Another sleep apnea "victim"

[Pad A Cheek]

It certainly sounds like you have been through the ringer trying to treat severe sleep apnea. This story makes me think that this is one of the reasons people just give up on the whole CPAP thing. They do not feel better, and the machine is a challenge to use and clean and pay for replacement parts.

There are several things you are doing right. You came to this forum and asked questions. You are interested in your results and know that they will give you clues to solve the issues. You have not given up and thrown the whole thing out.
Perseverance is a powerful thing. Keep trying to get this sorted out. I look forward to your posts with great AHI and that you are actually feeling more energetic. I am believing that you will get this worked out.

Take care,
Karen

[grubstake]

Superdave,

You can fix this. You are on the right path.

1. Medically sleep care is commonly poorly done, a lot of "sleep center" medicine is basically a CPAP mill. I though my experience was bad. Yours has been terrible. Sleep Apnea untreated can put you in an early grave. Yours is really severe. Good on you for taking ownership. Don't let "the man" keep you down!

2. My last machine was the same S8 Auto you have and I just had Medicare replace it with a the Airsense 10 Auto. A newer machine like that model will provide you with a lot more information, and you'll be able to use Sleepyhead free software and see a lot more. While you probably have severe obstructive apneas your current machine doesn't let you see Central Apneas which may require a different type of machine.

3. Call Medicare and tell them you think you need a new machine and ask them about the coverage and deductible. If your sleep study is adequate for Medicare and your machine is over 5 years old and not working right they will likely cover a new one. Perhaps yours is making funny noises or sometimes misbehaves. You might need to get a doctor's letter or prescription. They might want a new home sleep study; they will cover that. Get the ball rolling ASAP and get yourself a new machine.

4. Your spreadsheet numbers are useful but don't tell the whole story. Don't look at just AHI. Your AI numbers might be more important. Your info suggested you can have LONG apneas, that's bad stuff. HI is a less serious short event but is bundled into the AHI. Notice that your AI varies a lot more, there is a story there somewhere.

BUT...you can't tweak the machine and look at one or two nights of results and trust that the change had anything to do with it. Change settings only with a particular goal in mind, give it some days or a week and see how it worked before messing with something else.

5. A huge number of external events will impact sleep quality that have nothing to do with machine settings. Back up a few steps and look at your lifestyle and habits as many of them have a HUGE impact on sleep. Read up on "Sleep Hygiene" and take it seriously. For many people improving exercise, diet, and various 'bad habits' have a BIG impact on sleep quality. (Personally I'm a couch potato by disposition, my numbers take a bad turn if I don't get any exercise and flip right back instantly if I get regular move-around exercise like taking a walk every day. Like flipping a switch.

6. So analysis and tweaking isn't the most important thing, but looking at your posted info, if I had numbers like that myself, I would keep the machine in AUTO mode, keep the MIN pressure just below the long term 95% pressure (not lower), keep the MAX 6-8 higher than the min. EPR lowers the minimum pressure of the machine all the time you aren't inhaling...if you set MIN to 10 and EPR to 3, your machine minimum pressure is really 7, with a boost to 10 when you are inhaling. With obstructive sleep apnea the pressure is what keeps your airway from collapsing...you don't want it to do that while your are exhaling before the pressure rises again. So I would be thinking about avoiding a MIN any lower than necessary for comfort. If it's tolerable with EPR off -or- a corresponding increase in MIN for each level of EPR, that could avoid airway collapse. Example MIN-10, EPR-3 has the same base pressure as MIN-7, EPR-0. The first one has a pressure boost of 3 while inhaling, the second doesn't.

Good luck and keep at it!

Grubstake

[SuperDave]

grubstake, thank you for taking the time to craft such a thoughtful response. I am awaiting a newer model loaner, which should produce some better data. While waiting I will continue using the old S8; i guess 40 AHI is better than 80. I hope to have SH data in a week or so, then let the wing-dinging begin.

