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JPop
Unread post  Post subject: Split Study, below threshold  |  Posted: Thu Mar 25, 2021 11:45 pm

Joined: Wed Nov 11, 2020 2:46 pm
Posts: 6
Location: North Coast, Ohio
PAP Mask: Dreamwear gel pillows, Resmed F30i
PAP Machine: Philips DreamStation, Dreamstation Go
Humidifier: Dreamstation and Dreamstation Go Humidifiers
Pressure Setting: Auto Setting, 7-10 cmH2O

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After 2 years of successful CPAP therapy, elimination of lifelong migraine headaches (59 years old), and consistent use of my CPAP machine, my split night study revealed that I never reached the threshold of 5 events per hour to conduct the second half of the test with a mask. I'm a bit miffed as over the last few months I've seen a return of some of the headaches, the Doctors have reduced my pressure twice, initially set at 12-15cm-H2O for a year, reduced to 10-15cm-H2O, and finally 5-13cm-H2O. Ahead of the last pressure change, I experienced O2 Saturation averaging below 88% and as low as 82%. In a subsequent blood test, I was also flagged for having high CO2 levels in my blood.

Some additional details as a result of using CPAP, I have lost 75lbs and now have a body fat percentage of 19%. I no longer have high blood pressure and I am no longer on any prescription medications. The initial follow-up visit revealed that I had a structural issue with my nose and led to surgery to repair a nasal turbinate and a caudal septum replacement for roughly the lower third of my nose using harvested rib cartilage. Took the better part of a year to heal completely, and nothing but positive results.

Enter my confusion as I believed my 5-13cm-H2O setting was too low and I had some better results when I moved things to 7-10cm-H2O. Now after being all wired up for my sleep study at the offsite hotel the hospital uses and I don't even move the needle enough to need therapy? The two subsequent nights at home I slept without a mask, restful sleep, and no morning migraine. Just can't imagine that all this just resolved itself.

Thanks in advance for your response.


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Respirator99
Unread post  Post subject: Re: Split Study, below threshold  |  Posted: Fri Mar 26, 2021 1:03 am
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Joined: Mon Apr 27, 2020 1:06 am
Posts: 200
Location: Australia
PAP Mask: Resmed Airtouch F20
PAP Machine: Resmed S9 VPAP Adapt
Humidifier: Resmed H5i
Pressure Setting: Min EPAP: 8.0 Max EPAP: 11.0 PS Min: 3.0 PS Max: 8.0

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G'day JPop

You've lost a huge amount of weight (congratulations!) and had surgery done so I guess it's possible that the physical issues causing your apnea have been resolved. I don't think t's common, but it has been known to happen.

Are you using Oscar to monitor your CPAP therapy? If so, why not post some daily charts here and we can maybe offer some more detailed advice. If you're not using it you probably should. The links in my signature below show how to install Oscar and format your charts for the forum.

_________________
Regards from Australia

* Download Oscar
* Oscar help
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JPop
Unread post  Post subject: Re: Split Study, below threshold  |  Posted: Fri Mar 26, 2021 12:22 pm

Joined: Wed Nov 11, 2020 2:46 pm
Posts: 6
Location: North Coast, Ohio
PAP Mask: Dreamwear gel pillows, Resmed F30i
PAP Machine: Philips DreamStation, Dreamstation Go
Humidifier: Dreamstation and Dreamstation Go Humidifiers
Pressure Setting: Auto Setting, 7-10 cmH2O

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Thanks 99! I do use Oscar although I feel like I've been chasing a bit.

Here's a look at a recent day pretty close to the norm.

Image

Thanks again for the help and let me know if I need to adjust anything on the Oscar data.


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JPop
Unread post  Post subject: Re: Split Study, below threshold  |  Posted: Mon Mar 29, 2021 8:54 am

Joined: Wed Nov 11, 2020 2:46 pm
Posts: 6
Location: North Coast, Ohio
PAP Mask: Dreamwear gel pillows, Resmed F30i
PAP Machine: Philips DreamStation, Dreamstation Go
Humidifier: Dreamstation and Dreamstation Go Humidifiers
Pressure Setting: Auto Setting, 7-10 cmH2O

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Here is the results of my Sleep Study.


SLEEP ARCHITECTURE:
The study started at 22:39:32 and ended at 05:13:51. Total sleep time (TST)
was 304 minutes resulting in a sleep efficiency of 79.9% (total recording
time (TRT) = 380 m). There were 13 awakenings with a total time awake after
sleep onset of 49.0 minutes. The sleep latency was 24.5 minutes and the REM
latency was 93 minutes. The patient spent 15.8% of sleep time in the supine
position. The sleep stage percentages were 10.7% stage N1, 78.3% stage N2,
0.3% stage N3 and 10.7% REM sleep. There were 57 arousals, resulting in an
arousal index of 11.3. There were 70 stage shifts.

