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Drawing conclusions from first night with new machine
#11
RE: Drawing conclusions from first night with new machine
(01-03-2019, 05:54 PM)Sleeprider Wrote: 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.

That's an interesting idea. I can certainly try sleeping on my back with the cervical collar to see if that makes a difference.

Also, I recall that my gastroenterologist suggested that while wedge pillows help for reflux, an even better idea is to sleep more or less flat on the bed but tilt up the head end of the bed itself. This would be more involved to implement, but I suppose I could give that a try as well.
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#12
RE: Drawing conclusions from first night with new machine
SR was talking about positional apnea, not apnea in general.  In sleep reports the sleep techs and the doctors seem to think the only positional elements are Back, R Side, L side and stomach and they typically ignore stomach, after all, who could possibly sleep on their stomach with a mask on their face.

That is a bad sleep report.  It makes no reference to any Hypopnea or Obstructive events for that matter, It does list an AFI and an RDI which makes me think this is a summary and not the full report. and since you have a small CA component it does not mention the absence of those events.

Assuming (lack of data) that you did not have any of the CA events before CPAP these would be Treatment-Emergent Central events and they should diminish or vanish over a 2 month period.  Thus I would ignore them mostly.

Oh yea, I didn't address EPR.  Set EPR to 2.  CA events tend to be higher with, Higher pressures, and Pressure variance from either eliminating obstructive events and/or EPR.
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
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#13
RE: Drawing conclusions from first night with new machine
Well, this seems like an improvement. Per the suggestions, on the AirSense I modified the pressure range to 6-12cm, set the mask type to nasal, and EPR to 2. As before I used the Dreamwear nasal cushions, slightly snugging the mask. Throughout the night I wore the Caldera Releaf collar. As you can see, AHI overall was now 3.40. I omitted the Snore section because it was 0 with nothing marked on it.

There seemed to be a time period for about an hour shortly after midnight when there was a larger leak, and then another time period aroudn 4 a.m. when a number of CA's and OA's occurred. For the most part, though, the night was much smoother. My own feeling was that sleeping was pleasant, the mask and pressure seemed comfortable, and getting up at 5 a.m. again I feel refreshed and awake.

If anything else jumps out from the charts or any suggestions come to mind, I'll be very interested. Thanks again.
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#14
RE: Drawing conclusions from first night with new machine
Looking good, 3.4 is more than good and most importantly you are feeling good. That should satisfy your medical team. That came mostly from your collar.
Of the 3.4 most of it is central, 2.26. Note how they are mostly occurring at your high pressures. I'd like to set your Max at 10 to see if we can reduce those a bit. You spent most of the night under 10 so it shouldn't affect your OA readings.

As Sleeprider said the CA isn't large enough to be a concern. MOST IMPORTANT here is how you are feeling about your therapy and any sleepiness you have at any time. So again, How do you feel?

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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#15
RE: Drawing conclusions from first night with new machine
Well, I have to say this is pretty nice. I dropped the max pressure to 10 as suggested, but otherwise everything was the same as the previous night (including use of collar). Can't complain about the AHI of 0.66.

The leak and snore around 4:30 a.m. were interesting. At that time, I was having a dream in which I was speaking. Partway through my speaking, I became awake, and I had the sense of a PAP air leak synchronized with what I was saying in the dream. I readjusted, went back to sleep and all was fine. This was no big deal in the bigger picture, but I had the impression that in my physical body I probably began to mouth the words I was saying in the dream, which probably caused the leak. Although I sleepwalked as a teen, as far as I know I don't particularly act out dreams. However, I'd be interested in setting up a videocam to check any nighttime movements I make, if I can figure out how to do so.

Anyway, that was just a small point of interest. Overall the result was great, and I feel refreshed after a nice night's sleep. Thanks again for the help!
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#16
RE: Drawing conclusions from first night with new machine
That's what I hoped would happen.  But one night is not a trend. Continue these settings.  

