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Brazen Therapy Thread
#31
RE: Lower pressure = lower AHI??
Brazen, you said "I have Raynaud's disease so it isn't uncommon for my finger pulse ox to read low, or not at all, at times.... "  Thanks for mentioning that!  I also have Raynauds but it's mild and almost non-existant in the summer so I hadn't given it any thought, but it might be just enough to make a difference over the course of at night.  It's also more in one finger (right index) than the others. From now on I'll avoid that finger when doing an overnight oximetry. 
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#32
RE: Lower pressure = lower AHI??
Gideon - thank you for your time!

What data set is telling you my resistance to breathing is better at 7-9? Is that the 95% flow limit, looking for below 0.1?
Sorry, it's obvious to you but I don't know how to read this data yet.
It would be helpful to have a wiki article on how to read the data from OSCAR and what to look for when trying to optimize treatment.

Of course losing weight, controlling diabetes, and not smoking benefits the body long-term.  We have the data to back that up.
I can teach patients the benefits and back it up with lots of data.  Quitting smoking gives patients fairly immediate health feedback, ie: not coughing up nasties every morning and easier breathing.  Diabetes is a more difficult disease process because few people actually feel better with a lower A1c (Type 1s are the exception because they tend to feel ill with very high A1c and feel improvement with treatment).  Diabetics also tend to be treatment resistant and don't follow recommendations well.

I have requested my full sleep study report and will post it when received. 

I'm not trying to be difficult.  Just trying to find the benefit.

I have looked for studies showing the benefits of treating mild OSA -- all the while wondering if that's really even my issue or if the sleep specialist just rubber stamped that.  Not having much luck finding the data.  Severe OSA... absolutely! I can grasp the long-term benefits.

When my only symptom of OSA was fatigue and the prescribed treatment isn't resolving that it's incredibly difficult to see the benefit. I don't want to give up on cpap if it can help me long-term, just trying to find that evidence.
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#33
RE: Lower pressure = lower AHI??
Read OSCAR - The Guide in my signature, A lot is covered there.
The examples I gave were targeted because of your nursing background, I have EMT in my background. I often try to explain things in terms the targeted user can understand.

Look at zoomed views of the flow rate, at 3-4 minutes so you can see the entire breath. Nearly everything can be seen in this chart, above zero on inspiration, below expiration, flat tops, or misshaped tops tend to indicate flow limits, and large breaths tend to be arousals which are bad simply because they interrupt sleep. As stated before flow limits show resistance, a partial obstruction in the airway.

RERAs indicate a detected series of flow limitations followed by arousal. The 95% Flow Limit value because it shows data and low numbers mean fewer flow limitations. These flow limitations also drive pressure increases in ResMed devices to eliminate potential future obstructive events.
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#34
RE: Lower pressure = lower AHI??
Thank you Gideon,

So, if I'm understanding...  Flow Rate is equal to respiration?

The first attachment is zoomed on restful sleep?
Second is an arousal?  I'm assuming this is not always related to airway obstruction? Loads of possible reasons for arousal?  Any way to tell from the data if it's related to obstruction vs something else waking me? (other than the obvious flagged events)
Third is an HA event showing messy respirations due to obstruction?

So the goal would be more time with the nice even restful sleep pattern? Doing so should equal feeling more rested?


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#35
RE: Lower pressure = lower AHI??
Thank you for pointing me toward the OSCAR guide... that is very helpful!

I feel like my breathing is very irregular all night long... even when events aren't being flagged.
Does that signal anything or is that normal?

What data can pinpoint whether it's REM induced apnea, UARS, etc?


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#36
RE: Lower pressure = lower AHI??
ThinMountainAir - glad I could give you something to consider
Raynaud's is the pits!
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#37
RE: Lower pressure = lower AHI??
Thanks, Gideon....... Good to know that! (I didn't).
My next visit is this November....I am quite optimistic on obtaining a BiPAP device then.....Only question left is DME availability.
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#38
RE: Lower pressure = lower AHI??
@Brazen

Go to the top of the page, see the large black band, and look for WIKI. Read through everything. There is even a section called "optimizing therapy."

As a nurse, you know there is daily variability as to how patients feel and react, and how good/bad their clinical numbers may be on any given day. Sometimes they make great progress in a day or two, and then there is a day or two when they don't. Sometimes there is a clear reason, sometimes not. So also is there daily variability in your OSCAR data. Normal human variability.

As to time to see results, I went about 6 months before the light switch turned on and I felt significantly better. Perseverance is key. Don't over-analyze. Just forge ahead. It is SO worthwhile.
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#39
RE: Lower pressure = lower AHI??
@ Clownbell

You're right. Clinical variability is in everything human.
Thank you for the point toward the optimizing therapy section in the Wiki, I've been trying to read all I can there. (Struggling to absorb these days)

I definitely have a tendency to over-think things. Also a bit of a stubborn streak.  Dont-know

So, even though I felt like I was sleeping way better without the cpap, the objective data suggest (through flow limits at lower pressure?) that I was struggling to breathe?
Obviously easier breathing is better for the body. 

But, it would certainly suck a lot less if the subjective  (restful sleep and daytime fatigue level) would align with the objective. 
It feels like steps in the wrong direction.
In most cases, if a pill had as unpleasant side effects as the cpap it would be considered failed treatment long before six months (Or you would be given additional pills to off-set the side effects if it was the only option).
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#40
Optimizing Help Please - Therapy Thread
Sorry, I was a little slow to get the message of one thread for therapy questions.

So, thanks to Gideon, I have the following settings on a ResMed 11:
AUTO
7-9cmw
3 EPR

I'm 117 nights in cpap life, 80% compliant over 4hrs. Struggling but really trying.
Average 95% flow limit is a .06 overall with the last week varying from 0.0 to 0.19.

The last two nights have been extra terrible with me waking up completely exhausted.  One night I know I had a mask leak situation, I spent most of the night trying to adjust it and just couldn't make it better. Last night was better for that.

What can I do to make things better?
Am I hitting REM sleep?
What are all the spikes through the night that don't get flagged? They seem to happen frequently all night - am I waking up a bit at each one?

I'm attaching some daily charts and will add some zooms as well.  Any other zooms that would be helpful?


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