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Typical Night - Sleepy Head Screen
#1
Hello the forum, I have waded thru the screen shot posting (I think).
always room for improvement.

He is a few nights ago. This would make you think it was from a sleep lab with no Cpap or Bi-Pap, but it is with my Bi-Pap. Looks like I am a long ways from have it under control.

Suggestions, observations are welcomed.

[Image: maswNAR.png]
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#2
did you have a sleep lab titration?
did you get prescribed a bpap?

Others know more, but I would reduce the PS, to see if that helped the CA, are they always this high?
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#3
Your machine, while in auto mode, is running almost the entire night at min PS (4.0) and min EPAP (13.5cmH2O)

Your obstructive events are pretty good so I would try setting the min PS to 3 and the min EPAP to 12.5 and see how it goes.
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#4
(05-26-2017, 07:43 PM)BrassCat Wrote: This would make you think it was from a sleep lab with no Cpap or Bi-Pap, but it is with my Bi-Pap. Looks like I am a long ways from have it under control.

Not that far, actually.  You are less than three events per hour from the treatment goal for *PAP therapy.  You've made a good start and we can tweak it to make it better.  Keep at it.
Ed Seedhouse
VA7SDH

Part cow since February 2018.

Trust your mind less and your brain more.


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#5
(05-26-2017, 07:51 PM)ajack Wrote: did you have a sleep lab titration?
did you get prescribed a bpap?

Others know more, but I would reduce the PS, to see if that helped the CA, are they always this high?

Hello ajack, I did an overnight sleep lab Dec 2016, evaluation Jan 2017 when I got the prescription for a Bi-Pap. Received a DreamStation Bi-Pap later that month. Been using it since.

I am not sure what PS is. I'm thinking you mean some kind of pressure, I am familiar with inspiration and exhalation pressure. Also that there is a setting for minimum differential pressure. PS????

When you say CA - I take that as Central Apnea. Yet, Sleepy head refers to CA As Clear Airway; is this the same thing?

Every night is different of course, but they all bad with OA, CA, hypopneas.

Stan.
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#6
did they put a bpap on you when they did the sleep study? BPAP can make the clear airways/centrals worse.
PS pressure support is the difference between the epap and ipap.

As bonjour also said, reduce the PS to minimum and maximum 3 and see how it goes. you can even reduce it further if it helps. You do have a higher breath rate that I would also keep track of.
If it were me I would contact your doctor and keep him on the loop. An ASV may be in your future if the CAs can't be reduced over time.
I would even try straight cpap, if the volumes/breath rate/minute vent stay ok.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4629962/
BiPAP may worsen central apneas due to CSR by increasing breath size of spontaneous breaths and forcing a triggered breath during the apneic portion, which is when the partial pressure of carbon dioxide (PCO2) level is already at its lowest.29 By further decreasing the PCO2, respiratory drive is reduced further and the duration of the apnea will often lengthen, although the oxygenation may improve with the deeper or forced breath. Sometimes the improved oxygenation and PS will help to eventually stabilize the patient’s breathing,30 but in our experience patients with CSR often find BiPAP intolerable or still have a suboptimal clinical response including fluctuations in the respirations and electroencephalogram.
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#7
Here are some history of my sleep apnea:

I did my first sleep lab around the year of 2000.  it was determined I had sleep apnea.  I received a CPAP machine by Silent Night. My memory says the pressure was set at 5 cm H2O.  I've been told that it can't be it's too small but that's what I remember.  I also was using a nasal mask.  I never had any follow-ups with the pulmonologist or the sleep lab.  My doctor said there was no need. I had severe signs from sleep apnea and they continued.

Could no longer work around 2006. I had confusion, fatigue and excessive sleepiness. I could no longer function as a computer programmer. At night I hallucinated, lights bouncing around my room (I am guessing Hypoxia) . In 2009 I was screened with an overnight oximeter test showing my blood oxygen going down to 78% of saturation, almost 3 minute hypopneas.  I was immediately put on and oxygen concentrator in addition to the silent night machine.  I got into a sleep lab probably two months later. There I was informed I was breathing through my mouth (Only using a nasal mask all this time). Immediately shifted the full face mask. My CPAP machine was upgraded to a Resperonics CPAP.  Overnight oximeter with that machine showed that the settings were no good, I was still having very low blood oxygen, I was upgraded to an auto CPAP. Stayed with that machine.

Waking up choking, events that took place in the summer of 2016 lead doing an in house somnograph, which Medicare would not accept, then a sleep lab in December 2016.

