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[Treatment] Chasing Zero - Newbie needs advice
#1
Question 
Hi,

I'm a newbie chasing the elusive 0.0. During an Ablation of the heart, my cardiologist said I snored quite badly and ordered a sleep study.

Here are the results:
BASELINE PORTION
Recording Time: 448 minutes

SLEEP ARCHITECTURE
The patient spent 174 minutes in bed with a total of 141 minutes of sleep time. Patient had a sleep latency of3.0 minutes and REM latency of 67.5 minutes. The patient had a sleep efficiency of 80.9%. Normal sleep efficiency is 90%. The sleep stages are as the following: Stage l- 30.1%,stage ll - 56.0%,stage lll/lV(SWS) - 0% and REM - 13.8%. The patient's arousal index was 31 .5 events per hour sleep. This is abnormal sleep architecture with severe sleep state disruption.

SLEEP DISORDERED BREATHING
Overall, the patient had 12 apneas, 8 obstructive and 3 central, and 69 hypopneas giving an apnea index of 5.1, a hypopnea index of 29.4 and an apnea and hyponea index (AHl) of 34.5. The patient's central index was 1.3. The patient was studied supine with an AHlof 104.9 conlpared to non-supine where the AHl was 17.5. The patient was seen in REM where the RDI was 24.6. Snore was present and rated 5/10 in intensity.

POSITIVE AIRWAY PRESSURE PORTION
PAP Time: 226 minutes

SLEEP ARCHITECTURE
The patient spent 226 minutes in bed with a total of 116 minutes of sleep time. Patient had a sleep latency of
19.8 minutes and REM latency of 3.5 minutes. The patient had a sleep efficiency of 51.3%. Normal sleep
efficiency is 90%. The sleep stages are as the following: Stage I - 18.9Yo, stage ll - 59.7%, stage lll/lV
(SWS) - 0% and REM - 21.5o/o. The patient's arousal index was 8.2 events per hour sleep. This is improved
sleep architecture with no sleep state disruption.

POSITIVE AIRWAY PRESSURE TITRATION
This patient was titrated from 5 to 11 cm H2O pressure on CPAP and did best on 11 cm H20 with an AHI of
0. The patientwas seen in REM supine sleep on CPAP at 11 cm. The patient's central indexwas 5.7. The
patient used an Air Fit Nasal Pillow medium during this study.

Impression:
1. This patient demonstrates severe obstructive sleep apnea with apnea and hypopnea index of 34.5 events
per hour sleep. There was a positional component to his sleep apnea.
2. This degree of sleep apnea is associated with cardiovascular and cerbrovascular risk and only positive
airway pressure has been shown to decrease these risks.
3. I would recommend starting the patient on CPAP at 11 cm H20 with 2 cm of EPR with heated humidity
and compliance monitoring.
4. I would recommend reviewing compliance data at 2-3 weeks to ensure an AHI < 10 events per hour of
sleep.

I woke up from the sleep study feeling refreshed - I was superman. This CPAP therapy is wonderful. It took about 1 month to get outfitted with the "gear", mostly due to another heart ablation.

Being an Anal rententive engineer, I've down loaded both the Resmed and sleephead software. The first thing I do every morning, even before showering and cleaning the gear, is to down load from the memory card and see where I'm at. I've not had a good nights sleep using the CPAP machine, and really can't find much difference with it on and off. Starting to get frustrated. I've attached a chart of daily readings.

I have been given a Resmed S9 with humidity, heated hose and AirFit F10 Medium Full Face mask.
for the past week have been chasing the elusive zero and the euphoric feeling of a good nights sleep, without any success. I realize not everyone will be able to get to zero, so I've set 5 AHI as my goal, even though the Dr said <10.

I'm ready to give up on this. Any thoughts would be greatly appreciated.

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#2
Well, I believe you need not focus immediately on "0". I do a happy dance at 2.5, after 6 months. I don't do tech, some will be around to help with that. Dealing with the strangeness of it all, the machine, mask and all, is a lot to start with. Hang in there, and learn all you can.
Post Reply Post Reply
#3
Less than 5.0 AHI is a reasonable goal. the Sleepyhead detail chart with events, flow rate, pressure and leaks would be most helpful in looking at your results. Include the details on the left side without the calendar so machine settings are visible.

