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Looking for some help - almost 5 years and not feeling a lot better
RE: Looking for some help - almost 5 years and not feeling a lot better
Snowing?  Thank god I'm a redneck!  

Bottom Line: Lets stay the course and work on the eye area leakage.

Your Flow Limit has reduced - a good thing.   Do you have a ClimateLine?  That would allow you to up the humidity level without experiencing rainout.  Your description seems to be aimed more at your mask than the settings.  The difference in pressure isn't that much.  I know if my mask is riding too high, I will experience the same thing as you describe.  I know you have been at this for a while but look over the Mask Primer, in case you might have missed something.  Also, How long have you had that mask?  Could it be time for another? Not every face fits every mask. For me, I've had better luck with the F&P Simplus and Vitera series.

Mask Primer:
http://www.apneaboard.com/wiki/index.php/Mask_Primer

Your thoughts?
Crimson Nape
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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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RE: Looking for some help - almost 5 years and not feeling a lot better
Do not take this as brushing you off or any other negative view, but sometimes we do have nights of more apnea even on well set therapy. I cannot be certain this is what this represents. Can you think of anything that may have changed not directly related to PAP therapy? Weather like snow as an example makes my breathing less than good, which will throw off PAP therapy. Could it be something of that sort that hinders therapy? Don't despair too badly, as we all have good and bad nights.

Save up your despair for a real bad catastrophic night. And do take time for a good coffee.  Coffee
this message is brought to you by Juan Valdez and the coffee grower unions of South America and Africa
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
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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RE: Looking for some help - almost 5 years and not feeling a lot better
(10-30-2020, 11:15 AM)Crimson Nape Wrote: Snowing?  Thank god I'm a redneck!  

Bottom Line: Lets stay the course and work on the eye area leakage.

Your Flow Limit has reduced - a good thing.   Do you have a ClimateLine?  That would allow you to up the humidity level without experiencing rainout.  Your description seems to be aimed more at your mask than the settings.  The difference in pressure isn't that much.  I know if my mask is riding too high, I will experience the same thing as you describe.  I know you have been at this for a while but look over the Mask Primer, in case you might have missed something.  Also, How long have you had that mask?  Could it be time for another? Not every face fits every mask. For me, I've had better luck with the F&P Simplus and Vitera series.

Mask Primer:
http://www.apneaboard.com/wiki/index.php/Mask_Primer

Your thoughts?

Snow is early this year, but it's not unheard of.  Looks pretty, but not fun to drive in.  It will be gone in a few days, as it will warm up again.  Have to say, after I spent a summer in Baltimore (more than 40 years ago!) I can say southern summers can be brutal.  (In the mid 90's well past midnight!  Oppressive humidity.  No AC then.) But your winters are more pleasant (overall) than up here.  The joys of living somewhere, there's usually a trade-off.

I'll stay the course a bit.  Seems sensible.  Most likely it's just change shock, as opposed to anything awry. 

I do have a climate line that was shipped with the machine.  I'll use it if I get rain out.  I will try to use what I have first.  (Kind of keeping the good hose in reserve...) I'm usually good with mild humidification.  If it's above 40% RH, I'm ok.  

I do change the cushions on a schedule of about 30 days or so.  The frame gets replaced every 3 months, but probably could go longer.  I used to get "free" CPAP supplies from my insurance, but that's changed to 20% copay recently.  'Nuff said.  No need to go on a rant, I'm sure everyone is going through this.  Spend more, get less.

Will look into another mask.  I'm between sizes on the F10.  The large was too large.  It fell off my chin.  Or (when I tried it,) I used it wrong.  Have learned a lot more since that time.  The medium seems a little small, given the way I need to wear it.  I have a deviated septum.  If the mask is lowered according to ResMed instructions, the mask usually constricts my nasal passages.  If I wear it up on the bridge of my nose, it doesn't seal as well, but I can breathe, however, the bottom of the mask comes up a little up from my chin, putting pressure on my lower teeth.  Basically I think I need a Medium+, which seems to be unavailable.

I will read the primer again, and maybe one more time after that, to see if my technique should be altered.  Might be as simple as washing everything every night (face and stuff).  Used to use wipes, but I guess I'll just wash the cushion with soap and water.  Very new clean supplies seem to work a bit better, so it's worth doing a little scrubbing now and again.

