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hemst101
Unread post  Post subject: Do I need CPAP?  |  Posted: Mon Nov 01, 2021 4:31 pm

Joined: Mon Nov 01, 2021 1:18 pm
Posts: 3

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New on this board. I am a 77 year old male. I requested a sleep study because I was kicking and punching during my sleep. A couple of times
I fell out on bed.(2X it felt as though I had levitated right off the mattress). This behavour (kicking, punching) would happen intermittently.
Sometimes months apart.
The results of the study are below.

Sleep Report
EEG
The total recording time of the polysomnogram was 512 minutes and the total sleep time was 419 minutes.
The sleep onset latency was less than 1 minute.
The proportion of REM sleep was 18% with a REM onset latency of 83 minutes.
The proportion of slow wave sleep was less than 1%
The spontaneous arousal index was unremarkable at 7 events per hour.

RESPIRATORY ANALYSIS
He slept in both the supine (42%) and lateral (58%) positions.
He demonstrated severe positional OSA that was mild in the lateral position.
He demonstrated airflow limitation consistent with an upper airway resistance syndrome.
The supine AHI was 84 events/hour.
The lateral AHI was 7 events/hour.
The apnea-hypopnea index was 39 events/hour.
The REM AHI was 17 events/hour.
Lateral REM sleep was seen.
There was no evidence of clinically significant central sleep apnea or hypoventilation.
Mean SPO2 was 93% with a nadir of 85%

OTHER ANALYSIS
Cardiac: Normal sinus rhythm. Heart rate of 51 bpm..
Movements: Periodic Leg Movement Index moderately elevated at 23 events/hour with no associated arousals.
Behaviours: No abnormal behaviors were seen.
: Some evidence of REM without atonia
:No witnessed dream enactment behavior.

I am presently in a 30 day trail period with a company that supplies equipment and a lifetime support for sleep apnea.
I have one more week left in the trial. I am using a ResMed ACAP and a nasal pillow mask with a chin strap.
My left nostril is constricted (~50%). RIght nostril is fine. Presently working out the bugs of the CPAP equipment.

Things I have noticed since I started the treatment.
I have had a neuropathy(?) in both my feet and up my medial shins for at least 10 years. Doctors have ignored my
complaints about this. Since starting CPAP this seems to be getting better. I have been checked for diabetes.
I get up only once per night to go to the bathroom (was 2 or 3)
I breathe easier with the CPAP machine. I never have the feeling that I'm suffocating at bit (would wake me up).
I can sleep on my back without snoring. (increases my AHI but not much)
I gained 4 pounds. (my BMI is 25)
Less irritable
Feeling better rested /more energy.

The problem is that I changed my sleeping habits when I started the study. I go to sleep earlier and at the same time each night.
I never read or use my ipad after I pack it in to go to sleep. So what is causing these improvements?

Also, I realize that the company has a stake in whether I continue with them after the trial period. I specifically asked whether I needed
to use CPAP for my symptoms. The representative ensured me that I did (specifically referencing the REM AHI of 17 events/hour.)

Positional therapy is possible, but I have a fairly prominent overbite with narrow upper pallet and uneven teeth. I can lie laterally but
I need to change position because of leg or hip discomfort. I discovered I like the supine position.

The question is - do I really need CPAP? It seems I am a borderline candidate.

I have OSCAR and have been learning the program


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Pugsy
Unread post  Post subject: Re: Do I need CPAP?  |  Posted: Mon Nov 01, 2021 6:37 pm
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Joined: Wed Aug 02, 2017 8:01 pm
Posts: 2496
PAP Mask: Bleep/DreamPort nasal mask
PAP Machine: ResMed AirCurve 10 VAuto

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You are not borderline unless you can totally stay on your side.
That is much easier said than done.

_________________
I may have to rise but I refuse to shine.


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Respirator99
Unread post  Post subject: Re: Do I need CPAP?  |  Posted: Mon Nov 01, 2021 7:34 pm
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Joined: Mon Apr 27, 2020 1:06 am
Posts: 399
Location: Australia
PAP Mask: Resmed Airtouch F20
PAP Machine: Resmed AirCurve 10 CS Pacewave ASV
Pressure Setting: Min EPAP: 8.0 Max EPAP: 11.0 PS Min: 3.0 PS Max: 8.0

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G'day hemst101, welcome to the forum.

What makes you think you don't need CPAP? Although your lateral sleeping AHI is relatively low, every other indicator shows you have severe apnea. In addition, you tell us that you can't sleep on your side for any length of time, which means we need to use the supine AHI as the baseline - and that was 84! In other words, you're getting strangled every 42 seconds the whole time you're on your back.

You've also told us that you're doing better with the machine, better rested with more energy, and breathing easier. You sound like a classic CPAP success story: the machine is doing its job - why would you want to give it up?

_________________
Regards from Australia

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hemst101
Unread post  Post subject: Re: Do I need CPAP?  |  Posted: Sat Nov 27, 2021 6:26 pm

Joined: Mon Nov 01, 2021 1:18 pm
Posts: 3

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Since there seems to be some interest in this posting here is an update to the Nov 1 post.

Thanks for the feedback Pugsy and Respirator99.

After posting the above, I continued with APAP and a nasel pillow mask until just over my 3rd week of the trial period. I then had to wait 2 weeks without APAP so that I could trial a Airfit F30i mask. During the these two weeks I decided to get more data on my apnea. To this end, I purchased a Wellue Ring O2 oximeter. What this oximeter showed was that my O2 saturation spent the vast majority of the time in the 90 to 98% range. My O2 score was 9.2 to 9.9 out of 10. After I got the F30i mask, I got 2 data points with APAP (O2 score 9.7;9.8). What this indicated to me was, while APAP did improve my O2 saturation, it did not make enough of a difference to justify the inconvenience ,disruption and cost of the APAP treatment.

