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Typical Night - Sleepy Head Screen
#11
(05-27-2017, 09:15 AM)quiescence at last Wrote: 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

I use an oxygen concentrator at night. The pulmonologist did not think I needed one from December 2016 until April 2017 when I did an overnight with oximeter (at my request), then he wanted me on oxygen. My neurologist has wanted me on oxygen at night since 2010 because of all the prior hypoxia I have had. With minimal exertion during the day, I am around 96% saturation on either hand. With exertion, stuping over, lifting things I do get winded. During those times I also get dizzy. I need to get an oximeter to check those times. My primary care doctor (good guy, attentive) had me get chest x-rays to see if smoking in my 20s / 30s has left me with lung injury. I will find that out next week.

I would have thought a pulmonologist would measure me under exertion and check blood oxygen, they know of my daytime fatigue. I even requested it during my first office visit with this pulmonologist. He did not think it was needed at that time. I will check into that next week, have my primary doctor push for that.

My c-flex is set at 3. I do not understand about c-flex and its settings. Where can I read about it?

I move around at night. Use to be on my back. I have tried sleeping on my sides only, but it makes my lower back so sore I have difficulty standing / walking next day. So now, I alternate around, when I move I am somewhat awake, go back to sleep quickly.

I know my apnea is worse sleeping on my back. I will try keeping a time period on my side and on my back tonight and see how the data changes.

Stan
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#12
He is my Sleepy Head screen from last night:

[Image: maswNAR.png]

I did not record time vs sleep position. But I believe the worst parts are on my back. the AHI is significantly higher, than normal. Yet, my head/mind is clearer this morning! Major leak was a bathroom call, otherwiae I do not seem to have problems with leaks.

I am not sure why the AHI is so large, only had 11 obstructions, 10 hypopneas reported. Had a lot of pressure pulses, 187. What triggered those if not obstructions and hypopneas? I have more to say about last night but have an appointment I need to go to.

I am not sure what clear airway is? Is this the same as a central apnea?? I now see I had 101 clear airways.

Stan
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#13
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.
As you have noted about half your events are Clear Airway or Central Apnea events.  xPAP machines do not measure brain activity so they cannot definitively identify Central Apnea.  Respironics calls these events Central Apnea, ResMed calls these same events Clear Airway events.  

CA events are fought by lowering pressure, and lowering PS or Pressure Support.  Thus my previous suggestions.

The below is from RobySue from a forum post with minor edits by bonjour

When a PAPer is reporting problems with centrals while on xPAP, the important questions come down to these:

1) Did the sleep diagnostic test (the one without xPAP) show any centrals?

2) How many centrals are we talking about and at what pressure(s) do they start?

3) Can the OSA stuff (the OAs, the Hs, and most of the snoring) properly be treated at a pressure level that is below that needed to trigger the CAs?

4) Does the number of CAs go up, down, or stay about the same after a few weeks on xPAP therapy?


Here's the thing you need to be aware of: Some people's bodies do have a bit of a problem regulating the CO2 levels in the blood when they are first put on xPAP therapy for obstructive sleep apnea. And the result of not properly regulating the CO2 level in the blood leads to the emergence of central apneas. Essentially, you only inhale when the CO2 level in the blood is high enough for your brain to tell the lungs and diaphragm, "Inhale Now". When the brain misinterprets the CO2 level or if the CPAP washes out too much CO2, the brain doesn't send the signal to "Inhale Now" and you don't take a breath when you are supposed to take one.


The problem with pressure-induced centrals seems to be aggravated by the addition of pressure. In other words, the higher the pressure setting on the xPAP machine, the more likely pressure-induced centrals are to occur. In some people, the CAs can be completely controlled simply by limiting the max pressure the machine is allowed to use. Pressures over 10 cm are more likely to cause problems with CAs, and hence if the OSA stuff is controlled with a pressure less than 10, the usual fix is to just use only enough pressure to control the OSA stuff. (A few people have trouble with pressure-induced centrals at lower pressures; other people find that their pressure-induced centrals might only be a problem if the pressure is really high--like above 15cm.)

