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TheGingerDoctor
Unread post  Post subject: What on earth is this??  |  Posted: Fri Sep 14, 2018 5:10 pm
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Joined: Fri Sep 14, 2018 4:28 pm
Posts: 7
PAP Mask: Amara View
PAP Machine: Dreamstation CPAP Pro
Humidifier: Dreamstation CPAP Pro
Pressure Setting: Currently on Auto-Trial, Pressure 12-16, C-flex 1.

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Hi everyone! First time poster...like EVER on ANY board online. I have a question about a specific thing I am seeing in my sleep regularly, which I have posted an image of below. I have no idea why this happens several times each night.

History:
I am pretty young, 33 years old. 3 years ago my wife encouraged me to get a sleep study because I have spent most of my life exhausted and she noticed my snoring. I got a sleep study, but they said my AHI wasn't severe enough to warrant a cpap, but that I may simply keep losing sleep from waking up while snoring. 1 year ago, I found out I have spent most of my life at extremely low testosterone. I have been placed on testosterone replacement therapy. However, since I started using testosterone (and I am at normal levels now) I have begun what my wife calls "violent" sleep. I started talking significantly in my sleep, waving arms around, and waking up continuously with HORRIFIC headaches, and huge entire parts of my body numb (like when your like "falls asleep" but whole sections of my body). It was seriously scary, like I can't describe.

I went back in for another sleep study, and they told me I had an AHI of 25. However, they said it was all Hypopneas, and I didn't even get past level 2 sleep (I knew my situation MUST be worse because I was super anxious during the in-lab study and had serious trouble sleeping). They prescribed a pressure of 9 and got me a CPAP. I won't bore you with all the details, but I have been on the thing for a month and a half, and adjusted a lot of things. At pressure of 9 I was getting continuous ratings of 40-50 AHI. With a lot of trial and error, I went from a pressure of 9 to 10, then just jumped to 13. I use a C-flex of 2. I have had a number of nights at 13 with an AHI of 2-5 and am feeling much better, but am still having several nights at 8-10. I feel great during the day, but by 3pm during the day I immediately become tired and want to sleep.

Things have been pretty good, I never have really had any issues with mask leaks, but every night I am getting a strange pattern of what you see below a few times a night. I believe they may be artificial OAs, but I am not sure what on earth this is. It seems like they are causing me to lose sleep Does anyone know what this pattern might mean? Thanks!
Attachment:
Untitled.jpg
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diamaunt
Unread post  Post subject: Re: What on earth is this??  |  Posted: Fri Sep 14, 2018 5:24 pm
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Joined: Wed Mar 02, 2016 2:26 am
Posts: 2010
Location: Dallas(ish)
PAP Mask: Resmed P10
PAP Machine: Resmed S9 vpap auto
Pressure Setting: 18/13-25/19

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Your pressure's too low.

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TheGingerDoctor
Unread post  Post subject: Re: What on earth is this??  |  Posted: Fri Sep 14, 2018 5:28 pm
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Joined: Fri Sep 14, 2018 4:28 pm
Posts: 7
PAP Mask: Amara View
PAP Machine: Dreamstation CPAP Pro
Humidifier: Dreamstation CPAP Pro
Pressure Setting: Currently on Auto-Trial, Pressure 12-16, C-flex 1.

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I have thought about this too, but what is holding me back is that the other 80% of the night Its working fine for me. I have had major issues with Aerophagia so badly that it can keep me up. Don't you think that this is a period of time where I am awake, trying to fall asleep? I thought the bigger flow meant I was in a waking situation.

Thanks again!


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diamaunt
Unread post  Post subject: Re: What on earth is this??  |  Posted: Fri Sep 14, 2018 7:12 pm
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Joined: Wed Mar 02, 2016 2:26 am
Posts: 2010
Location: Dallas(ish)
PAP Mask: Resmed P10
PAP Machine: Resmed S9 vpap auto
Pressure Setting: 18/13-25/19

Offline
The bigger flow *before* an apnea likely means that you were awakened by something else.

