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[CPAP] New and need some help lowering AHI
#71
Casey, these are pretty remarkable improvements. Results in this range are quite acceptable therapeutically, so it looks like CPAP is going to be fine for you.

The machine is designed to maintain 7 cmH2O pressure at all times. It should be able to spool up as you inhale to maintain positive pressure, and prevent the anti-asphyxiation valve from opening. The best way to test this is to just attempt to overcome the pressure when you're awake. You should be able to feel and observe if pressure becomes negative in the mask (mask will collapse inward and more resistance breathing until the valve opens). The valve is a pretty simple mechanical seal that works like a check-valve, and it is the machine that must maintain positive pressure. You may also be able to zoom in on the period where you saw this last night and see if you had some particularly vigorous inhalation. If you see the top of inhalation go flatter, that is a sign of obstruction or resistance, or possibly vacuum in the mask. You may even be able to see where the flow flattens out, then moves upward as the valve opened.
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#72
(12-08-2016, 10:27 AM)Sleeprider Wrote: Casey, these are pretty remarkable improvements. Results in this range are quite acceptable therapeutically, so it looks like CPAP is going to be fine for you.

The machine is designed to maintain 7 cmH2O pressure at all times. It should be able to spool up as you inhale to maintain positive pressure, and prevent the anti-asphyxiation valve from opening. The best way to test this is to just attempt to overcome the pressure when you're awake. You should be able to feel and observe if pressure becomes negative in the mask (mask will collapse inward and more resistance breathing until the valve opens). The valve is a pretty simple mechanical seal that works like a check-valve, and it is the machine that must maintain positive pressure. You may also be able to zoom in on the period where you saw this last night and see if you had some particularly vigorous inhalation. If you see the top of inhalation go flatter, that is a sign of obstruction or resistance, or possibly vacuum in the mask. You may even be able to see where the flow flattens out, then moves upward as the valve opened.

SR,

Yeah I was pretty shocked with the results myself. Going to do another day or so on 7CM CPAP and them possibly go to 6.5CM CPAP if CAs persist around current numbers.

I spoke with Philips Respironics in regards to the valve and their theory is that the excess humidity/water droplets in the lines and mask are weighing it down and forcing it to close for brief moments. They want me to try to get the humidity droplets under control first and if the problem persists to get it replaced.

~Casey
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#73
I just realized upon a second look that I only gave you the 1hr trend of the Pulse Oximeter. Here are both for comparison. Are these what someone would consider good results?

1hr trend - http://imgur.com/jj3wmFS
All data - http://imgur.com/Drzgbpr

~Casey
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#74
(12-08-2016, 10:50 AM)caseyfontneau Wrote: I just realized upon a second look that I only gave you the 1hr trend of the Pulse Oximeter. Here are both for comparison. Are these what someone would consider good results?

1hr trend - http://imgur.com/jj3wmFS
All data - http://imgur.com/Drzgbpr

~Casey

I also did not realize that I can import this data into sleepyhead... wow. My bad again. I'll do that when I get home and do it that way going forward.
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#75
I agree that your numbers do look pretty good. I like your idea of moving slightly lower at a fixed pressure. Remember that as you lower the pressure you might see an increase in OAs an also see the CAs convert back to Hypopneas. As you are aware mask issues are our most common problem.

Rich
Apnea Board Member RobySue has posted a Beginners Guide to Sleepyhead Software here:  http://www.apneaboard.com/wiki/index.php...SleepyHead

Download Sleepyhead
Organize your Sleepyhead Charts
Post from Imgur


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#76
(12-08-2016, 06:04 PM)richb Wrote: I agree that your numbers do look pretty good. I like your idea of moving slightly lower at a fixed pressure. Remember that as you lower the pressure you might see an increase in OAs an also see the CAs convert back to Hypopneas. As you are aware mask issues are our most common problem.

Rich

Yea I'm cautiously optimistic that we're getting a handle on this. My goal is still 0.00 AHI and for the first time I feel like that might be attainable. Get my humidity /anti-asphyxia valve situation resolved and then slowly zero in on a CPAP level that works just right.

I'm going to do the Pulse oximeter another couple of nights probably, but I don't think any of the drops are too concerning as they swam to spike right back up.

