Hello Guest, Welcome to Apnea Board !
As a guest, you are limited to certain areas of the board and there are some features you can't use.
To post a message, you must create a free account using a valid email address.

or Create an Account


New Posts   Today's Posts

In Need of Noobie Education
#1
Grin 
In Need of Noobie Education
Yet another noob here needing education and advice!! To give you some background, here is an excerpt from my sleep study.  "This was a markedly abnormal study with 388 obstructive apneas lasting as long as 51 seconds, 265 central apneas, 45 mixed apneas, 76 obstructive hypopneas, yielding an apnea/hypopnea index of 98.2, respiratory disturbance index of 104.  Sleep disordered breathing was associated with severe sleep fragmentation with arousal index of 39 and frequent desaturations below 80% with 5 minutes below 70%."  Oh-jeez Now you know why I'm The Outllier.  I just don't fit anyone's bell curve in this, or any other part of my life!!

I just got my bipap 2 weeks ago, so I realize it's early to make a call on success/failure of treatment, but my AHI is bouncing all over from a low of 1.87 to a high of 36.02.  That 1.87 was the ONLY observance under 5.  My prescription is 14/9 ST with a backup of 10.

For the instances where my AHI is more than desirable, there is only one culprit according to Sleepyhead: hypopneas.  All my events are hypopneas with the exception of a sprinkling of Unclassified Apneas.  In looking at my leak rate I'm sure those are due to mouth breathing. I practice mouth taping with a vertical strip of tape but even on bipap, I get so air hungry, I breathe through the little corners of my mouth to get air despite the tape.  Sometimes I forego the tape and I get leaks as a result.  In any case, many nights show 100% hypopneas.

I realize you cannot teach the entire theory of CPAP treatment in a simple response, but I would like to understand the impact of IPAP, EPAP and PS on apnea scenarios. Why do you raise or lower them?  What does that do to better or worsen a hypopnea?  How does PS play into it?  I am a bio-hacker from the word go and am ready to do some self adjustments, but I lack theory to know how to apply changes. (And I'm not throwing my medical team awjay, it will be another month before I can be seen.  In the meantime, my settings are not fully appropriate. Unsure )  However, an AHI of 30 is MUCH better than 98 and at least I can go thru my day without stimulants and without my lil head bouncing off my keyboard!!  Too-funny

My goals are 1) BREATHE and have proper oxygenation during the night and 2) get restorative sleep.  These hypopneas interfere with both goals.

As an aside, I have a CMS 50D+ and have just ordered a 50F.  I would like to use these with Sleepyhead, but it does not seem to recognize the newer versions of the firmware and I get a message that says no oximetry module can parse it (real time or saved to my HD).  Anyone know what happned to jedimark?

Please share your thoughts, understanding and suggestions!!  In researching my own questions, this board has provided invaluable information.  I'm just not sure where my next steps should be.
Thanks
Post Reply Post Reply
#2
RE: In Need of Noobie Education
The software that came with your SP02 meters will help to show what is going on. Is your oxygen still dropping low with cpap ? you may be in need of extra oxygen added.

In my case I saw improvement right away with cpap. In looking back it was not much improvement but at the time I was happy. Over time and with the addition of oxygen I found much more improvement. It took six months with the oxygen to help my body heal and a year before I reached what I now think is my max improvement.

My oxygen was dropping into the mid 60's during sleep. It now stays in the 90's and I feel so much better.

Keep reading this forum and check your oxygen readings. Let us know what you are seeing.

Okay

Post Reply Post Reply
#3
RE: In Need of Noobie Education
For me the 50F with the blue face works with Sleepyhead running on a Windows virtual machine.
I have heard that the white face model has had issues. Which one do you have?

My first test results were not as bad as yours but still pretty bad and my scores bounced all over the place for a few months while figuring out how to get used to it, what mask is the real fit for me etc.

I can tell you that you have to resist the temptation to chase those scores. When you find advice on changes here that fit your situation, make changes a little at a time and give it some time before doing more. Once I stopped chasing scores I got on the right track.
Post Reply Post Reply
#4
RE: In Need of Noobie Education
Outlier, you clearly have mixed apnea with both central and obstructive events. I will be very very surprised if you control that without a different technology called ASV (adaptive servo ventilator). Your doctors know that you have mixed apnea, and apparently started you on a ST (spontaneous/timed) bilevel that can provide timed backup to help you breath during centrals. The ST is relatively primitive compared to ASV. What you need to know, is that will likely fail ST before you get promoted to ASV. Once that happens, you will be a much happier camper.