Sometimes the problem with pressure induced centrals is self-limiting: The body takes a while to figure out the whole xPAP thing, but after a few weeks it *does* adapt and by that point many people who had some issues with pressure-induced CAs notice that the number (and length) of the CAs in their data starts to decrease. And after a few more weeks of using their machine, the CAs essentially disappear---in other words, the person gets some isolated ones here and there, but the number of them is small and the overall AHI is consistently less than 5 (and often significantly less than 5) and the person reports feeling and functioning better in the daytime. The fact that many people's bodies take a while to adjust and that the number of CAs recorded often goes down with continuing to use the machine is a major part of why many sleep docs and most insurance companies don't just immediately switch an xPAP newbie from a CPAP/APAP or BiPAP/VPAP to an ASV machine at the first sign of pressure-induced centrals. Other reasons for not immediately switching include the cost of an ASV and the fact that learning how to sleep with an ASV can be much harder than learning how to sleep with a CPAP/APAP or BiPAP/VPAP due to the drastic pressure increases used to "trigger" inhalations as a way to prevent the central apneas.

Given that you are seeing some centrals and your overall AHI is sometimes in the 5-10 range instead of the 0-5 range, it's worth watching the centrals, but it is also worth giving your body some time to adjust to the AirCurve. And if you jumped from the AirSense to the AirCurve right away because of the centrals, then it really may be best to be patient for 2-4 more weeks of using the AirCurve with your current settings.

It's also worth mentioning that some people find that frequent changes to the therapeutic settings aggravates their problems with centrals. In this case, two important questions to ask are:

A) How long have you been using xPAP? (In this case, that means both the time you used the AirSense and the time you've used the AirCurve.)
B) How frequently do you change the settings? What is the longest you've used a particular setting?
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#14
Hello Bonjour,

Thanks for the lengthy post. I appreciate the time you
put into it. I am reading thru 2nd time, trying to digest it all.
Will make changes for tonight.

Stan
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#15
reduction of flex setting has shown to have a positive effect on CA score.  here is one post to review for what flex does: http://www.apneaboard.com/forums/Thread-...#pid206250 - pay attention to the internet search, because it will get you a publication that has good graphics.

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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#16
Hello,

I have changed the pressure settings, I lowered them to the same settings that I initially had when I started therapy with the dream station in January. I started therapy with the Dream Station on January 25 this year. I had dental work done in February 24th, you can see the spike in my AHI  probably from taking Tylenol 3 which contains codeine.  the pulmonologist made a change in my pressure M March 20 9 AM not sure what happened on April 6 with another pressure change. It appears it was set back to my original values, my BiPAP has a cellular phone link, my pulmonologist  can make changes from his office. Why it got sent back to the original value I do not know.

My AHI numbers have dropped considerably for the last two nights, those nights were I have just reduced the pressure. It looks very much like the AHI numbers for the first month of therapy  from the end of January towards the end of February. What is very different is how it the pressure feels to me. That first month of therapy, the pressure felt very high. My chest would feel sore in the morning. (As a side note why is it the cat ignores me all day long, then when I sit at my computer she has to sit in front of me and block my keyboard, wanting me to give her attention. Nice cat, go away).

My prior machine was Phillips Resperonics System One Auto CPAP machine. I believe it was broken, not working correctly. The auto mode did not function, the pressure never increased during the night, but it certainly used to function that way. It was running at 12 cm H2O. I don't even know if it was really delivering 12 cm pressure (calibration).

Let's get back to when I first started using the Dream Station. The pressure setting it was  set at was leaving my chest sore. I am now, for the last two nights, back to the same exact pressure settings. My impression of this new pressure, it does not feel the same as it did during the first month. I'm trying to figure out what this means. Have my chest, lungs, and / or diaphragm muscles strengthened with the use of this Bi-Pap over the last few months? I was using the system One Auto Cpap at a LOWER pressure!

Anyway let's get to the show,  here are the screenshots of the overview and the recent daily use:
[Image: mdMeVFV.png]
[Image: H2CkB0P.png]
Thanks, Stan
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#17
Nice results, you have essentially halved your AHI.

Note these settings as they are good safe settings to go back to.
The most important question now is How do you feel?

At this stage anything you change needs to be smaller, this is tweaking, seeing if we can improve a little bit, not necessary to do, the numbers are fine.
give a a week then reduce min PS by .5 and min EPAP to by .5 to 2.5 and 11.5 cmH2O respectively to see if your number improve a little.
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