New to CPAP

[Swisssleeper]

Hi all,

So two nights in and I am sure there was more success last night, I feel I slept more and managed to find a position on my side which seemed to help. Although when I was dropping off I had events which would wake me,  this would happen when I stopped breathing throughout the night as I woke to change position. I have posted my sleepyhead charts below for the two days and would appreciate your input and thoughts.

Many thanks.

[ajack]

First how much of that are you awake? that period shouldn't be counted. Did you get a copy of your sleep study, or can you find out if you had central apnea in the study?
Some new users to cpap, have what is known as pressure induced or emergent central apnea, this can be the body getting the balance of o2 and co2 right. These normally resolve within 12 weeks in most people.
https://www.verywell.com/what-is-complex...ea-3015311
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2576324/

I would have min 8 max 11 to narrow the pressure gap for now, having the max at your 95% will treat most oa/h for you.

I'd go back to the doctor with these charts and see what he wants to do, these would be a concern if there was significant o2 desaturations with them. The swiss may have a system of providing recording o2 meters for this period of time. If not, if it was me, I'd buy a recording o2 meter from china on ebay for US$50. called cms50f with cd and cable, choose the supplier based on delivery time.

positional therapy can help a bit, there are a lot of hypopnea still, I wonder if you put your chin to your chest? This can obstruct the airway, a cheap foam cervical collar for sore necks can help a lot and is worth a try.

I think there may be a 3rd sleep test coming up for another machine, if the forum can't help you with those CA, if there is an o2 drop with them. Are the machines free in switzerland ?

[Swisssleeper]

Hi Ajack,

For the first session I was awake until 23.30-23.45 and then fell asleep, I woke at around 4.00am but with lots of waking to get comfy, the second night I dropped off around 22.40 woke at around 12.30 dropped of again within 15 mins or so and then woke again at 2.20ish when I got up for a drink. I am seeing the doctor again on the 2nd of August so I will discuss the point you raise regarding 02 and also take copies of the daily reports so he can see them. I will also ask him for a copy of the sleep test, he didn't mention central apnea but that's not to say it wasn't there as my french is pretty bad and his English the same lol.

my chin does drop if I sleep on my back but I don't like the position and struggle to get to sleep, I have always been a tummy sleeper so the side seems a good compromise, I am not sure about wearing a collar as well as the mask 

I get the machine for 1 year free and can try different machines masks until I get the correct one for me, after a year I have to buy all the equipment myself at full cost,,,,, ouch.

Thanks for the links I will have a read up.

[ajack]

so that cluster at 12:30 can be thrown away, that makes it look a bit better. you can turn the machine on and off when you wake up, this will mark the sleepyhead chart to easily see it.

That should work out fine for you, you can get an asv or vaps. If you need it till the CA settle and then get a cheap fixed pressure cpap. You will be well titrated by then and know your cpap pressure. With sleepyhead, you can still titrate a fixed cpap, if it has a sd card.

you only need to wear the collar for one night, to see if it fixes stuff....sort your pillow to support your neck,  so that you can get your chin up and head back to open your airway

[Gideon]

 With sleepyhead, you can still titrate a fixed cpap, if it has a sd card.

Correction, you can still titrate a fixed cpap, if it has a sd card and supports full data.  
Most models have SD card capability to support measuring compliance.  NOT all support full data.

Current Machines to Avoid

• ResMed AirStart™ 10 CPAP Machine with HumidAir™ Heated Humidifier (all models, 37201) (Lack of full data capability)
  
  
• ResMed AirSense™ 10 CPAP Machine with HumidAir™ (37015, 37203) (Lack of full data capability)
  
  
• Philips Respironics DreamStation CPAP (DSX200x11) (Not all DreamStation Models, Check SN on bottom) (Lack of full data capability)
  

[ajack]

It does make it easier with full data, ...But it doesn't need full data to titrate. If it has an AHI oa/h readout and pressure, I think we could titrate it. I will correct it and say that a sd card isn't really needed either. there are a few machines that doesn't have them, I started off on a chinese resmart without a sd card and got that working ok.

[Sleeprider]

It's going to take some time to sort out whether these issues can be addressed through CPAP, or if you have complex apnea with many centrals and central hypopnea that may not be responsive to CPAP. Here are a few articles for you to review so you can understand what we may be dealing with:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2576323/
https://www.hindawi.com/journals/sd/2014/798487/
http://www.webmd.com/sleep-disorders/gui...ep-apnea#1

Many people present with clinical obstructive apnea, but when placed on CPAP develop central apnea or mixed apnea. You appear to be one of those lucky souls. You may be able to accomplish a reasonable level of treatment using CPAP, however if we cant get significant reduction of these events, a different class of machine called ASV (Adaptive Servo Ventilator) may be required. The ASV is an expensive machine costing about $3000 USD here in the U.S. from online DME suppliers.

In my experience working with forum members with complex apnea, the best results have been achieved by using relatively low pressure and no EPR or Flex. The less variation in pressure, the better the results seem to be. It is reasonable to continue using your machine as it is currently setup from 6-15 pressure EPR in Ramp only. Some individuals naturally experience high CA and H events when starting CPAP therapy and spontaneously improve, however if you continue to show numerous CA and H events, then the next step is to make your pressure fixed.

From your data so far, it appears that setting the machine at minimum 7.0 maximum 7.0 may produce the best results. The objective will be to balance OA and CA to find the lowest possible event rate. CA is caused by higher pressures and pressure changes, so we fix the pressure at 7.0. The lower pressure may allow some OA events to bleed through. We will need to see the results for several days to decide if this is viable, or if some adjustments are warranted.

[Swisssleeper]

Thanks for the responses, the links provided some good reading. 

It's quite a lot to take in so bare with me ! For clarification I should try and position myself so my chin doesn't drop, I should also continue with the machine as it is now to get some more readings to ascertain it's not just me getting used to CPAP ? 

If the readings persist to be as they are it may be a new machine to try? Not to sound blasé but I am not overly concerned by the cost of the machine if it solves the issue. I think I have suffered with this for a long time and really want to loose this exhausted cloud that hangs over me constantly. I am not sure if you need my age but I am 37 with no other health issues, slightly overweight (5kg)but not a lot and I am pretty active. 

I just had a quick look at the machine is it like the Resmed air curve 10 ASV you would recommend if the reading persist to be the same ?

I really do appreciate the input you all have given and if I have misunderstood please do let me know. 

Thank you.

[Swisssleeper]

Further to the above this is the third night, I adjust my pillow so my head wouldn't drop but it was a pretty bad night with episodes of stopping breathing and very high CA. On the positive my wife say the snoring is gone but she says she keeps having to check I am alive as she is so used to really loud snoring lol

I know its only the third day so I have a long road but I really hope it gets better than last night, feeling exhausted. 

[DavePaulson]

Ouch, you might want to include a screenshot of a zoomed in view of about a 4-minute section with that has clear airways in it.