The ASV works using an auto-adjusting EPAP pressure to address obstructive apnea. It then uses a variable pressure support (PS) from 0-15 cm to create an IPAP that is comfortable during normal spontaneous breathing, and that can induce a breath during a central event or increase volume during hypopnea or periodic breathing. There are two ASV machines in common use; the Resmed Aircurve 10 ASV and Philips BiPAP Auto SV Advanced. Of those two, I would have a strong preference for the Resmed due to its more comfortable algorithm (PaceWave) to maintain a respiratory rate and volume based measurements of your own respiration rate from the previous 30 minutes. So the rate changes naturally and is personalized, rather than timed. The ST provides fixed pressure and can never auto-adjust the EPAP to prevent obstruction with changing sleep position and needs, and it provides fixed pressure support, so it nearly useless for central hypopnea, and is a comparable "kludge" compared to ASV in resolving central apnea. Your profile shows "Airsense 10 ST", that is probably an Aircurve 10 ST. The only catch on whether you will be approved for ASV is, you must not have congestive heart failure with a left ventricular ejection fraction less than 40%. You will need to be screened, using an echocardiogram to be approved for ASV.

In order to optimize your current ST therapy, I recommend reading Resmeds Titration Protocol. The basic principles are that if you are seeing obstructive events, raise EPAP; if you have centrals raise PS, and of course you will need to fine-tune the backup rate (timing) for machine induced breaths. This link to a PDF file will explain much of this to you, but focus on page 37 for the ST titration https://www.resmed.com/us/dam/documents/...lo_eng.pdf

Don't hesitate to let your doctor know the ST is not working. He is probably expecting that and will move the process forward once it is determined you fail with ST, assuming you can be approved for ASV.
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.
Post Reply Post Reply
#5
RE: In Need of Noobie Education
Thanks for the reply!! I'm certainly concerned about my sat levels.  Since I currently have the CMS 50D+, I only test with it one night (It's clunky and not safe around my face when I'm fiddling with my mask!!)  The night I used it, my lowest sat was 84% for about 2 minutes at my lowest.  This is a vast improvement over when I saw during my sleep studies and even on my own.  I've seen it as low as the 50s.

I just got my 50F last night and will start using it nightly to see what's going on.  I have wondered about oxygen supplementation and I'm glad to see it worked for you.  I also appreciate the comment that it took 6 months for you to heal. There are really no baselines that I could find in my research regarding healing time.  Thank you so much for including that!!

I guess with no support in Sleepyhead, I will continue to use the software CMS provides, as you suggested. I find their charts to be quite intuitive and the pulse data helps.

Last night was an interesting night . . . I woke up at 5am and checked my AHI.  It was 1.2.  I went back to sleep for 90 minutes and at 6:30, my AHI was at 4.2.  I haven't downloaded the data to Sleepyhead yet, but I'm sure I will seen clusters of hypopneas and if my oxygen sats took at hit, it would have been right there.

I'm excited to add the oxmetry data with the 50F and see how goes!  Hopefully those final hypopnes can be controlled and I can reoxygenate and heal like you have!! Thanks again for sharing your thoughts and experiences with me!
Post Reply Post Reply
#6
RE: In Need of Noobie Education
I got the 50F with the blue face. I am assuming that since my 50D+ is relatively new (not more than a few months old), that it either has newer firmware or the file format has changed.  That may be invalid.  I'm running Windows 8 on a laptop so hopefully it works for me too.  How old is your 50F?

And I do hear you with chasing numbers.  I am. Data Head and LOVE analysis and Sleepyhead gives me such wonderful data to play with.  But to your point, the numbers are just an approximation of what is going on with me I'm not vested in specific goals there.  I really just want some good, restorative sleep so I can have my life back.  Thanks for the reminder on what's really important!!
Post Reply Post Reply
#7
RE: In Need of Noobie Education
Thank you for the detailed explanation between the bipap and ASV and why the bipap may not be sufficient!!  I asked in my lastest sleep study titration why they recommended bipap over ASV.  They said 'you weren't  able to tolerate anything in the ASV range.'  I have ZERO confidence in that statement.  Here's why.