RESPIRATORY DATA:
Snoring was noted. There were 20 respiratory events consisting of 20
hypopneas. The apnea-hypopnea index (AHI) was 3.9 and the central-apnea index
(CAI) was 0.0. The respiratory disturbance index (RDI) was 3.9. The mean
oxygen saturation during the study was 93.0%, with a minimum oxygen
saturation of 88.0%. The patient spent 0.1% (0.3 min) of sleep time with an
oxygen saturation below 90% and 0.0% (0.1 min) of sleep time with an oxygen
saturation at or below 88%. The wake supine end-tidal CO2 (ETCO2) value was ~
43 mmHg. The maximum ETCO2 was 57 mmHg. The patient spent 5.0% of sleep time
with an ETCO2 above 50 mmHg. The wake supine transcutaneous pCO2 (TcpCO2)
value was ~ 44 mmHg. The maximum TcpCO2 during sleep was 57 mmHg. The patient
spent 5.0% of sleep time with a TcpCO2 above 50 mmHg. Cheyne-Stokes/Periodic
Breathing was not present. Supplemental oxygen was not administered.

REM-Time REM AHI NREM-Time NREM AHI Total-Time Total RDI Total AHI
Supine 0.0 m 0.0 48.0 m 15.0 48.0 m 15.0 15.0
Off-Supine 32.5 m 11.1 223.5 m 0.5 256.0 m 1.9 1.9
Total 32.5 m 11.1 271.5 m 3.1 304.0 m 3.9 3.9


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DeltaBravo3.8
Unread post  Post subject: Re: Split Study, below threshold  |  Posted: Mon Mar 29, 2021 4:38 pm
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Joined: Sat Jul 04, 2020 8:38 am
Posts: 589
Location: Waynesboro, Pennsylvania, USA
PAP Mask: F&P Vitera & Simplus, ResMed F20 N/P30i & old Amara View
PAP Machine: Required to start over on ResMed AirSense 10 AutoSet.
Humidifier: HumidAir and Heated hose
Pressure Setting: Auto PAP 7-14, EPR full time 3

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I don't know how much this helps, but in 2015 I was diagnosed with severe Apnea via a lab diagnostic. I tried a CPAP and failed compliance. In '16 I did a bariatric surgical procedure called bariatric sleeve. I netted a loss of about 75 pounds. In early 2017 I still had Apnea troubles so a new lab diagnostic showed an AHI of about 37, about half of the one in '15. But I still need PAP. I'm fact I need specialized therapy due to Asthma and pre-existing Centrals. Sometimes, but not always, weight loss can remove PAP nessessity.

_________________
Duct tape carrying K9; the tape helps quiet stupid.
Dave K9DWB 73s


https://www.sleepfiles.com/OSCAR
http://www.apneaboard.com/wiki/index.php/OSCAR_Help
http://www.apneaboard.com/wiki/index.php/OSCAR_Chart_Organization


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JPop
Unread post  Post subject: Re: Split Study, below threshold  |  Posted: Tue Mar 30, 2021 11:12 am

Joined: Wed Nov 11, 2020 2:46 pm
Posts: 6
Location: North Coast, Ohio
PAP Mask: Dreamwear gel pillows, Resmed F30i
PAP Machine: Philips DreamStation, Dreamstation Go
Humidifier: Dreamstation and Dreamstation Go Humidifiers
Pressure Setting: Auto Setting, 7-10 cmH2O

Offline
Thanks for the reply. Any information helps as on so many levels I believe I am getting better control of my health, while at the same time it just seems to be dusting off the debris of what the underlying issues are.

One week in since the sleep study, I've had 4 mornings with migraines and 3 evenings where I woke up overheated without CPAP. I'm guessing the overheating is due to shallow breathing and low O2 saturation or high CO2. While neither of the issues were absent with CPAP therapy, they weren't at the same frequency.

Tonight I am going to try going back on CPAP, work on dialing in my pressure and reduce the auto range. The auto increase in pressure always leads to leaks, or perhaps the leaks are the cause of an auto increase in pressure. Either way it's problematic and once I get close I'm going to abandon the auto.

Thanks in advance for any further information, it's appreciated.

Oh, and the last thing is I have a follow up appointment in 6 weeks. My Doctor is the current director of sleep disorder research at Cleveland Clinic, focused on the relationship between sleep disordered breathing and abnormal cardiac electrophysiology as well as cardiovascular disease. She was the only Doctor I could find that seemed to be able to take a 30,000 foot view of my issues. To every hammer the problem is a nail, and with the things that have been improved, I just felt I was in need of a Doctor who wasn't handcuffed by a single discipline.


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