Thanks for the advice.
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RE: Looking for some help - almost 5 years and not feeling a lot better
BTW on masks: have you looked up Fisher & Paykel line of masks, such as full face Vitera and Simplus? Simplus is the older style but both comfortable, and are similar. I was given the Simplus after the sleep study, and it is better than ResMed F20 in my opinion. At least for me. Both of these masks have more give in the cushion, F&P calls it RollFit.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
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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RE: Looking for some help - almost 5 years and not feeling a lot better
(10-30-2020, 11:35 AM)SarcasticDave94 Wrote: Do not take this as brushing you off or any other negative view, but sometimes we do have nights of more apnea even on well set therapy. I cannot be certain this is what this represents. Can you think of anything that may have changed not directly related to PAP therapy? Weather like snow as an example makes my breathing less than good, which will throw off PAP therapy. Could it be something of that sort that hinders therapy? Don't despair too badly, as we all have good and bad nights.

Save up your despair for a real bad catastrophic night. And do take time for a good coffee.  Coffee
this message is brought to you by Juan Valdez and the coffee grower unions of South America and Africa

Dave, not taking it as a brush off at all.  I've learned via my own experience and via other here, that treatment is a process.  It takes a while.  As for last night, sure, things changed.  A few machine settings, it snowed, and a few other things that aren't subjects for this board.  The heat's been on a bit, so the indoor humidity is dropping a bit.  I can tell, as I'm waking up rather dry in the morning.  Have some distilled water, and will add some humidification, which should help tonight.

There's no despair on my part, 'tis merely reporting a minor bump in the road.  If I didn't mention the bump, I'd be a bad reporter.  I did mention some good findings, with an improvement in the reduction of exhalation issues.  

We'll stay the course a while, with minor changes.  Hopefully I'll adapt well to it all.  If not, I'll be back...  I'm still adhering to Rule 22  Bigwink  

Might just take you up on the offer for a good cup of joe.  I'll have some Ethiopian Yirgacheffe espresso if you don't mind!   Coffee
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RE: Looking for some help - almost 5 years and not feeling a lot better
(10-30-2020, 12:33 PM)SarcasticDave94 Wrote: BTW on masks: have you looked up Fisher & Paykel line of masks, such as full face Vitera and Simplus? Simplus is the older style but both comfortable, and are similar. I was given the Simplus after the sleep study, and it is better than ResMed F20 in my opinion. At least for me. Both of these masks have more give in the cushion, F&P calls it RollFit.

I will look into these masks.  Old fashioned and cheaper, aren't necessarily bad!  And if they fit better, why not?
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RE: Looking for some help - almost 5 years and not feeling a lot better
No problemo. But be warned about when it's your turn to buy. Here's my coffee cup; a converted Sheetz soda cup of 52 oz. Yes I actually used it for coffee. Remember the glass coffee carafe these convenience stores used for coffee? This cup takes a pot itself.

[Image: 8iIN9Te.jpg]
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
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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RE: Looking for some help - almost 5 years and not feeling a lot better
(10-30-2020, 12:41 PM)SarcasticDave94 Wrote: No problemo. But be warned about when it's your turn to buy. Here's my coffee cup; a converted Sheetz soda cup of 52 oz. Yes I actually used it for coffee. Remember the glass coffee carafe these convenience stores used for coffee? This cup takes a pot itself.

[Image: 8iIN9Te.jpg]

Gee Dave, (just joking) no wonder you can't sleep!  Lolabove  
If I drank that much coffee, I'd be flying!  Shoot, I wouldn't be far from a restroom either!  

I do love my coffee.  Although it plays havoc with me if I drink it much past 2PM.  So I don't.  Don't have any chocolate past 3PM either.  Stinks, but caffeine is metabolized slowly in my body.  Seems it's genetic.  I have associates that can have an espresso or two for a nightcap.  Not me - that keeps me up all night.  However, the better I sleep, the less coffee I need.  Kind of a reverse incentive, don't you think!  Still like coffee and want it though. Smile

