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Effort to improve treatment of OSA and IH
#71
RE: Effort to improve treatment of OSA and IH
(09-15-2020, 08:19 AM)Sleeprider Wrote: I really don't know the answer to excessive sleep time. I think establishing a schedule you can live with would be a good idea. Get 8 to 9 hours of sleep, use consistent bedtime and wake time and get on with life.  If you need an hour in the afternoon, set an alarm. Eventually you will establish better sleep hygiene and the schedule will become a new habit.

Any idea what's causing all these CA apneas? This was a relatively high AHI night for me, at least since starting on the Resmed. Not sure why.


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#72
RE: Effort to improve treatment of OSA and IH
To reduce the CA’s try reducing the EPR to 2 but to be fair the AHI number of 1.4 CA’s is not particularly high
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#73
RE: Effort to improve treatment of OSA and IH
(09-21-2020, 12:10 AM)jaswilliams Wrote: To reduce the CA’s try reducing the EPR to 2 but to be fair the AHI number of 1.4 CA’s is not particularly high

Yeah I just noticed they tend to cluster around a short period. I was hoping to understand them better. Can I ask what the rationale of reducing EPR and how it relates to CA's? I really don't understand the mechanism of CA's, and wasn't aware that it is related to exhale pressure.
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#74
RE: Effort to improve treatment of OSA and IH
EPR tends to work very similar to a BiLevel machine. The EPR provides additional ventilation which can cause some users sensitive to it to get over ventilated and stop breathing until the CO2 levels raise.

Looking at your graph and the cluster it may be you were actually awake then and not breathing regularly or as simple as a roll over. Zoom into the flow and show a 2 minute period arround a CA with that zoomed view we can see what happened to your breathing.
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#75
RE: Effort to improve treatment of OSA and IH
Personally, I would not chase the CA events at that level. They usually minimal duration events and are rarely an issue for your sleep quality. This looks like a typical sleep arousal that settles down into good therapy. Reducing EPR is usually effective when we see these events distributed through the night, but you go for hours with no events. Everything looks great, and if you reduce EPR you may trade off for more flow limitation or comfort issues. Feel free to give it a try and do what feels best.
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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#76
RE: Effort to improve treatment of OSA and IH
(09-21-2020, 07:45 AM)jaswilliams Wrote: EPR tends to work very similar to a BiLevel machine. The EPR provides additional ventilation which can cause some users sensitive to it to get over ventilated and stop breathing until the CO2 levels raise.

Looking at your graph and the cluster it may be you were actually awake then and not breathing regularly or as simple as a roll over. Zoom into the flow and show a 2 minute period arround a CA with that zoomed view we can see what happened to your breathing.

(09-21-2020, 09:21 AM)Sleeprider Wrote: Personally, I would not chase the CA events at that level. They usually minimal duration events and are rarely an issue for your sleep quality. This looks like a typical sleep arousal that settles down into good therapy. Reducing EPR is usually effective when we see these events distributed through the night, but you go for hours with no events.  Everything looks great, and if you reduce EPR you may trade off for more flow limitation or comfort issues.  Feel free to give it a try and do what feels best.

Thanks for the insights: here are 2 snips of of the CA events from two nights ago. I use two levels of zoom to show about 10 min and 3 min respectively

   
   

Sleeprider, one of the CA events was 40 seconds long. Is that getting to the point where there's a suffocation risk?

I gave EPR = 2 a shot last night and had what felt like some decent sleep but as always I struggle to measure subjective feeling precisely.

   
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#77
RE: Effort to improve treatment of OSA and IH
Your trial at EPR 2 looks good, and that is something you might want to try for a longer period. The closeups looks like arousal sleep disturbances that are not particularly important to therapy, but the suggestion to pursue what is most comfortable to you is probably the best advise at this point.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


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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#78
RE: Effort to improve treatment of OSA and IH
(09-15-2020, 03:21 AM)QuietSign Wrote:
(09-14-2020, 08:34 AM)DaveL Wrote: QuietSign I'm so impressed with the work you're doing here, and the help you've received. I'm on the same path. I have a ResMed Autosens For Her machine. Brand new. And a Knightsbridge dual-strap. Brand new as well. Find I need to be careful putting the Knightsbridge on.  If I don't take care, I end up mouth-breathing.

I've done this a long time. I'm so impressed that you have great knowledge, and are getting wonderful assistance here.
Thanks, I appreciate your kind words. Can I ask if you were in a similar boat of having a cpap machine that wasn't quite working well, prompting a switch to a Resmed?

