[CPAP] New user, looking for tuning advice

[wkf94025]

@DB and @bonjuor:

1) Glad to know my quota for attachments will grow over time. Until then, would you prefer I use imgur or Dropbox?  I am quite familiar with Dropbox if that is productive for you experts. I have not used Imgur, but happy to spin up quickly on that if that is the favored method here.

2) I am pleased that you interpret the sleep study graph as I did, meaning events without CPAP are mostly OA. And that centrals now showing up are treatment-emergent. I look forward to snuffing those out with your collective assistance.

3) I had to leave town yesterday on short notice business travel, without my machine, so I have no data from last night. I will try the recommended settings tonight, Min pressure = 7, EPR =1.  By the way, last night's sleep was fairly good without the machine, 6.5 hours with no wake ups that I am aware of. Is it possible a week of CPAP use could have residual benefit the first night without therapy?

4) Pulse oximeter arrives today. Excited to get that data flowing and hopefully integrated. Any recommended Wiki Pages or threads regarding doing so?

5) Interpretation of results is fascinating to me. I will provide zoomed in detail on flow rates from tonight's sleep. Is there a favorite wiki page or extensive thread where interpretation of the various graphs is explained in more detail? If not, I will absorb the Jedi knowledge base by reviewing other post over time.

6) OSCAR still on the to-do list. Hopefully today.

7) Any observations on the O2 saturation levels from the original sleep study? Above 90% virtually the entire time. What does the community believe to be the threshold below which temporary or permanent damage is being done? I assume impact is a function of both the percentage drop and the duration of depressed O2 sat, i.e., the "area under the curve". 

8) Yes, who is Dave?  ;-)

[Gideon]

Dave is the one who introduced me to his Ducks on this forum as he was going through a hard time in his therapy, and to whom I mistakenly referred to instead of DB. Dave, the sarcastic one who 'affectionately' referred to his med team by the sound of that animal.

Sorry guys, I was on my phone and I claim the privilege of old age for that slip.
Out of couriosity, did I send you here? (beerdujour)

[DeepBreathing]

Perhaps you thought the D in DB is Dave - no, my first name is Deep.

Out of couriosity, did I send you here? (beerdujour)

No... It wouldn't be much interest to me as a non-drinker (apart from an evening G&T). My father was deeply into home brew until the time he accidentally used molasses fortified with cod liver oil.  

would you prefer I use imgur or Dropbox?

Please use Imgur or similar in preference to Dropbox. That way everybody can see your charts without having to download them. Or attach them direct to your posts.

By the way, last night's sleep was fairly good without the machine, 6.5 hours with no wake ups that I am aware of. Is it possible a week of CPAP use could have residual benefit the first night without therapy?

 Probably not - the therapy works while the pressure is applied but goes away when you turn the machine off - I'm not aware of any residual benefit. It's probably just a happy coincidence that you had a good night. (But don't knock it!)

Pulse oximeter arrives today. Excited to get that data flowing and hopefully integrated. Any recommended Wiki Pages or threads regarding doing so?

Have a look here: http://www.apneaboard.com/wiki/index.php...SleepyHead   The article was written for SleepyHead but AFAIK it's the same procedure in Oscar.

Interpretation of results is fascinating to me. I will provide zoomed in detail on flow rates from tonight's sleep. Is there a favorite wiki page or extensive thread where interpretation of the various graphs is explained in more detail? If not, I will absorb the Jedi knowledge base by reviewing other post over time.

Try this one: http://www.apneaboard.com/wiki/index.php...rpretation   The information was largely taken from the Beginner's Guide to SleepyHead, and still needs some tidying up and adjustments for Oscar. It's on my To Do list.

[wkf94025]

Mixed results last night.  I upgraded to OSCAR, and imgur, so here's the upshot of last night:

• Upped min pressure to 7, from 4 previously.  Dropped EPR to 1, from 3 previously.  Upped humidity from 4 to 5.  Dropped ramp from 45 to 15min (I fall asleep very quickly if tired, which I was.)
  
• AHI = 2.4, so clearly not a disaster.  Zero OA's, and one large/long leak.
  
• After two hours, took an 8min break, then used CPAP for another 1h20min, with min pressure dropped to 5.6 (splitting the difference between previous 4 and new 7 setting).  
  
• I didn't care for the increased pressure at all.  Perhaps 3cm jump was too much for one night.  In fact, part of me is intrigued to try min pressure even lower than 4cm.  Thoughts?
  
• After 3.5 hours of the two CPAP sessions, pulled it all off and slept another 3+ hours with out issue, apparently.  Feeling fairly rested this morning.
  

I took four screen shots from OSCAR and uploaded them to imgur.  They are:

• Night overall, showing first several graphs (in recommended order per wiki)
  
• Night overall showing next several graphs (in recommended order per wiki)
  
• Zoomed in on first CA event
  
• Zoomed in further on same event
  

I am visiting my supplier in 2 hours, and tempted to pick up full face mask and pillows.  N20 nose-only mask at min=7cm isn't feeling like the optimal setup.  Curious how 7cm min pressure would feel with more or less gear on my face.

Comments welcome on last night's data.  Happy to put data file in a dropbox, if anyone wants to cruise the data in more detail.

