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ghiro
Unread post  Post subject: Undiagnosed sleep apnea  |  Posted: Sun Nov 26, 2017 11:09 pm

Joined: Fri Nov 24, 2017 1:07 pm
Posts: 10

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My family doc recommended me to use a cpap. Years ago i have been testedbut I was not able to sleep. Now i have decided to spend my money in apap (ResMed Air 10) And mask (ResMed AirFit F20 because my nose at night is congested) rather then spending thousands ina sleep study.
I am 6’1” and i weight 249. I am 53, and i have been taken hbp med for 10 yes (losartan 100). I have been feeling tired in the morning for a long time. In the next couple of days i will try my apap.My thinking behind my purchase is that if i have sleep apnea i should be able to find out looking at cpap data and how i do feel.
I have insurance but i need to spend the first $6000 before receiving assistence that why i decided to be on my own.
Is there anyone that based on my situation can advice me?


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Daniel Gagner
Unread post  Post subject: Re: Undiagnosed sleep apnea  |  Posted: Mon Nov 27, 2017 4:44 am
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Joined: Thu Aug 17, 2017 4:23 pm
Posts: 57
Location: Maine
PAP Mask: Respironics Dreamwear nasal
PAP Machine: Respironics Dreamstation 500
Humidifier: respironics
Pressure Setting: 9=13

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I had a sleep study long ago before apnea was a thing. Recently I decided to get an apap machine for myself. I ordered it on Amazon, a phillips dreamstation. I am a nose breather so I have their nasal dreamwear mask. Some people are mouth breathers. I'm not sure I could use a full mask. I'm not claustrophobic but it doesn't sound fun to me. So far the unit has been good. I started out with apap settings of 5 and 12 and I got an AHI of 19. If you're new to this, that's a number that indicates how many obstructive events you're having per hour. I know years ago, my sleep study showed I was having up to 60 per hour. Since then I've experimented and adusted my settings to about 9 and 13. My AHI has dropped to under 2 events per hour and sometimes under 1.

The initial settings that I guessed on sort of let me make a rudimentary sleep study on my own to get a baseline to work off from. Using the sleepyhead software I was able to put the SD card from the machine into my computer each day and look at the graphs to see what was going on each night. It takes a little study, and people here and on other boards can help you if you let them see some of your data. It is doable and sort of fun in a way. The results are worth it in the end if you get it going right.

This forum and one called apnea board have some great people on them. Good luck.


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Pugsy
Unread post  Post subject: Re: Undiagnosed sleep apnea  |  Posted: Mon Nov 27, 2017 5:25 am
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Joined: Wed Aug 02, 2017 8:01 pm
Posts: 760
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

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We can get you pointed in the right direction.
Are you using a heated hose or regular non heated hose?


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Allessio77
Unread post  Post subject: Re: Undiagnosed sleep apnea  |  Posted: Mon Nov 27, 2017 6:42 am
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Joined: Thu Nov 02, 2017 8:04 am
Posts: 40
Location: Cottonwood, AZ
PAP Mask: Quattro Air and Airtouch F20
PAP Machine: ResMed Airsense 10 Auto
Pressure Setting: 7-11

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Pugsy wrote:
We can get you pointed in the right direction.
Are you using a heated hose or regular non heated hose?


I would like to know the issues surrounding hoses....I have to pick up my machine this week!


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Pugsy
Unread post  Post subject: Re: Undiagnosed sleep apnea  |  Posted: Mon Nov 27, 2017 7:28 am
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Joined: Wed Aug 02, 2017 8:01 pm
Posts: 760
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

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Allessio77 wrote:

I would like to know the issues surrounding hoses....I have to pick up my machine this week!


It helps to know which hose is being used when it comes to advice about humidity settings. That's one of the reasons I ask about which kind of hose is being used.

Heated hoses have long been thought to have only one goal....prevent condensation in the mask or hose but they really have other fairly important functions as well.
For me not only condensation prevention but better more constant humidity delivery (along with more customization available in humidity) and comfort in terms of hose air temperature being delivered to my nose.

