jgudnason's Treatment Thread

[jgudnason]

Hi All,

new to the wonderful world of PAP.

Initial diagnosis via a sleep center; Severe OSA with an AHI of 45.4 
unfortunately, I dont currently have the detailed sleep study info which those numbers came from.  I was verbally told over the phone that my heartrate peaked at 112, and had some periods of low O2 saturation as well.  (i have requested my study, will see where that goes)
I will say all symptoms matched my experiences, I certainly snored a lot, and wife has observed various apnea events over the years.. so no big surprise.

My experience at that point was a sleep center wanting my credit card to pay for a machine prior to any other info.. hmm.
Long story short, I started researching, purchased my own machine online (and good timing too, as #foamgate was just getting going), fired my sleep clinic, and now here I am, basically self adjusting my machine as we go.  In Canada, slightly different than the US, my machine was covered by my insurance just based on the Rx.  no contract or compliance numbers required.  My machine was purchased from CPAP machines Canada (not currently on the supplier list), and I actually got a combo unit, the Resmed AirMini along with the Airsense 10.

also got a couple masks, the P10 and F30.  I have not yet slept with the Full face, as I decided if i could make the P10 work, that would be the better solution.  Historically I have been a mouth breather at night, but I've been having great success with the P10, so obviously mouth breathing was more due to the apneas than not.

Anyway, on to the results.  My very first night i had fantastic numbers (ahi 0.5), but no SD card in the machine, so nothing I could see in Oscar.  I've since put an SD card in, and have been having more typical results with AHI in the 1-3 range generally.
Initially started with a 4-14 range, and ESP 3.  first couple nights there were huge pressure ramps, so set pressure to 7 based on median.  Since adjusted up a bit more to 8, with a current max of 11 (have only hit that once very briefly, usually under 10).
Since starting treatment June 25, the majority of my events have been CAs, so trying to get that a bit more under control.  couple nights ago, dropped my ESP from 3 to 2, which did result in fewer CA's reported.  will probably try dropping that to 1 and see where it goes.  Also removed ramp last night.

I did also order a wellue O2 ring, which i received yesterday, so last night's sleep, i also have heart and o2 info, which is really interesting.  I do have corresponding o2 dips along with the apena events, and had one occur while i was just falling asleep which triggered the o2 ring vibration.  I actually remember the not-breathing, the vibration, and the subsequent arousal. interesting / trippy / neat to know and understand what's actually happening.

So overall, I'm very happy with my results to date, but I wanted to start the thread so i have a place to put the info, and obviously get some setting feedback.  I'm pretty happy and confident i'm going in the right direction, but as i dont currently have a sleep clinic going over my results with me, this forum is the next best thing (well, probably actually best thing.. not next best).

I have about two weeks of data i could share, but for now i'll just put the last couple nights, and ask if there are any suggestions, recommendations, or other comments.

three shots included on the post.  July 2 being an example of one of those "wow wtf" apena even periods.  added more shots (july 2-6) on imgur here:
(oops.. i cant post a link until I have 4 posts.. i better go make some more posts first!)

Cheers, and thanks everyone for the help and Support.

[factor]

Welcome to the forum. 

The centrals are most likely treatment emergent. 

How long have you been on CPAP?

I dont see much of a flow limit issue or hypopnea.  I would set you epr to 1 or 2.  It could be causing co2 flushing at the highest setting of 3 like in you earlier screen shots.

Looks like you nicked the ramp that is good.

Also a-lot of people are mouth breathers because their body is looking to get O2 in as fast as possible.  As you level out you may find you go back to the nose.

Others much better than me will help you shortly.

[jgudnason]

first night was June 25, so it will be 2 weeks this friday.

So far i've had great success with the nasal pillow. I read somewhere on here the tongue stick technique, did that the first night, and so far outside of a couple small mouth leaks, i've been successful breathing through my nose 100%. Just told myslef.. do it. I highly suspect the apnea's were causing my propensity to mouth breath.
of course, i haven't had the pleasure of a cold + pap yet. will see how that goes.

i've moved the EPR to 2 the last two nights, which has dropped the CA's substantially. will probably drop it to 1 tonight and see how that goes.

[factor]

I read somewhere on here the tongue stick technique

Tongue exercises.

https://youtu.be/wNscQ3bGxNk

Hang in there and keep us posted.

[jgudnason]

here is the link to more oscar shots:
https://imgur.com/a/5jldZ86

[jgudnason]

almost a month in..
settings have settled down to 8-11 range, with an EPR of 2.  (i did try setting it to 1 for a night, but that was not a nice sleep at all).
i've been on the  above settings for 12 days now, with an average ahi of 1.19, so i think we are going good.

I still mostly have centrals vs obstructive, and it seems i usually have a flurry of CA's as i'm falling asleep or just after falling asleep.  (some days more than others..)
also have a wellue o2 ring, and it buzzes me most night falling asleep as the centrals hit and my o2 drops below 86.  I can actually feel myself stop breathing (somewhat aware) and wake up again to breath.  kinda a weird feeling. 

I've included some shots of the "falling asleep" CA's
Normal?  any way to correct for them?  I could try going back to an EPR of 1 for longer than a day to see what that does.

I'm not particularly worried overall, i realize my total AHI is doing quite well, and most days i have blocks of 1-2 hours at a time with no recorded events, so i'm getting good sleep generally, but these clusters do affect my numbers overall, and they do disrupt my going to sleep.  Feeling generally well rested, although not a huge difference over my time before the machine.

also last screenshot is a closeup of some events.. how is the Resmed differing between CA's and OA's ?  the waveforms look identical, but it classified some as CA and some as OA.
fyi, my snoring is gone, and i can actually sleep on my back now, which is nice (always side slept before to prevent snoring..)