A big flow *after* an apnea, is you gasping for breath after being choked.

I can't see what happened before that started, but there's several "can't breathe! PANIC! GASP" sessions there.

And your 80% of the night is fine... is why I dislike fixed pressure machines, *intensely*. You might be able to do with less pressure during that 80% of the night, but for those periods... maybe you're in REM, maybe you rolled over to your back... you need more pressure.

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TheGingerDoctor
Unread post  Post subject: Re: What on earth is this??  |  Posted: Fri Sep 14, 2018 7:29 pm
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Joined: Fri Sep 14, 2018 4:28 pm
Posts: 7
PAP Mask: Amara View
PAP Machine: Dreamstation CPAP Pro
Humidifier: Dreamstation CPAP Pro
Pressure Setting: Currently on Auto-Trial, Pressure 12-16, C-flex 1.

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Thanks Diamaunt! I know, as you can see from my experience from my original sleep study, I'm pretty sure I was vastly under-diagnosed. I needed an auto from the start, but ignorantly I accepted my fixed machine, and I don't think there is much I can do. I am currently experimenting with the "auto-trial" mode on my cpap pro dreamstation. I am already noticing I can get along most of the night with even an 11...but those REM times look like it takes a 15 or so to stop the events. It's very frustrating...and 13 all night makes me so bloated and it takes an almost 4 hours to start feeling better from the gas in the morning :( Just the one day on the auto mode I am dealing with the gas SIGNIFICANTLY better.


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Pugsy
Unread post  Post subject: Re: What on earth is this??  |  Posted: Sat Sep 15, 2018 6:09 am
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Joined: Wed Aug 02, 2017 8:01 pm
Posts: 832
PAP Mask: ResMed AirFit P10 or DreamWear Gel nasal pillows
PAP Machine: ResMed AirSense 10 AutoSet for Her
Humidifier: ResMed AirSense 10
Pressure Setting: Depends on the machine as I actually have more than one

Online
My OSA is documented about 5 times worse in REM than in non REM sleep stage. It's quite common and also quite common to need more pressure during REM and sometimes a lot more. I found that I sometimes need 6 to 8 cm more pressure during probable REM times.
Fortunately higher pressures briefly during those times haven't caused aerophagia issues.

You aren't going to be very happy when you have to go to fixed pressures all the time.
I think you would make an excellent case for a full time auto adjusting machine and maybe even a bilevel pressure machine that is auto adjusting.
The Flex exhale relief available on the Respironics machines even at the most will only drop the pressure 2 cm and that's only if you breathe forcefully. The most it can ever do is a 2 cm drop.

I suggest that you contact your doctor and present your case....the need for higher pressures only during REM and the fact that you are having significant aerophagia issues even with the sometimes higher pressures in auto trial mode.

And if I may make a brand suggestion...push for a ResMed auto adjusting machine...preferably the AirCurve 10 VAuto or at a minimum the AirSense 10 AutoSet. I have use both brands...the ResMed algorithm will stand a better chance of dealing with those REM dependent apnea events at lower pressures. I can't guarantee it for you but for me I found I was able to use 3 cm lower minimum with the ResMed apap than with the Respironics apap. I still see the 6 to 8 cm more pressure needs during REM but the time spent up there is kept to a minimum.
With Respironics I need a 10 cm minimum and with the ResMed I need a 7 cm minimum.
This could be significantly important to someone who has aerophagia issues plus the AutoSet offers a full 3 cm drop during exhale which could possibly greatly improve the aerophagia issues.

Ask your doctor...your DME most likely won't do the change unless the doctor orders it but you can ask them and/or your doctor.
If you don't at least ask the answer is always "no".


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TheGingerDoctor
Unread post  Post subject: Re: What on earth is this??  |  Posted: Sat Sep 15, 2018 7:10 am
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Joined: Fri Sep 14, 2018 4:28 pm
Posts: 7
PAP Mask: Amara View
PAP Machine: Dreamstation CPAP Pro
Humidifier: Dreamstation CPAP Pro
Pressure Setting: Currently on Auto-Trial, Pressure 12-16, C-flex 1.