My nose like nice consistent humidity and doesn't like it when I go changing from what it prefers and if your nose is unhappy with the humidity it is getting it will let you know with some rather unpleasant allergy like symptoms.
I also keep my house/bedroom rather cool in the winter and my nose doesn't like the air temp when its really cool. I would get what I call ice cube nose syndrome in the winter. The cold air simply would cause me to wake up because it hurt or was just uncomfortable.
Now granted the 84 degrees hose temp I use in the winter works well and feels good in the winter but doesn't feel so good in the summer so I just turn back the hose temp in the summer to pretty much no added heat but by using the heated hose I don't have to give up the humidity that my nose likes to get the cooler air temps.

If you don't use a heated hose any warmth you might or might not want is going to have to be from the humidifier heating the water and maybe the air some. It's hit or miss in terms of hose air temp and if you like cooler air then you won't be getting much moisture when you just rely on heating the water chamber. Ambient room temp and humidity ends up being more of a factor when a heated hose isn't used.

My suggestion...get a heated hose and the temp can easily be adjusted one way or the other for comfort and the humidity delivered is going to be more constant whether it be a lot or a little. It's more versatile.

As to why I asked here...mainly to get an idea where to advise someone to start with the settings to have a greater chance of being comfortable with whatever they are using. What I would suggest for someone using a heated hose isn't going to be the same as what I would suggest for someone not using a heated hose.


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Allessio77
Unread post  Post subject: Re: Undiagnosed sleep apnea  |  Posted: Mon Nov 27, 2017 8:40 am
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Joined: Thu Nov 02, 2017 8:04 am
Posts: 40
Location: Cottonwood, AZ
PAP Mask: Quattro Air and Airtouch F20
PAP Machine: ResMed Airsense 10 Auto
Pressure Setting: 7-11

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Thanks for the illuminating explanation.

Since I live in AZ with little humidity...you are suggesting that a heated hose is preferable. (I get a 'ice cube nose' also...it does get cold in the winter).

Does Medicare cover this when I first get my machine, or do I have to buy it?


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ghiro
Unread post  Post subject: Re: Undiagnosed sleep apnea  |  Posted: Mon Nov 27, 2017 9:18 am

Joined: Fri Nov 24, 2017 1:07 pm
Posts: 10

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I have both


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Pugsy
Unread post  Post subject: Re: Undiagnosed sleep apnea  |  Posted: Mon Nov 27, 2017 10:07 am
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Joined: Wed Aug 02, 2017 8:01 pm
Posts: 760
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

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Allessio77 wrote:
Does Medicare cover this when I first get my machine, or do I have to buy it?


Medicare will pay for it either when you first get the machine (its and either or type of thing at the beginning) or when the allowance time frame is up for a new hose which is 3 months.
Machines are typically boxed up 2 ways...one with the heated hose and one with a slimline non heated hose. So a lot depends on which boxed up version the DME stocks. BTW the heated hose is also a slimline hose. Slimline refers to the diameter of the hose.

Heated hoses typically cost a little more than the non heated hoses but aren't horribly expensive if a person elects to just order one online and skip insurance entirely. So not the end of the world to want a heated hose and only have the non heated version. There are ways to make the non heated version work quite satisfactorily....heck, we did it for years and years before integrated heated hoses were the norm. I think it is just a little easier and simpler to get there with a heated hose but you can still get there with a non heated hose.

Medicare replacement schedule in case anyone is wonder about time frame or HCPCS billing codes.
Image


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Pugsy
Unread post  Post subject: Re: Undiagnosed sleep apnea  |  Posted: Mon Nov 27, 2017 10:30 am
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Joined: Wed Aug 02, 2017 8:01 pm
Posts: 760
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

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ghiro wrote:
Is there anyone that based on my situation can advice me?


Several forum members here who can probably get you started doing the DIY thing with your mask and your equipment.
It's not all that difficult unless you run into something unusual and if you do cross that bridge if/when you come to it.
Doing it yourself is fairly simple for the majority of people with OSA with some education about what you are doing and why.

