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Anyone looking sleep apnea / CPAP / BiPAP / ASV advice?

Discussion in 'Off-Topic Discussion' started by rhaliuk, Jul 25, 2022.

  1. Jul 25, 2022 at 7:48 PM
    #1
    rhaliuk

    rhaliuk [OP] New Member

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    Hi guys,

    I am a registered polysomnographic technologist (sleep tech), and I wanted to check if anyone has any questions related to sleep apnea / CPAP or any other PAP device usage, etc. I currently have 4 credentials - RPSGT (registered polysomnographic technologist), CCSH (certification in clinical sleep health), CCT (cardiovascular technician), and CRAT (certified rhythm analysis technician). I am currently working on my RN degree with the final goal of becoming an APRN specializing in pulmonology and sleep.
    I have been in the sleep field for 5 years, and I have a lot of useful information that I don't mind sharing.

    DISCLAIMER: My suggestions/advice in NO WAY replace a physical exam and/or diagnostics done by a physician. I am not liable for your health and you should always consult your primary physician/sleep specialist.

    Questions?

    Note:

    Sleep apnea = irregular breathing. It includes snoring (relaxed soft tissue vibrating as air goes past it), RERAs - you snore and try to breathe harder than usual + your brain wakes up, hypopnea - narrowing of the airway by 30%, and apnea - narrowing of the airway by 90%.

    Quality sleep study experience includes the following:
    Do you ever sleep or wake up on your back? No. Then do not sleep on your back during the test since some people have irregular breathing only or mostly during supine sleep. If you sleep on your back during the study, it might lead to misrepresentation of your actual sleep.

    Quality sleep study follow-up:
    The sleep lab doctor/technologist SHOULD show you the hypnogram (graph of your sleep). It shows sleep stages, leg movements, blood oxygen, body position, and breathing events. They should explain how severe your apnea is in terms of the number of events and in terms of the severity of airway narrowing. High numbers = how many times you wake up. High severity of airway narrowing - your oxygen drops.

    CPAP - air compressor that keeps your airway open. You breathe on your own.
    BiPAP - air compressor that blows more when you inhale and less when you exhale. You breathe on your own.
    ASV - air compressor that is capable of pushing the air in when you are not trying to breathe.

    Alternative treatments:
    Oral appliance - no guarantee that it works. LITERALLY NO GUARANTEE. Sometimes it works and doctors will rely on your self-assessment of symptoms.
    Oral appliance moves your tongue/jaw forward to open the airway behind. Done to patients with mild apnea.
    Positional therapy - you have sleep apnea only or mostly on the back. Stay away from sleeping on your back!
    "Inspire" - $20K and up - a pacemaker that stimulates the nerve that goes to your tongue and pushes it forward. Rigorous screening to see if you qualify. I have seen patients who failed it AFTER the thing was implanted.

    Why can't I remember waking up 90 times an hour? When we record your test, we observe your brain in terms of frequency - how fast it is working. When you sleep, your brain waves slow down. When you wake up, they speed up.
    Arousal - brain speeds up 3-15 seconds (not enough to become conscious).
    Awakening - brain speeds up for over 15 seconds and you will remember waking up.
    Apnea is followed mostly by arousals, not awakenings.

    What does a sleep study look for?
    The study checks mostly for interrupted sleep - either by irregular breathing or involuntary leg movements. That's why we put electrodes on the legs! If it's not your legs or breathing that wakes you up, we call it"spontaneous arousal" - no idea why you wake up.
     
    Last edited: Jul 25, 2022
  2. Jul 25, 2022 at 7:51 PM
    #2
    MatthewPTguy

    MatthewPTguy Not a new member

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    I LOVE my CPAP machine… good sleep is divine.
     
    rhaliuk [OP] likes this.
  3. Jul 25, 2022 at 7:59 PM
    #3
    rhaliuk

    rhaliuk [OP] New Member

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    That's really good to hear! I have been using mine for 2 years and I love it too.

    I find that patients often have a ton of questions or wrong understanding of their diagnosis, etc. Some were given the wrong mask size or type of mask... DME companies are often worse than Dunkin.
    I have tried every single mask that is currently available on the market since I have free access to all of them. I hope my personal experience, plus the knowledge I gathered while working with multiple doctors/thousands of patients can help someone on this forum.
     
    MatthewPTguy likes this.
  4. Jul 25, 2022 at 8:02 PM
    #4
    Bakershack

    Bakershack Critical of Noncritical Thinkers

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    How about CPAP for dogs? My wife keeps waking me up and it's the DOG that is snoring!
     
  5. Jul 25, 2022 at 8:16 PM
    #5
    rhaliuk

    rhaliuk [OP] New Member

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    Well...I have been talking about this to my friend who is a respiratory therapist, and the idea was to have a dog sleep in a pressurized chamber, but it is nothing more than speculations at this point.