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Pugsy, this is awesome information, thank you! Glad to know my situation could be considered somewhat "normal."

I've posted below my last night sleep on the "auto trial." It's useful for information, but doesn't as smart as an actual auto machine. I really have suspected I need some sort of auto situation. This is what i've noticed between my two experiences:

Fixed at 13: Isolated big clusters of events at about 1 hour and at about 3 hours after going to sleep. The rest of the night is generally ok with few to no events. Result is usually AHI 7-9. Serious discomfort from aerophagia lasting for a 3-4 hours after waking. I feel pretty great and "rested" without any brain fog as soon as I wake up (usually around 6am for work) and throughout the day, but by 3-4pm in the afternoon I am tired and want to go to bed immediately after work.

"Auto-Trial" 11-16: No Isolated big clusters of events at anywhere in the night (the pressure is jumping up at 1 hour to 3 hours of course), but only a few tiny events throughout. Result is usually around AHI 3. Almost no discomfort from aerophagia that lasts only 20 minutes or so after waking. I don't feel as good in the morning, or fully "rested," which is unfortunate, but I have little brain fog and I can stay pretty well awake till 9 or 10 at night.

I guess I am choosing my battles between that good rested feeling vs. how long I can stay awake. My DME only hands out Dreamstations...it really stinks that I would have to spend money on an entirely new machine when I am so poor as is, haha....

Do you think that I will get a better waking "feeling" with an actual Auto machine over my regular CPAP imitating it on "Auto-Trial" mode? It seems this mode is quite jumpy and jarring, and not as intelligent as an actual APAP...

Thanks again for all you guy's help!
Attachment:
Current Situation.jpg
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Pugsy
Unread post  Post subject: Re: What on earth is this??  |  Posted: Sat Sep 15, 2018 2:39 pm
User avatar

Joined: Wed Aug 02, 2017 8:01 pm
Posts: 832
PAP Mask: ResMed AirFit P10 or DreamWear Gel nasal pillows
PAP Machine: ResMed AirSense 10 AutoSet for Her
Humidifier: ResMed AirSense 10
Pressure Setting: Depends on the machine as I actually have more than one

Online
Auto trial is does what a full time auto does. Exactly the same but you have a limited time frame for which to use it. It's not a scaled down version of the real thing except for the 30 days time limit (which BTW I think we can get more 30 days available but it would mean having to erase all past therapy data to do it).

It looks jumpy due to the scale of the graph but instead if you were to zoom in on things you would see that any changes take place over several minutes.


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TheGingerDoctor
Unread post  Post subject: Re: What on earth is this??  |  Posted: Sun Sep 16, 2018 8:31 am
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Joined: Fri Sep 14, 2018 4:28 pm
Posts: 7
PAP Mask: Amara View
PAP Machine: Dreamstation CPAP Pro
Humidifier: Dreamstation CPAP Pro
Pressure Setting: Currently on Auto-Trial, Pressure 12-16, C-flex 1.

Offline
Thank you Pugsy for the advice. I'm thinking I might need to talk to a doctor again, cause i'm not quite sure whats going on. Even the auto is becoming quite inconsistent. I've placed an image from last night, which is my lowest AHI I've ever had since being on therapy. However, I feel absolutely terrible today, almost like I did when I wasn't even on therapy. You can see it is drastically different from the previous night. I guess AHI isn't necessary always everthing!

Thanks for all the wisdom! I really appreciate you all.

Attachment:
Terrible Night on Auto.jpg
Terrible Night on Auto.jpg [ 1003.98 KiB | Viewed 389 times ]


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diamaunt
Unread post  Post subject: Re: What on earth is this??  |  Posted: Sun Sep 16, 2018 2:42 pm
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Joined: Wed Mar 02, 2016 2:26 am
Posts: 2010
Location: Dallas(ish)
PAP Mask: Resmed P10
PAP Machine: Resmed S9 vpap auto
Pressure Setting: 18/13-25/19

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Please hit F9 and f10 to turn off the useless right sidebar and calendar.

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