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[Treatment] First night. Can't be happier...
#1
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First night. Can't be happier...
Hello all,
 
I am extremely glad of having had the chance to find this marvelous forum. I’ve learnt much from you guys, by reading and acquiring knowledge from your awesome posts and wikis. I’m very grateful.
 
My surgeon and I had scheduled a bariatric surgery (gastric sleeve) for next October. Amongst all tests made, I was prescribed to pass through a sleep test. Scared to see the results: total AHI was 54.6 (OA 35.1, Hypopnea 18.4, CA 0.5 and Mixed Apnea 0.6). Clearly, I have an issue with OA and H.
 
Surgeon is convinced that OSA will be eventually reduced or even eliminated when the weight loss is significant but my sleep doctor (Neumology expert) said we can’t wait for that. I had to immediately start the CPAP therapy now. I didn’t take a sleep study titration to fix pressures; doctor suggested starting with constant pressure of 8 cm H2O.
 
My health insurance covers the costs of the CPAP treatment. When I got in contact with the DME, I stated clearly that I wanted a data-capable device and if possible, I preferred an APAP. The DME said that a Resmed S9 Autoset + Humidifier was available so I went all in. I was warned that the APAP didn’t have an SD card; no big deal, I had one at home.
 
My wife told me that I open the mouth when sleeping (mouth breathing) so decided to ask for an FFM to the DME. He gave me two options: Phillips Amara View and Resmed Mirage Quattro, and recommended the Resmed. It’s a bit bulky but I finally chose the Mirage Quatto, which has turned to be pretty comfortable and effective.
 
I tested the S9 Autoset over the day and noticed that low pressures, lower than 8 cm H2O, had the effect that I starved for air. I finally set up the APAP in 8 Min, 20 Max, 3 EPR. No ramp (I wanted 8 as soon as possible, less than that it’s not pleasant).
 
Results are attached. I slept pretty nicely all through the night, although when I came back from the toilet (4:15 AM), I took an hour to fall asleep again. No major leaks from the mask. Mouth a bit dry in the morning (I set humidifier at 2, water level has not dropped much so I may increase a notch for tonight).
 
I feel ok this morning but still have that feeling of dizziness / sloppiness in my head, which might be familiar to you all. I reckon that I need longer therapy to feel better.
 
Could I kindly ask for your feedback about my graphs, please? I attach the full night sheet and a zoom-in of the OAs around 3:50 AM.

Should I narrow the min-max interval? I’d welcome your inputs and suggestions  Wink
 
Thanks a lot !!!
 
Rumble.


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#2
RE: First night. Can't be happier...
Congrats on your success. It looks like you have done your homework by finding this forum . Great results. To me it looks like your apneas might be the result of sleeping on your back because they were clustered. Others will give their opinions soon. For a 1st time user you couldn't ask for better results.
car54
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#3
RE: First night. Can't be happier...
It takes a while for the body to recover from years of sleep apnea. Your numbers look great and you should start feeling more rested as time goes on.

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#4
RE: First night. Can't be happier...
Thanks a lot !!!

Regarding setup, should I persevere then with 8-20 pressures, and EPR 3? Any hint?

I've purchased a Resmed P10 nasal pillows mask and a chin strap. Once I get the apneas under control with the FFM, I want to try increasing confort with a lighter non-invasive mask. I will have to learn how to keep my mouth shut though...

Regards,

R.
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#5
RE: First night. Can't be happier...
Yes I would keep everything the same.
Download SleepyHead
Organize your Sleepyhead Charts
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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: First night. Can't be happier...
Excellent, thanks a lot.
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#7
RE: First night. Can't be happier...
With early use AHI's as low as yours, I would wait a bit and be very hopeful that you have found the 'right' form of therapy before tinkering with the settings.  You are fortunate; many of us have taken weeks, even months, to adjust to the therapy, or even to find one that works.  Good luck, and I wish you continued success.
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#8
RE: First night. Can't be happier...
Bien Venido! I think your settings are working well with 8-20 and EPR 3. You are fortunate to be well treated at fairly low pressures. I think you will eventually find that a slightly higher minimum pressure may be better, but this is working great and no need for changes. With regard to bariatric surgery, we have a number of members that have accomplished significant weight loss this way, however most do not find that it adequately resolves sleep apnea and they continue to use CPAP. Weight loss is a significant benefit to health and can contribute to obstructive apnea. Just keep your expectations realistic and understand that relatively few individuals find their need for CPAP is eliminated with weight loss. We have many members that do not fit the stereotype of an older, overweight male, and are thin, fit, young and female. Apnea is surprisingly common, and under-diagnosed among those that do not fit the stereotype.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#9
RE: First night. Can't be happier...
Muchas gracias, Sleeprider. I decided to go ahead with bariatric surgery, because I'm in a pre-diabetes phase that must be addresed, in addition to minimizing all other health complications associated to obesity.

If weight loss helps me to eliminate OSA, excellent; if not, all love to my new CPAP friend. Positive attitude, no matter the outcome.

Regarding my settings, last night total AHI went up a bit, from 1 to 3. I had a few OA events clustered in a short period of time; the APAP went up to 19 cm H2O (the mask was about to pop like a bottle of champagne and I had difficulties to exhale...). I might have put the head/neck in a bad position or something; leak rate remained low all night.

Will keep 8 Min - 20 Max, EPR 3 as you guys have kindly suggested.

Next challenge is moving to nasal pillows, keeping AHI low and mouth shut. Cervical collar and chin strap are on their way to my home...

Thanks again, amigos.
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#10
RE: First night. Can't be happier...
Rumble, if you find obstructive events begin to cluster and are a concern, you can probably improve your results and experience lower pressures by using s soft cervical collar to keep your airway aligned. Many members have used this technique with great effectiveness and comfort. You can try this experiment; sitting in a comfortable chair, relax and breathe normally. Now let your neck relax and your chin to drop. If you feel your breathing becomes more restricted as your chin drops towards your chest, then positional apnea is likely part of your obstruction. A soft collar like the Dr Dakota Snoring Stop or The Eliminator Series Sleep Aid collars might be a good solution. These are partial collars that prevent chin-tuck while you sleep.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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