feedback and/or suggestions for adjustments

[CaspianCmonster]

I have been on a Cpap for the last 2 months, 100% compliance, around 7 hours per night (of cpap time, not sleep). 

Norway has a really strange system. We figured out I have PLM (and always have) which launched an extensive series of tests (sleep study, normal and sleep deprived EEGs, MRI (all clean other than the sleep study) and then to the ENT for a CPAP before looking into the PLM more. 
 
The strange thing is after all that there is no follow up and no communication between the specialists (the ENT didn't have the detail sleep study results for example, my GP has no visibility of what is going on...)  there is zero detailed evaluation of the cpap data so far, (just a non-technical nurse looking at the averages)

So that leads me here. I would love to setup an EEG at home but there really don't seem to be any viable options for that. I will get a logging SPo2 shortly, I have a night vision camera and a "smart watch" charge 6 but the SPO2 is useless with that.

I know I have mixed apnea but I don't know what the mix is. The Cpap says basically all central but that isn't a super reliable measure from what I understand. I have none of the scary causes of central apnea and the PLM and restless leg have always been a problem.  It is probably that the CA is related to the PLM and some medications I take 
 
I will attach a few of recent nights that are more or less typical. There is quite a bit of variation between nights, but never the sorts of near zero events some people post. 

I think there may be some benefits from the cpap but that is always hard to evaluate. 

I am running a resmed 11 with 5-15 cmh2O, with a N20 mask and finally started manually adjusting the temp and humidity as the nurse just had it on automatic which ended up waterboarding me when the room was cold. I started with a P30 but that was really bad for many reasons although perhaps with better settings it might be worth trying again. 

thanks

[Sleeprider]

You seem to have mixed apnea, and the only way I know to help find a better solution for you is to try some trial and error experimentation. While most of your events appear to be clear airway, you also have considerable flow limitation, which can be disruptive to your sleep. I would like to try something that may seem counter-intuitive in light of the CA, but it often works out. If you can change settings to Autoset Standard mode with minimum pressure 7.0, maximum pressure 12.0 and EPR 3, I'd like to take a look at how that works out for you. If it increases CA we will need to go down a different path, but we need to learn what works and what doesn't to make some progress.

For humidity settings, try manual mode at setting 4 and Climateline tube at 28-30 degrees C.

[CaspianCmonster]

Thanks for the feedback. I will give it a try and report back.

A few weeks ago I tried lowering the max to 12 for a few nights but didn't raise the min or increase the ERP so perhaps this will be different.

I like a good science experiment and am dedicated to finding a solution but am still surprised that online forums are the only way to do it both under the US and Norwegian systems. Do you have any idea what percentage of people can just start with basic settings and have it work without adjustments etc? I guess the forum is going to be bias towards those who don't get immediate results but logically I would expect follow up is necessary in most cases, even if it is just mask fitting etc.

thanks

[Sleeprider]

The tendency of doctors is to use default settings for many individuals to start therapy, so a lot of them show up here with minimum 4, maximum 20 and no EPR. The other problem is decidedly inferior devices that simply don't deliver efficacy, no matter how much optimization we try, or even devices with no data feedback. Thankfully most of the machines that have no data are mostly obsolete or discontinued. Anyway, the sleep medicine gatekeepers tend to be more of a hindrance than help, and often make up non-existent rules like a patient can not change their own settings, or actually reprimand those that do. In the U.S. most sleep doctors do not even look at machine data and understand it is much more lucrative to order titration sleep studies. Even members that show up with a clinical titration are rarely even close to optimized.

[CaspianCmonster]

Hi, I tried the new settings (7-12 pressure and EPR of 3) for three nights. 

I am not sure I can see any significant difference, either looking at the high level or in detail. 

It looks like maybe the flow limit hits are a bit less perhaps. 

One funny thing I have noticed, the evenings where I have had some wine I have far fewer events, I am not sure if that is good or bad. 


Any ideas (other than harassing my doctors to do their job) 

I am going to see if I can get the detailed sleep study results so I can see what the mix was between central and obstructive apnea (without the CPAP) 

thanks

[jdougc]

Your light sleep looks good but as soon as you go into deep or REM sleep your CAs begin to appear.