Newbie report on Encore software findings

[Pugsy]

I am so glad I got the software today. 6 nights of treatment so far with minimal improvement. While not expecting a miracle I thought I would see maybe a little improvement. I guess if you can count cutting out the morning need for a nap and only having the need for afternoon nap, some improvement though.

I have been sleeping for only maybe 2 to 3 hours at a time. Lucky to get 6 hours of therapy in a night. Lots of awakenings. The daily averages on the machine haven't been bad at all. AHI around 5.5 and leak rate pretty much in line with rate chart. While the AHI is a bit high it isn't off the charts and still much better than before treatment.

This below is all that I know so far about my sleep studies and this was verbal. I haven't had a chance to get the actual reports.
Initial sleep study:
11 events per hour in non REM sleep, 53 events per hour in REM sleep, long sleep latency to get to REM, O2 dropped to as low as 73% with average being in mid 80's, no centrals, and up to 40 second long apneas. Never met criteria for split study because I didn't enter REM where I was rocking and rolling until too late in the study to do any effective titration.

Follow up titration study: no results available except scripted for 8 cm of pressure and I found out I couldn't tolerate a mask on my nose or a strap around the base of my skull. I did have significant trouble falling asleep though.

I won't try to post the graphs for my daily stats from the software reports right now. There is no need to at this point. I do really well for about 2 hours. Leak rate is nice and straight and maybe one AI or HI but when I get close to that 3 hour mark or a little over all Hell breaks loose. Clusters of AI's and HI's (about half and half) along with an increase in vibratory snores and a good size zipper line on my leak rate. I suspect that I am entering REM and relaxing more and most likely opening my big mouth again. Also even though I start sleeping on my side I always seem to wake up on my back.

So then I get up to go to the bathroom and go back to bed. Get back to sleep and the graph again shows a good straight line for leaks and rare events for another couple of hours or so. Then things get fired up again. I may have 10 to 15 events within that 30 to 45 minute time frame before I wake up again fully.

While the overall daily average AHI is 5.5 to 6.5 (never has been more than that in 6 nights), The overall event totals for the 6 hr time frame may be 30 something giving me the overall average in the 5-6 range but the majority of the events are happening in a relatively short period of time. Same thing holds true with the leak rate. It is good enough most of the time to keep the average down to where it looks good on the LCD daily average.

Without the software I wouldn't have seen this trend. Pretty much points to my opening my big mouth most likely in REM. I will now investigate chin straps and other mouth shutting techniques as need be. While even 10 events and hour is much less than my original 53, it is still enough to significantly disrupt restful sleep and likely a good part in the reason I haven't seen a lot of improvement.

Without the software I would have been sitting here scratching my head wondering what was going on. My pressure where I spent the most time was at 9cm. 90% has been running around 10cm. Obviously the pressure is good. My daily averages look good but they were a bit misleading to me. Am I too far off on my thinking here? Is this why we say get the software if at all possible?

Brenda

[Pugsy]

Anyone know why I might have lost a little over an hour's worth of data? I would swear that I never woke up after I went to sleep last night. Any other night yes, I have been up alot but not last night. See break in data on reports.

I went to Walmart last night looking for something to use as a homemade chin strap. Settled on a sweatband that I found over where the jockstraps were. Quite comfortable for my size and apparently pretty successful. I can now post my results with some pride. Discount the last leak zipper line as I had a semi coughing fit for some reason.

So these results are for night #7 of treatment and I am very happy to report that this morning for the first time I can say I see a marked improvement. I feel great!! Huge difference. The only change made was the addition of the sweatband. I fell asleep quickly and did not get up once to go to the bathroom.

Thoughts on upping the Max to 13cm??

[GumbyCT]

I too have seen interruptions or breaks in my graphs when I knew I was sleeping. Or it just started in the middle of the nite when I know I went to sleep earlier.

fwiw - any breaks more than 59 minutes will begin another session. Too many sessions within 7 days results in loss of detailed data. For more info search for "Data Loss". I have to run.

[ozij]

Congratulation, Brenda. Your thinking is right, and you're moving in the right direction.

O.

[Pugsy]

Thank you Ozij and GumbyCT

I will not worry about the data loss unless it persists regularly. I did do some reading about it and this eased my mind. Not a big deal if rarely happens.

