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I am TOTALLY (and hopelessly) lost!
#11
RE: I am TOTALLY (and hopelessly) lost!
(06-10-2020, 09:10 AM)Danno54 Wrote:
(06-09-2020, 05:03 PM)Dormeo Wrote: I really don't want to be a bother but I don't know where else to ask these questions.  Should I be addressing these to the Doctor at the sleep center?  Well, actually his PA because I've never met him.
It's been my experience that you're better off asking here.  Collectively, we've dealt with more variations of therapy that any one Dr or RT.  I'll temper that by pointing out that we're not professionals, so, by all means, run the advice you get here past them. 

That said - one point about your answer about adjusting the straps.  Counter-intuitively, sometimes it's possible to make it too tight.  Depending on mask and the seal type, you can actually cause leakage by tightening it too much.  It should never feel too tight, and actually shouldn't even leave a visible mark on your face. :-) 

If you find getting a good seal to be a problem, experimenting with different masks, and different *types* of mask would be a good idea.
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#12
RE: I am TOTALLY (and hopelessly) lost!
My apologies to Dormeo, I didn't mean to ignore the question just simply forgot to respond.  I do indeed breathe nasally throughout the day.  I have to work pretty darn hard (not as hard as I used to, I'm getting older!) before I need to breathe through the mouth to get enough air.  The ONLY time I breathe through my mouth is after I have been asleep a while.  Let me modify that statement.  Since I have been using the PAP I don't really know which way I breath.  There are no "tell-tale" signs of mouth breathing so I can't honestly answer that question correctly at the time other than to say when I am awake the ole snozzola gets all of the work!

While I'm at it, I forgot to reset the PAP last night but I'll change setting this evening and post an "after" report tomorrow.
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#13
RE: I am TOTALLY (and hopelessly) lost!
So, step one is further adjustments with your current mask, per CHanlon's suggestions, and testing the adjustments while lying on your back. If that doesn't get the leaks under control, then step two would be to try a nasal mask or nasal pillow mask. Looking forward to seeing what the new settings might show us.
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#14
RE: I am TOTALLY (and hopelessly) lost!
(06-10-2020, 10:08 AM)Dormeo Wrote: I'll be interested to see a chart with the new settings, if you'd like to post one.

I set the pressures higher, refit the mask, refit the mask, and refit the mask again.  I appears me and this foam lined cushion just don't get along. I think I had better luck with the silicone seal. I have attached the screenshot from this morning but I'm unaware of which graphs you would be interested in viewing. It appears the leak rate was really high the first 90 minutes or so but it didn't seem that way. I didn't "feel" any leaks that were that bad. I am making two assumptions here. First, I am assuming the time spent on "mask leak test" is not included in the statistics. It took me a few minutes but not ninety. And two, the leak test has auto-shutoff after a preset time because when I finally got the straps sufficiently tight to stop the leaks and I reached over to turn off the test, the status screen showed 5cm and there was little pressure in the mask. Maybe that's why it stopped leaking and I really didn't have the straps tight enough. Time will tell.


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#15
RE: I am TOTALLY (and hopelessly) lost!
This is going nowhere until you get a soft cervical collar and deal with the positional apnea.
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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#16
RE: I am TOTALLY (and hopelessly) lost!
FWIW I'd have to agree. The collar will cut most of these clustered events. We've seen it quite a few times here the past 6 months or so how effective these collars are. As is, the machine can't possibly open a mechanically closed throat.
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#17
RE: I am TOTALLY (and hopelessly) lost!
You cut your large leak time in half, which is good. The question still remains, however, whether this is the right mask for you. Give it a little more time, but then either try the silicone version or try a nasal pillow mask. There seems to be no reason to think you're a mouth-breather.

As Sleeprider and Dave note, you are showing clustered events, and they are pushing your AHI way higher than it should be. Do try a soft cervical collar or an Eliminator-type collar. it is pretty amazing the difference that can make, as I've seen in many threads.

If that doesn't help, the next plan would be to train yourself to sleep on your sides, in case supine sleep is what is causing the clusters. But the collar is a much easier experiment, and it'd be very nice if it worked.

The additional pressure support didn't make much of a dent in the flow limitations. But leave the EPR at 3, I would say. And leave the maximum pressure at 20 for now.

Keep us posted, would you? I truly think if you have the patience for some experimenting you will sleep more better and get your AHI down.
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#18
RE: I am TOTALLY (and hopelessly) lost!
Well, you can tell I have a HUGE aversion to going to bed with any more apparatus attached than I absolutely MUST but it makes no sense at all to seek the advice and wisdom of those much more experienced and informed than I and then just ignore it!  It appears there is a trip to "somewhere" to investigate a cervical collar in the near future (you can read that as "tonight", my wife is looking over my shoulder as I type).   I am assuming this is something I can acquire from a local CVS or Walgreens.  I am deeply in debt for all of the responses and as much as I hate the idea of all of this taking place, it makes "the boss" happy and I hope somewhere in the not too distant future it will all come to fruition.  As they say "it couldn't hurt".
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#19
RE: I am TOTALLY (and hopelessly) lost!
Honestly, I have an aversion to recommending a cervical collar specifically because I want to minimize the amount of apparatus that is worn. In your case I have no qualms recommending it. With lower 'clustering' I'll frequently say, let's see if it's a one-off occurrence, in your case it is way beyond that.
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#20
RE: I am TOTALLY (and hopelessly) lost!
There's several collars that are popular and give consistent results. If it were me, I'd get whatever is available quickly and that's rather inexpensive. Try it overnight and see if it did in fact change the clusters. If there's good results from using any old collar then consider buying the best you can get that maximizes comfort. Just something to consider.
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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