[SuperDave]

There is an app that works with the Apple ewatch for tracking sleep stages. It uses motion sensors and heart beat to graph your sleep stages during the night. I realize these apps are not reliable, nor are they clinically/scientifically accurate. (REM can't be determined without EEG.) Not withstanding, it's still interesting to compare the watch's graphs with graphed cpap sleep data. The watch app identifies awake time, stage 1,2,3 and REM time; I've observed that the awake times are fairly consistent with what I remember from the prior night, even if the sleep stages and REM are not reliable.

This tool could be useful for looking at data in sleepy head and for discounting any events recorded during the awake times.

[SuperDave]

Last nights watch graphs

[SuperDave]

1st ever graph per sleepyhead. using a loaner prs1 bipap auto 760. The quality of sleep was about normal, with multiple arousals. I have been fighting a viral infection for a week with sinus congestion, deep chest cough and excess mucus, which resulted in numerous arousals due to cough. The first thing I noticed is in the pressure graph; the max pressure should be increased. The second thing is the leaks-is this a problem? Could frequent coughing influence the leaks? BTW, the ahi has come down significantly from the sleep study benchmark of 84. Please review the graphs and feel free to offer any suggestions for improving AHI.

[SuperDave]

my sleep watch tracked the arousal times. The arousals are the orange colored bars in the graph, below.

[SuperDave]

this chart shows a CA, OA, and a H. Note that the machine pressure stays flat and is in the range of 9.5 cmH2O, below the max of 15.

[Pugsy]

Ignore the time over red line leak statistics. It's based on a ResMed leak threshold of 24 L/min. Look on the Events graph..see the LL line...that's large leak per the machine. I can't see any. Let's fix it though...go to Preferences in SH...then CPAP tab and change the 24 L/min red line threshold to something more suitable for Respironics machine...only thing is Respironics doesn't ever give us a fix static red line threshold because their threshold varies with the mask used and the pressure...but let's at least get it close.
Change to 24 to 70 L/min...it's a nice conservative line.

Let's make some drastic changes because obviously this is not good.

If you can handle it...turn PS off and see if the centrals/CAs reduce any (I will explain why later) To turn it off...set the PS minimum to 0 and the PS maximum 0.
If you can't handle it...leave it alone for now.

Yes..more pressure is needed for the obstructive stuff (OAs and hyponeas)...
Change Minimum EPAP to 12 and IPAP max...open it up to 25

See what things look like tomorrow.

[palerider]

Jibbers Crabst!

Not the worst AHI we've seen, but, it's up there.

[Pugsy]

Note that the machine pressure stays flat and is in the range of 9.5 cmH2O, below the max of 15.

You were expecting a much faster response to something?
It doesn't work that way...no response at all to any CAs/centrals...and the obstructive stuff they don't do anything during the event...non of these machines will except the ASV machines. They all wait until the event is over and then they re-evaluate things based on what has been going on. A little bit after this time frame the pressure does increase significantly.

[jwoceanside]

It's a money hungry business. I had two Sleep studies, which they charged Medicare $8,600 each. The Pulmonary MD another $500 per 3 visits. And add the RedMed machine and mask.

Before I saw the Pulmonary guy I went to a Sleep Specialist---acquaintance. Was advised of 13 possibilities for Chronic Fatigue and how the medical industry tries to rip you off. Sleep Apnea is a serious condition, but besure you see a reliable Physician

[SuperDave]

I mistakenly thought the machine would increase pressure to immediately break through an OA. Now I understand the machine doesn't incr pressure unless there are several occurring within a short period of time.

Here are the results for Friday night, 1/18. Twice, I woke up, noticed the high pressure, so I hit the ramp button so I could go back to sleep. Ramp was 7, but can be raised to 9, and still be comfortable.

[Pugsy]

How did you sleep last night?
Spend any or much time awake with machine and mask on?

Another increase in the minimum EPAP tonight....from 12 to 15.
Keep PS at 0 min and max
Keep Flex off if you can
Keep IPAP max at 25
Use ramp if you need it to be comfortable with the higher minimums.

[Pugsy]

What position are you sleeping?
Side with sometimes on your back?
Or on your back primarily?