~Casey
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#77
(12-08-2016, 06:31 PM)caseyfontneau Wrote:
(12-08-2016, 06:04 PM)richb Wrote: I agree that your numbers do look pretty good. I like your idea of moving slightly lower at a fixed pressure. Remember that as you lower the pressure you might see an increase in OAs an also see the CAs convert back to Hypopneas. As you are aware mask issues are our most common problem.

Rich

Yea I'm cautiously optimistic that we're getting a handle on this. My goal is still 0.00 AHI and for the first time I feel like that might be attainable. Get my humidity /anti-asphyxia valve situation resolved and then slowly zero in on a CPAP level that works just right.

I'm going to do the Pulse oximeter another couple of nights probably, but I don't think any of the drops are too concerning as they swam to spike right back up.

~Casey

I like your O2 levels. Yes you may be able to do more fine tuning of your numbers. At some point you are going to have to figure out what is going on during the last 1/4 to 1/3 of the night.

Rich
Apnea Board Member RobySue has posted a Beginners Guide to Sleepyhead Software here:  http://www.apneaboard.com/wiki/index.php...SleepyHead

Download Sleepyhead
Organize your Sleepyhead Charts
Post from Imgur


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#78
Results from last night are looking pretty good. Unfortunately for some unknown reason my data from the Pulse Oximeter could not be pulled off Sad ... I have a weird scenario with that. I have SleepyHead installed on my MAC, but I installed parallels on my mac to install windows 10 to install SpO2 Review and sharing files between operating systems seems rather difficult so I'm not sure that I'll be able to get Pulse Oximeter data imported without just maybe installing SleepyHead onto windows 10 within Parallels as well. So utterly complicated. Nonetheless once I figure it out, I'll be able to include Pulse Oximeter data as well.

My thoughts are to keep the 7cm settings since it still improved so much and see how it does another night. I am still working on my humidity issue, but it was a lot better last night. I went with hose temp 80 and humidifier 3 figuring that the warm hose would be able to carry less humid water w/out rain out.

If you're familiar with the AmaraView and how it is a reusable headgear / hard face cover piece that the mask attaches into you'll be able to picture this, but the condensation builds up between the outer shell and primary mask. Not sure how much I'll be able to do about that with an ambient room temp of 55.

Whole Night - http://imgur.com/qKu3xUl
5 min - http://imgur.com/1UtFpSc
5 min - http://imgur.com/ldXUNXs
5 min - http://imgur.com/gtHt6cc

~Casey
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#79
Pad-a-Cheek, Supplier #31 is now selling an Amara View mask liner. The owner of that business is a CPAP user and designs and makes her own stuff. This might help insulate the mask. In any event this looks like a work in progress, and maybe you can help out with feedback. Here is what she says about it.

Quote:I have tested it myself and found that it worked after I fiddled with it and pulled on my mask and adjusted my position. It leaked badly at first, but after a little bit, it sealed and then worked well. I want you to know this before you order it. If it does not work for you, please let me know and return it for a refund. This mask was tough to design a liner that would work well. I need your feedback.

If you are not using a fleece hose liner, you definitely want to give that a try as well. Greatly increases the comfort by making any hose contact with your skin soft and warm.
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#80
I'll have to check out those liners. They don't say what size they're for which I find a little strange, but I guess it's possible to be a one size fits all. Maybe I'll email them.

Additionally I figured out how to get my data to import from the pulse oximeter. Apparently It recorded fine last night and Just didn't show up in Sp02 Review.

So ignore the fact that the event flags area had to be highlighted for me to actually take a screenshot I had accidentally saved the oximeter data to the wrong time frame :-/ I'll have it on point for tomorrow, but here is how it looked with the sleepyhead import. I removed snore and imported pulse and 02 to make room in the screenshot.

Whole Night w/Pulse Oximeter - http://imgur.com/S6xVWSC
Whole Night before pulse oximeter import - http://imgur.com/qKu3xUl
5 min before pulse - http://imgur.com/1UtFpSc
5 min before pulse - http://imgur.com/ldXUNXs
5 min before pulse - http://imgur.com/gtHt6cc
~Casey
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