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[Pressure] SunsetsBrew's Journey
#1
SunsetsBrew's Journey
Hello!  My name is Brew and I have been suffering from some pretty bad chronic sleepyness (waking up tired and yawning), lightheadedness, fatige, dizziness issues for the last 6 months or so, and I was prescribed a sleep study back in March and due to covid they are only doing at home studies and had a HUGE wait time.  Fast forward to today, I finally have my apap machine and am ready to start therapy.

stats:
Male. 33yo
240lb
15.1 AHI before treatment start

Machine: Airsense 10
Mask Philips Dreamwear nasal pillow

Originally prescribed 4-20 pressure ranges with EPR of 3, and after only a small amount of reading it seems that prescription is pretty off for a number of reasons.  I did the first night with the prescribed settings and then the 2nd night with minimum up to 7, EPR still at 3.  attached are my oscar results.

I didnt feel any different when I woke up either night, but both my CA and OA counts went down, I do want to dial in on the CA events, and I may take the ramp off and try EPR at 1 (seems that is the suggestion for similar cases on this forum.

I got a Philips dreamwear nasal pillow mask but I am open to trying others, I kinda feel like I sometimes open my mouth when I sleep.

But looking forward to trying to kick some of the health issues I have been facing and would love feedback and settings suggestions as my doctor has been pretty unhelpful lately.

Excited to start working through this!


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#2
RE: SunsetsBrew's Journey
Welcome to Apnea Board Central.

Do turn off Ramp and EPR down either to 2 or 1 and note the change in CA versus OA. A typical CA to OA issue is that acting on either to make it go down will make the other go up. Call it the teeter-totter effect. Reason for this is what you adjust for effective reduction of CA will likely cause OA to increase and vice versa.

Your doc really works hard to get you default CPAP pressures 4-20. Yippee. You already know more than Dr. Dolittle, yet he makes the boat payments.

Give the edits a try, nix Ramp or very short time and pressure close to or equal to 7. EPR down, your choice of 2 if you want to back off this slow, 1 if you're wanting a medium back down, or off for full blown backing off. This may be temporary, but we need to get your CA down.

Oh yes, order your full detailed diagnosic. Doc will probably hate you, but who cares. If they fuss, mention HIPAA law, it permits you to request and receive it. No isn't an acceptable answer. Once you win the fight to get this, post it all redacted.
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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#3
RE: SunsetsBrew's Journey
So I turned the ramp off and the EPR to 1, it looks like that made my CA events go up, I did notice that those settings made me open my mouth more as well, you can see the leak graphs going crazy compared to the previous nights.  I am a little unsure of what to do next, I might turn the epr up to 2 and see if that helps at all.


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#4
RE: SunsetsBrew's Journey
With leaks at a Max 21, you're closer to ResMed's redline for leaks. The therapy accuracy is in question at this rate of leaks.

Give a sample zoom on of some of the CA in case chart gurus want one. Include an area with low leaks but with a few CA. This zoom is not just making the chart bigger, but zooming in for more detail like on a map. Show a 10 minute zoom and 3 minute.

I don't see the answer, how long have you been on PAP? I'm wanting to see how far along you are in regards to treatment emergent Apnea that has a 3 month timer.
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: SunsetsBrew's Journey
I have just started therapy this was my 3rd night, in my study, I only had 1 Central Apnea event over the ~7 hours of data, and now I am getting many (making up the bulk of my events).  It even looks like it logged some CA events while I was awake (I can tell about when I went to sleep as the flow rate changes).  and I can attest it is because the pressure is weird to breath back out into, not sure if it is just a getting used to it thing or if I need to look into it further.

Below is a 5 min zoom and a 10 min zoom of the same area, minimal leaks.


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#6
RE: SunsetsBrew's Journey
got my AHI down to 1.68 today from ~5.5 as of the last two nights.  I turned EPR back up to 3 fulltime and also removed the 2nd pillow I was using to try and get my neck more straight.

Had a couple more OA and H events, but the OA events look very similar to what the machine is calling CA events.  I also posted a zoom, can someone sanity check me on that?  To be fair, I do not truly know what I am looking at.


I am still waking up lightheaded and a bit brainfoggy so going to keep tracking that and hoping that if I keep my AHI down around 1 it help start to help.


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#7
RE: SunsetsBrew's Journey
Welcome 

Do you have a copy of your sleep study post a redacted one if you do.

Currently your CA is most likely Treatment Emergent CA.  What it means is your body has dealt with you having OSA which deprived your body of oxygen for years.  So now with CPAP your airway is more open and you are breathing better.  So you body is like WOW....Oxygen.  So it will take a month or so for these to go away.  Your body has adjust to the new normal.  

All your other settings seem ok for now.  In general look to feel better as days go by.  It wont be overnight and it might fluctuate.
Thank you,
Brent aka Factor

Just a Regular guy.
My untreated AHI was 87.  You can do it hang in there.
"You can if you will"   Jerry Kramer

Got OSCAR?
Organize Charts
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#8
RE: SunsetsBrew's Journey
Thanks for the welcome yall!  I uploaded a redacted copy of the sleep study and I will put last nights oscar data into my next post

Here is my oscar data, a few more CA/OA than the night before.  I also ordered a full face mask to try out (F30), the nasal pillows was the one that came with my unit and I would like to see if the full face will  help me with mouth breathing.


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#9
RE: SunsetsBrew's Journey
The zoomed examples of CA appear to be SWJ as they are preceded by arousal.
These are not high enough to be a concern, watched yes, concern no.
Your numbers are great

On your brain fog, I'd like you to set your min to 9 and then evaluate how you are doing. Brain fog is a sign that you are possibly not getting enough oxygen or working too hard to get it. The is a trial and a further adjustment either way may be suggested based on the results, mostly on how you feel.
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#10
RE: SunsetsBrew's Journey
Looks like the report gives you almost all Obstructive and just 1 Central. Hypopnea were of longer length than Obstructive Apnea, with at least 1 Hypopnea event being 75 seconds. The longest Obstructive was 36 seconds. You scored 15.1 AHI, just within moderate range. Pretty much vanilla Apnea, that's good news for you as the more complex stuff can be lots harder.

They played a lazy doc card with the Auto CPAP machine and default wide open pressure 4-20. Meaning they took zero brain power to not adjust the PAP specifically to your needs. So it's a good thing you edited it yourself, because they're not.

For now, I'd consider dropping EPR to 2 for a night and check the treatment emergent CA activity. See if it drops any, and make a note to determine if PAP therapy feels more comfortable with EPR at 3 or 2. Otherwise run PAP as is a few days and see where you're at.
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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