Long Day's Journey Therapy Thread

[Long day's journey]

I experienced a lot of afternoon sleepiness last week which isn't a good combination with my sendentary job. Felt like I was sleepwalking through the last few hours and too exhausted after work to do much. Wondering if I need a readjustment of my pressure.

Quick facts:
* Sleep study on 6/5/19, AHI of 33
* Recently started using the right mask in the last few weeks: F20 (since I'm a mouth breather)
* Center also adjusted my pressure then from APAP to 8 on 7/24/19. But this was done from the data on the old mask (F10) which I could only tolerate about 4 hours a week.

Any advice would be appreciated as I'm still at the stage where I'm not sure what's normal & what isn't. I received a 100 from the MyAir app on Friday (8/2), but still didn't feel that alert on Saturday. (I know I probably shouldn't put too much stock in the app, but find myself checking it anyway).

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[zonker]

I experienced a lot of afternoon sleepiness last week which isn't a good combination with my sendentary job. Felt like I was sleepwalking through the last few hours and too exhausted after work to do much. Wondering if I need a readjustment of my pressure.

Quick facts:
* Sleep study on 6/5/19, AHI of 33
* Recently started using the right mask in the last few weeks: F20 (since I'm a mouth breather)
* Center also adjusted my pressure then from APAP to 8 on 7/24/19. But this was done from the data on the old mask (F10) which I could only tolerate about 4 hours a week.

Any advice would be appreciated as I'm still at the stage where I'm not sure what's normal & what isn't. I received a 100 from the MyAir app on Friday (8/2), but still didn't feel that alert on Saturday. (I know I probably shouldn't put too much stock in the app, but find myself checking it anyway).

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welcome to the zoo! and thank you very much for reading the newbie thread. always good to see someone come in and give the experts here information to work with.

did the center explain why they decided to set your machine to cpap mode?

is the afternoon sleepiness new with your cpap therapy or did you suffer from it beforehand?

you are saying that you sleep longer with the f20?

now, take a look at your charts;your pressure wants to go higher, but can't because it's capped at 8. so, in my humble opinion, you need to raise the pressure. and unless there is a specific reason for cpap mode at 8, i'd also consider changing to apap mode. that will let your machine tackle each event as it happens.

now, mind you, *I* am not an expert. when one of those shows up, kindly disregard my blitherings and pay attention to one of them!


good luck!

[Long day's journey]

Thanks for the reply Zonker!

did the center explain why they decided to set your machine to cpap mode?

* Yes, the Nurse Practitioner said that my pressure always seemed to hover about 8, so she set it to that. And I just realized reviewing the data from the past few weeks (and learning out how to interpret it) that the pressure was capped at 8 on my visit on July 10th, not the visit on July 24th.

is the afternoon sleepiness new with your cpap therapy or did you suffer from it beforehand?

* I suffered it off and on, but often would be amazed at how alert I was at work, given that I only slept 4-6 hours, often with an hour + gap in the middle of the night (although I tried to avoid working on the boring parts of my job). Last week was worse than usual though, and even just driving to work I'd feel my eyes heavy.

you are saying that you sleep longer with the f20?

* Yes, much longer, I'm not only holding on for the minimum of 4 hours to satisfy the insurance company (I told the nurse practitioner that it was a blessing and a curse to have the monitoring). This new one I can keep on for 6+ hours, with no large leaks and only mild redness at the bridge of my nose instead of the bruising with the other mask. I'm attaching an image from the time of the previous mask, which usually didn't record the latter portion of the night.

I will leave a message with the sleep center tomorrow and ask them to look at the data (I feel like I've paid them enough money at this point & I'm curious what they'll say). If I don't hear back from them by tomorrow night, I'll take your recommendation and change to apap. Thanks again!

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[Pugsy]

Your varying pressure needs might be related to sleeping position or maybe even REM sleep and we don't always have the same amount of REM nor do we often just stay in one position all night.

I second the idea to increase the max and let the machine decide if it needs to increase the pressure for whatever reason. It won't increase it without a good reason. You might have nights where it barely goes above 8 and you might have nights where it goes to 10 or 12 or maybe even a little more for periods of time.

[Long day's journey]

Thanks for the advice Pugsy! You're recommending to keep it in apap mode with a range of maximum 10 or 12, right?

My former primary said that it was best to keep the machine in apap mode, as you may have varying amounts of congestion, etc.

The sleep center told me that you ultimately don't want to rely on the company's algorithm to determine the pressure and that was why they recommended the titration study (which was denied by insurance, instead the insurance only approved the apap machine).

Do you have any opinion on this?

[zonker]

Thanks for the reply Zonker!

you're most welcome! i'm just happy that pugsy came in and verified my suspicion that the pressure needs to go higher. she's the moderator of this forum and even better, she's one of the most knowledgeable on this site. (the other is palerider and he may yet come by to answer as well.)

so i leave you in her capable hands.

just one more thing, as columbo used to say.

many people when they are brand new to cpap are reluctant to change their settings on their cpap machines. you may or not be one of those people. but i assure you, you can take this into your own hands if you want to. there is something available online called a "clinicians manual". with this, you can figure out how to change a lot of things, including your own pressure.

i'm NOT telling you to do this if you feel uncomfortable doing it. but many of us here change our own settings.

stick around and learn some stuff. you can do this.

good luck!

