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Is this the best I can do?
#1
Is this the best I can do?
Hello, everyone. 
I was wondering if this was the best I can do? I see so many people getting to such low numbers that I wonder if I am doing something wrong. I have my Dreamstation set at 11 - 18. I find that if that low number is any higher, I keep waking up swallowing air and feeling sick with air in my stomach and burping. Even set as it it I still have problems with air swallowing, but not constantly as it is when set at 12. I don't feel that I am sleeping well. I usually wake up around 3 am and am wide awake for awhile. Then, when I finally get back to sleep, I end up sleeping a total of 9 to 10 hours. I am not feeling really rested. This may be due to the aerophagia. My AHI is usually between 4 and 7ish. I have moved, so my sleep doc is no longer nearby. Do I need a new doc for help? 
Thanks


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#2
RE: Is this the best I can do?
Your graphic representation of leaks shows quite a bit of leakage, even if the other stats don't indicate 'large' leaks.  Perhaps I'm reading your chart incorrectly, but it seems to me that on some nights you have leakage.  It may truly be innocuous from the machine's standpoint, but if you're continually getting aroused by leakage, whether air in your face, noises, or both, you won't sleep properly.  Arousals are bad, and should be avoided.


I do see some minor clustering of events, but not enough for me to suggest you might benefit from a neck-restraint of some kind.  When people experience intractable snoring, flow limitations, arousals, leakage, and notable events such as obstructive events, we suggest they purchase a soft foam cervical collar and wear it fairly loosely at night to prevent the chin from tucking toward the chest...which far too many of us do when we sleep.


I'll leave off from dealing with your pressures and let others offer their opinions.  Please stand by.
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#3
RE: Is this the best I can do?
(09-10-2019, 02:54 PM)littlefatcat Wrote: Hello, everyone. 
I was wondering if this was the best I can do? I see so many people getting to such low numbers that I wonder if I am doing something wrong. I have my Dreamstation set at 11 - 18. I find that if that low number is any higher, I keep waking up swallowing air and feeling sick with air in my stomach and burping. Even set as it it I still have problems with air swallowing, but not constantly as it is when set at 12. I don't feel that I am sleeping well. I usually wake up around 3 am and am wide awake for awhile. Then, when I finally get back to sleep, I end up sleeping a total of 9 to 10 hours. I am not feeling really rested. This may be due to the aerophagia. My AHI is usually between 4 and 7ish. I have moved, so my sleep doc is no longer nearby. Do I need a new doc for help? 
Thanks

Welcome to the forum, let's see what we can do for you

First, Approximately 1/3 of your apnea is central apnea.  
Second, you need more pressure, BUT
Third you suffer from Aerophagia at higher pressures.

You also are showing signs of tucking your chin (The clusters of obstructive events).  For now we will just keep an eye on it.

Looking at the Aerophagia first.  Try a Flex setting of 2, full time, no other changes.  This should allow a lower average pressure allowing a "higher "bottom" pressure".  The next step is to try 12 again with the Flex set on, and maybe 13 if 12 works but we will see first.

If this doesn't work we would need to either give it time or talk to your doctor about getting a BiLevel machine so we can effectively use a lower exhale pressure to help relieve the aerophagia.
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
OSCAR

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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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#4
RE: Is this the best I can do?
Thanks so much! I will turn flex to 2 tonite and see what happens (C-Flex: is that correct?) I’ll post my results in a few days. Should I start a new thread or post results on this thread? I am leaving Pressure where it is for now. Also, I do have a cervical collar, but am not wearing it right now. It didn’t seem to make things any better when I did wear it. Also, at higher pressure (12 or so) I have issues not only with aerophagia, but also with cheek puffing and mouth leaks. My mouth is not open, but the air puffs out between my my lips. I have tried  bite guard and taping....doesn’t help my ahi. I also have a Dreamwear full-face mask which i tried only once.
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#5
RE: Is this the best I can do?
Please keep you results in the same thread.
Download OSCAR

Organize Charts
Attaching Charts

Mask Primer
Soft Cervical Collar

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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#6
RE: Is this the best I can do?
ALWAYS keep anything that is about you in this thread. That provides a very important history and eliminates the need to search and see if one exists.
Speaking of history, it would be great if you posted redacted copies of your sleep studies, full copies with charts and tables and not just summaries. Summaries often leave out important details that are important. Right now your diagnostic study is important because of your higher percentage of Central Apneas than most people.
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
OSCAR

Download OSCAR
New to Apnea? Helpful tips to ensure success
Soft Cervical Collar
Mask Primer
Dealing with a DME
Organize Charts
Attaching Charts

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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#7
RE: Is this the best I can do?
Fred Bonjour: You said to try a Flex setting of 2, full time, no other changes. By full time do you mean A-Flex? I had set it on C- Flex, but will change to A-Flex tonight.

Also, I thought I had a copy of my most recent sleep study results, but the one I found was quite old. I will contact my doc and have them send me a copy to post. Hopefully that won’t take them forever to do.
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#8
RE: Is this the best I can do?
Either flex . I'm looking for the pressure relief
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
OSCAR

Download OSCAR
New to Apnea? Helpful tips to ensure success
Soft Cervical Collar
Mask Primer
Dealing with a DME
Organize Charts
Attaching Charts

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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#9
RE: Is this the best I can do?
How tall are you? Your median tidal volume seems a bit low.
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#10
RE: Is this the best I can do?
The difference between C-Flex and C-Flex+ is largely the timing of exactly when it switches between the inhale and exhale pressures. In the plus mode, it starts to switch a little earlier, anticipating your breathing a little more. I think A-Flex (in auto only) is very similar to C-Flex+ (in fixed mode).

The difference is subtle. I personally like C-Flex+/A-Flex better, but some may find it disconcerting. Whichever is more comfortable is just personal choice.

Caveat: my expertise lies in embedded controllers from an engineering perspective, not the clinical effects. Nothing I say is intended to contradict advice from those more knowledgeable.
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