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[CPAP] skot's cpap journey
#21
RE: skot's cpap journey
Update. I switched masks last night and used the F30i but I think the pillow is the wrong size. Around 03:20 I reverted to the F20 fuller face mask.

I still feel that I'm waking up every hour or so, and the CA and OA lines seem to reflect that. Tonight I'm changing pillows on the F30i to see whether the CAs diminish.

I did get a couple of calls from the UK NHS Sleep Clinic, and they were pleasant enough but the advice was simply "to keep at it". I really feel that I would benefit from an in-person session with a variety of masks to verify good fit.

As ever, any suggestions appreciated.


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#22
RE: skot's cpap journey
The CA is not the problem. Your OA is more than double the CA and is clustered suggesting a positional issue (chin-tucking).
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#23
RE: skot's cpap journey
(05-26-2021, 05:44 PM)ab skotl Wrote: I really feel that I would benefit from an in-person session with a variety of masks to verify good fit.

Have you asked for that? Here in the US most insurance companies (who for the most part all follow Medicare) cover that. It's really the only thing that separates the brick and mortar DME's from the online DME's.
Sleepster

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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#24
RE: skot's cpap journey
If his area is anything like mine, the NHS isn't doing that right now because of COVID. Mine have been great about sending me any mask I've asked for (so far) to try out, though, but yeah, it would be a lot easier to try in-person. There IS one of the UK websites (I can't remember which now) that has an insurance option where you can pay a little extra and if the mask doesn't work for you, you can send it back for a refund (less the "insurance" price). But it's really hard to get that in-person appointment right now.


See my comparison of Viatom/Wellue and CMS50F oximeters here.

Not a doctor, definitely not your doctor, all advice is given as-is and represents simply my own understanding as a fellow patient and OSCAR user.
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#25
RE: skot's cpap journey
Thanks for the responses, folks. As Ratchick says, it doesn't really seem to be an option in the UK at the moment.
In somewhat desperation I went back to the F30i mask again last night, with the SW (wider) pillow. I didn't get the suffocating feeling that I felt with the narrower pillow, but the results don't seem great (at least, I think they don't look great).

Please see attached image, and any advice again is very welcome.


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#26
RE: skot's cpap journey
It's definitely dropped your OAs a little, your centrals are about the same, maybe a little higher (but Centrals are nothing if not inconsistent). What is the EPR set to, 3? If so, and the centrals stay higher, you might need to tweak the value a little down... I'm not sure if maybe some of those are positional, or if they're pressure-related, the OAs that are left. Sorry - I'm not that great with charts yet, but hopefully someone else will give you a hand soon. Smile Glad you weren't suffocating this time, though.


See my comparison of Viatom/Wellue and CMS50F oximeters here.

Not a doctor, definitely not your doctor, all advice is given as-is and represents simply my own understanding as a fellow patient and OSCAR user.
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#27
RE: skot's cpap journey
Cheers for that - yeah, not suffocating is a definite bonus!

EPR is 3 right now.

By the way, are Centrals not as concerning as OAs/UAs?
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#28
RE: skot's cpap journey
It depends. Centrals are a HUGE problem if they're the underlying cause of your disordered breathing (as they are for me, I have severe CSA with 80+ CAI untreated on my sleep study, and at best a 1/3 -1/2 of that on CPAP - hence hassling my doc for ASV instead). But a few centrals aren't necessarily a big problem - some can happen simply because the treatment is more effective. Sometimes EPR can trigger them - and in those cases, it's usually down to the fact that while on the CPAP, your breathing is more effective, and you're exhaling more CO2 than normal.

It's actually high levels of CO2 that trigger the need to breathe if you are breathing more effectively, you need to breathe less often and in the extreme, this can cause periodic breathing (which has a very characteristic pattern where your breaths get smaller and smaller as because you have less urge to breathe until eventually, you pause long enough between breaths that your carbon dioxide levels build up again, you start breathing again, and the breaths get bigger and bigger until you blow off the carbon dioxide again, and then the cycle repeats.

These treatment-emergent centrals are expected - they happen in a certain portion of people, and the higher the pressure, the higher the EPR, the more likely that is. Unfortunately, the things that treat obstructive events and flow limitation also increase the chance of centrals. Some people aren't really troubled by them, others need to find a balance of the right settings to manage both the OSA and the centrals, and a minority need another kind of therapy if their centrals are high no matter what, and they can't manage both the OSA and the centrals.

For many people with treatment-emergent centrals, the idea is to not get rid of them all at once - because by leaving a few (not enough to impact on general wellness) that can prompt your body to adjust to the better night respiration and give you the urge to breathe at lower levels of CO2, so the centrals stop - usually this happens with someone new to using PAP (or new to consistently using it) within the first couple of months or so.

So yes, it depends. Centrals are definitely not "less severe" but the cause and number of them is important. If the EPR or pressure ends up with higher centrals, the fix is simply to turn them down, and find the balance between increased centrals and decreased flow limitations/obstructive events. to get the lowest AHI and best symptomatic results you can. Especially at levels <5.


See my comparison of Viatom/Wellue and CMS50F oximeters here.

Not a doctor, definitely not your doctor, all advice is given as-is and represents simply my own understanding as a fellow patient and OSCAR user.
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#29
RE: skot's cpap journey
Thanks very much for taking the time to post that extremely detailed and helpful response, ratchick. That's a great explanation and really helps me understand what I'm looking at.

I'm thinking that I'm still very much in trial and error mode and need to get comfortable with the mask. If I can then get the OAs down a bit I can start tuning to see if the CAs can come down?

Thanks again - amazing to think there are so many people who can take the time to help others through this!
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#30
RE: skot's cpap journey
Absolutely. Give it maybe a few days (and see what the others say about the obstructives) and most importantly how you feel in yourself. It can take a while for you to feel "normal" again, even when you have good numbers, but fingers crossed, we'll all get there in the end!


See my comparison of Viatom/Wellue and CMS50F oximeters here.

Not a doctor, definitely not your doctor, all advice is given as-is and represents simply my own understanding as a fellow patient and OSCAR user.
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