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Increased Min. Pressure & CAs really high?
#11
Thanks OpalRose for your continued support.  Switched back to the DreamWear Mask to get better sleep for a few nights at least - data included here.  In reading other posts it appears that if any "Central Apnea" was recorded on the sleep study a better machine might be required?  My original study events listed 12 Apneas, 149 Hypopneas, 3 Central, and 158 Obstructive with no mixed apneas.  Should I press this issue with my doctor or would you consider this a small portion of the overall problem and not be concerned?  I am also sure I need to try a different FFM as I am not having a lot of success with the Hybrid mask.  I went to this mask as I have used the pillows system in the past plus have a high degree of claustrophobia - any suggestions?  I have a shaped memory foam pillow that has the neck support similar to the soft cervical collar but I'm going to get the one suggested to see if that will help.

I have also included a short "snippet" of the charts around the group of events just before having it wake me up to see if anything of value can be learned from it.

Thanks again ever so much for your assistance.

[/url]     [url=http://imgur.com/AMkUaJb][Image: AMkUaJbm.png]                  [Image: GfmVw4um.png]
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#12
Don't know what happened at IMGUR but the wrong link was assigned to last night's reading.....  Here's the correct one.

[Image: AMkUaJbl.png]
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#13
it does seem like you are waking throughout that ordeal. wow what a way to be aroused.

it shows no signs of you holding your breath or choosing to move about.

QAL
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.
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#14
There are a few clear airway events, but not all that high.  

If you don't feel you can do without EPR, try turning it down to 1.  

LEAKS....  This will be hard if you can't settle on a mask that works for you.  I doubt it's the pressure, as it isn't that high.  

Another thing... Are use using a Chin strap or preferably a "soft" cervical collar?  This could be key in controlling your jaw/mouth from dropping open.  

I think your numbers will settle down and sleep better once you get a good mask fit and possibly use a "soft" cervical collar. You are probably waking frequently from the leaks.
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#15
Tried the soft collar with the Liberty Hybrid Mask and set EPR to 1 - Still over half events are CA - not a good nights sleep either - not able to fully control leaks with this mask - stats and a small snippet attached - any other suggestions?

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#16
Limit max pressure to 12.0. All of your CA occurs at higher pressure. I expected it to drop with the reduction of EPR OpalRose suggeste earlier, but let's start narrowing the range from the top.
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#17
IMGUR did it again - gave me the wrong link to the snippet - here's the correct one....

[Image: 5VknMoQl.png]

(05-04-2017, 04:55 PM)Sleeprider Wrote: Limit max pressure to 12.0.  All of your CA occurs at higher pressure.  I expected it to drop with the reduction of EPR OpalRose suggeste earlier, but let's start narrowing the range from the top.

Many thanks Sleeprider - will dial in the new numbers tonight - should I leave EPR still at 1 or dial it back up again?
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#18
TexasTiger,

I'm not up to speed on everything you've written.  But in the data you added today and yesterday, the leaks are significant. Indeed, the leaks are probably MORE significant than the CAs being recorded by your machine at this point.

You also write:
Quote:Switched back to the DreamWear Mask to get better sleep for a few nights at least - data included here.   
Which mask do you find most comfortable?  My advice is to try to make that mask work rather than doing a lot of swapping masks in and out.  Unless you're doing a lot of mouth breathing in the DreamWear mask and you aren't interested in trying to use a chinstrap or some other method for encouraging the mouth to stay shut.

Quote:In reading other posts it appears that if any "Central Apnea" was recorded on the sleep study a better machine might be required?  My original study events listed 12 Apneas, 149 Hypopneas, 3 Central, and 158 Obstructive with no mixed apneas.  Should I press this issue with my doctor or would you consider this a small portion of the overall problem and not be concerned?
No, there's no need to press the issue with your sleep doc about 3 CAs on a diagnostic sleep study that had 158 Obstructive events.  A few CAs (and even a few obstructive events) here and there are common in people with perfectly normal sleep.  Your problem is the 158 obstructive events on the diagnostic study, not the 3 central ones.

That said: Some people do have a tendency to develop a problem with central apnea once they start xPAP therapy for OSA.  In most of these people the CAs disappear on their own after a few weeks of sleeping with the xPAP machine.  So even when an xPAP records a bunch of CAs for a new PAPer, most sleep docs and most insurance companies are going to say that the problem is worth monitoring, but they won't want to start talking about moving the patient to a different machine unless the problem persists after the patient has been using the machine for a month or two.  And if there are other problems --such as bad leaks or the patient reporting serious problems with getting to sleep or staying asleep--- they may want to wait until the patient has tried to work on those problems for a while.

Moving to an ASV machine (the usual machine used to treat central apneas) is likely to increase the problems you are having with leaks: In addition to the positive pressure that is currently causing problems for you, the ASV machine uses wide pressure differences between IPAP and EPAP to "trigger" inhalations in order to treat the central apnea.  Those pressure swings can make it very difficult to get a quality mask seal if you are already having trouble with leaks.  

Now in a month or two, if you are still often seeing total AHI's in the 9+ range with a CAI > 5.0 and with the CAI making up 50% or more of the total AHI AND if you feel like you are actually sleeping with the machine rather than fighting with it for long periods during the night, THEN it might be time to talk to the sleep doc about whether the APAP is the right machine for treating your apnea.

I want to talk about a couple of your data shots in separate posts.
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#19
Thanks robysue for your suggestions.  The best and most comfortable so far is the dreamwear but I have less leaks with the Liberty Hybrid.  Still fine tuning the tension and adjustment of the Hybrid and believe it could work best for me.  I have extreme allergy problems and breathing through my nose is sometimes difficult at best.  As for the CAs, I have had 50%+ CAs with the CPAP set at 9 cm with the EPR set at 3 but AHI mostly running 8+ so the DME provider thought it better to set at 9-15 where additional problems started.  It was only through being fortunate to find this wonderful forum I can now find some beneficial help in just "Getting a Good Nights Sleep"!  Here's a sample of what it looked like before switching the pressure to 9-15...

[Image: XX2n8uDl.png]
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#20
(05-04-2017, 04:55 PM)Sleeprider Wrote: Limit max pressure to 12.0.  All of your CA occurs at higher pressure.  I expected it to drop with the reduction of EPR OpalRose suggeste earlier, but let's start narrowing the range from the top.

Many thanks to jeffy1958 for the excellent post on mask fitting - LL finally better (at least for one night...)!  Last suggestion for pressure max. @ 12.0 reduced the CAs to less than half but still not a good nights sleep (was having a lot of sinus problems from allergies last night as well).  Charts attached - any additional suggestions?

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