It surprises me you were titrated on nasal pillows and are using a full face mask. Any reason? You happy with it? We see you sleep study titration results, but we don't know if you have an S9 Autoset or Elite, and what pressure, ramp and EPR settings you are using.

Your hypopnea index is fine, your OA index is still too high. That usually suggest more pressure or on an auto, higher minimum pressure. The use of EPR can allow the airway to occlude during the exhale phase causing OA on the downbeat. I think you can probably halve your current apnea index with the way you're working at it, but I'd like to look at better daily details before making suggestions.

Sounds like you came through the ablation procedures well. That tachycardia could well be the result of years of untreated sleep apnea. Glad you're getting help now!

Post Reply Post Reply


#4
My initial thoughts:

You were titrated at 11cm H2o pressure with a "Nasal Pillow" Mask. So why did you switch to F10 FFM for therapy?

I have found that you need higher pressures on FFMs than Nasal Pillows. I started with an F10, my AHI was < 0.5 and my 95% pressure on APAP was upto 11cm H20 but then I switched to the nasal pillows mask and I sleep very well with AHI < 0.25 on a straight pressure of 8 cm h20 (so there is at least a 3cm pressure reduction by going to nasal pillows P10 from FFM F10).

You have 2 options now:
1) If you want to stay with the F10, you may need to raise the pressure in increments till you get your AHI under control.
2) You can switch to the P10 immediately.

Also, its just been one week on this for you. After a few more days the Central/Clear Airway events should reduce to insignificant and that will help the AHI no. as well.
Started APAP 4-20, Closed range to 7.5-14, then straight 8.0 w/ Aflex 3
RDI always below 1. But sleep much much better at straight pressure.
Started on F10, Tried Quattro Air successfully. Finally settled on P10.
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#5
Welcome to the Board lkallen! Give yourself time to get used to everything. Like the above posters, was there a reason for switching the mask type from the study? The delta between supine and non-supine is large, so try side or stomach sleeping instead of on your back.

Think of yourself as the project. You are going to make continuous small adjustments, slowly, over the next three months to tweak things perfectly for you. I like reading with the mask on as an indicator that the low pressure level is right: not too little, not too much. The data will tell you if you are bumping into the ceiling level, which therefore needs adjustment higher.

Take your time, relax and get used to the machine/mask therapy combo.

Post Reply Post Reply
#6
(03-15-2015, 12:31 PM)Sleeprider Wrote: Less than 5.0 AHI is a reasonable goal. the Sleepyhead detail chart with events, flow rate, pressure and leaks would be most helpful in looking at your results. Include the details on the left side without the calendar so machine settings are visible.

It surprises me you were titrated on nasal pillows and are using a full face mask. Any reason? You happy with it? We see you sleep study titration results, but we don't know if you have an S9 Autoset or Elite, and what pressure, ramp and EPR settings you are using.

Your hypopnea index is fine, your OA index is still too high. That usually suggest more pressure or on an auto, higher minimum pressure. The use of EPR can allow the airway to occlude during the exhale phase causing OA on the downbeat. I think you can probably halve your current apnea index with the way you're working at it, but I'd like to look at better daily details before making suggestions.

Sounds like you came through the ablation procedures well. That tachycardia could well be the result of years of untreated sleep apnea. Glad you're getting help now!


Thanks all for the quick reply's. I think the report is goofed up on which mask was used. I tried all three types of masks. The most comfortable was the FFM and that is what I used. I found the Nasal Pillow to be very uncomfortable.
Another disparity with the study was the EPR rate, they reported 2cm, the therapist set it up at 3cm. I tried 2cm, it was a little difficult so left it at 3cm.

I have a Resmed S9 Autoset with H5i Humidifying and Heated hose. Using a AirFit F10 Medium Full face mask. S9 is set in CPAP mode by the therapist at a pressure of 11cm. The data shows it is putting out 10.9cm.
I start out at 5cm, ramp to 11cm in 5 minutes. I'm using a EPR Full time at level 3. Ramp is ok, no issues with falling asleep.