    CPAPs are basically air compressors that stabilize the tissues of the upper airway from completely collapsing/narrowing/vibrating. The vibration is what causes the snoring.
    I have never heard about CPAP being offered to dogs YET. My guess is that snoring in dogs can be treated the same way it is treated in humans - injection snoroplasty to stiffen up the soft palate, surgery to remove the access of tissue (uvulopalatopharyngoplasty), reducing inflammation (if present), weight loss ( if needed), etc.

    Performing a sleep study to determine the right pressure on a dog would be worse than pediatric studies on 2-3-4-year-olds.

    Imagine putting nasal pillows on a dog - they would open the mouth and start to freak out. Using a FFM would be a nightmare, too.

    https://harol.it/en/2020/10/24/cpap-helmets-for-animals-veterinary/

    Would you take extra time putting this on your dog and then taking it off twice a day? Maybe they can be trained to insert their head into the device once they are ready to sleep. Yeah. Not a good idea haha.
     
    Last edited: Jul 25, 2022
    Bakershack likes this.
  6. Jul 25, 2022 at 8:36 PM
    #6
    T-Rex266

    T-Rex266 Sushi, and Teslas Staff Member

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    @GODZILLA was it you or someone else having issues sleeping (probably from your night shifts)
     
  7. Jul 25, 2022 at 8:40 PM
    #7
    BTBAKER

    BTBAKER BE YOU. THE WORLD WILL ADJUST.

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    I wore CPAP for mild apnea. I saw no difference at all. Now I have a mouth piece and it does seem to help.

    I was told I have more central apnea events. What is the best solution for central?

    Thank you.
     
  8. Jul 25, 2022 at 8:41 PM
    #8
    GODZILLA

    GODZILLA ASCM#1 Douchebag formerly known as 50 Buck

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    I have random insomnia. When I do sleep, I generally sleep fine. It's just falling asleep that is a struggle at times.
     
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  9. Jul 25, 2022 at 9:31 PM
    #9
    rhaliuk

    rhaliuk [OP] New Member

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    Hi! Your question is very interesting. Your problem is actually quite common.

    I must start by saying that sleep apnea is often described as "well my friend, you stop breathing". I reject that definition right away. I always say " You have irregular breathing". When you complain to a doctor about snoring, you are a suspect for "relaxed airway". When the soft tissue in the upper airway relaxes, it vibrates and produces snoring. You come for a sleep study, and we then check if it is only snoring aka primary snoring diagnosis, or if it is more than just snoring. The relaxation of the airway could cause its narrowing. Depending on the degree of narrowing, we classify breathing events into apnea - 90% narrowing, hypopnea - 30% narrowing, RERA less than 30% narrowing but your effort to breathe is increased+you snore+you wake up from it. Apnea itself can be central - you are not trying to breathe, or obstructive - you are trying to breathe.
    So, you can tell that sleep apnea can be classified not only by the number of events (current guidelines), but also by the severity of narrowing.

    So, take a look at your printout of results if you have it - your AHI# includes apneas+hypopneas. Your RDI# has apneas+hypopneas+RERAs. AHI is more serious than RDI because AHI causes oxygen drops. RDI shows how often you wake up from your irregular breathing.
    If your AHI is 0/hr but RDI is 5/hr, some doctors will call it mild sleep apnea. In my opinion, it is ridiculous.

    Mild apnea is currently defined as 5 to 15 events/hour. It is not always recommended to be treated. Doctors will often talk about "clinical significance", or how much this mild apnea contributes to your overall health issues while deciding whether treatment should be prescribed. For example, if you have heart problems, respiratory disease, or complaints about daytime sleepiness, it will most likely be recommended. If you are a healthy individual with mild sleep apnea, some doctors will tell you to simply monitor for worsening/symptoms.

    Historically, the MINIMUM number of breathing events per hour of sleep in order to qualify for treatment changed. It used to be 10, but now it is 5. In Europe, as far as I know, it is still set at 15 events per hour.
    So, let's stick to the U.S. guidelines - up to 5 events an hour is "normal". The second you hit 5 events, some doctors will freak out and recommend CPAP. Would I? No.

    You need to understand that some places juggle around the "mild apnea" and define 5 snore-related arousals as apnea. You snored 5 times, your brain woke up - you are diagnosed. I really need to review your results to explain your specific case.

    Central apnea means the absence of respiratory effort. You pretty much are not trying to breathe for at least 10 seconds at a time. If I recorded your study, I would see your breathing channels flatline.
    It happens to most of us when we are falling asleep. It is considered normal when we are transitioning into sleep, but abnormal at any other point. I have seen patients who woke up from an involuntary leg movement (leg jerk), and then they had central apneas when they were falling back to sleep.

