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Best Practices lower AHI/RDI in first 30 mins of sleep
#21
RE: Best Practices lower AHI/RDI in first 30 mins of sleep
the fact that the machine doesn't respond by increasing pressure properly, given flow limitation preceding apnea, I would suspect a defective machine - altho when all is said and done, it may be that you require straight cpap. Some people develop CA events in response to pressure changes (including flex)
هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه  هههههه
Tongue Suck Technique for prevention of mouth breathing:
  • Place your tongue behind your front teeth on the roof of your mouth
  • let your tongue fill the space between the upper molars
  • gently suck to form a light vacuum

Practising during the day can help you to keep it at night

هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه  هههههه
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#22
RE: Best Practices lower AHI/RDI in first 30 mins of sleep
I agree with the attempt to turn off Flex, and choosing a fixed pressure might be beneficial in the 13.5-14.0 range. I disagree you have a leak problem. Walla Walla mis-read your chart. Your leak rate is essentially zero.

[Image: KmFOt1I.png]
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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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#23
RE: Best Practices lower AHI/RDI in first 30 mins of sleep
Yep I blew that one. I just looked at the first chart which showed a med. leak rate of 25% and 95% rate was in the 50's. I didn't read the rest of the charts. Off to the dog house I go!

Oh-jeez
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#24
RE: Best Practices lower AHI/RDI in first 30 mins of sleep
Walla Walla

"You made me look" ... and that is a good thing.   I now understand intentional leak rates and how to read the Leak Rate Waveform.  Thanks much for posting the reply!!


..........

For the group... Googling around located these two intentional leak rate charts.   If these links are not already in the wiki they might make good adds.  

https://www.resmed.com/us/dam/documents/...er_eng.pdf

https://www.continuedcare.com/wp-content...-ports.pdf

[Image: RFGKbeXl.png]

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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#25
RE: Best Practices lower AHI/RDI in first 30 mins of sleep
[Image: YMRJf95l.png]
For this experiment the Dreamstation APAP settings were: 
 - Min/Max  = 13cm / 18cm (Min increased from 12cm the previous night)
 - Ramp = 5 mins, starting at 7cm   (No change from previous night) 
 - FLEX = OFF  (Previously, FLEX = AFLEX, level 1) 

Doh!!  Forgot to put the SD card back so no flow data.

Do have a leak opportunity to improve.



I have a little bit of atrial fibrillation with rapid ventricular response (a-fib w/rvr) and have the feeling CAs might be an ongoing issue I can not shake with the APAP.       

Question: If my results are left with primarily CAs symptoms but I am able to stabilize AHI below 5.0 will the medical community consider my Apnea as treated and not want to approve a more expensive machine than CPAP/APAP?
  

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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#26
RE: Best Practices lower AHI/RDI in first 30 mins of sleep
(11-14-2017, 12:03 PM)WillSleep Wrote: Doh!!  Forgot to put the SD card back so no flow data.

I did this on occasion when I was first using SleepyHead.

For me the best thing to do in the morning was to go get my laptop and bring it back to bed. Then I would remove the SD card, read it in the laptop (it has a built-in SD reader), return the SD card to the machine. Only then would I examine the SleepyHead data.

Using that procedure made it hard to forget to return the SD card.

Dreamstation hint: I find that about 2% of the time that I insert the SD card into the machine I get an error message. Something along the lines of it not being able to read the SD card. I pop the card back out and right back in and that fixes the problem. So, watch the display for the confirmation or error message when inserting your card.

Also, thanks for the links to leak rates for various masks. My DME tech set my dreamstation mask settings, but I  will use those tables to see if his setting makes sense.
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#27
RE: Best Practices lower AHI/RDI in first 30 mins of sleep
SnoringInOregon.

Thanks much for the tips on building a good SD card habit and also what to do when I see that Dreamstation SD Card error message!

