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[Symptoms] 40 days in, stats are all over.
#1
Question 
40 days in, stats are all over.
Greetings!
I've just hit my 40th day on a DreamStation Auto CPAP with humidifier and heated hose. I've achieved an AHI below 5 once, and my statistics vary wildly. My events are predominately CAs, but some nights there are more OAs, and rarely, there are more Hypopneas than anything else. My Leak Rate and Snore seem acceptable. Many of my events cluster in a 10-20 minute range, so I recently started wearing a cervical collar, which seems to make everything even more random, with increases in Snore and Periodic Breathing.

I was diagnosed with Sleep Apnea by a NovaSom home sleep test, which didn't complete sucessfully either night. Each night, after approximately 3 hours I would start getting a "Check Breath Sensor" warning every fifteen minutes. Everything seemed fine - I would huff into the sensor (and learned swearing into it worked equally well Rolleyes ) get "Breath Sensor OK", and start again - 15 minutes later, same thing. I finally called tech support at 4am and was basically told to "Unplug the sensor, then plug it back in" (the magic cure for anything electronic!), which made no difference. They sent out a new Breath Sensor, with the same results. I was told they got enough data between the two nights for a diagnosis of Sleep Apnea with an AHI of 23.9. I still don't have a copy of my results, so I don't know the breakdown.

I don't have a Sleep Doctor - just my GP and my Lincare RRT, and neither seem very invested in my progress. I've been making my own prescription changes from the machine defaults as prescribed - now currently EZ-Start off, Auto Min gradually moved up to 9.5 and Auto Max down to 15. I've stopped using Ramp, but am still using AFLEX 3, and have changed from a DreamWear FFM to a nasal cushion. Things have shown some improvement, but not below the 5 AHI target.

My biggest concern is that I might need a BiPAP or ASV, and my Original Medicare window for that prescription change is closing soon, at least without another sleep study, which right now is something I'd rather not be doing. If I need to make a machine change, I'd like to be able to present a convincing case for it.

I have an OSCAR Daily screen shot for each day of treatment, with junk sessions turned off where I've just been trying to get back to sleep, but I have no idea which to post. Any insights would be appreciated. Thanks!
   

   
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#2
RE: 40 days in, stats are all over.
Hey there,

I just joined the forum as well. I can't offer you any advice, but perhaps I can offer you some re assurance that I am going through the same thing almost exactly. Doctor's that don't particularly care, wild variability in AHI on a day-to-day basis, large proportion of Clear Airway apneas, etc etc.

I have tried the mouth taping thing to no avail... Perhaps you could give that a try.
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#3
RE: 40 days in, stats are all over.
Hello TheMadBear,

To help determine where you are at and what is needed, can you please setup your Oscar Daily View as per the link in my signature "How to organize your Oscar Charts".

Once you've done that, take a screenshot so we can see what is going on.

Sleep tight,
Damian.
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#4
RE: 40 days in, stats are all over.
Welcome to Apnea Board. It's important to know if these central apneas were pre-existing or whether they started after you go the machine. Get hold of the sleep study report (the whole thing including charts and tables) and post it here. Ensure you remove any personal ID on the document.
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#5
RE: 40 days in, stats are all over.
Hi, thanks.
Mouth breathing isn't an issue for me. I went from the DreamWear FFM to the nasal cushion after I found that I was able to keep my mouth shut while asleep, verified by my leak stats. I know I DID have problems with open mouth sleeping, but since I started APAP that's gone away - possibly because I also started using Flonase to keep my sinuses open.
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#6
RE: 40 days in, stats are all over.
(03-29-2020, 08:55 PM)DeepBreathing Wrote: ...Get hold of the sleep study report (the whole thing including charts and tables) and post it here....

I finally reached someone at NovaSom and was able to get my report within minutes. Unfortunately, it doesn't include charts and tables - Here's what I got:
   
   
   
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#7
RE: 40 days in, stats are all over.
Hi - 
I'll attach the last 3 days, though they don't show the range I've been experiencing.
Thanks!
   
   
   
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#8
RE: 40 days in, stats are all over.
Any separation of Central Apnea and Obstructive Apnea events weren't shown. I don't think I missed it somewhere on the report. As this was a home study, maybe it couldn't do an event breakdown. CA events do typically do an elusive trick we call consistent inconsistency, so I'm not surprised you sometimes get them and sometimes you don't.

I would ask you include detailed descriptions in a post on how you feel regarding your sleep and therapy on the DreamStation. Any feeling of not enough air or any uncomfortable sensations while using the machine? Descriptions help us put things in context. I do know an AHI of 8 plus in that representative OSCAR chart is not acceptable as treated successfully. Doctors are looking for an AHI of 5 to consider you treated, but here on AB we are looking for less than 5 with a high comfort level also.
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: 40 days in, stats are all over.
(03-31-2020, 07:34 PM)SarcasticDave94 Wrote: I would ask you include detailed descriptions in a post on how you feel regarding your sleep and therapy on the DreamStation.

The therapy is fine, ever since I moved the min (and ramp, while I was using it) pressure up. At 4, on inhalation it felt like I was trying to suck air back through the machine. Now that I'm used to 9.5 min, it feels like that's my balance point. I've had few problems with the process - I did my due diligence as soon as I discovered (got a phone call from Lincare - Surprise! My GP didn't bother to let me know the sleep test results) I was getting a machine, and studied all the tips for living with CPAP. My first FFM cushion was too small, and that made my gums sore after a few hours of use. I switched to a medium, and that problem was eliminated. After I figured out that I could keep my mouth closed after using Flonase to clear my sinuses, I got a nasal cushion, and have been using that ever since. I extended the heated hose and ran it over my headboard, and between that, and the top swivel on the DreamWear masks, I've had no issues with tangled hoses or pulling the machine off my nightstand. 

My biggest issue is that the headgear seems to make me tense my scalp muscles, and after a few hours of sleep, I wind up with a low grade headache that keeps me from getting back to sleep. I try for up to twenty minutes, and if I've hit compliance for the night, I usually just take my gear off and go back to sleep. This is probably also related to my pillow issues - I was in need of something different before I got the machine, and now I can't seem to find any arrangement of pillows that keeps me in comfortable alignment. I've started taking naproxen sodium before bedtime, and that seems to help with the headache, and I have a CPAP pillow on order from Amazon, but with things the way they are right now, it's still over two weeks before it's scheduled to arrive.

In the meantime, I'm just watching my averages trend down, and now back up. I think I might stop using the cervical collar for awhile and see if my stats start to return to where they were previously - not good, but better than they're trending now. I was hoping the collar might help with the clusters of events I see, but it doesn't seem to have done much in that regard, and since starting with it, I've seen other problems increase.

Overall, it feels like 4 hours a night is better than nothing - I don't wake up feeling more tired than when I went to bed. Wish I could get to the point where I can get 7-8 hours at even 5 AHI, but I don't have any idea how to get there - I've tried raising the min for OAs, and lowering the max for CAs and have been at the same settings for the past 11 days and I'm not seeing what looks to me like consistency. Maybe it's the phase of the moon Bigwink ... or I'm just worried that I'm on the wrong type of machine, and if I don't get that resolved before my initial 90 days, I'm going to be stuck with it for 5 years Dont-know
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#10
RE: 40 days in, stats are all over.
Excellent info. Upping pressure from the basement like you've already done with comfort/medical cause is exactly what we'd advise. You're one step ahead already.

Feel free to ask questions for help or suggestions. Since you're already posting OSCAR, use the machine and post a standard chart with comments. We'll guide you along as needed to get the therapy going the right way ASAP.
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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