[Pugsy]

I guess I need to up my maximum pressure a bit. Today I feel everyone of those clusters of OA's. Woke up with headache. Multiple awakenings last night. Very common for me because of pain issues. Melatonin trial the other night made me very dizzy. I fall asleep easily but wake often. And yes, had to get up an pee after the first cluster of OA's about 2 hours into treatment last night. I know my leak rate is up a bit and I am working on keeping my mouth shut.

Thoughts anyone?
Thanks,
Brenda

[GumbyCT]

If there are no centrals in your Hx, I would prob bump it up 2-3cms to see if that helped. Keeping track of your sleeping position may prove helpful.

[Pugsy]

If there are no centrals in your Hx, I would prob bump it up 2-3cms to see if that helped. Keeping track of your sleeping position may prove helpful.

Thanks,
No history of any centrals. I did specifically ask this question to the doctor's nurse.

I take Ultram for pain. While one of the cautions for it is drowsiness most of the time it makes me a bit hyper so I haven't been trying it at night. Ambien CR is wonderful but I took my last pill from the 7 day trial given by sleep doctor the other night. I don't think I want to try those type of sleep aids. I tried Benadryl last night but only 25 mg.
Tonight I will up that dosage as well as my tx pressure.

I start out sleeping on my side but seem to end up on my back (which also increases back pain). I have instructed my husband to get me back on my side and he says he did do this last night a couple of times. He is over the road truck driver and we only get one or two nights together so I can't rely on him every night. I will try to rig up something to prevent my going over onto my back.

I have a long history of this fragmented sleep pattern with frequent awakenings. I can't blame it all on OSA. I have arthritis in the SI joints in the pelvis along with the lower lumbar spine. It hurts just to turn over in bed. I need to find something that will let me sleep just deep enough not to feel the pain.
Brenda

[Wulfman]

Based on your comments about awakenings and seeing your reports, I'd recommend a straight pressure of 10 cm. There could be some "positional" issues, but when your pressure goes higher than 10, there are clusters of events being shown on your reports. I also see some residual snoring which is driving pressure increases. With a single pressure, you should be able to eliminate a number of "unknowns".......and probably sleep better.


Den

[ozij]

This time I disagree with Den.

11 events per hour in non REM sleep, 53 events per hour in REM sleep, long sleep latency to get to REM, O2 dropped to as low as 73% with average being in mid 80's, no centrals, and up to 40 second long apneas. Never met criteria for split study because I didn't enter REM where I was rocking and rolling until too late in the study to do any effective titration.

Considering the dramatic REM vs. NREM differences, And those desats, I think the auto has to be given more of a chance.
I would give its head for a few nights - if your OA drops, that would be fine. If it doesn't, it will be time to think again.

The chart shows the OA cluster started deep into the 12 cms pressure (another reason I would not want to keep a min=max=10) -- the machine was driven there by the snores - so I doubt those are pressure induced apneas - but the OA did appear at that pressure - which is why I think it's worth it to give the auto it head. Additionally, the snores aren't dreadful - so I think the pressure won't be driven upwards uncontrollably by snores.

Step 1: Leave max. wide open - and we'll see what happens and how you sleep.
Step 2: If you sleep well - fine. If you don't sleep well, start raising the minimum gradually, and maybe dropping the max, till you sleep well.

I think if we go only by your (supposed) REM sleep, the fixed pressure will be pretty high, and I can see you benefiting from lower pressure in NREM.

O.

[Wulfman]

This time I disagree with Den.
O.

Wouldn't be the first time...... (but I still stand by my previous post)

Pugsy,

You might look for some type of wedge pillow to keep you off your back. There's also the old "tennis balls sewn in the tee shirt trick" or wearing a backpack or something else to keep you from going into that position. I've also had the lower back pain on many occasions, but in my case, I can't sleep on my back in bed.
Keep in mind that mattresses, bed pillows and optional mattress pads (foam or whatever) can make big differences, too.

If some of your awakenings are caused by the pressure changes, and if you raise your maximum to the maximum end of the pressure settings, I'm guessing you'll probably be waking up before the machine can clear your events.

Interestingly, in those three charts, the pressure of 12 (90% number) appears to be the better pressure in the first two......but the worst in the third one. Like I've said before, people can't always go by the "90%" number for their pressure setting.