    Oral appliance - mouthpiece or tongue retainers - is a shot into the dark. There is nothing that guarantees its success. Sometimes it works, sometimes it doesn't. Ideally, a doctor will send you for a sleep study to confirm that it works instead of simply relying on how you feel about it. It is used to treat mild apnea in case you can't get used to CPAP. Oral appliance either moves the tongue forward and increases the opening behind it (more airflow), or repositions the jaw by moving it forward just like your mouthpiece. It does not treat central sleep apnea since it does not physically move air in and out of your lungs. When you are not trying to breathe (central sleep apnea), you need something to do it for you.

    We currently treat central sleep apnea with ASV machines - expensive ass air compressors that push air in whenever you have an episode.

    A neurologist that I work for, told me that most people on CPAP eventually stop having central apneas even though CPAP is a simple compressor and does not push the air in during central apnea episodes. Your CPAP machine should have a screen where it will tell you if you have any episodes. It will even tell you if they are centrals! If you have a few, not a big deal.
    ___________________________________________________________________________________________________________________________________________________________________
    Sorry for the small pieces here and there, but it is a little harder to explain stuff over the internet than I thought. I will eventually get better at it!

    I need to see the printout of your study but until then I would say stay away from sleeping on your back if you can. Some people have sleep apnea exclusively on the back.
    Check my first post and tell me if the quality sleep study/follow-up was performed? Unlikely.
     
    Last edited: Jul 25, 2022
  10. Jul 25, 2022 at 9:48 PM
    #10
    What the!?

    What the!? New Member

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    Thanks for being here. I love my CPAP. During long shifts people have offered a bed to me afterwards to get 8 hours of sleep. Honestly I feel more refreshed with 2 hours of CPAP sleep than 8 hours of broken sleep by interrupted breathing.

    One of the challenges of camping…I need my CPAP with me when I sleep.
     
    rhaliuk [OP] likes this.
  11. Jul 25, 2022 at 9:52 PM
    #11
    rhaliuk

    rhaliuk [OP] New Member

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    I hope this thread helps some people.
    Do you have a battery-operated one that you use for camping?
     
  12. Jul 25, 2022 at 10:03 PM
    #12
    5N0W808

    5N0W808 Master Debater

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    Phillips recalled my Bipap device so i haven't used it =in like 2 years. Still waiting on Phillips to either send me a refund or a new device.
     
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  13. Jul 25, 2022 at 10:06 PM
    #13
    rhaliuk

    rhaliuk [OP] New Member

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    They have a fancy term for this "shift work sleep disorder". I would also check if it is behaviorally induced (inconsistent bedtime) or maybe it is related to bedtime anxiety/certain medication for depression.
    Just in case: sleep apnea can also cause difficulty initiating sleep since your body is not very happy about choking. That's the case in severe apnea. People who do have severe sleep apnea might wake up after a few hours of sleep, often out of dreaming when breathing is the worst, and they can't fall back to sleep.
    In my experience, sleep apnea is often just a part of a problem with insomnia patients. Shift work disorder is more than likely the cause.
     
  14. Jul 25, 2022 at 10:08 PM
    #14
    rhaliuk

    rhaliuk [OP] New Member

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    Use the HEPA filter for your hose (should cost less than a dollar), and continue using the machine. That's what most of the patients I am seeing are doing. The doctors write "I explained the minimal risks and that benefits outweigh it". BiPAP is often prescribed for severe apnea, and the benefits of usage might outweigh the risks. The risks are actually tiny. Did you use the SOCLEAN to clean your machine or the masks?

    https://www.directhomemedical.com/c...MNILJzNcJESybbuRm2XzpUMoSYqM6ytwaArcaEALw_wcB

    Its 5$ dang it.
     
  15. Jul 25, 2022 at 10:36 PM
    #15
    GODZILLA

    GODZILLA ASCM#1 Douchebag formerly known as 50 Buck

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    Anxiety, stress, and procrastinating to prolong the time I don't have to get up to do things I don't want to do (like talking to people) are my guess. Brain won't shut off, I don't fall asleep.
     
  16. Jul 25, 2022 at 10:43 PM
    #16
    Coal Dragger

    Coal Dragger New Member

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    Yeah I suffer from insomnia at times as well. Brain just will not shut off.

    I also sleep with an oral appliance and it helps with snoring. I am sure a CPAP is in my future as I get older and soft tissues get softer, plus a couple decades of lifting weights has given me a pretty thick muscular neck according to my doctor and that doesn't help with my airway.
     
    rhaliuk [OP] likes this.
  17. Jul 25, 2022 at 10:51 PM
    #17
    rhaliuk

    rhaliuk [OP] New Member

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    Have you ever tried 5mg melatonin an hour before sleep? Thats about the only medication (produced by the body) Id take. Once in a while, so that you don’t develop tolerance.
     
