Newbie in up to his neck, throw me a line (of advice)

[OfftoNeverNeverland]

Dear CPAP Talk Members: I am 61 and brand spanking new to PAP therapy. My wife of 35 years has always told me I suffer at night, as I snore, snort, twitch, and have apnea. My wife was so correct. I have had the common side effects from apnea, i.e., high blood pressure, overweight, and developed a heart atrial flutter (electro-converted back to normal rhythm in October). The arrhythmia really scared me (I do not get scared easily) and do not want to die from apnea (embarrassing if not tragic). I went to a cardiologist, electro-converted, sent to a sleep study (don't get me started on that experience) and was diagnosed with severe OSA with an untreated AHI of 59.6. My DME provided a DreamStation autoBiPap with Dreamwear full face mask. That mask did not permit sleeping on my side as the air tube on the right side occluded from the pillow and air flow is severely lessened. Sleeping on my back (supine) gave me AHI's around 12--too high for me. Thanks to this forum, I tried and am now using an Amara View mask with nasal ports to permit nose and mouth breathing (nose stops working in the night--deviated septum from being broken a few times). I can sleep on my side now and have averaged around 3-4 AHI's this way. I occasionally get a great night and hit a 0.54 AHI this week (pasted below). I also have mustered up the courage to DialWing it a bit (got into the Therapy mode) and raised my Rx settings of 5 cm/H2O EPAP and 7 cm/H2O IPAP (PS down of 2 cm/H2O) to a more effective PEEP of 6 cm/H20 EPAP and 9 cm/H20 IPAP (PS down of 3 cm/H20). I have not seen any increase in my CA's so I am pretty sure that I am not throwing off too much CO2 at those settings. I also changed the rise down to 2 and modified the ramp time to 15 min. I have not wanted or needed motivational coaching and have informed the sleep coach same via email. I felt our bedroom was getting too crowded with the sleep coach, DME and BC/BS Anthem (and other third-party vendors in all likelihood) surveilling me like a lab animal, so I removed the hidden cellular modem and put it in the basement (Respironics coach not liking that), as I learned from this forum that the modem "off" feature is slyly and silently reversed back to "on" in 3 days time per Respironics's own literature. I will share my data with my provider via SD card when I meet for the 31+ day compliance meeting and they can share with those needing compliance data to get paid--I am focused on my therapy.

My question is how to get better AHI averages as I seem to average around 3-4 AHI (7.3 hrs sleep on average) but I see that many of the CPAP Talk members "effortlessly" get around 1 or less AHI's (AHI envy on my part ;->). My best AHI was 0.54 this week but last night's 3.66 is typically how it goes. I seem to be hit or miss. I am a newbie and my sample size is inarguably small so I will take the kind advice offered here and apply it right away. Thank you in advance for any thoughts/advice. Accept my apologies if I did not post my graphic results correctly (first time at this).

Off to Never Never Land

[zonker]

welcome aboard, "off"! you've come to the right place.

i'm not the person to advise you on the technical aspects. those experts will be along shortly.

what i want to do here is just encourage you. you are off to a good start. it's going to be a journey, a process; in other words quite a trip!

you may adjust at once(not likely) or it may take some time.(most likely) but in any event, please stick with it. we are all different in how we adjust to therapy, just as we are all different in what we need to make that happen.

good luck!

[LSAT]

If you ignore the CA group just before you woke up, you are doing great and can leave everything alone. CAs are common when you are just falling asleep or when half awake just before fully waking up. On this board they are referred to a SWJ...Sleep/Awake Junk.

[palerider]

My question is how to get better AHI averages as I seem to average around 3-4 AHI (7.3 hrs sleep on average) but I see that many of the CPAP Talk members "effortlessly" get around 1 or less AHI's (AHI envy on my part ;->). My best AHI was 0.54 this week but last night's 3.66 is typically how it goes. I seem to be hit or miss. I am a newbie and my sample size is inarguably small so I will take the kind advice offered here and apply it right away.

My best advice at this point is to just chill.. you're doing quite well, that line of sawtooth points on your pressure line say the machine thinks you're doing really well too. (it only does that when your breathing is VERY regular and smooth). The collection of centrals when waking up, or going to sleep is fairly common, and not something you can fix, or worry about... they're "transition apnea" and wouldn't be counted on a sleep study.

Just let things bake for a while, get more used to the machine. Good job so far.

Accept my apologies if I did not post my graphic results correctly (first time at this).

We don't want APOLOGIES! We want *PERFECTION!* and, your screenshot was perfect. You give me hope and comfort that people *can* read instructions, the future of the human race is a little less bleak.

[DreamDiver]

OTNN,

Welcome.
Keep doing whatever you're doing. It takes time for your body to adjust. It looks like you're ahead of the curve compared to others on the forum. You are so on top of this. Congratulations.

