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Chart Envy
#31
RE: Chart Envy
Learned friends - some help please

Over the last few nights I thought I had this figured out with 2 sub 10 nights but then in between some horrible results

Please have a look at the attached and provide any thoughts you might have - everything is the same, hygiene, mask, pillow, settings yet I'm getting wildly different outcomes

Would mouth breathing in the mask cause this ? Should I go back to taping my mouth inside a FFM ? Loathe to do this as struggling to breathe through nose for whole night just now due to air quality

Looking for help please as to what could be happening on the trends, not just cataloguing this time

Rob
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#32
RE: Chart Envy
the ahi bar chart from 6/6 to 8/13 provides a vivid snapshot of just how poor your treatment has been. as sleeprider said, the only consistent thing about complex apnea is inconsistent results on cpap/apap. not sure I looked at all your posted charts but I don't think I saw any with ahi under 5 and your ca is variable and often very high. there's still a very small chance that the ca is treatment induced: looks like it's been less than 2 months and you are fighting leaks. what did your diagnostic sleep study that reported ahi of 49 say? I was dxed obstructive even though my study produced 192 ca's to 204 oa's, had a previous diagnosis of all ca, and apap treatment was unable to get my average ahi below 5-6, plus I felt awful. I can imagine you must not be feeling better either as your results look much worse than mine. if it were me I'd be calling every day complaining about my consistently not-good-enough to downright horrible results so far and to find out the results of the titration study, assertively pressing for some much needed attention. maybe anything is possible and we'd hope they know better than we patients but I'd be quite concerned if your sleep advisors think your current treatment is going to improve.
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#33
RE: Chart Envy
Read Waldo1945's thread http://www.apneaboard.com/forums/Thread-...tral-Apnea

There is a solution, and you might have to go "full rogue" to make it happen. Your Philips Dremstation Auto just isn't getting it done.
Sleeprider
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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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#34
RE: Chart Envy
What a great thread, many thanks Sleeprider, I too see an ASV in my future and great to hear of struggles leading to a great outcome - sleep doc session on the 27th to review the titration sleep study so here's hoping ASV will be the outcome.

In the meantime, assuming I do have Complex Apnea, is it possible to get a night without any centrals (as per attached) and still have central - still wondering how this trend is possible ?

As there is also time between now and then I was thinking of tightening the settings a little, 8.5 with a FFM doesn't seem to give me enough air at times so thinking of raising that to 9 or 9.5 and tightening the max from 13 to 12.5 too until I get the results - thoughts ?

Rob
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#35
RE: Chart Envy
What makes this harder to diagnose and get help to resolve is that it is inconsistent. Once night over 40 AHI with abundant CA and then something under 4 AHI with scattered hypopnea. You just don't know what you're going to get, and what kind of night you might have during a sleep test.

Using a narrow range of pressure and even fixed pressure can help to narrow down the possibilities. This also helps to minimize sleep disruptions, so you would not be the first to experience improvement from a narrower range of pressure. I think it's a good idea.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Optimizing Therapy
Organize your OSCAR Charts
How To Attach Images And Files to your posts
How To Deal With Equipment Supplier
Mask Primer
Beginner's Guide to Sleepyhead

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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#36
RE: Chart Envy
Just an update from me to capture learning.

On speaking to the hospital sleep tech, it is possible to get a night without centrals yet still have complex - this wasn't clear to me.

Since last we spoke I've tightened in my min/max a little, firstly from 9-12.5 for a few nights and then lowered the max again to 11.5 and here's what I've learned.

The first couple of days seems to go a but haywire when I bring down a max then it seems to settle - when I lowered to 12.5 I ended up with two awful days followed by 2 sub ten days. I have just had the first two awful days on 11.5 so now hoping for some better ones.

I should say even with the large deviation in results I'm definitely feeling a bit better and less tired during the day.