  18. Jul 25, 2022 at 10:56 PM
    #18
    rhaliuk

    rhaliuk [OP] New Member

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    Oh yeah. The worst apnea Ive seen was 192! events per hour - a body builder btw. All the tissues in the neck (outside of the airway) will end up pushing on the airway causing it to narrow at night.
    Aging will worsens the severity for sure. Make sure that whoever does your PAP titration is knowledgeable!
     
  19. Jul 25, 2022 at 10:59 PM
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    GODZILLA

    GODZILLA ASCM#1 Douchebag formerly known as 50 Buck

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    Unsure of the amount, but I tried a melatonin drink/beverage about a year ago. It had the same effect as the Sominex sleep aid, I slept, but didn't feel like it. Felt like I blinked and 8 hours had gone by, but I had cottonmouth for an hour and a headache all day. I have avoided sleep aids regardless of ingredients since then.
     
  20. Jul 26, 2022 at 1:21 AM
    #20
    5N0W808

    5N0W808 Master Debater

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    I don't know what SOCLEAN is. I used soap and water
     
  21. Jul 26, 2022 at 5:13 AM
    #21
    BTBAKER

    BTBAKER BE YOU. THE WORLD WILL ADJUST.

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    No follow was performed. I appreciate the thorough response!
    I have used tennis balls, pillows etc to stay on my side as much as possible but it minimally helps. I always find a way to move around.

    I’ll look for my study. I have had three and all have been in home. I was told central is more common at the altitude I live at.
     
  22. Jul 26, 2022 at 6:35 AM
    #22
    Luckie Stiff

    Luckie Stiff New Member

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    I've got what my doctor said is moderate apnea, average is 19 events per hour. I have a CPAP but can't use it due to some PTSD issues, I literally freak out and go into a panic attack. I inquired about Inspire but was told my BMI is 3 points too high so my insurance would say no go. I sleep with the head of my bed elevated and that seems to work although not completely. Doc said try nasal pillows, the strap around my jaw gave the same reaction as the mask. Spent $600 on a mouthpiece that sits in a drawer because it has to be "locked" bringing up the same panic issues. What do you recommend? I would kill for a solid night of restful sleep.
     
  23. Jul 26, 2022 at 6:56 AM
    #23
    texasrho83

    texasrho83 Teacher in a Tundra

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    I sleep well. I fall asleep fast and stay asleep. Problem is, well her problem is, that she says I snore :anonymous:

    Guess that comes with age as I never used to snore. At least no one ever told me.
     
  24. Jul 26, 2022 at 6:58 AM
    #24
    texasrho83

    texasrho83 Teacher in a Tundra

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    Was it called Neuro Sleep?
     
  25. Jul 26, 2022 at 7:17 AM
    #25
    bosscib

    bosscib New Member

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    I've been a CPAP user for years and am a huge advocate. I haven't seen my doctor lately so my rx's expired. Any recommendations on the cheapest place to buy mask cushions without a rx? It seems like everything else the prices have gone up.
     
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  26. Jul 26, 2022 at 7:42 AM
    #26
    nobodyintexas

    nobodyintexas What?

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    Whatever this forum told me to do
    I got one a few years ago. I think I did a 10 on my sleep test. not bad. but I snore.

    Now I sleep like a cadaver. uninterrupted sleep.

    I'm a tad heavy (5'11" 235), as I've lifted weights since college ('85?). so my neck is large...19" collar.

    If you snore....& If your insurance supports a CPAP, get one. or at least do a sleep study. I did the at home one.

    my Blood Pressure dropped 10 points.
    my squat went up 50lbs.
     
  27. Jul 26, 2022 at 8:21 AM
    #27
    rhaliuk

    rhaliuk [OP] New Member

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    The prices for masks have been ridiculous. Wholesale nasal (for a lab) 10-15$, full face - 25$. I don’t know about the cheapest place for a patient, but check out the “sleep apnea support group” on facebook where people share their experience and cheapest ways to get a mask.
     
  28. Jul 26, 2022 at 8:26 AM
    #28
    rhaliuk

    rhaliuk [OP] New Member

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    Will your doctor give you an Rx without redoing the sleep study? Ive seen both - some doctors will keep renewing it as long as the machine works (why redo the entire study if you can literally check the data from the machine to see if it works?!); some will insist on another test.
     
  29. Jul 26, 2022 at 9:54 AM
    #29
    Bammer

    Bammer I'm disinclined to acquiesce your request.

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    I had my test back in 1999, I was taking two breaths a minute ! Been on a CPAP machine since then, changed my life. I went from getting up to 10 hours of sleep and dog ass tired all the time, to 7.5 hours and fresh as a daisy !
     
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  30. Jul 26, 2022 at 12:07 PM
    #30
    Coal Dragger

    Coal Dragger New Member

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    Well if that’s not a positive endorsement I don’t know what it is.
     

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