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Home Sleep Study - Low AHI but significant desat
#41
Ohmy 
RE: Home Sleep Study - Low AHI but significant desat
I gave the F30 full face mask a try last night since I really, really don't want to play with mouth taping.
Mouth taping is looking like a better option now.   Oh-jeez


My husband told me this morning that he doesn't understand how it's possible to stop breathing so many times while air is actively blowing in my face to keep me from stopping breathing.  Poor guy got less sleep than I did last night.

So, I have a question about the differences in treatment between pillows and full face: 

- This looks to me like an EPR setting that works fine with nasal masks (P10) has a much bigger impact on CA events when used with a FFM.  I'm assuming that it's wiping out my CO2 and driving up my CA events.  If so, is it reasonable to assume that decreasing the EPR could reduce the CAs?  Or is this a high enough instance of CAs that I shouldn't expect a full face mask to work at all?  It just seems like a dramatic increase in events and it makes me suspicious of the usefulness of FFM in my case.

- I'm not going to subject my husband to another night like this one, but I'm traveling for work for the next two weeks and can try this again with EPR turned off while I'm traveling, to see if it will work.  (I picked up some mask liners that might reduce the leaking issue later in the night...I think that was due to oil building up on my skin and making the seal less effective.)  Does that sound reasonable?  Is there anything else I can do to make a FFM more effective without causing more desats in the process?

As an aside, is mouth taping likely to be that important for me anyway?  Even with mouth leaks I never crossed the large leak threshold, so maybe I'm making too much of it.  I don't have a good feel for whether or not it impacts how I feel each morning.  I guess I should just try it once and see if it makes a difference.

Thanks for any comments or advice you can offer.


   
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#42
RE: Home Sleep Study - Low AHI but significant desat
Hope my experience helps you. I, too, have a low AHI. Flow limits is my challenge.

I switched to the F30 FFM from the P10 with mouth taping, and now back to the P10 with mouth taping again. I found the F30 temperamental, as far as leaks were concerned, but I eventually got it to work. I tried the mask liner, that helped, but was tricky to use. What helped me fit the F30 was by allowing time to quietly review and follow the Apnea Board Mask Fitting Guidelines. http://www.apneaboard.com/wiki/index.php...l_Strategy  I stopped using the mask liner, as I found I didn't need it.  I used the F30 without liner for months, and worked around the leaks. I watched the ResMed "how to" instructional video. It helped by showing how to adjust the mask when leaks arise.

I stopped using the F30 because I am a side sleeper and the mask straps were causing me head pain and headaches. (I have never had headaches.) I got so I didn't want anything substantial on my head, so I went back to my beloved P10 with new mouth tape. I now use 3M "strong hold" tape, easy removal for sensitive skin. I just suck my lips inward and slap the tape on starting at the center. Be sure to fold back a little bit of the edges on each end for a handle to give you quick removal. 

Good luck.
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#43
RE: Home Sleep Study - Low AHI but significant desat
(05-10-2021, 05:13 PM)TiredOne789 Wrote: Hope my experience helps you. I, too, have a low AHI. Flow limits is my challenge.

I switched to the F30 FFM from the P10 with mouth taping, and now back to the P10 with mouth taping again. I found the F30 temperamental, as far as leaks were concerned, but I eventually got it to work. I tried the mask liner, that helped, but was tricky to use. What helped me fit the F30 was by allowing time to quietly review and follow the Apnea Board Mask Fitting Guidelines. http://www.apneaboard.com/wiki/index.php...l_Strategy  I stopped using the mask liner, as I found I didn't need it.  I used the F30 without liner for months, and worked around the leaks. I watched the ResMed "how to" instructional video. It helped by showing how to adjust the mask when leaks arise.

I stopped using the F30 because I am a side sleeper and the mask straps were causing me head pain and headaches. (I have never had headaches.) I got so I didn't want anything substantial on my head, so I went back to my beloved P10 with new mouth tape. I now use 3M "strong hold" tape, easy removal for sensitive skin. I just suck my lips inward and slap the tape on starting at the center. Be sure to fold back a little bit of the edges on each end for a handle to give you quick removal. 

Good luck.

Thank you for that input.  It does seem to track with my experience so far.  I read the mask fitting primer but haven't spent the time to do what it says.  I'll go back and re-read it and see if I can follow the process.