My coffee machine makes at most 2 8 oz cups at a time.  But those cups are awesome.  And I can make another at anytime.  Can dial in any strength, from dishwater to melts your spoon strong.  I'd be glad to make you as many cups as you like - next time you are up my way, you're welcome to drop by.  No joke. lots-o-coffee Give me a heads up so I have enough on hand. Grin   Kind of nice there's a few coffee emoji's here - no doubt your influence.  Coffee
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RE: Looking for some help - almost 5 years and not feeling a lot better
sorry for off-topic coffee drift: I was a tractor trailer driver and got hooked on coffee then. About 8 or so years ago, I had an episode where coffee wasn't good enough to keep me awake on one overnight drive from Indy back to PA so I drank 3 Monsters in about 5 hours. Tried to get Starbucks on PA turnpike rest area at about 3 AM and hands were shaking so much I spilled the coffee while stirring in sugar and creamer. Now I only drink 8 oz coffee before noon, on most days anyway.

OK FWIW these F&P masks are relatively new, so not old schoolish, but Simplus is the older one as Vitera is basically a remake of Simplus as I recall. Sizes are real close to an F20 for S M L, but check to be certain for yourself.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
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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RE: Looking for some help - almost 5 years and not feeling a lot better
Yesterday, I went to the F&P website to look up the masks that have been recommended.  Downloaded the fit guide.  I haven't tried today, but yesterday I was totally stymied in printing the gauge to size.  No matter what I tried, scaling in the "print manager" (I use Ubuntu, but this is the windows equivalent), the print was stubbornly undersize.  Not by a little.  The alleged 4 inch ruler on the page measures exactly 3.62" with my Starrett scale.  I tried to upscale by 110.5% which should have corrected the pdf print.  The printed ruler was the same length.  Found the problem today, need to scale to 100%, turn off page scaling (on a different tab!) and turn off auto rotate and center.  Then print and measure.  Finally scale to the right value.  In my case the scaling was only 100.4%. Funny how being off-kilter due to sleep deprivation hampers simple problem solving...  

Back onto sleep results.  Used the humidifier.  Helped a bit with dryness.  Slight numerical improvement.  Overall feel a bit tired, much more tired than say the "good day" Thursday.  Lighter headache though.  As mentioned on earlier days, feel, how do you say it, more ventilated.  Don't know if good or bad, but that's the feeling.  Washed the mask and face last night, seemed to have less of a sensation of eye leaks.  Leak rate was the same as yesterday.  Sorry, didn't even notice if I had big eye bags this morning, must of zoned right through shaving this morning.  Three hours later I can still see them.

Geeky stuff: For what it is worth, I calculated the AHI, etc taking out the SWJ for last night.  Correctly or not, I estimated the end of SWJ when the respiration rate seemed to first stay at the median.  At least last night, it was longer than I expected, effective sleep onset of 41 minutes.  Wrote a short program to do the calculations in python.  Had to manually populate values, but some day, it would be good to create some sort of add on to OSCAR.  (I would really love to have access to the flow rate sample by sample, have some ideas on some event detection that I would like to try.  Nothing like real data to work on - it's messy!)  

Last night, subtracting SWJ:  AHI = 1.525, CA = 1.144, OA = 0.127, H = 0.254.  Also calculated UF2 = 1.017, which is significant relative to the other indices.  (Comparable magnitude.)  

Since I was mucking about in the data, determined the average duration of the UF2's to be 10.5 seconds.  To me, that seems significant, since apneic events are defined to be at least 10 seconds.  Also calculated the average change in Tidal Volume between the VAuto and my old machine.  I took the mean of the last 8 days of each machine.  The mean TV for the ResMed is 345, for the Philips it was 315.  The ResMed resulted in +9.5% increase in TV.  Now, this isn't really a fair comparison, obviously the settings and therapy are different, and we are assuming the calibrations of both are accurate, but it is different and tends to support the reported sensation of being better aerated.

Ok, got that out of my system...
I do note that in the current mode, the machine has no authority to make corrections.  At the moment, I am not considering allowing automatic machine made corrections yet, until things are a lot more stable.  That will take a while.  I think that is prudent, to minimize the interactions.  However, I counted at least 3 areas the machine may have corrected the flow restriction by increasing inspiratory pressure, but couldn't because the settings.
   

Based on the current results, the course of action is to stay the course a while?  See if things settle?  What about Trig=Very High?  Forgot to try that last night, as I was so preoccupied with the water.
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