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First time CPAP use

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MidnightRider +0 points · 7 months ago Original Poster

I'm in the UK. I had a sleep study just before Christmas and it showed that I wake up over 50 times per hour. Severe sleep apnea was diagnosed and I was told that I would be given a CPAP machine as a matter of urgency. Covid 19 has now hit and the respiratory clinic are devoting 100% of their resources to fighting this. They couldn't even give me an estimate of when I might get my CPAP. Frustrated, I've now bought a machine online from the US with the intention of ploughing ahead myself. (There was a bit of messing around as the CPAP machine came from the USA (2 pin plugs and 120V and I'm in the UK, 3 pin plugs and 240 volts) but finally I've got all the gear and intend to use my CPAP machine for the first time tonight).

So this is what I have: A Philips Respironics DreamStation A nasal pillow mask with cushioning (I researched this online and it may be better than the full face. Time will tell I suppose). All the cabling etc. I've connected everything up, adjusted the fit, checked for leaks and it seems to be doing what it is meant to.

Now the questions:

  1. First off, am I mad to be doing this without the support of a health care practitioner?*
  2. There is all sorts of stuff on the machine that I don't think I need or understand. Humidifier settings, bluetooth settings, pre-heating, recording and data. Do I need to bother with any of these or are they really optional extras?
  3. The pressure is set to 5.0cm H2O. Ramp is set to 4.5cm H2O. I do not know whether these are right and can not work out how to adjust them if they are not right. Should I just see how it goes tonight?

Thank you.

MR

*I've been waiting six months now. I'm abusing alcohol to get to sleep and have put on maybe 20lbs since Christmas. I can't carry on indefinitely like this.

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Sierra +0 points · 7 months ago Sleep Patron

The power adapter should take 240 volts, but you will need a North American to UK plug adapter. Certainly the best way to get into a CPAP is with the help of a practitioner. However, in this COVID situation, I probably would do what you have done. Some thoughts on your questions:

The humidifier is a comfort feature. It certainly helps especially if the air is dry. I do turn on the preheating when I remember to do it, but it is not critical. Again, just a comfort feature. The machine should have a SD card and should record data to it automatically. It is kind of important. There is a free software available called OSCAR that you can download. It requires a PC or a Mac and a SD card reader to get the data to your computer. The software will display many machine readings and what it is doing during the night. It is very helpful in optimizing the settings of the machine. The adjustment can be managed in other ways, but using the software is the best.

My suggestions for initial settings would be 7 cm minimum pressure and 15 cm maximum. If you set the minimum pressure too low, it can feel suffocating. The ramp is optional, and you may want to leave it off until you are more familiar with the machine. Here is a link to a technical manual for the machine. It is kind of difficult to use because the manual covers a few different machines. If you have any questions after looking at the manual, just ask.

Once you have the machine set up, I would try it before going to bed, and while you are watching TV or something. It does take some time to get used to. I would recommend against the alcohol as while it tends to help you get to sleep, you can wake up in the middle of the night and not be able to get back to sleep again.

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MidnightRider +0 points · 7 months ago Original Poster

Thank you. You've been a great help. Using the link you sent me I've got into the Therapy setting and set it to 7 and 15 as you recommend. I've also enabled the humidifier. I've bookmarked the manual for future use.

One final question if I may - is it true that using CPAP means I won't have to go to the toilet 4 times a night? I read somewhere that entering REM sleep stops your bladder filling up. Is this true?

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Sierra +0 points · 7 months ago Sleep Patron

You should download that pdf manual, as you never know when links like that disappear. I certainly have noticed a reduced need to get up in the night. Not sure how the CPAP does it, but it seems to help. I also try to avoid any drinks after dinner, and also try to limit sleep to 7-8 hours -- which means going to bed later, or getting up earlier.

Let us know what you sleep report says, or post the daily report from OSCAR, and it should be possible to refine your settings from that suggested starting point.

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MidnightRider +0 points · 7 months ago Original Poster

This is how the numbers look:

Therapy hours = 6.0 AHI = 40.7 Mask fit = 63% Periodic breathing = 17% 90% pressure = 15.0

Number of times went to toilet during night = zero!

I don't know what this actually means. Could someone please advise me on what the overall story is that these numbers are telling?

In terms of subjective experience: I didn't have any irritation with the mask, although it came off a couple of times as I moved around. I don't think that I removed it deliberately. There were no feelings of discomfort or suffocation. I was in a very deep sleep this morning, with mask on, when my wife woke me up. It took about an hour for me to get out of bed as I was so sleepy - sleepy as in still asleep, not tired from lack of sleep.

Once again, thank you in advance.

MR.

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Sierra +0 points · 7 months ago Sleep Patron

I would interpret the numbers as follows:

Therapy Hours - Time the machine was running. Target would be ideally 7-8 hours a night.

AHI - Total number of central, obstructive, and hypopnea events that lasted 10 seconds or longer. An AHI of 40 is not good. The standard target is to be under 5 for AHI. It would be more revealing to know what the breakdown of events are.

Mask Fit - From that technical manual on page 4-27 it seems to be the % of time you leakage rate is high. 63% seems like too much, and the mask probably needs adjustment. Or, it could mean it was off longer than you thought during the night.

Periodic Breathing - This can be related to central apnea events. 17% seems high

90% Pressure - This means 90% of the time your pressure was at 15 cm or less. This indicates that 15 cm maximum may not be enough.

If you have a PC or Mac and SD card reader I would highly recommend downloading the OSCAR software. It would give you a much better idea what is going on. About all I can suggest based on the basic numbers you have reported is that the maximum pressure may need to be increased to say 18. The information you are missing is the breakdown of the type of events, for example obstructive vs central. I don't see from the manual how to display that, but it must be stored on the SD card. There are two other threads that are quite current an they are with a DreamStation machine. If you look at those threads you will get some idea what information is available with OSCAR.

AHI 16.7 Newly Diagnosed

UARS Suddenly CPAP not Working

If you are unable to use OSCAR, you may want to look into downloading DreamMapper. I think it is pretty basic, and not equivalent to OSCAR, but it may be better than what you have for determining your type of AHI events.

Look at it this way. You got through the first night, and that generally is the worst one. Learning to sleep with the mask and machine on can be the most difficult part.

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MidnightRider +0 points · 7 months ago Original Poster

Thanks. I've just finished my one hour afternoon nap and the numbers were quite different (mask fit 100%, periodic breathing 0, 90% pressure 9,0, AHI 5.4) I think that the mask was off for a lot more than I realised last night. I'll give it a few more days then check back in for further advice.

Thank you once again.

MR

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Sierra +0 points · 7 months ago Sleep Patron

That is the benefit of OSCAR. It will tell you exactly what happened during the sleep. But yes, the mask has to be on for it to help. It also has to be on to get accurate readings.

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KennyAZ +0 points · 7 months ago

I’m glad you were able to get a machine and start using it amid all this! I got mine 2 1/2 months ago so I was lucky to get it just before covid got really going here. I think I had to wait over a couple of weeks to get mine after my night using one at the sleep center and I was ready to break in and steel one lol.

Have you had a sleep test with a cpap machine or just one that diagnosed you with apnea? I’m asking because if you’ve had one using a cpap maybe you can contact your doctor and ask them for the pressure settings they used for you to get good results. Also I don’t know that I would worry about sleeping a little longer the first few nights. I’m not a doctor but I know I NEEDED to do some catching up my first few days of using mine.

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