The only change I would suggest is to safely raise the head of your bed per your gastrointestinal specialist.
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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#17
RE: Drawing conclusions from first night with new machine
...and that's how it's done!   like
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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#18
First couple of nights a little rocky on permanent machine
As recounted here, I recently had a trial week with an AirSense 10 Autoset machine and Dreamwear nasal cushion mask. After setting the pressure to 6-10cm and the EFR to 2 based on great advice here, I was thrilled to see AHI as low as 0.66 and 0.77, though in the remainder of the week I had a couple of nights in the 2.1 to 2.3 range, mostly due to Clear Airway. (I gather this might be treatment-emergent centrals that will hopefully ease off.) I then turned in the equipment and waited for my permanent machine.

It arrived the day before yesterday, along with a Brevida mask that I wanted to try based on a recommendation here. For the first night, I wanted to replicate the exact setup and settings I'd used during the trial week, using the same Dreamwear nasal cushion mask. I also continued using the same Caldera Releaf cervical collar I've slept with since the trial week. I'd say the night went okay (see first SleepyHead screen shot, dys-night1.jpg). AHI was 4.7, again mostly driven by a Clear Airway of 3.89.

Before turning in last night, I tried a trial fit of the Brevida. It seemed good, very quiet, but there was just a bit of a leak down the left side of my nose that I wasn't able to remove. I therefore decided to use the Dreamwear mask again for last night. I have to say that the night didn't go well (see dys-night2.jpg). AHI was 8.06, partly driven by Clear Airway of 4.54 but also a greater amount of Obstructive and Hypopnea than I'd been seeing since using the cervical collar. You can see where I was awoken by air pressure a total of seven times and reset the machine. Overall I felt I was awake a lot of the night and didn't get good sleep.

The one factor I can identify that had changed compared to previous nights is that I was wearing the Dreamwear mask somewhat tighter than previously (not tight enough to cause marks, but what I'd call snug). Can this cause the issues I was seeing?

Otherwise, going forward, I thought I'd try working with the Brevida. The leak down the exterior of my left nostril is relatively small, so in the bigger picture maybe it's not important.

I've also been experimenting with tightness of the cervical collar. I want it tight enough to do its job, but I've found on some prior nights (when waiting for the PAP machine) that if it's too tight I actually remove it sometime during the night in my sleep. I wonder if having it too loose could have enabled the obstructives and hypopneas I was seeing last night?

If anyone sees anything in the SleepyHead reports that suggests anything else to try, I'd be all ears.
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#19
RE: Drawing conclusions from first night with new machine
Remember that while on any CPAP including a bi-level without backup, Central events will be consistently inconsistent.  

The 19th is interesting because you woke up after several of the CA clusters.  This is important info to track.  I would put all such charts in a folder as possible evidence that this machine is not working for you.  It MAY help you get an ASV machine in the future.  I'm not saying yet that it is, just to keep this kind of data.  Also note any sleepiness issues and when they occur.

Settings, honestly I'd leave them alone for now.
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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#20
RE: Drawing conclusions from first night with new machine
(01-20-2019, 12:21 PM)bonjour Wrote: The 19th is interesting because you woke up after several of the CA clusters.  This is important info to track.  I would put all such charts in a folder as possible evidence that this machine is not working for you.  It MAY help you get an ASV machine in the future.  I'm not saying yet that it is, just to keep this kind of data.  Also note any sleepiness issues and when they occur.

I'll make a point of doing that. I know my sleep doctor was on the fence about whether I needed any treatment at all, as he viewed my untreated sleep-test AHI of 8.x as just "a bit" above the normal range. So if most of my AHI's with the AirSense are close to 5, he'll probably consider me done.


(01-20-2019, 12:21 PM)bonjour Wrote: Settings, honestly I'd leave them alone for now.

Yes, at this point I think I'll mostly tweak the masks and try the Brevida. Also as mentioned in one of the threads, my gastrointestinal doctor suggested elevating the head of my bed instead of using a wedge pillow for the purpose of avoiding reflux. I'll probably give that a shot to see if by any chance it changes anything about my sleep.
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