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Drawing conclusions from first night with new machine
#1
Drawing conclusions from first night with new machine
As discussed here, last night I had my first night of a week-long trial with an AirSense 10 Autoset machine and Dreamwear nasal cushion mask, with data recorded to SleepyHead, and I'm now trying to make sense of it.

I'd previously used APAP three years ago, but due to sinus problems my doctor suggested trying a sleep positioner instead, since my AHI sleeping on my back was high, but sleeping on my side was zero. Recently I had a new at-home sleep study because I'd been feeling somewhat more tired during the day. The test again showed AHI of 0 on my side, 11.87 on my back, for a composite AHI of 8.7. I noticed I was having RERA's even on my side, however, and my percentage of REM sleep was below the low end of the normal range, so I wanted to try APAP again to see if this could be improved.

Overall for last night with the AirSense, SleepyHead gives me an AHI of 7.57. I had a challenge snugging up the nasal cushions, and at one point around 1:40 a.m. I awoke aware that pressure was high and a lot of air was escaping the mask, so I readjusted it and it seemed to improve. At 5 a.m. I intentionally awoke for an hour to take care of something, then went back to sleep for a final 90 minutes or so. During this period I sometimes woke up aware that I was forcefully exhaling through my mouth instead of through my nose. Earlier in the night I'd also noticed I woke up with an extremely dry mouth, suggesting a fair amount of mouth exhalation. I was surprised to see that I had a number of OA events sleeping on my side, as I thought these primarily occurred on my back. My HMO set the machine pressure to 4-20cm. Last night I see the pressure averaged 6.52, and the highest was 14.1.

Some plans going forward:

-- Try the Dreamwear nasal pillows instead of the cushions

-- Work more on snugging up the mask

-- Consider trying a chin strap to prevent mouth exhalation

Beyond that, I'm not sure what to tweak. Should I consider adjusting the pressure? I also recently bought a Caldera Releaf cervical collar -- would it be worth trying this as well?

I'm happy to post SleepHead screenshots if anyone can suggest what would be the most useful segments to look at. Thanks in advance for any ideas.
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#2
RE: Drawing conclusions from first night with new machine
Look at the "Organize" link in my signature.  
Events, Flow Rate, Flow Limits, Snore, Pressure, and Leaks
you will also need to drop the Pie Chart and the Calander.

Fred
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
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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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#3
RE: Drawing conclusions from first night with new machine
(01-03-2019, 12:55 PM)Dyssomniac Wrote: As discussed here, last night I had my first night of a week-long trial with an AirSense 10 Autoset machine and Dreamwear nasal cushion mask, with data recorded to SleepyHead, and I'm now trying to make sense of it.

I'd previously used APAP three years ago, but due to sinus problems my doctor suggested trying a sleep positioner instead, since my AHI sleeping on my back was high, but sleeping on my side was zero. Recently I had a new at-home sleep study because I'd been feeling somewhat more tired during the day. The test again showed AHI of 0 on my side, 11.87 on my back, for a composite AHI of 8.7. I noticed I was having RERA's even on my side, however, and my percentage of REM sleep was below the low end of the normal range, so I wanted to try APAP again to see if this could be improved.

Overall for last night with the AirSense, SleepyHead gives me an AHI of 7.57. I had a challenge snugging up the nasal cushions, and at one point around 1:40 a.m. I awoke aware that pressure was high and a lot of air was escaping the mask, so I readjusted it and it seemed to improve. At 5 a.m. I intentionally awoke for an hour to take care of something, then went back to sleep for a final 90 minutes or so. During this period I sometimes woke up aware that I was forcefully exhaling through my mouth instead of through my nose. Earlier in the night I'd also noticed I woke up with an extremely dry mouth, suggesting a fair amount of mouth exhalation. I was surprised to see that I had a number of OA events sleeping on my side, as I thought these primarily occurred on my back. My HMO set the machine pressure to 4-20cm. Last night I see the pressure averaged 6.52, and the highest was 14.1.

Some plans going forward:

-- Try the Dreamwear nasal pillows instead of the cushions

-- Work more on snugging up the mask  Careful, a very common issue is overtightening the mask

-- Consider trying a chin strap to prevent mouth exhalation  Try the Caldera first

Beyond that, I'm not sure what to tweak. Should I consider adjusting the pressure?   Yes, to 6 minimium if you are having any issues 4 to 20 is a common initial setting.   You can either leave the Max alone or set it to 16 for now. [b]Expect different settings after we see the charts.[/b]
I also recently bought a Caldera Releaf cervical collar -- would it be worth trying this as well? This should help with mouth breathing or positional apnea, both of which could be confirmed after seeing your charts.

I'm happy to post SleepHead screenshots if anyone can suggest what would be the most useful segments to look at. Thanks in advance for any ideas.
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
OSCAR

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New to Apnea? Helpful tips to ensure success
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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: Drawing conclusions from first night with new machine
Thanks for the comments. See 2 file attachments for SleepyHead data.

One note. On my MacBook screen I couldn't seem to get Event Flags, Flow Rate, Pressure, Leak Rate, Snore and Flow Limit all on one screen at one time. So I took two screenshots, one that includes Snore and the other including Flow Limit.

