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A new wrinkle--big CSR event
#11
(08-16-2016, 11:55 AM)PoolQ Wrote: If you change your settings and are not getting the results you would like, bring us some plots so we can help fine tune the settings. You should have some plots of when you changed to APAP and got the same AHI, lets see one of them.

I'm changing them tonight...I'll follow up with the results. Meanwhile, here's a double digit AHI on APAP:

http://imgur.com/p29Xt79

Appreciate the input

Dave

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#12
Okay, this is what we needed. notice that your pressure stays at max most of the time and that most if not all apneas happen when the pressure is maxed out. You get more leaks at the max pressure, but for now nothing that the CPAP can't handle. Those snores and flow limits are still pretty high and often.

I would raise the max limit to 14 and see what happens. If your 95% pressure follows the change to 14, you may need to go to 16. This is needed to find a max that is about 2cm higher then the 95% level. Right now they are both the same, so higher is indicated.

Your centrals are still low, so they are not being triggered by the pressure or pressure changes-good news
you might want to tighten the strap a little (1/8") to prevent leaks at the higher pressure, or you could wait on that to see if more leaks actually happen and then tighten the mask if they do.

Once you get the apneas under control you can then look at your lower pressure as you seem to move away from it right away and never go back down to it.
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#13
(08-16-2016, 07:41 AM)dclaryjr Wrote: SleepyHead rated my AHI as 'Horrible" and now I have a new concern. What's with the long CSR event?

http://imgur.com/0j21Ghu

If the CSR events repeat, might I suggest you check with your physician.

I spotted several nights of short CSR breathing. My cardiologist told me that these could be related to cardiac events like congestive heart failure or atrial fibrillation. A simple blood test, BNP (B-type Natriuretic Peptide) can determine if you are carrying additional fluid.

In my case, following up the repetitive CSR readings saw a BNP approximately 8 times my baseline and I was given a mild diuretic. They also did an echo-cardiogram to check blood flow dynamics. You may wish to read more at http://thorax.bmj.com/content/53/6/514.full

Since there are multiple causes, I wouldn't worry too much over a single event. Repetitive events on different night are another issue. Best of luck.

"The object in life is not to be on the side of the majority, but to escape finding oneself in the ranks of the insane." -- Marcus Aurelius
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#14
WTF?! This did not have the intended result. Worst AHI ever.

http://imgur.com/pbafIrW

(Note: I shut down the machine twice--once to cough and once for an itchy nose).
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#15
The pattern is not that much different from the first data you posted. In auto mode, the machine goes to the maximum pressure and stays there. I'd be interested to see you plug in some EPR and see if that helps things, although I'm beginning to think body position is playing a strong role here.

Do you find you tuck your chin at night? These extended clusters of OA are sometimes resolved using a SOFT cervical collar. Not the type used for injuries; soft collars just keep your chin from sinking toward your chest which is a leading cause of obstruction when sleeping on your back. This is still obstruction with flow limitation and snores corresponding to the periods with OA and H events.
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#16
I was thinking on the same lines as Sleeprider concerning back sleeping.

I think you can overcome back sleeping with a little effort. I know when we're used to doing something one way, it's hard to change. Some folk use body pillows to stop them from rolling on their back.

I second the use of a soft cervical collar. I use one off and on, even when I'm on my side because I tend to tuck my chin into my chest. So that stops me from doing that.
You can purchase fairly cheap at Amazon, just be sure it's soft.

After looking at this latest graph, I think the max pressure setting should be raised to allow the Apap to do what it needs to. Also, as mentioned, try an EPR setting. That will help you with exhaling against pressure.

Don't get discouraged, it take some trial and error to get it right. Smile
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#17
At about 1:40 you go to max pressure and stay there, this means that there is nothing left for the machine to do to try and stop the apneas and obviously they are still happening.

Finding a way to not back sleep "could" stop all this and let the machine operate in a more comfortable and useful pressure area.

CPAP for most is not life as usual in many ways, however it can and does make our waking hours much, much closer to life as it used to be. The alternative of not using CPAP correctly can and does ruin both our night and day life.

Do everything you can to recover your days and never give up, never surrender.
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#18
(08-17-2016, 08:37 AM)Sleeprider Wrote: Do you find you tuck your chin at night?

I'm not sure but I use on of those asymmetrical Tempurpedic pillows that is thicker right under the neck. I would think that would make chin tucking difficult. But maybe not.

(08-17-2016, 08:57 AM)OpalRose Wrote: I think you can overcome back sleeping with a little effort. <snip>.
I second the use of a soft cervical collar. <snip>
After looking at this latest graph, I think the max pressure setting should be raised to allow the Apap to do what it needs to. Also, as mentioned, try an EPR setting. That will help you with exhaling against pressure.

Don't get discouraged, it take some trial and error to get it right. Smile

Normally when I sleep on my side, I eventually wake up with pain in my shoulder. I'm not sure how I can overcome that.
The collars are cheap--that sounds like it's worth a try.
I'm gonna bump it to 16 tonight to see if that "getting to max and staying there" pattern repeats.

(08-17-2016, 12:17 PM)PoolQ Wrote: At about 1:40 you go to max pressure and stay there, this means that there is nothing left for the machine to do to try and stop the apneas and obviously they are still happening.
<snip>
Do everything you can to recover your days and never give up, never surrender.

I guess that's what's at the heart of the matter. What get's me in this firewall state. By the way, check this out. It's the first time I went to APAP. It keeps reaching max and dropping until a stretch very late.

http://imgur.com/Zcd1WLc

Thanks for the help everyone. I'll keep looking for answers.

Dave

P.S. I'm also thinking losing 65 pounds might help.
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#19
65 pound gone can never hurt, well for most of us at least. Smile

That graph looks much better. Your 95% is still at your max, you need to raise your max. Remember it will not go higher than it needs to, but it has to go as high as it needs. Many people take their machines home set to 4-20 by the "professionals", 4 is typically too low for most and the 20 does not really hurt anything, you just want a reasonable max pressure so it treats everything without going nuts if your just holding your breathe in a dream or something
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#20
I used to have one of those pillows. Loved it. I think they keep your head in a very good position while sleeping.

(08-17-2016, 01:00 PM)dclaryjr Wrote: I'm not sure but I use on of those asymmetrical Tempurpedic pillows that is thicker right under the neck. I would think that would make chin tucking difficult. But maybe not.

I have seen advice to people from time to time suggesting they not sleep on their back. I don't understand the reasoning behind this if we have a CPAP machine to provide pressure to maintain our airway. Why not sleep in whatever position is most comfortable? Oh-jeez
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