For the record, I never implied that the apneas were pressure induced.......I suspected they were "positional". It also may turn out that a pressure of 10 cm. may even be a little low, but it would be a place to start.

In the end, this is YOUR therapy. We can only make suggestions. You have a machine that has many options and you need to find what works best for YOU.


Den

[ozij]

I know you didn't imply they were pressure induced, Den, I was thinking out loud, and explaining why opening the range seemed safe to me.

You're assuming the apneas are positional, I'm saying they may be stage related - espcially if we go by the PSG. Neither of us can tell for sure - but I would rather err on the side of one night's pressure waking me up because of the changes, than on the side of having major desaturations.

Please let us know what you decide to do, Pugsy, and how it turns out!

ozij wrote:
This time I disagree with Den.
O.

Wouldn't be the first time...... (but I still stand by my previous post)

No - but we often agree.
O.

[Pugsy]

Thank you Wulfman and Ozij for your thoughts. I do appreciate your input.

I will set auto to max and see what happens. I looked back at my other data (that I didn't post) and I see a couple of OA clusters where there were no snores to drive the pressure up. For the past couple of months since I started this educational road I have been paying more attention to sleep patterns and how I feel. When I dream I wake up with a headache. Lots of times when I have nights where I wake up every couple of hours and likely don't get into much REM sleep, I don't wake up with a headache. Course I still feel like crap because I haven't rested.

While some of my events are very likely related to position, my gut tells me that the driving force is REM stage sleep. The reason I wanted the auto unit was because I knew that my non REM sleep events weren't all that bad. I wanted the flexibility of being able to get by on a lower pressure during that time if at all possible. Since I don't have my actual sleep study results to look at yet, I am only guessing, but I would bet good money that my worst desaturations were in REM sleep.

So tonight I will do this
Set auto to max but keep my 8 cm min. I may or may not have a problem with the pressure increases. There is only one way to find out though. I have to try it.
Will see if I can find something to keep me off my back. It hurts my back anyway. The tennis ball thing doesn't appeal to me, LOL, just what I need is something else poking me in the back to wake me up but I can try to maybe use some sort of wedge support.
Will also try to keep my mouth shut more. If this sweatband was another inch wider it would be a better chin strap. Just how good is this PapCap chin strap anyway? Do I have to wear the cap part with it to anchor it? I can't tell from the product description.

Brenda

[Pugsy]

Report on last night's changes:
I added Polygrip to my routine since the homemade chin strap was less than ideal. Oops, didn't know how much to use and I used way too much. Very effective and not nearly as bad as I thought it would be.
Went to bed around 10:30PM, woke up shortly after 2 AM, wide awake, no headache. No problem with air pressure spikes. I never have noticed any pressure change. I don't know why I woke up but this happened before CPAP too.

Tried to get back to sleep, couldn't, pulled data card out and went to see what was going on. Geezz, saw that leak rate and my lips were glued shut. Changed my pillows to extra small, took 2 Ultram and forced myself to lay in bed till I went to sleep. Woke up around 6:30 AM, no headache but did lay there and tossed and turned till I got up so that last bit of data may be skewed a bit plus I think I had a tiny break in my lip seal.

I see snores on the first half and only one on second half. Since mouth was glued shut, how does it find any snores? Mask leakage at the pillows? Obviously I did better with the extra small with leakage and they felt great.

All in all a much more recuperative sleep even if it was fragmented. No headache and I feel much better than I did yesterday morning. I had awakenings but not as many that I was aware of. I added an old buckwheat type neck pillow as support against my back to keep me from rolling over onto my back. It actually gives support to the lower back so it feels good if I lean against it yet supports enough to keep me at about a 45 degree angle. I remember waking only once on my back and repositioning myself.

I was never aware of any pressure increase, machine never woke me up that I could tell. I never hear it do anything. Still have C Flex set at 1. Don't need or use the ramp. Takes me only about 5 breathes to get acclimated to the pressure when the machine comes on. Guess I am lucky there.

I think I will continue with things like this unless someone has a better idea. Having pressure on max doesn't seem to hurt anything, I never come close. Probably will reduce it later if we see that it seems to continually top out at 13.

Thanks,
Brenda

[ozij]

Hi Pugsy,
Glad you're feeling better! I'd keep this for a week - or even two.
O.