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Seven weeks in, could use some support
#1
Seven weeks in, could use some support
Hello Everyone. I’ve been on APAP therapy for about seven weeks and I’m still struggling with it. I'm reaching out for help in hopes you'll share your tuning expertise to improve my AHI.

I’ve always been an extremely light sleeper, somewhat chronically fatigued and some other symptoms related to apnea. I don’t snore much and never had a partner mention I wasn’t breathing or that I awakened with gasping. It was only after I learned many family members were diagnosed and on CPAP did I pursue a sleep study, after realizing that apnea may be why I was waking up so often and feeling so tired. 

My study was in an overnight sleep clinic and diagnosis is severe sleep apnea with up to 45 AHI. I was initially prescribed 4-10 cmH20 with 3 cmH20 EPR. AHI is now reduced and OSA is essentially zero. However, AHI still hovers around 4, and routinely exceeds 5 and even higher, almost all flagged as central apneas. I don’t seem to be sleeping better overall, but maybe a slight incremental increase in daytime energy.

I had a subsequent titration study in sleep clinic 10 days after starting with APAP. The post-titration MD consultation resulted in a prescription adjustment to 5-10 cmH20. No other changes or recommendations other than to stick with the therapy and it “may get better”.

When I shared my concerns about Sleepyhead data such as the ongoing high central apnea flags and periodic breathing events (many flagged as Cheyne-Stokes), he was unconcerned and insisted the data was invalid because it doesn’t include all the other non-respiratory data one gets in a full sleep study. He said because AHI was under five “most nights” the therapy is “successful”. 

I’ve tried various minor setting adjustments in attempts to mitigate AHI (pressure, EPR), and dial up comfort (temp and humidity) to no avail. However, I did not stay with new settings for multiple nights in a row.

Additionally, I’m having issues with the headgear. I sleep best on my side, but the mask leaks excessively when I’m not on my back if I don’t very carefully adjust my position, which is awakening. I’ve found the Resmed P10 pillows to be the least obtrusive (I’m very sensitive to sound levels) and the most comfortable initially, but about halfway through the night I awake with such extreme skin discomfort I have to switch back to the Dreamwear. 

So that’s the backstory. I’ve been very diligent about the therapy, I really want success so I’ll sleep and feel better. Here’s my questions, and of course I’m open to any/all advice. I’ve attached last night’s data which is pretty typical.

- Any recommendations for CPAP settings adjustments to reduce AHI?

- What’s the functional difference when the machine is set to nasal versus pillows? If I switch headgear in the middle of the night, do I really need to change that setting?

- What’s the best gear for side sleepers? My DME provider fitting experience was a nightmare, but that’s another story…

Thanks in advance to this awesome community, I’ve see many have been helped immensely!!!


[attachment=7013][attachment=7014][attachment=7015]
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#2
RE: Seven weeks in, could use some support
Last night was worse than usual, but it's not the first time the data looked like this. Something seems amiss, I'm frustrated my doctor dismissed similar readings. Thanks for any inputs.


[attachment=7037][attachment=7038]
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#3
RE: Seven weeks in, could use some support
I hate to say it but there's not a lot that can be done. Your not using high pressure so you can't really adjust any lower. Your going to need your Doctors help. Your probably going to need and advance type of machine called an ASV.
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#4
RE: Seven weeks in, could use some support
Very sad to read that. My next MD appointment is seven weeks out.

Sad
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#5
RE: Seven weeks in, could use some support
You might want to call and try to move it up or at least getting put on a waiting list in case someone cancels.
Download SleepyHead
Organize your Sleepyhead Charts
Posting Charts
Beginner's Guide to SleepyHead
Mask Primer
5
Advisory Members serve as an "Advisory Committee" to help shape Apnea Board's rules & policies.

Membership in the Advisory Members group does not imply medical expertise or qualification for advising Sleep Apnea patients concerning their treatment.



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#6
RE: Seven weeks in, could use some support
One thing you could try that seems to reduce the Central Apneas, would be to turn off EPR, or just reduce it to 2 or 1 - possibly in stages of three or four days each, to see it that reduces the CA.

Keep posting those charts, too, especially after any changes in setting have had a chance to settle.
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#7
RE: Seven weeks in, could use some support
(06-26-2018, 01:45 AM)ScoobyDoo Wrote: Hello Everyone. I’ve been on APAP therapy for about seven weeks and I’m still struggling with it. I'm reaching out for help in hopes you'll share your tuning expertise to improve my AHI.

I’ve always been an extremely light sleeper, somewhat chronically fatigued and some other symptoms related to apnea. I don’t snore much and never had a partner mention I wasn’t breathing or that I awakened with gasping. It was only after I learned many family members were diagnosed and on CPAP did I pursue a sleep study, after realizing that apnea may be why I was waking up so often and feeling so tired. 