[OfftoNeverNeverland]

Thank you so much for the encouragements. It is an honor to have some of the board "Yoda" types respond to my first posting and I did indeed take the time and effort to try to post correctly in respect for this god-send cpap blog and the advice and comfort has been great. I haven't heard boo from providers or DME yet, just the respironics coach who wants me to put the modem back in (not happening). In your experiences, can the sleep coach get you into legal or medical trouble for not letting them surveil you? I have been 100% compliant even though it feels weird not to wake up exhausted now. I understand the collective wisdom for me is to take the time to see if I am at the right pressures for a lower ahi average, so just cool it for awhile and not stress over the cpap varsity who hit sub-one AHIs all the time

[Okie bipap]

The only time you have to worry about someone monitoring your treatment is if you are purchasing your equipment through your insurance. Insurance companies want to make sure you are actually using it before they will pay for it.

[palerider]

In your experiences, can the sleep coach get you into legal or medical trouble for not letting them surveil you?

Tell 'em to go pound sand. The only "trouble" that there might be is if you don't meet the 'compliance' requirements, and the can get that info at the end of the period, either via you putting the modem in, or mailing then a SD card, or taking the machine in, (options).

So far, the CPAP police have failed to bust down anybodies door at 6am for *anything* much less not listening to some self styled "sleep coach". (did they have a loud whistle?)

[LSAT]

Shhhhhh...I think Sheriff is listening

[DreamDiver]

... In your experiences, can the sleep coach get you into legal or medical trouble for not letting them surveil you? I have been 100% compliant even though it feels weird not to wake up exhausted now. ...

If you have a DME or your sleep doctor's facility is acting as the DME, they're going to want proof of compliance so they can get their cut of the insurance pie. Unless things have changed drastically over the last five years, there's usually a compliance number that can be read off the machine's control panel that will give them evidence of compliance.

Good luck!

[OfftoNeverNeverland]

All: Just following up a bit after my initial post. After really digging into more of the posts as well as just about all of the extremely helpful overviews on PAP data and interpretation of same on this site, I concluded from analyzing my own AutoBiPAP data on an event-by-event basis that I was still not insufflated enough at my IPAP of 6 cm/H2O and inspiratory PS of 3 cm/H2O, as I was getting many Flow Limitations (FL) and Vocal Snoring Type 2 (VS2) events, as well as too many OA/CA's, for my satisfaction. My data review convinced me that my throat/pharynx was still collapsing or being semi- or fully obstructed due to there being not enough pressure support between breath cycles (I also lowered my Rise to 2 to get a faster flow cycle). Thus, to start 2019 off fresh, I increased my EPAP to 7 cm/H2O with inspiratory PS of 2 cm/H2O and I have been getting good results (several nights with AHI less than one (1.0) so far). I intend to stay at this pressure for a while to see how my body handles it. I have not seen any increase in Central Apneas (CA) or sore intercostal muscles at my new EPAP pressure of 7cm/H2O, so I am fairly confident that I am not throwing off too much CO2 (hypocapnia) or have too high a dwell pressure. I would appreciate it if some of the CPAP Oracles on this blog take a look and see if you spot any issues with my new posted data. As I am "condemned" to sleep with PAP therapy for the (hopefully long) rest of my life, I decided to embrace this new normal and feel like I control it rather than having this mechanical "alien being" control me while overseen by the unwanted "Orwellian" nightly surveillance by an assigned "sleep coach" (until I popped out the embedded modem to put a stop to that). After 28 days of continuous use since first getting my PAP and making my own therapy pressure adjustments to titrate my AHI results along the way, I am 100% compliant under the 4hrs/24hrs and 70% of a month (21/30 days) Medicare compliance metrics forced on all of us, so the "Compliance Police" can just chill. I wish everyone similarly situated a Happy New Year and hopefully ever lower AHI's.

[Pugsy]

Certainly acceptable results on paper and I see no reason to change anything.

How are you sleeping and feeling?

Do you ever cheat and sleep without the machine after you have met the official 4 hour use number?

[OfftoNeverNeverland]

Pugsy: Thank you for the fast response. No, I have not slept one minute without the PAP in place since starting 28 days ago. I napped on Christmas day for a hour or so in the afternoon but still wore the PAP during the nap. I range from a low of 5.5 hrs of sleep for one night (shortest) to 9.3 hrs (longest) with an average of 7.1 hours per night. I feel much much better and much more energy as compared to how I used to feel. I had headaches for a week or so after I started PAP therapy but I attribute that (per other posts) to my body healing and having repairs that were delayed due to never getting past Stage 2 sleep (I have "normal" dreams again and not of the nightmare type.) That said, I still do not like using the thing as it is a lot of effort and I have to fly/travel with it on due to work issues. My new philosophy is when you get served with lemons, try to make lemonade..........

[Pugsy]

I don't really like having to use it either but I have done it for over 9 years.
Still would rather not use it but I use it anyway.

I had one night a few years ago where I couldn't use it one night because I was on a trip and forgot the long hose and didn't realize just how bad I could feel if I didn't use it. I got a real rude reminder just how bad things were without it.

The bad feeling was really, really bad...and I don't want to have to go through all that again..
So I made lemonade out of those lemons and decided it was pretty darn good lemonade.

[palerider]

I don't really like having to use it either but I have done it for over 9 years.

I like it better than the alternative.