Where do you live? That will help decide if you want to start with a heated hose or not.
Or just use the heated hose and make the hose and hose air temp setting to "auto" and let the machine sort it out.
It works for the bulk of the people who use this machine...start there and then make adjustments if needed.

The provider/clinical manual in case you didn't get it.
https://sleep.tnet.com/home/files/resme ... -guide.pdf

Get SleepyHead software so you can evaluate your therapy in better detail than can be done by using the data available on the LCD screen.
https://sleep.tnet.com/equipment

For settings...2 choices that I would suggest.
Either minimum of 6 with max of 10 or minimum of 6 with max of 20.
Only reason to limit the maximum pressure might be just to limit the chances of the variations in pressure going a bit wild and disturbing your sleep. Some people can sleep through some big changes and it not disturb sleep and others can't.
The machine won't go anywhere without a good reason in its little mind.

For exhale relief (called EPR on your machine) I would suggest trying all the settings including off and see which one simply feels the best no matter what the number is and start with what feels the best.


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ghiro
Unread post  Post subject: Re: Undiagnosed sleep apnea  |  Posted: Thu Nov 30, 2017 4:53 pm

Joined: Fri Nov 24, 2017 1:07 pm
Posts: 10

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Thank you so much Pugsy! I have used sleepyhead and it recommends to seek help from a doctor since my ahi is over 10. Since I started using the cpap this week I will wait and see if these data are consistent. But even if I go to a doctor what can he do? :o


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Pugsy
Unread post  Post subject: Re: Undiagnosed sleep apnea  |  Posted: Thu Nov 30, 2017 5:21 pm
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Joined: Wed Aug 02, 2017 8:01 pm
Posts: 760
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

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It might be something as simple as a pressure change to get your AHI down to a more acceptable level.
We were just guessing as to what to start with in terms of pressure.
It's rare that we guess totally right the first time....but you gotta start somewhere.

Your AHI of 10....what is it composed of?
How much in each event category?
Can you share an image of the detailed SleepyHead report so we can see what you are seeing?


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ghiro
Unread post  Post subject: Re: Undiagnosed sleep apnea  |  Posted: Thu Nov 30, 2017 5:39 pm

Joined: Fri Nov 24, 2017 1:07 pm
Posts: 10

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AHIApnea Hypopnea Index 10.50
ResMed AirSense 10
AutoSetModel 37028 - 23172177555
PAP Mode: APAP
Min 4 Max 16 (cmH2O)
Date Sleep Wake Hours
11/28/2017 23:32:21 05:32:22 06:00:01
Large Leak 6.34%
Clear Airway 3.33
Unclassified Apnea 0.67
Obstructive 3.67
Hypopnea 2.83
RERA 0.50

Event Breakdown

Statistics
Channel Min Med 95% Max
PressureTherapy Pressure (cmH2O)
W-Avg: 9.21 4.12 8.78 13.74 15.68
EPAPExpiratory Pressure (cmH2O)
W-Avg: 6.70 4.02 6.26 10.90 12.68
Minute Vent.Amount of air displaced per minute (L/min)
W-Avg: 8.47 0.00 8.00 13.00 23.12
Resp. RateRate of breaths per minute (Breaths/min)
W-Avg: 14.99 0.00 13.20 26.60 46.40
Flow Limit.Graph showing severity of flow limitations (Severity (0-1))
W-Avg: 0.02 0.00 0.00 0.14 0.75
Leak RateRate of detected mask leakage (L/min)
W-Avg: 5.52 0.00 1.20 32.40 106.80
SnoreGraph displaying snore volume (?)
W-Avg: 0.01 0.00 0.00 0.00 1.36
Insp. TimeTime taken to breathe in (Seconds)
W-Avg: 2.23 0.28 2.10 3.60 19.06
Exp. TimeTime taken to breathe out (Seconds)
W-Avg: 2.15 0.08 2.18 3.38 5.24
Tidal VolumeAmount of air displaced per breath (ml)
W-Avg: 604.46 0.00 600.00 980.00 1900.00

