dx OSA Oct/2012. Husband and I are CPAP "duelies" for 6 years now. Respironics system one and Swift FX for her nasal pillows. Husband has ResMed AirSense 10.
SF East Bay Area, California
Hi ter0624 and welcome to the forum.
Your eye pressure, with your drops, is actually in the low normal range. And your CPAP treatment pressures are thankfully on the lower end of things. The 2007 study that got glaucoma patients all frightened over CPAP treatment involved 21 OSA patients being treated with CPAPs at a great variety of treatment pressures. These patients were sleeping in various positions, but all lying flat in bed (the supine position is known to raise IOP - intraocular pressure). The researchers themselves indicated that one couldn't draw firm conclusions from such a limited study and recommended that more research be done with a much larger pool of subjects gathered worldwide. Strangely, no such follow up studies seemed to have happened to date. One must contrast this with the tremendous pool of studies that exist linking OSA to glaucoma. People with untreated OSA are ten times more likely than those without OSA to develop glaucoma over their lifetimes.
Research studies all around the globe have demonstrated the association of OSA with glaucoma. What's really interesting is the finding that this association isn't because of IOP changes or changes in chest pressure. Instead, it's most likely caused by the drop in oxygen levels in the blood, which happens when you stop breathing. Routine low oxygen concentration in the blood may contribute to degradation of the optic nerve - potentially leading to glaucoma. This is the current hypothesis.
Healthcare providers have decided to err on the side of caution. They wholeheartedly recommend CPAP as the first, most effective and least invasive treatment for OSA, but throw in this caveat for those with glaucoma...that they get regular IOP screenings every 3 months and ophthalmic check-ups, which is what your caregivers are doing. I really wouldn't worry about your CPAP causing you any harm. You're going to be followed for that. You're going to be OK.
Weight loss has many benefits, but it's not a "cure" for OSA. OSA is a moving target that usually worsens over time, with the occasional seasonal illnesses and as some other chronic health conditions come home to roost. Deciding that your apnea is better is not a good reason to stop CPAP treatment. I don't think I would stop CPAP unless I had another sleep study that proved my untreated AHI (Apnea/Hypopnea Index) was under 5.
Do you have a copy of your sleep study? If not, by all means go get one. You're entitled to it. Consider getting the Sleepyhead application (available for free online) so that you can review your own sleep data on a daily basis. What you learn will amaze you as you see for yourself how your CPAP treatment "saves" you each night. You'll find out if your mask is leaking too much. You'll be able to troubleshoot, with others here on the forum, how to make your CPAP treatment even better and even more comfortable.
So...have at it, friend...and the sooner the better.
Hi again purplefan100:
Obstructive Sleep Apnea (OSA) is most likely but your doctor gets to diagnose this. Please check in with your doctor ASAP about the chest pain. That merits immediate further investigation. OK?
The ramp gives you a starting pressure of, let's say 7, and sets a time of, let's say 5 minutes to "ramp up" to your necessary treatment pressure. With auto CPAP, the needed pressure fluctuates with the apneas to keep the airway open. The purpose of ramp is comfort while you are transitioning into sleep. It is most often used with "fixed" CPAP (the pressure is set at one fixed pressure such as a patient's maximum recommended pressure). It is often uncomfortable to transition directly to one's maximum pressure of, let's say 12, when getting to sleep. The pressure is felt too strongly at first and sleep is prevented. So a ramp is used to help the patient ease into their prescribed pressure setting. Once the patient is asleep, the strength of the necessary pressure isn't noticed.
My husband's ramp is also turned off. He has auto CPAP and doesn't mind his minimum pressure set at 9 (his maximum pressure is set at 11). He goes to sleep without any issues.
The ramp is on for my auto CPAP. I have a start pressure of 7, which I like - it feels good to me. My minimum treatment pressure is also 7. My ramp is set for 5 minutes and my maximum pressure is 12. I suspect my ramp could be turned off and I wouldn't even notice. As it is, my starting pressure will never immediately jump to 12 because my ramp is there to hold things back. It will take at least 5 minutes for it to do so. It's like starting horses at a trot, then breaking into a gallop at 5 minutes because you need to get there quick.