When I got my machine, I dutifully brought it home home, set it up and used it that first night.   I was rudely awakened at 3am because the machine was blowing air up my nose when I was trying to exhale and when I was breathing in, it cut the pressure off and made me feel like I was suffocating.  So I called my DME, got a respitory therapist on the phone whole told me I had to adjust to all this because I was new to it but it was all quite normal and I should 'breathe with it'.  I told her the machine should let me breathe when I was able i.e.should be in spontaneous mode and back me up when I don't breathe, i.e. be in timed back up mode.  She told me th machine was physically incapable of doing that.  My doctor's office mentioned clinicians manual and it took me no time to find it, and go into the machine and see the settings.  Sure as anything, it was in timed mode and everything other than my IPAP/EPAP was defaulted  to factory settings.  No attempts were made to approximate my breathing or adjust to my comfort.  I was NOT happy with the answer, "you're new, just get used to it".

But it it make me remember what woke me up (under sedation) during my sleep study.  It was the experience of having air injected up my nose during exhalation.  I literally sat up and ripped the mask off when it continued to pulse counter to my breathing rhythms.  It wasn't my newness to CPAP, it was the therapy was contrary to my breathing. Because of that, I don't have confidence in the statement that I could not tolerate ASV.  I'm certain I refused to tolerate it if they ran ot contrary to my breathing!!

I certainly will my doctor know if my treatment is not working.  Because I have had values under 5 (last night was my second one), I have hopes that the current machine might work.  I have definitely seen that masks and their adjustments affect outcome.  That's why I was hesitant to post to the forum so early.

Oh! And I did see a cardiologist who basically kicked me out of his office!! He saw nothing wrong other than sleep apnea and sent me on my way.  He is ordering an ultrasound just to be sure, but he does not suspect any heart issues at all.

Thank you for your post - there's much to consider here!!
Post Reply Post Reply
#8
RE: In Need of Noobie Education
If you are getting 5's at this stage on the S/T setting, You may do ok and not need the ASV. either one will apply a breathing rate when needed, so you will get the machine triggered breath that you found uncomfortable
I'd spend some time on the titration guide that sleeprider put up and fine tune your settings. you could post the chart from sleepyhead for opinions
mask fit http://www.apneaboard.com/wiki/index.php...ask_Primer
For auto-cpap, from machine data or software. You can set the min pressure 1 or 2cm below 95%. Or clinicians commonly use the maximum or 95% pressure for fixed pressure CPAP, this can also be used for min pressure.
https://aasm.org/resources/practiceparam...rating.pdf
Post Reply Post Reply
#9
RE: In Need of Noobie Education
Mine was purchased within the last two months and is the blue face.
It should work plug and play with any Windows box.

When you get it if it doesn't work post what the version is, it comes up when you turn it on.

The only time I have a problem with it is I have to use an adapter to go from USB-A to USB-C
(New MBP Pro) and not all adapters are that great.

The only thing you have to make sure of is that the time on your 50F is set right before you record, or make sure you know what time you started it. You will need to check that time when it imports the data.

Little tip: Whenever you start the record function it clears the previous record.
It can hold 24 hours max. So if you are using it daily to set up a record, you need to download the data every time.
Post Reply Post Reply
#10
RE: In Need of Noobie Education
The fact that I'm getting under 5 suggests it's possible to the current machine may meet my needs.  That's why I wanted to tweak it a bit and play with variables within my control.  I can see the value of an ASV if warranted as well.

Hopefully, I can attach my screenshot - it shows my AHI from MyAir since I started treatment.

I certainly will spend time in the titration guide!!  Thanks!!
Post Reply Post Reply


Possibly Related Threads...
Thread Author Replies Views Last Post
  Junebuggy - Therapy/Education junebuggy 6 455 10-20-2023, 06:35 PM
Last Post: Jay51
  Noobie UARS, pls help me fix my breathing :/ newuser1002 38 4,027 03-15-2023, 06:43 AM
Last Post: fishfinderG
Question Noobie Question: CPAP or BiPAP? UARS? Alleries newuser1002 22 2,289 07-10-2022, 04:33 PM
Last Post: newuser1002
  What software to use as a Noobie? cbt2610 6 862 05-18-2022, 11:05 PM
Last Post: Homerec130
  Is re-education of the airway muscles possible? dolceitalia 8 1,019 09-21-2021, 01:24 AM
Last Post: dolceitalia
  Noobie has Ramp Start and Stop Question tsolanto 4 1,410 09-10-2017, 06:07 PM
Last Post: Gideon
  Need humidifier education Rcgop 6 1,668 12-25-2016, 09:50 PM
Last Post: Crimson Nape


New Posts   Today's Posts


About Apnea Board

Apnea Board is an educational web site designed to empower Sleep Apnea patients.