During the two weeks I also managed to get a phone consultation with a sleep specialist. I had spent him my polysomnograph report, Oscar data and Wellue data. He did not see the raw data from the polysomnogram or the polysomnopgraph. (because of the stupid beaurocratic BC, Canada data sharing system). He did not access the Oscar data. Based on this, the decision was made to go with positional therapy. I will get another polysomnogram in about 6 months at his clinic and monitor myself with the Wellue Oximeter. He wants to determine more about my possible REM Sleep Behaviour Disorder

As of now, I am using the Wellue Oximeter to monitor my sleep. The device is worn on a finger and has a feature that the ring will vibrate if you fall below a preset O2 and wake you up. I seem to have solved the problem of lying laterally. I put a stiff pillow against my chest and lie in a slightly prone position. This has worked well for the past two nights. My O2 has not fallen below 90% (vibration setting 89%).

For information on wellue Ring O2 see this video. https://www.youtube.com/watch?v=N8FMw3CeDN0. It is a bit pricey ($160 US). You can get discount coupons depending where you buy it. I've seen as high as 20%. Video offers 10%. I consider it a great little device.


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Respirator99
Unread post  Post subject: Re: Do I need CPAP?  |  Posted: Sat Nov 27, 2021 7:33 pm
User avatar

Joined: Mon Apr 27, 2020 1:06 am
Posts: 399
Location: Australia
PAP Mask: Resmed Airtouch F20
PAP Machine: Resmed AirCurve 10 CS Pacewave ASV
Pressure Setting: Min EPAP: 8.0 Max EPAP: 11.0 PS Min: 3.0 PS Max: 8.0

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Welcome back hemst101. It's good to hear that you're getting on top of your sleep problems. However there were a few things in your post that I want to comment on:

Quote:
I then had to wait 2 weeks without APAP so that I could trial a Airfit F30i mask.

Why? Why couldn't you keep going with the mask you had?

Quote:
He did not access the Oscar data.

Disappointing but not unexpected. Did he look at any other data apart from oxygen saturation? For some reason a lot of doctors seem dismissive of detailed data - or perhaps they don't know how to interpret it. In any case, it seems he has nothing in regard to the way your machine is working, so to some extent he's just guessing.

Quote:
What this oximeter showed was that my O2 saturation spent the vast majority of the time in the 90 to 98% range. My O2 score was 9.2 to 9.9 out of 10.

O2 saturation is not the only factor that needs to be considered. It's important but (in my view) other things are more important, such as the number of arousals you have due to apnea. There is a whole sequence of events that occur during and immediately after an apnea; not the least being the shot of adrenalin your body receives every time. This can have deleterious effects on your heart and lead to symptoms such as arrhythmia. (I know from experience).

Quote:
I seem to have solved the problem of lying laterally. I put a stiff pillow against my chest and lie in a slightly prone position.

Great! If you can keep that up, it should improve your symptoms. However in your first post you said: "I can lie laterally but I need to change position because of leg or hip discomfort". So my question is - does this pillow technique avoid the leg and hip pain?

_________________
Regards from Australia

* Download Oscar
* Oscar help
* Organise your Oscar charts


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hemst101
Unread post  Post subject: Re: Do I need CPAP?  |  Posted: Sun Nov 28, 2021 5:15 pm

Joined: Mon Nov 01, 2021 1:18 pm
Posts: 3

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Question 1.
I had a 1 month trial period. I had problems with the nasal pillow mask - "chipmunk cheeks" and the air going straight through my nose and out my mouth. As mentioned, I have a fairly large overbite so it is difficult to keep an oral seal even with a chin strap. With about a week left in the trial, I decided to try the Airlift F30i which is a modified full face mask. However, there was a problem fitting me and the apnea outfit I was using (RHS -Respiratory Home Services) had to wait 2 weeks to get the proper sized mask. I used the pillow mask until the trial was finished, returned the equipement and waited for the new mask. They were going to charge me $100 for a new trial, but I made a deal with them to let me use the new mask for a week, since I had requested the F30i just as my 3rd week of trial began. The F30i was a better mask as it solved the aforementioned problems, but I still determined I did not want to continue with APAP. The ~ 2 week period gave me a chance to investigate alternatives (Wellue) and set up a consult. Short answer - the trial included 2 masks.

Question 2

I sent the specialist doctor (who runs a sleep clinic) the ResMed Data, 3 Wellue reports I had available (one using APAP, two without APAP), short history, RHS home apnea test (done 2 years ago) and a rather comprehensive questionaire from his sleep clinic. He had the polysomnogram report from the hospital but no raw data or polysomnogram chart. This was a fairly brief consult (20 minutes or so). I described to him my dissatifaction with the APAP, brought to his attention the Wellue reports, discussed RSBD and a possible polysomnogram in the next few days. As expected, he was not as well versed as I was re the report. I had to remind him of my REM without atonia for example. It was decided that I try positional therapy. We put off the polysomnogram until spring next year. He wants to see the atonia. I am going to try to get through the beauocratic bullshit (I was a X-RAY Tech for the same hospital region so know the patient can get their data.) and send the data to him ( he does not have privileges at the local hospital).

Question 3

Yes I understand this. However, I have not been woken up yet by the O2 ring and my O2 has not fallen below 91%. So this is just a process to see how I do. My 3% and 4% ODI are well under 5/hr Sometimes under 1/hr

Question 4

I can lie with the pillow against my chest and my hips rotated with my left leg bent and against the bed. This means I am not lying right on my hip and creating a pressure point. Seems to work for me.


Attachments:
File comment: LH report without APAP
RH report with APAP

Wellue.JPG
Wellue.JPG [ 1.71 MiB | Viewed 970 times ]
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