I had been highly compliant since I first got used to using the first CPAP machine. It probably took three months to get used to wearing a mask. I woke many times with the mask off, who wants to feel like an elephant with a trunk hanging off your nose all night. but I have no problem wearing a mask now for the last 16 years.

My follow up visit with my pulmonologist in April this year after doing an overnight oximeter found my blood oxygen going down to 79% using the auto Bi-PAP. He told that my apnea condition is probably beyond what the Bi-PAP can for me. This did not sit well, freaked me out a bit. I join this forum after that and started reading the posts.  I downloaded sleepyhead software about Tuesday this week. So I jumped in with both feet trying to learn it. Sleepyhead certainly is a lot of program and it has excellent features, I'm really impressed. Again, really impressed.

I will be seeing my regular Doctor and then the pulmonologist next Tuesday.
I am considering an oral device in addition to the bi-pap. Will not get to that clinic till July. So, will keep doing what I can with the Bi-pap.

In January, after I received the Dream Station,  I had 2 teeth finally go bad  and had to have them pulled. They had gotten so sore I could you even wear a full face mask.  I was prescribed Tylenol 3 for the pain. That  contains codeine. It certainly exasperated my sleep apnea, but there may have been of benefit to this. I woke up with difficulty breathing, and began to experiment with my throat / neck muscles, with the position of my neck, opening and closing my mouth, and moving my lower jaw forward.  I had never experimented like this before.

When I first received the machine the pressures were set fairly aggressively. It seemed like it overfilled my lungs. It truly ventilated me like I have not had before. It left my chest a bit sore in the morning. It gave me an excellent base of comparison of being well ventilated and now having the apnea exacerbated my breathing. Laying in bed before going to sleep I discovered my lungs were not filling anywhere like they had been when I first got the machine. Opening my mouth would increase the amount of air the Bi-PAP would put into my lungs. So I tangibly discovered the first blockage at the top back of my mouth blocking airflow from my nose down to my throat. Even with that, I still had restrictions in my breathing when  compared took before I had taken the Tylenol 3. Positioning my head backward increases the discernible airflow. I also found moving my lower jaw forward also discernibly increases my airflow. 

Due to a sore back I had a chiropractic adjustment. After the first visit, during which he also adjusted the Atlas, I noticed the AHI cut in half. After a few days the AHI went back up. I thought, "what a stupid machine, can't believe the AHI reading". One week later I had an adjustment again including the Atlas.  Again my AHI went down. This time I took notice. That is when I searched the Internet for Atlas adjustment + sleep apnea, and found a correlation. This is also when I started posting to this forum.

So now with this forum and the sleepyhead program to see what I can do about minimizing the effects of sleep apnea on me.

So that is just a short history.

Stan
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#8
subject to a CVD check up. ask for a trial on a resmed ASV. BPAP works by pressure., ASV works by volume and a back-up rate.
I think that is where you are heading and probably should have got there already.

beforehand, with the help of the forum, you can tweak the bpap back to more like a cpap and see where it goes with the CA, but given your history, I doubt they are pressure induced clear airways.

you need the pressure you need to overcome obstruction. the PS may have been set too high and why you felt over ventilated.
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#9
(05-26-2017, 08:20 PM)eseedhouse Wrote:
(05-26-2017, 07:43 PM)BrassCat Wrote: This would make you think it was from a sleep lab with no Cpap or Bi-Pap, but it is with my Bi-Pap. Looks like I am a long ways from have it under control.

Not that far, actually.  You are less than three events per hour from the treatment goal for *PAP therapy.  You've made a good start and we can tweak it to make it better.  Keep at it.

Hello Ed Seedhouse,  VA7SDH

Thanks for the response. I will keep at it.

Stan, KO6YB
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#10
remind us whether you are now on supplemental oxygen. also, do you need oxygen during the day or is low oxi only when you sleep?
do you tend to sleep in one or many positions (back, left side, right side)?
would you be adverse to trying the soft cervical collar?
what intrigues me is that you flow rate jumps about quite a bit, and wonder if you are aware of becoming awake throughout the night if even for a short period before nodding back off.
if you have a flex setting, do you know what the current setting is? (OFF, 1,2, or 3)

I really hope you discover how to get your particular sleep issues resolved soon.

QAL
Dedicated to QALity sleep.
You'll note I am listed as an Advisory Member. I am honored to be listed as such. See the fine print - Advisory Members as a group provide advice and suggestions to Apnea Board administrators and staff concerning Apnea Board operation and administrative policies. Membership in the Advisory Member group should not be understood as in any way implying medical expertise or qualification for advising Sleep Apnea patients concerning their treatment.
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