Total time in apnea 00:15:39
Time over leak redline 6.342%
Machine Settings

ModeCPAP Mode APAP
Pressure MinMinimum Therapy Pressure 4.00 cmH2O
Pressure MaxMaximum Therapy Pressure 16.00 cmH2O
Antibacterial FilterAntibacterial Filter Yes
Climate ControlClimate Control Manual
EPRResMed Exhale Pressure Relief Full Time
EPR LevelExhale Pressure Relief Level 3cmH2O
Humidifier StatusHumidifier Enabled Status On
Humidity LevelHumidity Level 4
MaskResMed Mask Setting Full Face
Patient AccessPatient Access Yes
RampRamp Enable Off
Smart StartMachine auto starts by breathing Off
TemperatureClimateLine Temperature 27 ºC
Temperature EnableClimateLine Temperature Enable 2
Session Information



CPAP Sessions
On Date Start End Duration
ResMed Session #1511929941
Click to disable this session. 11/28/2017 23:32:21 05:32:22 06h 00m 01s

The last time you used your ResMed AutoSet...
was yesterday (on Tuesday, November 28, 2017)
You had an AHI of 10.50, which is considered horrible, please consult your doctor
You machine was on for 6 hours, 0 minutes and 1 seconds.
You had significant periods of major mask leakage.
Your pressure was under 13.74cmH2O for 95% of the time.


Last edited by ghiro on Thu Nov 30, 2017 5:43 pm, edited 1 time in total.


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ghiro
Unread post  Post subject: Re: Undiagnosed sleep apnea  |  Posted: Thu Nov 30, 2017 5:41 pm

Joined: Fri Nov 24, 2017 1:07 pm
Posts: 10

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I will try to find a way to share the image. Last night I was not able to use the cpap more than a couple of hours because I tried to tighten the mask because of the leaks and it bother me quite a bit (And I did not sleep). Thanks!


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Pugsy
Unread post  Post subject: Re: Undiagnosed sleep apnea  |  Posted: Thu Nov 30, 2017 8:20 pm
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Joined: Wed Aug 02, 2017 8:01 pm
Posts: 760
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

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No need for the image for me to see what can be done to improve that AHI.

Your minimum pressure is 4 cm so it is starting out as low as it will go and it needs to get to probably around 9 or 10 to have the best chance of doing a better job and it takes too long to get there from the 4 cm starting point.

Try setting the minimum pressure to 6 or 7 instead of the 4 cm and see how it does. You might end up needing a little more but I prefer to increase it slowly as it is usually a bit easier to adjust to.


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ghiro
Unread post  Post subject: Re: Undiagnosed sleep apnea  |  Posted: Thu Nov 30, 2017 8:33 pm

Joined: Fri Nov 24, 2017 1:07 pm
Posts: 10

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OK I will try tonight thanks again!


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ghiro
Unread post  Post subject: Re: Undiagnosed sleep apnea  |  Posted: Mon Dec 04, 2017 11:36 am

Joined: Fri Nov 24, 2017 1:07 pm
Posts: 10

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I expected to feel better, not much has changed, any idea?


AHIApnea Hypopnea Index 15.90
ResMed AirSense 10
AutoSetModel 37028 - 23172177555
PAP Mode: APAP
Min 8 Max 20 (cmH2O)
Date Sleep Wake Hours
12/4/2017 01:18:58 10:28:24 09:07:02
Cheyne Stokes Respiration 5.32%
Large Leak 0.00%
Clear Airway 10.75
Unclassified Apnea 0.00
Obstructive 2.41
Hypopnea 2.74
RERA 0.00