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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#28
RE: Best Practices lower AHI/RDI in first 30 mins of sleep
[Image: biqOcbUl.png]
For this experiment the Dreamstation APAP settings were: 

 - Min/Max  = 15cm / 16.5cm (Change from 14cm/17cm previous night to provide a tighter less APAP like range)
 - Ramp = 10 mins,   (Change from 5 mins the previous night) 
 - FLEX = OFF  (No change from previous night)  
 
Keeping my Lab notebook up to date, Logging my Key Observations:
 
Results apart from CPAP / Sleepyhead data -- Last night's AHI was 2.92 but I feel horrible, tired and worn out.
- Even though I am not feeling good the current situation FAR, FAR more positive than where I was two weeks ago, before starting APAP.
- My mind feels mostly clear but I zero REM sleep my body feels half run over by a truck and not rested.
- In the morning my eyes hurt a little more as pressure increases. 
- As Min pressure has increased my throat and lungs feel a little worked over in a way that lasts most or all of the day. 
- As Min pressure has increased I have started to develop a small persistent 24/7 cough.     
- Average SpO2 was 97% and overall Saturation metrics were not too bad.. about 8.5/10
- Heart rate volatility contradicts the low AHI implication that last night should have been restful sleep
 - - Heart rate was only in a stable 57-61bpm smooth stable range for 45 mins from 2:00am - 2:24am
 - - HOWEVER, remainder of the night heart rate was volatile ranging from 55bpm to peaking at 77, 85 or 92 (matching my overall feeling of not getting a good night sleep).
 
 
I believe most events tagged OA are really CAs and the only true OAs that occurred are those OA events that occurred while Leaks are shown. 
- I have been paying and recording times and what was happing with my body as OAs and CAs occur while I am fully awake or starting to drift to sleep (with the APAP gear on and while I am wearing a collar but NOT wearing any CPAP gear).    
- My working theory:
 - - All OAs that have CSR breathing patterns and occur while I am awake, just going to sleep and immediately after a significant arousal are in effect not OAs but true CAs.        
 - - When not fully "out" my body generates an involuntary "knee jerk" reaction and sometimes I intentionally react (move around, start breathing again) as responses to the Pressure Pulses.  My theory is because my body reacts to Pressure Pulses the Dreamstation is recording these CA events as OA events.
 
 
Regarding Titration Protocol - Sleepyhead observations apart from periods when the lower "Leak" line was visible: 
-  ZERO events occurred anywhere near after Pressure (or EPAP) dropped, so at a Min of 16cm, the 1.5cm Min/Max delta used last night did not introduce any events.
- Last night's results provided Zero evidence that these CAs are anything but natural, CompSAS.   CAs are prevalent at every pressure, with Flex OFF and Flex ON.    
-  16cmH20 might be close to the Min level required to remove OAs & FLs.
- - At an average pressure of 16cm one Flow Limit event occurred per hour
- - I saw ZERO true looking OA events except at times when pressure leaks were showing
 
What's next?
- A copy of my previous sleep test & treadmill EKG test results are coming in the US mail
- Leave Flex turned OFF, the Min/Max range tight and Titrate up and down in 1cm increments so I collect more data samples to strengthen the conclusions.  I am not enjoying these pressures with FLEX=OFF so to give my body a break from the pressure titrate down in 1cm increments first. 
- In 6 days show my Doc the data and plan next steps with him.   A local sleep lab seemed game to do an all-night BiPAP/ASV titration session for me for $999 cash (no insurance involvement).   Seems like that might be a good path, might get a good answer soon for ~$3500.00 cash (Doc visits, $999 cash Titration, $1800 BiPAP or $2200 ResMed ASV machine).  
 

Inputs anyone?
 
.


 
   
 
 

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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#29
RE: Best Practices lower AHI/RDI in first 30 mins of sleep
I'm impressed with your initiative and analysis. You seem to be on the right track, and it would be hard to advise you differently. I'll just follow along if that's okay.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
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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: Best Practices lower AHI/RDI in first 30 mins of sleep
Hey Sleeprider, thanks for continuing to check in.




.................  
Update for the day.

[Image: AqaL9CWl.png]



I have decided this is the conversation to bring to my Doc next week along with a stack of good data. 

"AASM based CPAP Titration protocol published by PR is complete.

Conclusion:  CAs and Hypopneas persist

Requested Next steps: Schedule a sleep lab titration for BiPAP AutoSV"

That is all.
J

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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