+- Apnea Board Forum - CPAP | Sleep Apnea (https://www.apneaboard.com/forums)
+-- Forum: Public Area (https://www.apneaboard.com/forums/Forum-Public-Area)
+--- Forum: Main Apnea Board Forum (https://www.apneaboard.com/forums/Forum-Main-Apnea-Board-Forum)
+--- Thread: [Diagnosis] Assistance in locating knowledge, please (/Thread-Diagnosis-Assistance-in-locating-knowledge-please)
Pages:
1
2
Assistance in locating knowledge, please - jegreene - 07-18-2018
I would appreciate assistance in locating thread[s] which will help me improve the efficacy of the APAP that I am using, now for 17 days.
I want to emphasize that I'm fortunate to have no difficulty adapting to the treatment. I've reached 7 or more hours each night. The exceptions are due to mask removal during the middle of the night without getting it put back on.
My AHI has averaged 9.5 with a few in the 5-10 and highs 13-18. A couple of nights have fairly long bouts of periodic breathing &/or just waxing/waning breathing of the right periodicity.
Prior to beginning the APAP treatment, oximeter readings indicated severe apnea with oxygen readings often in the 50's, so there has been a great improvement.
I am very fatigued during the day often, even though the readings indicate that I am sleeping much better.
Thank You for Your Assistance
PIZZA is ready now, later!
RE: Assistance in locating knowledge, please - dwd1249 - 07-18-2018
Post some Sleepyhead charts here and you should get some good advice on tuning your treatment.
See links for help on posting.
http://www.apneaboard.com/wiki/index.php?title=SleepyHead_Chart_Organization
http://www.apneaboard.com/wiki/index.php?title=Attaching_Images_and_Files_on_Apnea_Board
RE: Assistance in locating knowledge, please - Sleeprider - 07-18-2018
JeGreene, the #Sleepyhead program is free. My signature shows how to organize and post charts. If you are using a pressure of 5 cm according to your profile, and your events are mainly obstructive and hypopnea, then your pressure is too low. You have an Auto CPAP and should switch to Auto mode and start from a minimum of 6.0 and maximum of 14.0 until we can figure out what is going on. Here is how to change your settings: https://www.apneaboard.com/dreamstation-clinician-setup-instructions
RE: Assistance in locating knowledge, please - jegreene - 07-23-2018
I am attaching some records to show:
(1) A typical Pulse Oximeter record prior to treatment. Oxygen levels as-low-as low-to-mid 50's were typical; therefore, the Auto CPAP seems to have greatly improved the quality of my sleep breathing.
(2) An overview and more detailed view of a segment of poorly controlled sleep
(3) An overview of what appears to be a greatly improved, but not correctly managed, sleep
NOTE: My oxygen level normally ranges from 90-93; 95 would be high. This condition appears to have been there for some time.
I have brought the pulse rate and SpO2 into view for the OverView of the poorly controlled sleep.
In the more detailed view of the poorly controlled sleep, the pressure level doesn't appear to have much impact on the breathing pattern shown there. This degree of periodic breathing &/or waxing-waning breathing pattern has not been this prevalent in subsequent nights.
The last overview is for your assessment, good/bad/in-between ?? Note that there were no snore events.
I recognize that I did not follow your suggestions regarding display of sleep parameters. I will be glad to comply if you feel that they will assist.
Thank you and dwd1249 for your response to my inquiry, it is greatly appreciated.
RE: Assistance in locating knowledge, please - Mogy - 07-23-2018
Hi jegreene,
Did your original sleep study mention central sleep apnea? Did you have a Titration study? Who set the pressure settings for your machine?
It looks to me like you have central emergent sleep apnea. It means that the xPAP treatment is contributing to the central apenas that you are experiencing. It has to do with how much CO2 is present.
This happens to about 15% of us as we start with our machines. For the majority, your body adapts, and you are able to deal with the OSA effectively with the CPAP. For others, it continues to persist.
I was one of the people that my emergent sleep apnea settled down after a month.
If it persists, an ASV machine may be in your future.
You should consider working your pressure settings closer to a fixed setting, the min and max being the same. Also, work toward getting the EPR down to 0. Raise the min pressure and lower the max pressure.
A higher min pressure will help reduce the obstructive events, and the lower max may reduce the central events. Work toward getting the fix setting to 9 or 10.
You might also want to contact your doctor to explain that you are having treatment emergent central apnea.
Stom(another poster here) is currently going through a similar issue. His tread has some good info.
RE: Assistance in locating knowledge, please - Sleeprider - 07-23-2018
I am seeing a lot of periodic breathing, central and mixed apnea. You may end up with an adaptive servo ventilator (ASV) which can treat these issues. I agree you should include your doctor and make him/her aware of these issues. Until then, I suggest you try a fixed pressure of 6.0 with Flex off. This may tame the problem.
RE: Assistance in locating knowledge, please - jegreene - 07-26-2018
Thank you for reviewing my post and making a suggestion for improving the efficacy of my treatment, it is greatly appreciated.
I set the machine to provide a fixed pressure of 6 cmH2o and turned off the Flex feature.
I am attaching three views of last night's sleep, using the modified settings:
(1) The first is an overview of two sessions comprising the recordings for last night.
(2) The second provides more detail of the first session, with the associated oximeter data.
(3) The third provides a bit more detail of the second session, without oximeter data. I presumed that the details were similar to that of the first session.
NOTE: There was no snoring identified.
It appears to me that the localized nature of the abnormal breathing is quite similar to that localized nature of the severe apnea shown in my pre-treatment pulse-oximeter data attached to my second post.
Thank you for your time to assist me,
RE: Assistance in locating knowledge, please - Sleeprider - 07-26-2018
You seem to have a complex apnea, so our hope is to find a pressure that works best, until you are able to move to an appropriate therapy for complex apnea like ASV. I don't think you will see a lot of difference, but you might increase pressure to 7.0.
The way you feel (fatigued) is important, and you need to keep your doctor involved and guide him towards a bilevel with backup like ASV as the solution.
RE: Assistance in locating knowledge, please - Mogy - 07-26-2018
I think that there are 3 main things that affect the localized nature of the breathing issues.
1. REM. Offen we have worse sleep apnea during REM. Did your sleep study specify AHI during REM and NREM?
2. Sleeping on your back compared to side sleeping. Again, your sleep study may have some information.
3. Chin tuck. A cervical collar may help prevent chin tuck.
There may be other reasons but I think these are the main ones.
With that 1 night you were able to just about eliminate the central events. Hopefully, as you increase the pressure you will reduce the hyponeas before the centrals return.
I had some periodic breathing when I started, it slowly reduced until I rarely have any now.
RE: Assistance in locating knowledge, please - jegreene - 07-28-2018
I set the pressure to 7 cm.
Restlessness &/or ?? kept me from capturing the good data associated with the change. I discarded the mask, forgot to reinsert the SD card, etc. The data from the 1st night seemed to show that there wasn't much change.
This afternoon, I decided to use the mask while I napped -- late and too little is (perhaps) better than nothing. I have attached the nap data and I was surprised how quickly the abnormal breathing appears.
P.S. A referral has been forwarded to a group of sleep specialist and thank you for mentioning the fatigue -- it has been significant.