My study was in an overnight sleep clinic and diagnosis is severe sleep apnea with up to 45 AHI. I was initially prescribed 4-10 cmH20 with 3 cmH20 EPR. AHI is now reduced and OSA is essentially zero. However, AHI still hovers around 4, and routinely exceeds 5 and even higher, almost all flagged as central apneas. I don’t seem to be sleeping better overall, but maybe a slight incremental increase in daytime energy.

I had a subsequent titration study in sleep clinic 10 days after starting with APAP. The post-titration MD consultation resulted in a prescription adjustment to 5-10 cmH20. No other changes or recommendations other than to stick with the therapy and it “may get better”.

When I shared my concerns about Sleepyhead data such as the ongoing high central apnea flags and periodic breathing events (many flagged as Cheyne-Stokes), he was unconcerned and insisted the data was invalid because it doesn’t include all the other non-respiratory data one gets in a full sleep study. He said because AHI was under five “most nights” the therapy is “successful”. 

I’ve tried various minor setting adjustments in attempts to mitigate AHI (pressure, EPR), and dial up comfort (temp and humidity) to no avail. However, I did not stay with new settings for multiple nights in a row.

Additionally, I’m having issues with the headgear. I sleep best on my side, but the mask leaks excessively when I’m not on my back if I don’t very carefully adjust my position, which is awakening. I’ve found the Resmed P10 pillows to be the least obtrusive (I’m very sensitive to sound levels) and the most comfortable initially, but about halfway through the night I awake with such extreme skin discomfort I have to switch back to the Dreamwear. 

So that’s the backstory. I’ve been very diligent about the therapy, I really want success so I’ll sleep and feel better. Here’s my questions, and of course I’m open to any/all advice. I’ve attached last night’s data which is pretty typical.

- Any recommendations for CPAP settings adjustments to reduce AHI?

- What’s the functional difference when the machine is set to nasal versus pillows? If I switch headgear in the middle of the night, do I really need to change that setting?

- What’s the best gear for side sleepers? My DME provider fitting experience was a nightmare, but that’s another story…

Thanks in advance to this awesome community, I’ve see many have been helped immensely!!!

Rule 1 is to address the OSA.  Your data shows that OSA may not be addressed.  
Your zoom shows signs of OSA even when labeled as CA and CSR.  
Have you ever tried a higher pressure?  5 is lower than most people feel comfortable with.
Set the min to 7 and show the data.

I use nasal pillows. Use a firm pillow so when you are on your side your mask is at the end of the bed pillow. I don't want the bed pillow pushing on my mask.
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#8
RE: Seven weeks in, could use some support
Thanks all for the replies. Last night I lowered EPR to 2 per pholynyk's comment, and increased min pressure to 6 per tedvpap's comment. I didn't sleep well at all and Sleepyhead results were much worse.

I'm confused... Walla Walla implied lowering pressure might help, but tedvpap says increasing pressure might help mis-flagged OSA. I'm new here so don't know who the experts are or what do to when there is conflicting advice. Sleepyhead rarely shows OSA, yet tons of CA, etc...?

All evaluations are much appreciated and thanks again for any inputs. 

[attachment=7056][attachment=7055][attachment=7054]

PS tedvpap: I've also found P10 best for side sleeping with a hard pillow, but was always hindered by comfort because the strap is too tight for my big head haha. So last night I hacked the strap to loosen it (unhooked strap from plastic trim's mount and stapled it farther up trim so the strap is longer). That's what I used last night so was able to use the P10 all night for the first time Smile
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#9
RE: Seven weeks in, could use some support
I would agree with reducing EPR. Preferably to 0 if you can work down to it. For some individuals EPR can really exaggerate their CA events. It seems that you are already at a low pressure and I wouldn't advice increasing your min pressure due to the high volume of CA events you are experiencing. I would also agree with the opinion that you will very likely need an ASV machine based on what is on your charts so far. Do you have any charts with a below 5 AHI result you can post here?

I would be very interested to see what Sleeprider's opinion is on these charts...
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#10
RE: Seven weeks in, could use some support
(06-27-2018, 03:58 PM)ScoobyDoo Wrote: Thanks all for the replies. Last night I lowered EPR to 2 per pholynyk's comment, and increased min pressure to 6 per tedvpap's comment. I didn't sleep well at all and Sleepyhead results were much worse.

I'm confused... Walla Walla implied lowering pressure might help, but tedvpap says increasing pressure might help mis-flagged OSA. I'm new here so don't know who the experts are or what do to when there is conflicting advice. Sleepyhead rarely shows OSA, yet tons of CA, etc...?

All evaluations are much appreciated and thanks again for any inputs. 



PS tedvpap: I've also found P10 best for side sleeping with a hard pillow, but was always hindered by comfort because the strap is too tight for my big head haha. So last night I hacked the strap to loosen it (unhooked strap from plastic trim's mount and stapled it farther up trim so the strap is longer). That's what I used last night so was able to use the P10 all night for the first time Smile
Thanks for showing the data.  The slight increase in pressure cleaned up your OSA but certainly increased the CA.
Now you should work your way to a lower EPR and hope that eliminates the CA.
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