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18 mths of apap: need help optimizing settings to feel better [ASV]
#21
RE: 18 mths of apap: need help optimizing settings to feel better
thanks, tedvpap. I don't know anything about UARS so I'll read up on it a bit. it sure sounds consistent with my theory that sometimes unflagged apnea-like events are contributing to discomfort and awakening. the more I scroll through flow rates, the more varied fluctuations in breathing patterns I see.

although UARS would seem to support my theory I wonder if autoset RERA detection blows it up? I've read that UARS, flow limitation and RERA's are synonomous. should apnea-like events that are shorter than 10 seconds be flagged as RERA? some are associated with flow limitation but few are RERA. otoh, maybe it's possible to have short incidences of respirational trauma, for lack of a better term, without immediately flaggable arousals, but which lead to waking up?

btw, what tape do you recommend for a bearded fellow to block lip fluttering mouth leaks?
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#22
RE: 18 mths of apap: need help optimizing settings to feel better
(05-15-2018, 07:58 PM)sheepless Wrote: thanks, tedvpap.  I don't know anything about UARS so I'll read up on it a bit.  it sure sounds consistent with my theory that sometimes unflagged apnea-like events are contributing to discomfort and awakening. the more I scroll through flow rates, the more varied fluctuations in breathing patterns I see.  

although UARS would seem to support my theory I wonder if autoset RERA detection blows it up?  I've read that UARS, flow limitation and RERA's are synonomous.  should apnea-like events that are shorter than 10 seconds be flagged as RERA?  some are associated with flow limitation but few are RERA.  otoh, maybe it's possible to have short incidences of respirational trauma, for lack of a better term, without immediately flaggable arousals, but which lead to waking up?

btw, what tape do you recommend for a bearded fellow to block lip fluttering mouth leaks?

Since the machine does not truly know when you are asleep and when awake, I don't know how reliable machine determined RERA events are.  
Dreamstation Auto CPAP states: 
RERA (Respiratory effort-related arousal) is defned as an arousal from sleep that follows a 10 second or longer
sequence of breaths that are characterized by increasing respiratory effort, but which does not meet criteria for an
apnea or hypopnea. Snoring, though usually associated with this condition need not be present. The RERA algorithm
monitors for a sequence of breaths that exhibit both a subtle reduction in airflow and progressive flow limitation. If
this breath sequence is terminated by a sudden increase in airflow along with the absence of flow limitation, and the
event does not meet the conditions for an apnea or hypopnea, a RERA is indicated.



I don't have facial hair so I can't comment on how to tape.  What you can easily try is an Ace bandage to cover your mouth.  Make a coupe of wraps.  You should leak less and muffle the noise.
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#23
RE: 18 mths of apap: need help optimizing settings to feel better
is there a way to get sleepyhead time at pressure data in tabular form?

the graph shows how much time the machine spends at each pressure and the number & type of events occuring at each pressure. this info looks like it should be helpful to pin down optimal pressure settings, but it's time consuming and tedious to move the cursor along the time at pressure curve, writing down figures from quickly disappearing boxes for every 0.2 increment of pressure. and that's just for one night.

it's only been 2 days, but at my current setting of 10-20 epr2, I'm getting ahi's of about 5-8 with lower oa's and higher ca's than many prior settings. oddly, the statistics table on the daily page shows max pressure of 18.2 while the time at pressure curve shows 18.4.

one thing I noticed last night is that 16 of 17 ca's happened at <11.2cm (1 ca at 18.2cm). oa's are fairly evenly distributed through the range of pressures. h's fell between 10.8-11.4.

is it fair to hypothesize that these ca's are "natural" and not pressure induced?

if I can determine that this is a common pattern, is that enough to take to my next sleep doc with the complaint that apap is helping but not enough (and let's try another modality?)
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#24
RE: 18 mths of apap: need help optimizing settings to feel better
copied this from gwc2795 thread P10 mask leaks - need advice please

http://www.apneaboard.com/forums/Thread-...#pid260652

sheepless Wrote: Wrote:when I look at the attached graphs, besides the clusters W2 & others will point out [Image: smile.gif] (agree, and still looking locally for a soft collar), I see leaks that rise with pressure (which rises in response to obstruction) and more at lower pressure that look to be more closely related to events and flow limitations. I realize these things are all interrelated, even if I don't completely understand how, and I sure don't know what's chicken and what's egg.  but it does look to me like apnea and flow limitations are associated with leaks (if not the cause), even when pressure is at the low end of the settings. btw, I was aware of leaking from the lips during the first sleep, between 1 - 2 pm.  don't know where other leaks were coming from but other leaks do appear to be climbing before pressure rises and at the time of apnea and flow limitations (see for example around 5 - 6 am).  am I missing something here? 

besides commenting on whether unresolved apnea tends to produce leaks (where does the air go when not into airway & lungs?), feel free to weigh in on efficacy of therapy after looking at this chart.

thanks for bearing with me.  just trying to "get it".