Sleeprider. I've attach today's file, had to delete the previous attachment due to storage limitations. You'll notice a big leak about 6:15 am, started to drool, felt like a St. Bearnard, actually pulled off the mask dry off.

   




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#7
I wouldn't worry much about getting to a zero AHI. It's happened to me twice more or less at random, but I didn't notice any miraculous improvement those days. More important to get as much time in every night. If your machine stops your obstructive apneas and replaces them with hypopneas that's a big improvement! Sure, we'd all like to do even better.

But, you know, this isn't really a race. Life is not a battle to be won, but a dance to be danced.

Ed Seedhouse
VA7SDH

The above is my opinion.  It is just possible that I may, occasionally, be mistaken.

I am neither a Doctor, nor any other kind of medical professional.

Everything put together sooner or later falls apart.
Your brain is not the boss.
Our forefathers took drugs.
He's no fun he fell right over.
Post Reply Post Reply
#8
(03-15-2015, 01:28 PM)Lkallen Wrote:
(03-15-2015, 12:31 PM)Sleeprider Wrote: Less than 5.0 AHI is a reasonable goal. the Sleepyhead detail chart with events, flow rate, pressure and leaks would be most helpful in looking at your results. Include the details on the left side without the calendar so machine settings are visible.

It surprises me you were titrated on nasal pillows and are using a full face mask. Any reason? You happy with it? We see you sleep study titration results, but we don't know if you have an S9 Autoset or Elite, and what pressure, ramp and EPR settings you are using.

Your hypopnea index is fine, your OA index is still too high. That usually suggest more pressure or on an auto, higher minimum pressure. The use of EPR can allow the airway to occlude during the exhale phase causing OA on the downbeat. I think you can probably halve your current apnea index with the way you're working at it, but I'd like to look at better daily details before making suggestions.

Sounds like you came through the ablation procedures well. That tachycardia could well be the result of years of untreated sleep apnea. Glad you're getting help now!


Thanks all for the quick reply's. I think the report is goofed up on which mask was used. I tried all three types of masks. The most comfortable was the FFM and that is what I used. I found the Nasal Pillow to be very uncomfortable.
Another disparity with the study was the EPR rate, they reported 2cm, the therapist set it up at 3cm. I tried 2cm, it was a little difficult so left it at 3cm.

I have a Resmed S9 Autoset with H5i Humidifying and Heated hose. Using a AirFit F10 Medium Full face mask. S9 is set in CPAP mode by the therapist at a pressure of 11cm. The data shows it is putting out 10.9cm.
I start out at 5cm, ramp to 11cm in 5 minutes. I'm using a EPR Full time at level 3. Ramp is ok, no issues with falling asleep.

Sleeprider. I've attach today's file, had to delete the previous attachment due to storage limitations. You'll notice a big leak about 6:15 am, started to drool, felt like a St. Bearnard, actually pulled off the mask dry off.

Meant to say, tried different type of masks on during the sleep study. Chose the FFM and stuck with that. The report is wrong.
Post Reply Post Reply
#9
(03-15-2015, 01:36 PM)eseedhouse Wrote: I wouldn't worry much about getting to a zero AHI. It's happened to me twice more or less at random, but I didn't notice any miraculous improvement those days. More important to get as much time in every night. If your machine stops your obstructive apneas and replaces them with hypopneas that's a big improvement! Sure, we'd all like to do even better.

But, you know, this isn't really a race. Life is not a battle to be won, but a dance to be danced.

Thanks for the reply, I hope the obstructive go away soon.
Post Reply Post Reply


#10
Hi Lkallen,
WELCOME! to the forum.!
I encourage you to stick with CPAP therapy and not to give up, because it can take time for your body to get used to it...
If you get below 5, you are doing well, so try not to sweat it if you don't get to zero.
Hang in there for more responses to your post and much success to you with your CPAP therapy.
trish6hundred
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