Regarding the Knightsbridge, I'm wondering if you have any tips yourself on wearing it properly? I have tried both an L and XL to some success (planning on returning or donating the one that fits me less well), but I notice that it tends to slide forward on my head, despite tightening the rear velcro to be quite snug. I've lately been preferring the simpler loopy elastic strap, but definitely still experimenting.

I struggle with mouth breathing a lot, and I've noticed that a small piece of tape really can help. I've tried to make hermetic seals with the expensive Somnifix tape (not a fan) and generic surgical micropore tape (ok but adhesive is obnoxiously strong, even after dabbing it on fabric multiple times), but lately I've been preferring an "X" shaped mouth tape that is sold pretty cheap (90 for $10). The small "X" tape doesn't quite create a hermetic seal, it just adds a small local force keeping the center of the lips together.
Hi QuietSign!

Knightsbridge Dual Strap fit:
 Last night i figured something out. I've had issues with the cap slipping down a little after I've put it on.

Last night I put the strap on carefully.  Then I felt the velcro adjuster behind my head.  It was a little loose.  I tightened it again.  That worked!  I had no issue with the Knightsbridge strap moving lower towards my eyebrows.

My PapCap or whatever it's called actually slid down over my right eye while I slept. That spooked me up when I woke up in the middle of the night!

I had it all figured out!  Woke up.  Score on the S10 was 5  I can't remember doing so poorly.

I hope that suggestion helps.

I used  a larger headgear on my ResMed N20 to accommodate my Knightsbridge strap. 

You know this stuff isn't easy.    If I took the mask off to go to the bathroom middle of the night it would take forever to get equipped and get back to bed.  I'm so grateful I can disconnect the strap on my ResMed N20.

sleepin' on it

Dave
DaveL
Compliant for about 30 Canadian years

I'm just a cpap user like you. I don't give medical advice. I hope to learn from you, and share my experiences with you. 
Seek the advice of a physician before seeking treatment for medical conditions including sleep apnea. Sleep-well

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#79
RE: Effort to improve treatment of OSA and IH
(09-21-2020, 06:10 PM)Sleeprider Wrote: Your trial at EPR 2 looks good, and that is something you might want to try for a longer period. The closeups looks like arousal sleep disturbances that are not particularly important to therapy, but the suggestion to pursue what is most comfortable to you is probably the best advise at this point.
Another night on EPR = 2, and a flimsier piece of tape that results in a bit more leaks. Are the flow limits enough to be problematic? I wonder how you assess them - is getting to the 50 on the flow limit chart indicative of problems?


   
   

(09-22-2020, 08:26 AM)DaveL Wrote: Hi QuietSign!

Knightsbridge Dual Strap fit:
 Last night i figured something out. I've had issues with the cap slipping down a little after I've put it on.

Last night I put the strap on carefully.  Then I felt the velcro adjuster behind my head.  It was a little loose.  I tightened it again.  That worked!  I had no issue with the Knightsbridge strap moving lower towards my eyebrows.

My PapCap or whatever it's called actually slid down over my right eye while I slept. That spooked me up when I woke up in the middle of the night!

I had it all figured out!  Woke up.  Score on the S10 was 5  I can't remember doing so poorly.

I hope that suggestion helps.

I used  a larger headgear on my ResMed N20 to accommodate my Knightsbridge strap. 

You know this stuff isn't easy.    If I took the mask off to go to the bathroom middle of the night it would take forever to get equipped and get back to bed.  I'm so grateful I can disconnect the strap on my ResMed N20.

sleepin' on it

Dave

I think I've noticed that the fit when upright is a little different than the fit when lying down. I'll be more conscious to do a second adjustment when lying down, just before putting on my mask
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#80
RE: Effort to improve treatment of OSA and IH
QuietSign that's good.

I think it helps. However, I've had more problems putting the strap on in a hurry, and messing up doing that.

I really like the Knightsbridge strap. I've had other solutions. There is so much information here. My home made cushion under the jaw worked most/some of the time.
I've tried boxer's teeth guards and all kinds of things. I've taped too...
DaveL
Compliant for about 30 Canadian years

I'm just a cpap user like you. I don't give medical advice. I hope to learn from you, and share my experiences with you. 
Seek the advice of a physician before seeking treatment for medical conditions including sleep apnea. Sleep-well

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