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[CPAP] Suggestions & strange breathing
#1
Question 
Suggestions & strange breathing
Hi, I'll be upfront first off, have tried in another forum but not much feedback although their advice on raising minimum pressure did help.

See overview attachment for pressure and improvements. Have also posted a couple of days.

Noticed a couple of days ago a strange breathing pattern in OSCAR/Sleepyhead. It happens independent of pressure and usually follows a Hyponea or PB. It can resolve during the night, once again usually following a Hyponea but usually keeps up- all night regardless of what events happen. Checked data from 2 years ago it was happening then but went unnoticed.

Thank you again to all those who help others to better understand their condition. Wish the doctors would given how much we pay them !!! 

Also a big thanks to those involved in Sleepyhead and OSCAR.

   
   
   
   
   

Mike
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#2
RE: Suggestions & strange breathing
You are referring to the distortions to the top of the breath wave? I would suggest the same. Your machine likes to be closer to the 95% number. I'd try min 12 and review.
mask fit http://www.apneaboard.com/wiki/index.php...ask_Primer
For auto-cpap, from machine data or software. You can set the min pressure 1 or 2cm below 95%. Or clinicians commonly use the maximum or 95% pressure for fixed pressure CPAP, this can also be used for min pressure.
https://aasm.org/resources/practiceparam...rating.pdf
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#3
RE: Suggestions & strange breathing
You have 2 issues. Your AHI which indicates an increase in min pressure is needed and significant flow limitations and RERAs. Which indicates an increase in pressure on your machine since you already have flex enabled. The Definition os RERA is a series of flow limitations,very evident in your graphs, followed by a arrousal. Arrousals are bad.

I suggest an increase of 2 to you min. Eval then change by @ up or down or stay the same depending on evalustion
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
OSCAR

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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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#4
RE: Suggestions & strange breathing
Ajack & Bonjour thank you very much, will increase to 12 cm in a few minutes. I will review for 3 - 4 days and report back.

It was particularly bad on April 9th, when my minimum pressure was on 5 cm.

   

Thanks again,

                    Mike Thanks
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#5
RE: Suggestions & strange breathing
(05-09-2019, 08:41 AM)Mike54 Wrote: Ajack & Bonjour thank you very much, will increase to 12 cm in a few minutes. I will review for 3 - 4 days and report back.

It was particularly bad on April 9th, when my minimum pressure was on 5 cm.



Thanks again,

                    Mike Thanks
Mike, your EPAP is at 17 here and is obviously too high.  You are fighting to exhale, which is why that portion of the graph is a very short duration and rebounds above the midpoint before you begin to inhale.  You can see this to a lesser extent in your previous graph that showed your EPAP at around 14. I suggest reducing your minimum pressure back down in the 10-12 range.

I saw a comment that you are using flex.  I personally have trouble with flex.  When I turn it on, it reduces the EPAP pressure on expiration, "Expiration relief" which tends to cause me to have more apneic events.  I suggest trying it for a few days turned off.  If you must use it, only use setting 1.

If you are looking for something new to try, experiment with your sleeping angle.  If you have a recliner, try sleeping in it more upright.  If not, stack a bunch of pillows behind your back to sleep more upright.  Be careful not to tuck your chin though, keep your neck straight or slightly leaned back.  When I sleep flat in bed, I struggle to get under AHI=2.  When I sleep upright in a recliner, I can get AHI well under 1 regularly.  I use a soft cervical collar for roughly $10 when I sleep upright.  It keeps my neck supported and helps keep my mouth shut so I don't mouth breathe with my nasal pillow mask.

Keep working at it.  You will figure out what works best for you!  If you can't regularly get AHI under 5, you may have the wrong machine and may need to work with your doctor to get a bipap or even ASV unit.
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#6
RE: Suggestions & strange breathing
That is an old chart and with radically different settings than is being currently used. While I can see a BiLevel I do not see ASV in the future.
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
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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#7
RE: Suggestions & strange breathing and updates
It's been 5 days since I increased the pressure to 12 cm. My overview is showing a gradual increase in AHI and last night was a real shocker, feeling really tired and flat today.

In case anyone thinks it's positional, I wear a soft cervical collar and use a supine avoidance device.

OSCAR graphs attached.

               

Any help or comments would be greatly appreciated.

Mike
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#8
RE: Suggestions & strange breathing
It still looks positional. Do you still use the f20?
The 12 was ok on Friday, though enough to go 13. There was one cluster, positional? the second looks like you were waking or awake. The other charts are shockers and look very positional by comparison. I don't think the pressure to resolve non-positional apnea, changes this dramatically over a few nights. I guess we should add the position of your jaw to this.

A hot water and bite mouthguard that you can breathe through, may help keep your jaw and tongue from going too far back. They only cost $3 on ebay and would be worth a shot. I use them sometimes for a sore tooth, because of hard bite. I notice a difference in my charts.
Put this in ebay, scroll down. It is the one with a red plug that you take out afterwards.
use " to cut out a lot of other stuff. "NEW Dental Mouth Guard Bruxism Splint Night Teeth Tooth Grinding Sleep Aid" Amazon would also have them, get a few if you want to try it. You mess up the first couple.
mask fit http://www.apneaboard.com/wiki/index.php...ask_Primer
For auto-cpap, from machine data or software. You can set the min pressure 1 or 2cm below 95%. Or clinicians commonly use the maximum or 95% pressure for fixed pressure CPAP, this can also be used for min pressure.
https://aasm.org/resources/practiceparam...rating.pdf
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#9
RE: Suggestions & strange breathing
thanks for the quick reply Ajack.

Still using the f20, don't know how I would go with a mouth guard. I breath exclusively though my mouth, stuffed sinuses. Will check out availablity of mouth guards.

I use a large cervical collar, which allows me to open my mouth enough to breath but stops my chin from dropping forward too much. I wear the collar when sitting in my lounge chair, if I don't I wake up gasping for breath should I fall asleep.

I did note in my sleep diary that I woke up gasping for air on the Friday, so I may have been waking up when these events occurred.

See attachment for homemade supine avoidance device total cost $3 is normally covered in thin soft cloth.

   

Hurts like hell if you try to roll over, even a little bit.

On Monday 13th I was extremely tired as I was working in the garden nearly all day. Could this be why the figures were horrible? 

Mike
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#10
RE: Suggestions & strange breathing
If you have the collar loose enough to be able to keep your jaw always open. It may not be doing much to open your airway. You may do better with pillow adjustment or change. Look up bow tie pillow, you can see that if you tie a belt around your pillow, it would do the same thing. The idea is to get your head back, think like doing CPR with someone laying on their side.

I'm a mouth breather and I can use those with the breath hole in them. I haven't found them restricting my not welcomed mouth breathing. For a few dollars, it just removes one more variable. Once you identify what the issue is, then you can fix that issue and do away with the other stuff.

Most of friday night shows there is a solution. You say happily on 12-14cm
mask fit http://www.apneaboard.com/wiki/index.php...ask_Primer
For auto-cpap, from machine data or software. You can set the min pressure 1 or 2cm below 95%. Or clinicians commonly use the maximum or 95% pressure for fixed pressure CPAP, this can also be used for min pressure.
https://aasm.org/resources/practiceparam...rating.pdf
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