Mask - I got a medium for my F20 FFM which seems to have varying results (my current was small) it doesn't leak and feels much better on - longer below my mouth but is more bulky at the sides meaning I feel it much more turning over so a bit of a trade off.

I think I will be able to try without the chinstrap as it often wakens me with sore ears as it digs into them. Also I have a couple  of cervical collars to try so may start that tonight

Here are my results over last few days - overall my leaks have dramatically improved and my AHIs are slowly coming down, I think they would be coming down faster if I didn't keep tightening settings but this is a trade off with trying to get dialed in. I really hope an ASV is in my near future but trying to make the best of what I have for now

Onwards..........
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#37
RE: Chart Envy
Well an update to my 'Captain Slog' ..............

Medium Resmed F20 working really well, changed back to a regular down pillow from memory foam prevents the pillow pushing the mask off my face, this seems to be good for now.

Pressures - continuing to dial in the pressures, now at 9-10.5, will leave for another few days but thinking 9.5 to 11 might just about be optimum without ASV ?

Cervical Collar - I put off trying this out and had been using chinstrap only with FFM but the cervical collar has been a revelation - waken up far less often and generally more comfortable and a combination of bigger FFM and it are keeping my mouth shut. If like me you have been putting this off give it a try, its comfort may surprise you !

Humidity - have tried turning it off last few nights and don't seem to waken up with dry throat so will keep it off - have turned on a room humidifier at same time so maybe this is enough ? Do seem to struggle to breath fully through nose for first few mins of treatment every night then things seem to 'open up' when I relax - wondering why this is ?

Leaks seem to be lowest ever and well under control now with right sized F20, Collar and softer pillow.

Feeling a bit better over the last week but looking forward to seeing what the sleep doc says about the titration study on Monday. I also now have an appointment pending at the hospital doc where the sleep tech has been a great help so far.


That's it for now - comments / suggestions welcome

Rob
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#38
RE: Chart Envy
I've been reading this thread with great interest, because I have similar issues (though my AHI isn't as high as yours).  My doctor is reluctant to prescribe ASV, in spite of the fact that my CAs outnumber my OAs 2:1 on most nights.
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#39
RE: Chart Envy
Well this is interesting............

Since moving to the medium F20 FFM (around 18th) my snoring has been on the gradual increase - VS2 measure - is this something I should be worried about ? haven't really seen this measure discussed anywhere.

Last night I had really vivid dreams, two different ones that I won't repeat - again is dreaming a good sign or bad sign..... not sure ?

As a result of the dreams I felt is was a really crappy night's sleep and then low and behold a really low number for me.

Thinking 9.5-11 is going to be the non ASV sweet spot for me but going to stay at current until after I see my study results and speak to the doc on Monday. Would nudging the min up prevent more hypo apneas ? Would nudging the max up reduce the OAs ?

I also don't think I've stressed this enough during my learning - the hose caddy thing that now drapes the hose in a loop above my head allows me to turn without ever snagging the hose - its truly fantastic get one if you haven't already, search 'CPAP hose holder' on eBay. I also place it mid point of my pillow along the top of there mattress rather than side, seems to be optimum for me to roll over.

Thoughts on snore / dreaming appreciated.

Onwards...........

Rob
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#40
RE: Chart Envy
...........and now we're snoring (not audibly) but the VS2 reading was going through the roof over the last week so have spent an hour reading the forum about snoring, hence turning off the VS2 as this seems by all accounts to be just nonsense.

This seems to have started with the move to FFM and gotten considerably worse with the cervical collar but I think I'll take this and perhaps 'dial in' a little further after doc session tomorrow.

I'm thinking about measurable snores as being 'pre apneas' as others have described where they can be treated by a little more pressure but as I said staying the same until after tomorrow.

have to say the collar is just becoming part of the nightly routine and seems to be shaping to me a little and becoming more comfortable

Last two nights have been sub five AHI and felt less need for daytime snooze, leak rates all good and less disturbance during the night.

Must be due a blow up again, things going far too well !

Onwards........

Rob
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