Thanks for the advice on the 3M tape. I drool a bit (ok...it's really a lot) at night and have been concerned about finding the right tape.  I'll give the strong hold a try.  I really like the P10, so I was only trying the F30 to deal with the mouth breathing, and to prep for the inevitable allergy breathing challenges that will be here soon, once Mother Nature decides she's dropped enough snow on us for the season.  But hopefully I can stick with the P10 most of the time.
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#44
RE: Home Sleep Study - Low AHI but significant desat
I bought the 3M "strong hold" tape online through amazon by mistake . . .and love it. Be careful when purchasing it.  3M has another tape product in identical packaging for "sensitive skin".  The 3M strong hold works great on drool.
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#45
RE: Home Sleep Study - Low AHI but significant desat
The chart in the post from [04-28-2021, 11:07 AM] shows what seems a lower minute flow rate after the last CA. The amplitude of flow is less than before the CAs in the chart.  Is that what you see more often in minute flow charts? Higher minute flow before apneas?  I did not see any minute breathing charts.

I read that higher breathing rate (hyperventilation) can be a trigger of subsequent central events. In my case I see that 80-90% of all periods with irregular breathing and desats are preceded by a minute or so of increase minute flow rate. Typically going from around 6 liters per minute to 10-12 liters per minute. So a bit of hyperventilation.   My ASV device does not limit the hyperventilation but does stabilize the subsequent breathing.

Some of the symptoms of hyperventilation are very close to those of desats. Headache, dizziness, chest pain, palpitations.
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#46
RE: Home Sleep Study - Low AHI but significant desat
(05-13-2021, 02:13 PM)MrSpeed Wrote: The chart in the post from [04-28-2021, 11:07 AM] shows what seems a lower minute flow rate after the last CA. The amplitude of flow is less than before the CAs in the chart.  Is that what you see more often in minute flow charts? Higher minute flow before apneas?  I did not see any minute breathing charts.

I read that higher breathing rate (hyperventilation) can be a trigger of subsequent central events. In my case I see that 80-90% of all periods with irregular breathing and desats are preceded by a minute or so of increase minute flow rate. Typically going from around 6 liters per minute to 10-12 liters per minute. So a bit of hyperventilation.   My ASV device does not limit the hyperventilation but does stabilize the subsequent breathing.

Some of the symptoms of hyperventilation are very close to those of desats. Headache, dizziness, chest pain, palpitations.

Interesting.  I always move the SpO2 chart up and the vent charts down, since I'm usually focusing on the desats.  So I went back to 4-28 and looked at the CA cluster and took a quick screenshot.  I do see some crazy deep breathing between the events.  I'm not sure what it signifies, but hyperventilation does seem like a reasonable description.  But it looks like it's a response to the first CAs rather than a trigger.  Something else to ponder....

   
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#47
RE: Home Sleep Study - Low AHI but significant desat
Howdy everyone. Doing a quick check-in since it’s been a bit.  I’ve been doing some “playing around” to try to understand how things really impact my breathing/sleeping. I’ve never quite managed to find that sweet spot that I hit the first weekend with full alertness and feeling like I have a lot of energy.  But I’ve also never relapsed into the pre-PAP fatigue with headaches.   So, I’m definitely better than I was, but I still have something to strive for.

Here’s some info on the playing around, as well as some commentary on how altitude has been impacting my process:

- Min pressure:  I’ve settled on 9 as my minimum, but am feeling like I would be happier at 10 due to my slight air-starvation reaction as I’m falling asleep each night.  The only thing that’s stopping me is that I still have some aerophagia issues and I don’t want to exacerbate them.

- For Her vs. normal Auto: I’m comparing the two settings.  The For Her setting provides better control of events (AHI’s in the 0.5 range), but it’s reaction timing to CA’s seems to wake me up just as I’m changing sleep stages in the early morning hours, and severely disrupts my REM cycles.  The normal Auto mode provides much worse event control (AHI up to 5), but it doesn’t wake me up as it treats, so my oxygen is slightly lower, but my sleep is more consistent.  I haven’t decided which one I’ll end up choosing –  I need more evidence to make the final choice.

- Nasal pillows vs. FFM: I wanted a FFM backup for allergy season and because I’m having some significant mouth leaks, but I completely failed with it.  I went through the whole mask fitting process on the wiki and felt like it was seated well and slept fine, but my AHI was over 10 for multiple nights when using it.  (I dropped the EPR one of the nights to prevent CA, but still ended up with a boatload of them along with new OSA and Hypopneas, too.  And my SpO2 was worse than without CPAP.)  I’ve concluded that a FFM is actually worse for my particular situation, since I’m really an O2 issue not a classic apnea case.