I'd set your maximum pressure to 11.5cm to prevent the pressure from running away due to leaks . I think a collar will clear up most of the events with a pressure below 11.5cm.

[url=https://OSCAR Official Download Page ----> CLICK HERE ./]Download SleepyHead[/url]
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wallawalla, just 1 night with lower max per your suggestion but this is what 9 - 11.6cm epr2 looks like so far.  cluster of osa at 4am noted.

edit:  actually, the cluster has a a bit of everything, osa, csa, hyp.
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#25
RE: 18 mths of apap: need help optimizing settings to feel better
Make sure your chin isn't able to slip inside the collar. 

It seems you have advice coming from different threads. To avoid confusion and conflicting advice I'll refrain from further comments here.
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#26
RE: 18 mths of apap: need help optimizing settings to feel better
haven't bought a collar yet.

some of the other threads you refer to are other people's threads in which I commented. hoping to steer things my stuff back here to avoid hijacks. also, multiple perspectives are good as far as I'm concerned & I'm interested in your thoughts. don't think anyone else has commented on results of this pressure change that you suggested. I understand your point though. whatever you are comfortable with...
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#27
RE: 18 mths of apap: need help optimizing settings to feel better
finally, my first night with a soft collar.  can't say it was pleasant, but hoping to get used to it.  really adds to that feeling of being saddled by all the equipment.  but looks like it's worth it.  graphs look different than most of my history.  just one night but:

vastly reduced mouth leaks.  
still some osa clusters but fewer and a little less concentrated or intense.  
more pronounced snoring, flow limitations & RERAs.
not sure if more hypopnea but doesn't look like any fewer either.
no reduction in fragmentation; still estimating roughy 40 or 50% awakenings due to flagged events.

pressure waveform looks different too. still trying to learn how to interpret these things but looks to me like flow limitations are pushing pressure up pretty quickly? 

if reducing leaks and straightening neck/airway resulted in more accurate machine scoring (?) is it possible / likely/unlikely that unflagged disordered breathing, that might be the cause of so many full awakenings, is showing up more clearly in flow limitations, rera, snoring and maybe hypopnea?  I don't know enough to do more than speculate.

looking forward to the thoughts of others on this.
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#28
RE: 18 mths of apap: need help optimizing settings to feel better
I'm recommending that you try something very counter-intuitive. You actually have worse OA and sleep disruption when pressure rises. I'd like to see you use the collar using a fixed pressure of 9 with EPR at 3 to see where that takes you. It may blossom into more OA, but I am hopeful that it will actually do something to eliminate the many breaks in therapy you have EVERY night. If we can improve comfort and limit OA, we might have accomplished something here.
Sleeprider
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#29
RE: 18 mths of apap: need help optimizing settings to feel better
Sheepless

Your many breaks got me looking through my sleepy head data of a year ago when I was suffering the same way. Sleeprider and others were clear that CPAP was not helping me with the many disruptions, in my case due to leaks from the FFM which did not suit at all. I was climbing the walls as it was clear that I was not really achieving much with all the stopping and throwing the mask across the room.

For me, the nasal pillows and the neck collar did it as well as persevering with pressing my tongue against the roof of my mouth. As others have advised, I do that when I am awake too. Like now my tongue is firmly against my mouth palate-to make it 'normal' so that I do that 'naturally' when asleep. Of course it is a little different in a sleeping state as things flop. But I persevere. Of course there are good days and bad days, don't we all have em?

I sincerely wish you all good things and success with your experimentation, sleepless.
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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#30
RE: 18 mths of apap: need help optimizing settings to feel better
AI, thanks for the encouragement. with all the support found here I will persevere. the alternative hasn't been very good.

first night with collar reduced leaks - a lot. but not awakenings. I know only experimentation will tell, but are you thinking keeping leaks down will reduce fragmentation. makes sense; seems many fragment ends are associated with leaks. just no joy first night out.

Sleeprider, I will try 9cm epr 3 tonight. unless told otherwise, I'll set both min and max to 9 rather than switch to cpap because I'm interested to see what happens to flow limitations.
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