Hope this helps.
Yeayyyy! Just goes to show that simplest fixes are often the best. I'm so glad you've found a mask that you're comfortable with.
It's too bad about the Respironics Dreamwear… Lots of folks are very happy with it because it's so comfortable, but many report the leakage problems as you also experienced. It appears that with the lack of the more familiar "pillars" that rest inside the nostrils it's a bit harder to get an effective seal against the mask. You might really like the Resmed Swift FX nasal pillows mask. You have to get the right fit in small, extra small, medium or large. We all have different sized nostrils independent of our weight or height.
With your inconsistent Al using the Resmed Airfit N20, it seems safe to assume that this mask is not working for you. Try a different mask. You like the nasal pillows, so pick among them. The newest model is not necessarily the best.
If you don't already have the Sleepyhead application (free online), consider getting it so that you can review full data from your sleep sessions. You will be able to "see" how your mask choice is performing and get a feel for what is driving your AHI inconsistencies. You may need to get your own SD card to place in your machine, if you don't now have one, and an SD card reader. At the front, left-hand side of your Airsense 10 is a dual "cabinet" Open the upper cabinet. Insert your SD card which is in the unlocked position (the little lever on the side of the SD card is pushed up towards the inserted end of the card) into the slot. Your nights' sleep will now automatically be recorded. When your sleep session is over, remove the SD card from your machine and push the little lever downwards into the locked position. With your Sleepy head application up and running on your computer, insert the SD card into your SD card reader and then insert the whole shebang into your computer. Click "import data" and a message will appear asking whether you want to point the data to a particular drive. Click "yes" and voila...you have data! This is exceeding great fun and also quite interesting. So, go see what you've got!
Keep up the good work.
I wish I had had a choice. I'm in an Exclusive Provider Organization (EPO) . I could go outside my plan, of course, but the total expense would be on me and I'm just not that wealthy. First we go to our primary care provider and are referred for the at-home sleep study (no choices there). The results are analyzed and sent back to the primary care provider. If you have OSA, then you are referred to a pulmonologist (most of us never even see this person) and are taken care of by the pulmonologist's underlings - the respiratory therapists, who set us up for the 2-week titration (CPAP trial).
We do the titration. We report back in. The respiratory therapists review the sleep data, make treatment pressure recommendations which are then briefly reviewed by the pulmonologist for signature. Thus the treatment recommendations become a prescription. We dither about with the respiratory therapists over what mask to wear. Then, still without ever seeing the pulmonologist, we are packed off to the DME provider to pick up our spankin' new machines and masks. The respiratory therapists show us how to use our new machines and off we go into the great beyond of making CPAP work for us. "Call if you have a problem", they say. Right. Thank God for the forum. I'd have been so lost without it!
This is airport-runway-medicine. They line you up, give the lift-off command, and then you fly the thing with help from "Houston". "Houston...I've got a problem...". It's super-cost-efficient.
The best spot to position your CPAP is on an end table or night stand that is level with the top of your mattress (without covers on). Placing it there or lower is preferred. If the CPAP machine is placed above the level of the top of your mattress, rainout becomes likely. I came across this information on the former ASAA forum and it became quite useful - especially when traveling.
Try this maneuver: When you're ready to go to sleep and before your machine has been turned on, press your tongue against the roof of your mouth. Let the tip of your tongue rest against the backs of your upper front teeth. Relax. This should be a comfortable position. Turn on your machine. You do not have to consciously make your tongue stay where you have positioned it. Just relax and go to sleep this way. Your tongue will stay right where you left it. Somehow this seems to prevent the back flow. In the morning, you won't have dry mouth.
I agree with Sierra that raising your treatment pressures will likely make your problem worse. It's great to see that AHI under 5...and down from 80. Wow. That's great work!
Am I missing something here? Did purplefan post somewhere about the severity of her apnea?
You can pick this up at any drug store. It's a squeeze tube (small) of a gel-like lubricant made from normal saline solution. Mine has some aloe vera in it. It's very soothing.