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First Night on Therapy -- CA worries
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quiescence at last Offline

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Posts: 753
Joined: Nov 2014

Machine: REMstar System One with Autoflex
Mask Type: Full face mask
Mask Make & Model: Quattro AirFit F10
Humidifier: yes typical setting = 4
CPAP Pressure: 5-13 Autotritrating CPAP
CPAP Software: SleepyHead EncoreBasic

Other Comments: CMS-50F Plus oximeter /w SPO2 Assistant software. Avowed mouth-breather switching to nose-breathing

Sex: Male
Location: US

Post: #41
RE: First Night on Therapy -- CA worries
I will mention two things that seem to suggest you can lick the CA phenomenon.

1. you have successfully shown that the pressure is increasing as a reaction to flow limitations, and that once you reach the maximum, you still have flow limitations that would have driven the pressure higher.

2. you have shown there is some effect of reducing the EPR to zero, and that the nasal pillows and especially nasal mask were not necessarily bad. I note that the ratio of OA to CA is better during the two nights where FFM and EPR reduction are both used. It is not clear whether the use of nasal mask or pillows made results better or whether they just didn't make it much worse. It is somewhat telling that the nasal mask has more trapped volume than the pillows and that the CA were worse in nasal pillows nights. Roughly, the higher the volume, the better your results (while in EPR reduction).

I also use the info provided earlier in the post for the 19 Jun. It shows CA clusters at both the lower (lowest) pressure, and at or above 10 cmH2O. ( http://www.apneaboard.com/forums/attachment.php?aid=1549 )

My view is that when you have used 'trapped air' for a longer period, your brain will stop reacting to the abundance of O2 and lack of CO2, as slight (but strange) as it is under CPAP. I think you will benefit from stabilizing with one mask type of your choice and EPR of zero, and staying at the same setup for more than a week (like others have suggested). 1

I also think that you should increase the upper limit by 0.5 to 1.0 cmH2O, but then wait more than a week.

Finally, there really isn't much time you stay under 8 cmH2O. It may not make a difference whether you start at 7 or change the minimum to 8.

1 trapped air increases the rebreathing of CO2 slightly, mimicking other therapies, including the one pointed out in the report you reviewed above - stating "experimentally successful treatment of CompSAS with PAP therapy plus controlling inhalation gases blended with 0.5–1% CO2 resulted in an immediate (1 min) decrease in AHI"

QAL

For sores from FFM, I suggest periodic use of a mask liner material.

Dedicated to QALity sleep.
You'll note I am listed as an Advisory Member. I am honored to be listed as such. See the fine print - Advisory Members as a group provide advice and suggestions to Apnea Board administrators and staff concerning Apnea Board operation and administrative policies. Membership in the Advisory Member group should not be understood as in any way implying medical expertise or qualification for advising Sleep Apnea patients concerning their treatment.
06-26-2015 10:57 PM
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AndyB Offline

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Posts: 72
Joined: May 2015

Machine: ResMed AirSense 10 Autoset with RERA
Mask Type: Full face mask
Mask Make & Model: F&P Simplus, ResMed AirFit F10; PR Amara View
Humidifier: ResMed integrated heated
CPAP Pressure: 10.4-13.0
CPAP Software: SleepyHead

Other Comments: Diagnosed May 2015; EPR @ 1cmH2O; Ramp off; ResMed Climateline heated hose

Sex: Male
Location: SE Wisconsin

Post: #42
RE: First Night on Therapy -- CA worries
QAL,

Thank you for your insightful reply. i continue to be amazed -- and very grateful -- for the wealth of knowledge and experience on this forum, and for the generosity of members who share that with the rest of us.

Perhaps the best advice I've received is to be more patient with my CPAP therapy -- give it time to take effect. It's not reasonable to think that changing masks and settings every few days will produce a sudden breakthrough, so I will suppress my desire for a quick cure and allow things to unfold in a measured fashion. Take deep breaths , both figuratively and literally!