- Mouth leaks: I tried taping my mouth and it slightly reduced my mouth leaks, but not as much as I would have expected.   I did it on my business trip because the topic freaked my husband out and I didn’t want to mess with his brain too much.  Unsure  Since I returned home, I haven’t taped, and my leaks have gotten bigger.  I’m thinking that I need to commit to the taping for a bit and see if I can get it under control.  My results are definitely worse when my mouth drops open.

Here’s a couple of recent charts – nothing exciting.  Pretty much a consistent treatment at this point with a few O2 drops and a few events that don’t seem to be directly connected to the O2 drops.
 
 
       

Comments on altitude:
I had a 2-week business trip to Utah, which is just over half of my home altitude, and did some comparisons of how my Sp02 was impacted.  I ended up sleeping without treatment on the night before my early flight home, since the machine was packed up and I was being lazy.  It was a rough night, but it provided some good comparison data.  

It looks to me like the PAP can cover for ~4000ft of altitude, so it brings my treated Utah readings into alignment with my untreated sea level readings, and aligns my treated home readings with untreated nights at 4000ft.  I may be interpreting it wrong, but it's interesting data to consider, anyway.

   

General note on this comparison chart is that I sleep more soundly with treatment, regardless of my O2 levels.  The night at sea level was taken before I had a machine, and you can see that my O2 was good, but I tossed and turned and was generally uncomfortable anyway.  Same with all the non-treatment nights.  For the nights with PAP, I slept well even if my O2 was dropping.  If I woke up between sleep cycles, I fell right back to sleep after rolling over.  So I may not have my O2 fully above 90% yet, but I am definitely seeing improvements.
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#48
RE: Home Sleep Study - Low AHI but significant desat
Hello everyone.  Just doing a quick check-in to let everyone know that the assistance I received here has put me on the path to success.  Take a look at this chart, which is a near-copy of the one from the day before.  I don’t think I can do much better than this for AHI.  Plus, my minimum SpO2 is exactly 90%, so I’m staying in the “normal” range the whole night.  And I’m feeling better, too. 

   

I do have a few observations – because I have to do some kind of analysis when I have data, or my brain explodes.   Thinking-about

- Mouth taping is working.  It was the difference between continuous nights with 10 minutes of SpO2 below 90% and staying above 90% all night.  

  --It’s interesting that the charts still show some small leaks that are flat-topped like a mouth leak.  I’m interpreting this as a slight opening of the mouth and possibly leaking through the tape itself (I’m using the Cover Roll Stretch because the adhesive doesn’t irritate my skin, and it does allow a small amount of air flow).  I’m not worried about this – it doesn’t appear to cause any issues with my treatment, and it doesn’t wake me up or cause dry mouth.  What really interests me is the pattern.  If these represent REM sleep for the most part, then it looks like I’m re-capturing a mostly-normal sleep cycle.  I’m not awake for more than a second or two during the night – I typically roll over and fall back to sleep immediately.  It’s wonderful!

- Mouth taping is also improving my husband’s sleep.  (Taping my mouth, not his....I could see some of you thinking about that when you read it. Rolleyes )  Once he got over his uneasiness about the tape over my mouth, he admitted that he sleeps better without the noise.  He doesn’t wake up from the sound of a broken hoover vacuum (his descriptive term), and therefore he doesn’t wake me up to change my position to turn off the broken hoover vacuum. So we’re both getting better sleep.  Win-win.

- I’m sticking with the normal Autoset instead of the For-Her algorithm.  The “smooth” response of the For-Her seemed to generate more startle responses from me when CAs kicked in and woke me up through the night as I transitioned in and out of the different sleep stages.  The normal setting seems to commit to a pressure quickly and stay there, which lets me sleep longer.  It also seems to have reduced the CAs in general. The aerophagia has reduced as long as I sleep on my sides and stay off my back.  I’m still working out the best position to keep my repaired shoulder from screaming at me, but I’m managing to find enough positions that don’t include back-sleeping.

I continue to read and learn from the new posts and questions on this site, so it’s possible that I’ll have further comments in the future….because, you know, data makes my brain do analysis so it doesn’t explode.  But for now, I’m going to sit back and enjoy feeling well-rested.

Thanks everyone!
Thanks
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#49
RE: Home Sleep Study - Low AHI but significant desat
Be sure to remind him that the first CPAP was basically a modified Hoover?
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#50
RE: Home Sleep Study - Low AHI but significant desat
But it was a belt drive CPAP.
Dave

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