Event Breakdown

Statistics
Channel Min Med 95% Max
PressureTherapy Pressure (cmH2O)
W-Avg: 9.80 4.58 9.86 11.60 12.56
EPAPExpiratory Pressure (cmH2O)
W-Avg: 6.84 4.04 6.88 8.62 9.56
Minute Vent.Amount of air displaced per minute (L/min)
W-Avg: 7.56 0.00 7.12 11.38 21.50
Resp. RateRate of breaths per minute (Breaths/min)
W-Avg: 12.33 0.00 11.60 18.20 46.20
Flow Limit.Graph showing severity of flow limitations (Severity (0-1))
W-Avg: 0.01 0.00 0.00 0.07 0.46
Leak RateRate of detected mask leakage (L/min)
W-Avg: 1.43 0.00 1.20 6.00 14.40
SnoreGraph displaying snore volume (?)
W-Avg: 0.00 0.00 0.00 0.00 0.52
Insp. TimeTime taken to breathe in (Seconds)
W-Avg: 2.50 0.52 2.42 3.74 11.60
Exp. TimeTime taken to breathe out (Seconds)
W-Avg: 2.24 0.06 2.32 3.24 6.28
Tidal VolumeAmount of air displaced per breath (ml)
W-Avg: 619.63 0.00 600.00 940.00 1800.00

Total time in apnea 00:36:00
Time over leak redline 0.000%
Machine Settings

ModeCPAP Mode APAP
Pressure MinMinimum Therapy Pressure 8.00 cmH2O
Pressure MaxMaximum Therapy Pressure 20.00 cmH2O
Antibacterial FilterAntibacterial Filter Yes
Climate ControlClimate Control Manual
EPRResMed Exhale Pressure Relief Full Time
EPR LevelExhale Pressure Relief Level 3cmH2O
Humidifier StatusHumidifier Enabled Status On
Humidity LevelHumidity Level 4
MaskResMed Mask Setting Full Face
Patient AccessPatient Access Yes
RampRamp Enable Off
Smart StartMachine auto starts by breathing Off
TemperatureClimateLine Temperature 27 ºC
Temperature EnableClimateLine Temperature Enable 1
Session Information



CPAP Sessions
On Date Start End Duration
ResMed Session #1512368338
Click to disable this session. 12/4/2017 01:18:58 03:16:59 01h 58m 01s
ResMed Session #1512375563
Click to disable this session. 12/4/2017 03:19:23 10:28:24 07h 09m 01s


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Pugsy
Unread post  Post subject: Re: Undiagnosed sleep apnea  |  Posted: Mon Dec 04, 2017 4:57 pm
User avatar

Joined: Wed Aug 02, 2017 8:01 pm
Posts: 760
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

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Ouch...too many centrals/Clear Airway events.
Did you sleep soundly or were you awake a lot during the night?

You decided to try 8 cm as a minimum...and you are using EPR at 3...both can sometimes actually trigger centrals in a small % of people on cpap therapy.

IF..big IF.... you slept soundly then let's back up a bit.
Try the 6 cm minimum starting pressure and turn EPR off.
See what happens.

If you slept horribly and was awake a lot of the night the we don't know if those centrals are real or are awake breathing getting flagged by mistake.


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ghiro
Unread post  Post subject: Re: Undiagnosed sleep apnea  |  Posted: Wed Dec 06, 2017 8:08 am

Joined: Fri Nov 24, 2017 1:07 pm
Posts: 10

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Thanks Pugsy! I changed the setting as you advised and I am feeling better even though I still have problems sleeping with cpap


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Pugsy
Unread post  Post subject: Re: Undiagnosed sleep apnea  |  Posted: Wed Dec 06, 2017 8:11 am
User avatar

Joined: Wed Aug 02, 2017 8:01 pm
Posts: 760
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

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Still having a lot of wake ups?
If so any idea why? Anything you can put your finger on or just the brain waking you up to tell you that you have an alien stuck on your face.

Or...did you have trouble sleeping and have a lot of wake ups prior to starting cpap therapy?


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ghiro
Unread post  Post subject: Re: Undiagnosed sleep apnea  |  Posted: Wed Dec 06, 2017 10:01 pm

Joined: Fri Nov 24, 2017 1:07 pm
Posts: 10

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Right now I have problems to fall asleep. On average it takes me 2/3 hours. Before using the cpap I used to sleep longer but I had huge difficulties to stay awake during the mornings.
I am still trying to adjust to the use of the cpap.
My focus and retention of information was not very good before. I have not tried to study since I started using the cpap.
So.. now I do not have significant problems in waking up but I have huge problems to fall asleep!


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