[Pugsy]

Do you have any opinion on this?

I assume you mean this

The sleep center told me that you ultimately don't want to rely on the company's algorithm to determine the pressure and that was why they recommended the titration study (which was denied by insurance, instead the insurance only approved the apap machine).

and if so...my opinion is total bullshit. They recommend an in lab titration so they can make more money. Insurance companies are going away from this and just doing the apaps and when done correctly...optimal pressures can easily be obtained at home where we can actually sleep.

I had a titration study done in a lab...they didn't get it right either.
My OSA is worse in REM and I need a lot more pressure in REM ....but I slept horribly in the lab for that titration study and out of the 8 hour night...I got 156 minutes of sleep of which maybe 6 minutes I was in REM. Waste of my time and money and I ended up doing it myself with the apap machine I had. The recommended setting works fine for non REM but totally off for REM in my situation.

[Long day's journey]

many people when they are brand new to cpap are reluctant to change their settings on their cpap machines. you may or not be one of those people. but i assure you, you can take this into your own hands if you want to. there is something available online called a "clinicians manual". with this, you can figure out how to change a lot of things, including your own pressure.

I thought about this all day and asked myself: what kind of response do I want from the sleep center? To validate my concern? What if they don't or I get frustrated?

My husband once said I was too reliant on authorities and maybe in this case he's right. By coincidence, the sleep center called & said that insurance wouldn't approve a consultation by phone, so I cancelled the appointment (this place is 1 1/2 hours away anyway).

Thanks for giving me the encouragement to strike out on my own zonker. I'm going to change the settings tonight and see how it goes!

[Long day's journey]

I had a titration study done in a lab...they didn't get it right either.
My OSA is worse in REM and I need a lot more pressure in REM ....but I slept horribly in the lab for that titration study and out of the 8 hour night...I got 156 minutes of sleep of which maybe 6 minutes I was in REM. Waste of my time and money and I ended up doing it myself with the apap machine I had. The recommended setting works fine for non REM but totally off for REM in my situation.

I'm kind of glad my insurance didn't approve the titration study then, lol. During my sleep study they had to give me a sleeping pill at the beginning of the night and then in the middle of the night. I had the pes monitoring which was a whole lot of fun.

Do you have any opinion on this?

Sorry I wasn't more specific about the question--it was whether it's better to stay on apap or to settle on a level (such as 8 or 10, etc.) Maybe it just depends on your circumstances. Thanks for the info!

[zonker]

many people when they are brand new to cpap are reluctant to change their settings on their cpap machines. you may or not be one of those people. but i assure you, you can take this into your own hands if you want to. there is something available online called a "clinicians manual". with this, you can figure out how to change a lot of things, including your own pressure.

I thought about this all day and asked myself: what kind of response do I want from the sleep center? To validate my concern? What if they don't or I get frustrated?

My husband once said I was too reliant on authorities and maybe in this case he's right. By coincidence, the sleep center called & said that insurance wouldn't approve a consultation by phone, so I cancelled the appointment (this place is 1 1/2 hours away anyway).

Thanks for giving me the encouragement to strike out on my own zonker. I'm going to change the settings tonight and see how it goes!

oh, my. i am SO happy to hear you say this. my intent here is to encourage new users when they are asking for help. i'm very glad that you take my words to heart.

be advised that you are still going to be frustrated. at least with this forum, you'll have people giving you the straight dope and not just some made up bullsh*t.

it's going to take some time. and that would be true whether you were getting your advice here or from some doctor.

PLEASE do come back and let us know how this night went. it may not change that much, but we'll see where it goes from here.

good luck!

[babydinosnoreless]

I am not an expert but I am going to borrow from what I have seen them say regularly. Hopefully I get it right but I am sure they will correct me if I am wrong. My understanding is by capping the max pressure you are tying the machines hands and if needs to go up higher it can't. If it doesn't need to go higher it won't.

Good luck. . I changed my settings and the cpap police never came and got me.

[Miss Emerita]

It’s great you’re going to take charge of your apnea therapy! You will get excellent advice from the experts on the forum. One small thing to help them—in place of the mask pressure chart could you provide you flow limitations chart?

[zonker]

Good luck. . I changed my settings and the cpap police never came and got me.

i'm calling 9-1-1 right now, missy!!

[HoseCrusher]

Rodger dodger, got it.

Suspect doesn't appear to be dangerous but be alert. There is a rumor she has pink hair and knows how to put the pressure on...

[jimbud]

Rodger dodger, got it.

Suspect doesn't appear to be dangerous but be alert. There is a rumor she has pink hair and knows how to put the pressure on...