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New to CPAP, need help understanding SleepyHead data
#1
Hi, I am new to CPAP and apnea in general.
I don't like asking for help but I would really appreciate some feedback on what I'm seeing in SleepyHead.

First, some background. I'm 50, male, not overweight, and in seemingly good health except for persistent fatigue that ranges from annoying to debilitating. I've been trying to solve the fatigue problem for about 10 years now.

I had a sleep study six years ago that showed mild apnea with no drops in oxygen saturation and normal REM sleep.
AHI 0.7, RDI 6.5, 0 apneas, 4 hypopneas.
No treatment was considered necessary at that time so my PCP and I went looking for other causes.

A cardiologist did an ECG and an echocardiogram and said everything looked fine there.
An endocrinologist found everything normal except thyroid, D, and testosterone were at the low end of the normal ranges, so we've been boosting those to the high end of normal.

I switched to a new PCP and he thought it might be worth trying an auto-titrating CPAP to see if treating the "mild apnea" found earlier would make a difference.
At this point I'm willing to try just about anything.
I researched equipment and caught a good sale on the Philips DS560 and the ResMed F20 mask.

I've been using the machine for two weeks and I feel worse now than before. But at least I have some data to look at.
However, these graphs look very complex and I'm not sure what to make of them.
I can't embed images here (yet) so please remove the space in this link: https:// imgur.com/a/pc1sx

I have probably read through a hundred threads on this forum looking for similar patterns.
I learned a lot by reading here but when I look at these particular waveforms I feel like I don't know much at all.
I'm seeing both obstructive and central apnea events, and I'm not sure how many are normal. These look bad to me.

I have a follow up appointment with my PCP but I don't know if he will be able to interpret these.
I'm not even sure what kind of specialist I should be seeing.
There are three doctors within 100 miles of me who are board-certified in sleep medicine: a pulmonologist, a neurologist, and a "critical care" physician.
I'm guessing one of the first two.

To start with, can anyone tell me if these graphs are as scary as they seem to me or is this within the bounds of "typical" apnea?
Does anybody here get patterns like these? If so, what is your treatment?
Many thanks...
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#2
Not that bad, They are mostly obstructive events. I think more min pressure will help. try 8 for a few days and then review. I would leave max at 20 for now. There may be some positional therapy down the road if the clusters are still there.
new user http://www.apneaboard.com/wiki/index.php...re_success
mask fit http://www.apneaboard.com/wiki/index.php...ask_Primer
From machine or sleepyhead, set the min CPAP 1cm below median pressure. Or 2cm below 90/95%. max at 20cm for now. Forum will help you fine tune settings
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#3
Well bricked, I'm not a medical professional, but it looks like to me your main problem (at least for this one night) is that you only got about 3.5 hours of sleep.  Is that normal for you?
 
Also, since your sleep study was six years ago, it would make sense to have another.  Although as you will notice if you follow your sleepyhead data regularly, a single night’s worth of data is inconclusive.
 
If you are feeling worse using the CPAP, then it could be a simple issue of just not being used to it.  I effectively forced myself to get accustomed to my machine by taking sleeping pills.  Eventually, I was able to use the machine without any sleep aids.
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#4
For now, the minimum pressure needs to be raised.  A wide open range of 4min and 20max is not going to give you the results you need.

I would raise the minimum pressure to 8cm and lower the max pressure to 14cm.

This change will help with the obstructives, flow limation and snores.  If you are using ramp, turn it off or raise it to 6 for a short period of time.  You are better off if you don’t need it.

The other thing is I see some clusters on a couple graphs.  This could mean you rolled over onto your back, which you should try to avoid.  Also, you may be tucking your chin into your chest.

