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CAs and I are tighter than I'd like :)
#1
CAs and I are tighter than I'd like :)
Hi all, new member and first post. I love how helpful this forum is for apnea peeps! Can I ask y'all's advice on my situation please?

I've been using a CPAP for a few years but haven't seen my sleep doc in a while since it didn't seem to be getting me anywhere. As seen in my overview chart, some periods of time are better than others in terms of overall AHI. Regardless, CAs always seem to be a the majority of my events. And most days are filled with that "nappy time feeling" Smile

Thoughts please? Thanks!

           

Also, since I'm a noob definitely let me know how I might improve my post. Thx!
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#2
RE: CAs and I are tighter than I'd like :)
Update: I've been having dry mouth pretty bad. The last couple nights I have tightened up my chin strap - seems to help a little in terms of dry mouth and bringing AHI down a bit. Not sure if coincidence or not.
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#3
RE: CAs and I are tighter than I'd like :)
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.
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#4
RE: CAs and I are tighter than I'd like :)
They might asked for a zoomed out graph of your leak rate. They might see about lowering your EPR or PS to reduce CAs. Try soft cervical collar plus correct tongue posture to reduce mouth leaks.
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#5
RE: CAs and I are tighter than I'd like :)
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.
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#6
RE: CAs and I are tighter than I'd like :)
(05-25-2020, 05:31 PM)weiss27md Wrote: They might asked for a zoomed out graph of your leak rate.  They might see about lowering your EPR or PS to reduce CAs.  Try soft cervical collar plus correct tongue posture to reduce mouth leaks.

Thanks for the suggestion! I'm attaching a zoomed out version of the leak rate.
   
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#7
RE: CAs and I are tighter than I'd like :)
Your leaks are mask leaks, see how jagged the tops are. Review the Mask Primer for fitting hints. The two most common issues with masks are the mask does not fit you and the mask is tightened too much.
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#8
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.

Thanks so much bonjour! I'll have to dig out my sleep test results to see if I can add details for the "why BiLevel" question. I do recall they titrated for both pressures if that helps. Again, I'll dig into it. There are no respiratory or cardiac issues. Appreciate your insight.
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#9
RE: CAs and I are tighter than I'd like :)
A ROT, rule of thumb, Always include the full night chart because it gives context, then provide zoomed view where you would like a specific opinion of.
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#10
RE: CAs and I are tighter than I'd like :)
[quote pid='352227' dateline='1590446002']
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.
[/quote]

bonjour - I made the change you suggested above (decrease IPAP from 19.6 to 17.6). I also spent some time adjusting my nasal mask after reviewing the mask fit primer. Here are the results for these changes:

Mask leaks decreased significantly and comfort increased (yes!).
Zero OAs and some improvement in the CAs.
Note my sleep last night was not typical. Started on CPAP, then a storm rolled in and it was my turn to take the freaked out dog out of the bedroom so I dozed on the couch intermittently until I grabbed a few more hours on the CPAP.
Also, for the record, I was originally on a BiPAP pressure range of 15-21 before I decreased in in January out of frustration that the pressure was "blowing my mask off" (I now know that was a fitment problem).

Any thoughts? Thanks! 

[attachment=23302][attachment=23303][attachment=23304]
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