Andy
06-27-2015 10:54 AM
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AndyB Offline

Preferred Members

Posts: 72
Joined: May 2015

Machine: ResMed AirSense 10 Autoset with RERA
Mask Type: Full face mask
Mask Make & Model: F&P Simplus, ResMed AirFit F10; PR Amara View
Humidifier: ResMed integrated heated
CPAP Pressure: 10.4-13.0
CPAP Software: SleepyHead

Other Comments: Diagnosed May 2015; EPR @ 1cmH2O; Ramp off; ResMed Climateline heated hose

Sex: Male
Location: SE Wisconsin

Post: #43
RE: First Night on Therapy -- CA worries
In keeping with my plan to pick a path and stick with it for a while, last night I went back to a nasal mask (which had given me the best results so far, albeit at the expense of the bridge of my nose), left the pressure at 7-11 cmH2O, kept ramp and EPR off, and continued to tape my mouth closed with surgical tape (that has to go in the long run, but for now the tape is eliminating mouth leaks).

Not a great night, but not awful either. Woke up feeling reasonably well-rested and without a headache. If the bridge of my nose can take it (I put a blister cushion on it last night), I will give this setup a week or two without changes, in order to establish a baseline and, hopefully, allow my body and brain adequate time to adjust to my new regime.

Here's a screenshot of my SleepyHead report from last night. My AHI was 4.98, of which Ca was 3.13 and Hypopnea was 1.85. The key take-away for me is the long stretch of 4+ hours in the middle of the night with very few apnea events.

http://screencast.com/t/E49lgQ0bs

Thanks again to all for your interest and support,
Andy
06-28-2015 12:16 PM
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tedburnsIII Offline

Members

Posts: 196
Joined: Mar 2015

Machine: 3B RESmart APAP
Mask Type: Nasal mask
Mask Make & Model: Wisp nasal; ResMed FX nasal
Humidifier: came with unit-I vary it, currently set at '3', '5' is max
CPAP Pressure: 10 cm CPAP
CPAP Software: Other Software

Other Comments: Dx moderately severe OSA. Overnight pulse oximeter-CMS50D Plus

Sex: Male
Location: San Diego

Post: #44
RE: First Night on Therapy -- CA worries
The bridge of your nose will eventually adapt to the mask, or, perhaps you can lessen the top straps a bit. I would also suggest placing a little bit of K-Y Jelly in that area before attaching the mask.
06-28-2015 01:34 PM
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vsheline Offline

Advisory Members

Posts: 1,908
Joined: Jul 2012

Machine: S9 VPAP Adapt (USA Model# 36007, not better 36037 or 36067)
Mask Type: Full face mask
Mask Make & Model: F10 or SimPlus w/ 2Liners. MirageQuatro & Gecko gel pad
Humidifier: H5i
CPAP Pressure: 15 EPAP, PS 5-10
CPAP Software: ResScan

Other Comments: Marfan Syndrome, chronic bradycardia, occasional Cheyne-Stokes Respiration

Sex: Male
Location: California, USA

Post: #45
RE: First Night on Therapy -- CA worries
(06-26-2015 10:57 PM)quiescence at last Wrote:  I also use the info provided earlier in the post for the 19 Jun. It shows CA clusters at both the lower (lowest) pressure, and at or above 10 cmH2O.
http://www.apneaboard.com/forums/attachment.php?aid=1549

The CA events at lowest pressure shown in data on 19 June were soon after starting or restarting therapy, when falling asleep. These probably should be disregarded.

So, not sure whether CA events would be happening at both highest and lowest pressures when asleep. During sleep the machine is keeping pressure high nearly all the time, to avoid obstructive events.

Would be of interest to take measures to prevent rolling into supine position during sleep.

Obstructive Sleep Apnea usually varies strongly with sleep position, with flat on our back usually being the worst position.