But, all in all, not too bad.  Try these changes and give it 4 to 5 days to settle. And no, your graphs are not scary.
OpalRose
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#5
Hi bricked,
WELCOME! to the forum.!
Good luck to you with CPAP therapy, you have come to the right place for guidance.
Hang in there for more responses to your post.
trish6hundred
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#6
(10-03-2017, 10:09 PM)bricked Wrote: A cardiologist did an ECG and an echocardiogram and said everything looked fine there.

Something like paroxysmal supraventricular tachycardia (PSVT) can cause seemingly unexplained fatigue (and profound fatigue for some people) and requires a long-term monitoring device in order to see evidence of it. Even a holter monitor may not be on long enough - it just depends on whether your 'trigger' or whatever happens to occur while you are being monitored. For me, it took decades of being misdiagnosed before an electrophysiologist found it. You haven't described what you are experiencing with your fatigue though, so it probably isn't your issue... but just to say that those tests are only a view of your function in a specific moment in time. You may need longer monitoring to rule out something with your heart.
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#7
You have received some good suggestions, and the idea to increase minimum pressure to 8.0 is very good.  What we see in this chart is typical for a PRS1 Auto CPAP, where you tolerate the lower pressure, but when obstruction occurs, the machine is too slow to catch up with the apnea events.  Giving it a head start will not only help avoid those events, but will help you feel much more refreshed.  To me, a pressure of 4.0 is like air starvation.  You really need more support than that to feel good.

One more thing for you to consider.  It has been a long time since your last diagnostic sleep study. Since then you have added testosterone replacement therapy, and that is known to increase risk and severity of obstructive apnea.  That and adding a few years is probably enough to explain a need for CPAP.  In the chart you provided, we also see clustering of the apnea events.  While your machine is capable of stopping those events with pressure, there may also be a positional apnea component where you may be tucking your chin or sleeping on your back or some other physical reason that apnea is worse at some points than others.  At this point, I think increased pressure recommendation will resolve this and hopefully you will feel much better as well.

[Image: HRH4yVp.jpg]
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#8
Thanks for the helpful responses. It is reassuring to hear this data isn't as scary as it first seemed.

Yes, that first night I took the mask off after 3.5 hours and went back to sleep. Normally I wake up on my own after about 7 hours.

Last night I turned the EPR off and I think that makes it easier to sleep. I started with EPR set to 3 because it felt the most comfortable. However with EPR off the noise and the pressure is constant and it just seems less distracting that way.

Kiwii, thank you for sharing the tip about PVST, I had not heard of that and I am always on the lookout for other possible causes of fatigue.

If the clusters of apnea events are positional that would be super because that seems relatively easy to solve.
I'm going to set up a game camera with night vision tonight to see if I can correlate any movements with the apneas.
I don't want to change too many things at once so I'm going to gather data for a week with EPR off and then try to dial in the pressure range from the default 4-20 to a smaller range, maybe 8 to 14.

Thanks again. I will update when there is anything new to share.
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#9
Two things I've learned in the past week and a half:

1. Changing EPR ("A-Flex") from 3 to 0 just about eliminated the central apnea events. In the week before the change, there was an average of 9 CA events per night. In the week after the change, the average was just one CA event per night.

2. A cheap infrared game camera is a very useful tool. I set it to record 30 seconds of video when it detected motion, and when there was a cluster of apnea events in SleepyHead, I could look at any videos recorded around that time and try to correlate the sleeping position with the events. Unsurprisingly, most of the apnea event clusters took place when I was sleeping on my back. I could even see how my sleeping self thwarted the heavy pillow pushed up against my back in an effort to enforce side sleeping.

I raised the min pressure from 4 to 6 (just below the 2-week median of 6.5) and lowered the max pressure from 20 to 15 (just above the 2-week max of 14.4). I tried a minimum of 7 but woke early and didn't like the way it felt. It's too early to tell if that small change will affect the average API, but I'm guessing not.

Now, to figure out some way to let myself easily roll from left side sleeping to right side sleeping and vice-versa without allowing back sleeping... piece of cake, right? Thinking-about
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