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CAs and I are tighter than I'd like :)
#11
RE: CAs and I are tighter than I'd like :)
(05-25-2020, 05:33 PM)bonjour Wrote: Welcome to the forum.
Your AirCurve S is the manual machine.  Nothing wrong with the "S" but why do you have the BiLevel?  I'm looking for things that we might need to know about.  Any respiratory or cardiac issues other than Apnea?

You are mostly Central events. Looking at your closeups I do see hints of waxing and waning that indicate a CO2 driven Central Apnea.  The high PS (5) that you are using has increased the efficiency of your breathing, providing you with both an improved Oxygen SAT (no proof here) and increased removal of CO2 from your blood.  This is evidenced by the subtle waxing and waning of your flow rate.  This lowers your CO2 levels to below your apneic threshold resulting in your central apneas.  Decreassing your PS will help alleviate that and help to maintain a CO2 level above your apneic threshold.

Thus I would like you to drop your PS from 5 down to 3 so
EPAP=14.6 (no change)
IPAP = 17.6 (a decrease of 2)

Then observe and review the results.  I expect more changes.

Looks like I somehow messed up my last post, apologies for the noobness… my comments are above and here are the attachments:
           
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#12
RE: CAs and I are tighter than I'd like :)
(05-25-2020, 05:27 PM)sheepless Wrote: dry mouth is from mouth breathing. anything that will help keep your mouth closed will help, assuming you can breathe through your nose. folks use a chin strap, soft cervical collar, tape or practice the tongue suck technique. xylimelts or similar may help with dryness but won't help mouth leaks.

BTW, thanks sleepless. I have a chinstrap and will follow up on above options as needed
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#13
RE: CAs and I are tighter than I'd like :)
(05-25-2020, 05:33 PM)bonjour Wrote: Welcome to the forum.
Your AirCurve S is the manual machine.  Nothing wrong with the "S" but why do you have the BiLevel?  I'm looking for things that we might need to know about.  Any respiratory or cardiac issues other than Apnea?

You are mostly Central events. Looking at your closeups I do see hints of waxing and waning that indicate a CO2 driven Central Apnea.  The high PS (5) that you are using has increased the efficiency of your breathing, providing you with both an improved Oxygen SAT (no proof here) and increased removal of CO2 from your blood.  This is evidenced by the subtle waxing and waning of your flow rate.  This lowers your CO2 levels to below your apneic threshold resulting in your central apneas.  Decreassing your PS will help alleviate that and help to maintain a CO2 level above your apneic threshold.

Thus I would like you to drop your PS from 5 down to 3 so
EPAP=14.6 (no change)
IPAP = 17.6 (a decrease of 2)

Then observe and review the results.  I expect more changes.

Here are the graphs from my second night with the adjustments above. I'd be grateful for feedback from anyone who sees anything interesting. Should I be posting these, or waiting until I've had some time (a week or so?) with the new settings? Many thanks!

           
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#14
RE: CAs and I are tighter than I'd like :)
Thanks,

Your close up is showing that the central apneas appear to be based on your CO2 Apneic threshold as expected.
I'd now like to reduce pressure and PS this time to address your Central Apnea.
EPAP = 12
IPAP = 14
PS = 2

Please let us know how you feel with the changes.
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
OSCAR

Download OSCAR
New to Apnea? Helpful tips to ensure success
Soft Cervical Collar
Mask Primer
Dealing with a DME
Organize Charts
Attaching Charts

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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#15
RE: CAs and I are tighter than I'd like :)
bonjour - got it, many thanks for the input! Will make the change for tonight and report results.
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#16
RE: CAs and I are tighter than I'd like :)
Ok, so I made the changes to pressure last night: 12/14. Here's what I noted:

Felt about the same as before, fairly tired and sluggish most of the day.
There were more hypopneas than usual.
I noticed when I got up for the restroom that my sinuses seemed to close up fairly quickly, but when I got the CPAP back on they opened right up again. This used to happen ("long ago") but I didn't realize it had stopped until it happened again last night at the lower pressure. Sharing in case it means something to y'all.

Here are my three usual screen shots
           

I'll add a couple other observations next. Thanks! scottgbp
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#17
RE: CAs and I are tighter than I'd like :)
I also wanted to share the following...

There seemed to be periods of time where there was the flowrate waxing/waning but no registered CAs as shown here:
   

I also saw long periods of more steady breathing like here:
   

Thanks again!
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#18
RE: CAs and I are tighter than I'd like :)
Hi all, here are my charts from day 2 at EPAP/IPAP of 12/14. Bonjour, all, any comments or suggestions based on these?

I've included a flowrate wave form showing some of the waxing/waning ahead of the CAs. I also noticed some of the CAs were preceded by more steady breathing.

Again, thx! scottgbp

           
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#19
RE: CAs and I are tighter than I'd like :)
First of your numbers are good, and as such, there is no reason to change them.  How you feel is very important.  Please let us know that and how you perceive any changes.

That said I'd like you to try a lower pressure. Reducing by one
EPAP = 11
IPAP = 13
PS = 2

Let us know which you feel is better.
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
OSCAR

Download OSCAR
New to Apnea? Helpful tips to ensure success
Soft Cervical Collar
Mask Primer
Dealing with a DME
Organize Charts
Attaching Charts

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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#20
RE: CAs and I are tighter than I'd like :)
(05-29-2020, 10:37 AM)bonjour Wrote: First of your numbers are good, and as such, there is no reason to change them.  How you feel is very important.  Please let us know that and how you perceive any changes.

That said I'd like you to try a lower pressure. Reducing by one
EPAP = 11
IPAP = 13
PS = 2

Let us know which you feel is better.

Hi bonjour, it has been several days and I wanted to be sure and touch base. I've racked up 8 days with the last change down to E/I 11/13 and it seems to be an improvement. Since I'm an engineer I made a summary table lol, maybe only interesting to me haha:

   

For the last 8 days, FWIW there seems to be a correlation between the higher AHIs seen and poorer choices for food/drink. Overall I feel better, I am able to get moving (i.e., wake up) easier in the morning it seems. I still have a strong nap urge in the afternoon, but sometimes now I don't actually fall asleep. I know my numbers are pretty good now compared with before, but of course I'd take better numbers if I might feel better and welcome all input.


And here are the overview shots of last night. I'll add some zoomed-in shots of the CAs and a couple questions next:

       

Thanks! scottgbp
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