Perhaps if supine sleeping is avoided the pressure the machine needs to provide will decrease, perhaps leading to lower AHI and RERA.

Some methods for avoiding rolling into supine position during sleep:
1. Wear a light knapsack filled with light but bulky things.
2. Wear tee shirt with a couple tennis balls in pockets sewn on back, between the shoulder blades, lined up with the spine.
3. Sleep in comfortable reclining chair.
4. Sleep with head of bed on blocks, much higher than foot of bed.

Membership in the Advisory Member group should not be understood as in any way implying medical expertise or qualification for advising Sleep Apnea patients concerning their treatment. The Advisory Member group provides advice and suggestions to Apnea Board administrators and staff on matters concerning Apnea Board operation and administrative policies - not on matters concerning treatment for Sleep Apnea. I think it is now too late to change the name of the group but I think Voting Member group would perhaps have been a more descriptive name for the group.
(This post was last modified: 06-28-2015 04:12 PM by vsheline.)
06-28-2015 03:20 PM
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vsheline Offline

Advisory Members

Posts: 1,908
Joined: Jul 2012

Machine: S9 VPAP Adapt (USA Model# 36007, not better 36037 or 36067)
Mask Type: Full face mask
Mask Make & Model: F10 or SimPlus w/ 2Liners. MirageQuatro & Gecko gel pad
Humidifier: H5i
CPAP Pressure: 15 EPAP, PS 5-10
CPAP Software: ResScan

Other Comments: Marfan Syndrome, chronic bradycardia, occasional Cheyne-Stokes Respiration

Sex: Male
Location: California, USA

Post: #46
RE: First Night on Therapy -- CA worries
(06-28-2015 01:34 PM)tedburnsIII Wrote:  The bridge of your nose will eventually adapt to the mask, or, perhaps you can lessen the top straps a bit. I would also suggest placing a little bit of K-Y Jelly in that area before attaching the mask.

I think any type of oil tends to increase leaks. Many have found that washing their face (and mask) free from skin oil daily eliminates leaks. Also, not sure but perhaps K-Y jelly would be harmful to the mask.

I suggest wearing a mask liner. I use RemZzzs brand but homemade ones can be better. RemZzzs recommends using new liner each day, but I usually am able to use for at least a week if I am careful to not pull on it or stretch it out in any way.

The liner allows the mask to be less tight without allowing bothersome leaks.

Less tight is easier on the nose bridge and face and head.

As far as which type of mask may be best for creating dead space and decreasing CO2 washout, the Respironics FitLife Total Face Mask has a large amount of space under the mask. RemZzzs does make a mask liner for the FitLife TFM, and a liner is really needed with this mask, to reduce leaking. The RemZzs web site does not show these on their website, but I was able to order from www (dot) directhomemedical (dot) com which says "For Respironics FitLife Total Face Masks choose RemZzzs 6A-FLK Small or Large, or 6B-FLK ExtraLarge." Lately, I have been wearing the Extra Large FitLife with a liner, about once or twice a week to give my nose bridge a rest when needed.

The other masks I wear are Full Face Masks and are size Large and are plenty large enough for me, but the Large size FitLife was seriously too small for me. The Extra Large fits fine.

If you get the XL size FitLife I think you would need the standard or medium size head gear to go along with it. I have a really big head and the standard (medium) size headgear fits perfectly. The XL headgear was absurdly huge and unusable.

Membership in the Advisory Member group should not be understood as in any way implying medical expertise or qualification for advising Sleep Apnea patients concerning their treatment. The Advisory Member group provides advice and suggestions to Apnea Board administrators and staff on matters concerning Apnea Board operation and administrative policies - not on matters concerning treatment for Sleep Apnea. I think it is now too late to change the name of the group but I think Voting Member group would perhaps have been a more descriptive name for the group.
(This post was last modified: 06-28-2015 05:49 PM by vsheline.)
06-28-2015 04:30 PM
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