas?

1. The machine seems to score apneas and hypopneas readily while I’m awake and drifting off to sleep. I feel that this reduces the quality of the AHI score.
2. I’ve got a nasal (not pillow) mask, which fits reasonably comfortably. But I’ve always felt that it makes breathing a little harder because the airflow is reduced particularly with higher pressure. Going or returning to sleep feels like it takes work to breathe. Often one nostril is blocked for me, which doesn't help.
3. I sometimes feel that when the machine increases pressure, I wake up in response, and take longer to get back to sleep since breathing is more of an effort with the pressure.

I’ve included charts from an earlier night in the month. The first is an overview of the whole night, with a lot going on.

[attachment=30296]

The second shows a close-up of the first 40 minutes, with the machine grading a RERA, Obstructive Apnea and Hypopnea all while I’m still awake. It looks to me like I may have drifted off from 24:28, but then woke up to hit the pressure ramp button again. I think I fell asleep after that at around 34, but not before the machine graded another Central Apnea. This identification of problems while I’m still awake makes me lack confidence in the machine's ability to precisely identify problems, in general.

[attachment=30297]

The last chart shows a lot of scored events. The machine is increasing pressure, but it doesn’t really seem to have an effect. At the time I had set the machine to max out at 8 - maybe that’s still too low? I’m at a loss to understand why some of these are scored as obstructive and others central. The last hypopnea on the chart just before 01:56 looks like is just a low point in rhythmic breathing. Why was that a hypopnea?

[attachment=30298]

I’m curious if anyone has feedback or advice. It could be that I’m just not giving things a fair shake until I do a better job of more regularly getting a full night’s sleep with the machine and building up to a max pressure of 12.
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#2
RE: New User - not sure it's working for me
I think you uploaded attachments but did not add them, step 3 below

[Image: Attach-image.png]
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


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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#3
RE: New User - not sure it's working for me
Thanks...I did think it looked odd that I only got a bracketed 'tag' when I tried to insert the images.

I've repeated steps 1-3 again with this post. Last time I went on to hit the 'Insert into Post' button to the right of the attachments. That's when the bracketed 'tags' were put into my message. I haven't done that now, so hopefully the images show up in this reply.

Ah...yes, when I preview now, I see the images. I'm not sure how to use the 'Insert into Post' button, in that case.


Attached Files Thumbnail(s)
           
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#4
RE: New User - not sure it's working for me
Welcome to Apnea Board,

Yes do try again on the chart attachment. Also get you detailed sleep study report and attach the redacted version here too. You need that sleep report for your personal health file and HIPAA permits your request to receive your own report. If the report does in fact show Obstructive and Central Apnea as you've mentioned, you may not have proper Apnea treatment. It helps tremendously seeing the report to direct our suggestions in helping you succeed.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#5
RE: New User - not sure it's working for me
Central and especially Hypopnoea are being flagged rather frequently. I'd consider turning your Min pressure from 5 to maybe 6, noting that your Respironics records 7.4 is you 95% pressure. Eventually this will need to be closer to the 95% because the Respironics algorithm has the fatal flaw of slow response and requires the pressure to be set near your needed pressure. If not set there, you get this OSCAR result, events that were not treated. Also if you have Flex on, consider turning it down or off due to the CA events.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#6
RE: New User - not sure it's working for me
No your therapy is not working for you! Look at the pressure chart, it is up to the max and stays there for most of the night. 2 things this could be:

One to low of max pressure.

2. Positional apnea, although this is not a typical look of a chart with positional apnea it certainly could be. So let’s talk about positional apnea. What is it? It is when you get into a sleeping position where you cut off your own airway. NO PRESSURE CHANGE CAN HELP THIS! You have to find a way to stay out of this position.

It can be as easy as no sleeping on your back or reducing the height of the pillow. Anything that stops your chin from tucking down to you sternum.

If those simple remedies don’t work then many people have found using a collar to be very helpful. There is a link to collars at the bottom of the post. It has graphs of before and after. Please take a look at the link.
Apnea (80-100%) 10 seconds, Hypopnea (50-80%) 10 seconds, Flow Limits (0-50%) not timed  Cervical Collar - Dealing w DME - Chart Organizing
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#7
RE: New User - not sure it's working for me
I thought Dave and Stacey would recognize the signature of positional apnea by now. That is why there are clusters of OA and H events together with the squashed-flat inspiratory wave form (zoom in and you'll see it). Your therapy is working okay when your chin isn't tucked. I do think you need to change your pressure range from 7.0 to 12.0 rather than 5.0 to 8.0. The Philips Dreamstation is slow to get ahead of events, and your settings are too low for your needs. Please read these two wiki articles. You need to deal with your sleep position, especially your pillow or consider a soft cervical collar.

Positional Apnea http://www.apneaboard.com/wiki/index.php...onal_Apnea
Soft Cervical Collar: http://www.apneaboard.com/wiki/index.php...cal_Collar
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


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
RE: New User - not sure it's working for me
No sorry I was asleep at the wheel Sleeprider.

Correct on positional Apnea with the clusters. I agree with the rest as well. DreamStation fatal flaw on top of positional Apnea... Do the setting edit that's mentioned and get a soft collar.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#9
RE: New User - not sure it's working for me
Sleeprider that is what I wrote 3 paragraphs about, positional apnea.  Huh
Apnea (80-100%) 10 seconds, Hypopnea (50-80%) 10 seconds, Flow Limits (0-50%) not timed  Cervical Collar - Dealing w DME - Chart Organizing
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#10
RE: New User - not sure it's working for me
Stacey you put it on the right side of the screen. It's probably hard to see there. Coffee
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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