Regarding events, you'll notice at ~1:40 a.m. when I removed and readjusted the mask, and the pressure suddenly drops. Then from 5 a.m. to ~6:20 a.m. I was awake and away from the bedroom.

Thanks again for any thoughts on this.
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#5
RE: Drawing conclusions from first night with new machine
FYI you should be able to grab a horizontal edge of an individual chart and modify the vertical dimension but we can work with what you posted.

First, you do have a positional element to your events so the cervical collar should help eliminate this.  This is determined by the clusters of obstructive events in your chart.

Your machine settings show a full face mask and an anti-bacterial filter is being used.  The mask type is important because the different volumes require different amounts of flushing CO2 out of the system.  The AB filter because it increases the resistance of the system.  Please make sure these settings are accurate.

As you noted you are having a small leak problem.  The leaks you have to be concerned with are the grey on the LL (Large Leak) line in the events chart

The question I would like to ask is how do you feel?

Fred
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
OSCAR

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New to Apnea? Helpful tips to ensure success
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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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#6
RE: Drawing conclusions from first night with new machine
(01-03-2019, 03:26 PM)bonjour Wrote: First, you do have a positional element to your events so the cervical collar should help eliminate this.  This is determined by the clusters of obstructive events in your chart.

Your machine settings show a full face mask and an anti-bacterial filter is being used.  The mask type is important because the different volumes require different amounts of flushing CO2 out of the system.  The AB filter because it increases the resistance of the system.  Please make sure these settings are accurate.

As you noted you are having a small leak problem.  The leaks you have to be concerned with are the grey on the LL (Large Leak) line in the events chart

The question I would like to ask is how do you feel?

Thanks. Good point about the mask type being set as full-face on the machine; I'd noticed that too and wondered if it would affect air volume, since I was using a Dreamwear mask with nasal cushions.

So, before tonight I'll reset the mask type on the machine and will also try the cervical collar. Then will experiment between Dreamwear with nasal cushions vs. pillows.

How do I feel? During sleep, I find moderate to low air pressure comfortable, and I'm happy that my nasal passages are now clear enough for a nasal mask. However, when the pressure increases significantly I find it really uncomfortable.

As for how I feel in the morning, it's a little early to tell as I had an errand to run at 5 a.m. which threw my normal sleep cycle off. I think I'll reserve judgment on coming to a conclusion on that until I can try a few more nights.

Since my overall AHI without treatment was recorded as 8.7, and if I stay on my side it's consistently 0, I suspect my HMO is going to want to see the number come down a good bit before approving a permanent machine. I know when I used a Remstar several years ago I was able to get AHI's very low -- my problem at that time was just sinus/nasal issues. I was surprised in the data for last night to see the OA's occurring at times in the night when I know I was sleeping on my side. Hopefully this is just a one-time anomaly.
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#7
RE: Drawing conclusions from first night with new machine
(01-03-2019, 01:20 PM)bonjour Wrote:
(01-03-2019, 12:55 PM)Dyssomniac Wrote: Beyond that, I'm not sure what to tweak. Should I consider adjusting the pressure?   Yes, to 6 minimium if you are having any issues 4 to 20 is a common initial setting.   You can either leave the Max alone or set it to 16 for now. [b]Expect different settings after we see the charts.[/b]

By the way, after seeing the charts I posted, does that change your thinking in any way about pressure settings I might try?
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#8
RE: Drawing conclusions from first night with new machine
I would like to see a full copy of your diagnostic sleep study (redacted of course) without CPAP.  Not just the summary.  You have about 1/3 of your events as Central/mixed/complex apnea.  I want to see what you had in that sleep study.  The summaries often don't mention them and most patients don't recognize them.  The collar should get rid of mostt of your obstructive events. 

Most of your CA events are occuring at 10cmw or higher  so I was thinking of maybe 9.6 max. to see if we can make a dent in that.  so 6 - 9.6.  That is a very agressive move based on a 1 week trial.

Sleeprider, your thoughts?

Fred
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
Soft Cervical Collar
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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#9
RE: Drawing conclusions from first night with new machine
You're doing great here Fred! With settings of 4-20 and EPR at 3, we see median pressure at 6.5 and 95% pressure of about 12 cm. There is a strong positional apnea signal. While central apnea are being recorded, it is not a problem. My suggestion would be a pressure rannge of 6 to 12 with EPR turned down to 2.

Positional apnea should be improved with the collar, but as Fred and I have discussed, we are skeptical that the cause of apnea is from sleeping on your back. Instead we are moving in the direction that sleeping on your back on a pillow encourages the chin tuck towards your chest that causes obstruction at the soft palate. I think we added this discussion to the Optimizing Therapy wiki at the Positional Apnea heading.
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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#10
RE: Drawing conclusions from first night with new machine
(01-03-2019, 05:03 PM)bonjour Wrote: I would like to see a full copy of your diagnostic sleep study (redacted of course) without CPAP.

Attached are scans of the two pages of the recent sleep study report. The handwritten annotations were done by the tech as we discussed the report. For example, earlier in the night I slept on my side, whereas later I intentionally slept on my back. A third page just had my personal information with age (64) and height/weight/BMI (6'1", 165#, 21.8).

I greatly appreciate your time in looking at and commenting on this. Thanks much!
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