PS:  pulse oximeter arrived, but no bluetooth.  Ooops.  Returning today for a proper unit.  Fun to play with the kids last night.  My 7yo hit 172 pulse after a few minutes of jumping jacks.  Wow.

[wkf94025]

Uh, not seeing my imgur images linking properly.  Trying again here.









And also just inserting the links, in case my attempts at inserting image are somehow flawed.

graph #1
graph #2
graph #3
graph #4

Is there something on imgur that I need to do to make "Insert an image" successful here?

[wkf94025]

I'm still scratching my head over why my "Insert image" images are not working. I re-read the wiki and I believe I followed the steps correctly. Possibly some filtering/review/approval of new users?

[DeepBreathing]

It looks like you're linking to the Imgur page, not the image itself. I went to Imgur, right-clicked on the image and selected "Copy image address". This then goes in between the img tags, as follows:

Code:

[img]https://i.imgur.com/3MPLK1x.png[/img]

which should give the image:

[wkf94025]

Like this?  ;-)  Thanks DB.

[wkf94025]

Mixed progress last night.  I tried nose pillows for the first time.  I have two different size pillows on trial from the provider, and hopefully the other pair are smaller in size than the first pair I trailed last night, as I woke up 2 hours into the night with painful nostrils and pulled them off.  I had every intention of pulling out the N20 nose mask that I have used to date, but fell back asleep for another 5 hours.  Overall good night sleep, but largely without therapy.

Results uploaded to imgur include the night overall (3 screen shots as I scroll down in main graphs and left panel summary):

      

[EDIT: sorry, I shouldn't have specified the height and width of the graphs.  Here are links to the images]

graph #1
graph #2
graph #3

My amateur observations:

• The 3 OA's were within a few minutes of start, so I consider those a complete discard.
  
• The two H's seem mild, but legit.  
  
• The eight CA's cluster within ~30 minutes around midnight, about 15min after ramp up from 4cm min to ~5cm pressure begins.  Looking at flow rate for each, they seem legit.
  
• The AHI graph climbs to 10, but with first 3 OA's artifacts of startup, AHI is falsely high for most of the session.  I assume the rolling AHI metric largely drives the machine's pressure selection?
  
• Not that I am chasing AHI to zero, but if I discard the 3 initial OA's, the real AHI would be more like 5.3 than 6.8 (3 bogus events over 2 hours = -1.5 deduct from reported AHI).  Agree?
  

Here are a closer look at the longest CA (22 seconds):
   
               zoomed in somewhat                                   zoomed in further

                           zoom #1                                  zoomed in further

I welcome any observations on the brief session results.  At this point my overall goal is to stay with a stable, and comfort-driven set of machine settings, and focus on mask experimentation and selection for now.  My biggest question as to what's actually happening in my sleep is whether the CA's are therapy-induced or are happening independent of therapy.  Is there any way to run the machine in "no therapy, just monitor his sleep" mode?  Max pressure = 1 or 0?

Also, FWIW, OSCAR decided to import all nights from the SD Card, even though the previous nights were already in the database from the migration from SleepyHead.  Don't know if anyone cares about that duplication / lack of checking.



                 image link

[wkf94025]

Summary of last night's data and sleep:

• Switched from nose pillows (size M) to N20 nose mask after 1h43m.  Nose pillows are officially painful relative to N20 nose mask.
  
• There are a total of 3 sessions, which I don't understand, as I only remember waking up once to switch pillows to nose mask.
  
• After ~4 hours, I'd had enough therapy, and decided to sleep the rest of the night without.  ~7 hours total.  Resting pulse 51, which is high for me.  Earlier this week I saw 42 at wake-up, which surprised me on the low end.  Time to get a whoop bracelet.
  
• Sleep quality:  overall feels pretty good, but probably not as good as a night uninterrupted by gear changes.
  
• AHI = 2.78, with zero OA's or H's.  Several flow disturbances are near-CA level, but apparently too short in duration to qualify.
  

Gear misc notes:

• I am lacking the flex hose necessary for the full nose-and-mouth mask, which I will pick up this week so I can try that mask and compare to N20 nose-only.
  

• I am starting to research some open source / DIY / home brew EEG gear, as I really want to be able to understand more about sleep quality than respiration-only equipment can provide.
  
• Pulse ox arrives today.  This one has memory and USB capability, unlike the first one I mistakenly ordered.  
  

Questions about the data from last night:

• Is it coincidence that most of the CA's are during the second session, when I have N20 nose mask on versus nose pillows in first half?
  
• Anything to be gleaned from the clusters of four CA's, one at 2:52am and one at 3:36am, 4 CA's each?  Note that pressure was fairly low during most of the second N20-based session, around 5cm, with 4cm relief pressure.
  
• During first session, starting around 12:15am, pressure is more elevated, and flow pattern is amazingly consistent.  Am I just very tired and in a sleep coma, or is the more active mask pressure (5cm-8cm) in parallel with my breathing, a function of my breathing, or a very active machine?  I don't understand the machine algorithms and responses well enough yet to have a sense.  If you look at the Pressure graph (not Mask Pressure), from around 5cm to 8cm+ for an hour.  Why is that?  There was only one CA prior to that step up, and no other types of events.
  

I welcome any insights from the experts.

Overview of the ~4 hours of therapy:


More stats and graphs, overview:


First cluster of 4 CA's:


Second cluster of 4 CA's:


Period of more active pressure, zero events: