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Maybe I have apnea, maybe not, are all sleep doc jerks?
#11
RE: Maybe I have apnea, maybe not, are all sleep doc jerks?
It's clear that the higher pressure on your Overview chart accomplished much better results. I will refine my original recommendation to a minimum pressure of 9.0, maximum pressure 15.0, EPR 3 and combine that with the soft cervical collar. As Gideon pointed out, TURN ON EPR!

Your sleep PA is disinterested in anything but bean-counting the AHI. I strongly recommend you take your case to your primary medical doctor that has an overall view of your health and is less focused on insurance requirements, and discuss the flow limitations and and apnea clusters. You need positive air pressure therapy, and it will get better with EPR or bilevel pressure support. I would suggest that the sleep clinic environment failed to capture sleep disordered breathing typical for you, and failed to capture episodes of positional apnea. Note, that positional apnea can be more prevalent in some of our members when they sleep on their side in a fetal position rather than their back. Positional apnea is not dependent upon supine sleeping because the mechanism is chin tucking. I think you mentioned being uncomfortable and not sleeping in your natural position during the sleep study.
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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#12
RE: Maybe I have apnea, maybe not, are all sleep doc jerks?
OMG -- it all falls together now!

Yesterday I got the only cervical collar that had at the Walgreens. (Of course it's too big -- everything about my head, neck & airway is small -- I'm a classic case!)

This is last night. I think I spent most of the night on my back. I may have had my mouth closed virtually all night, but I certainly kept it closed as I was falling asleep, which is the first time in my life that I have ever made it as far as "very drowsy" with my mouth closed.
   

For comparison, this is four days ago, when I deliberately slept on my back but before the cervical collar. The first wakeup I woke up on my side, saw the 50 AHI and went back to sleep on my back. At the 1:30 awakening I was again on my side and I decided to go back to sleep on my side.
   

I'm not sure what the deal with the mask leaks last night from 3:40-4:43, but the collar is too tall and it's definitely interfering with the mask. So today's task is acquiring a cervical collar that fits! (I know that the wiki article I found here has pretty detailed instructions on how to measure.)

Have I mentioned that while I'm 5'7" -- not at all short for a woman -- everything in my cpap lifestyle is small or x-small? I had 4 permanent teeth pulled and 7 years of orthodontia as a kid to make my teeth fit in my little mouth. (Wisdom teeth pulled out later.) With my first mask, I had to cut the back of the headgear apart and safety-pin it back together with like a 2-inch overlap to get the straps off my ears. I started with a size small mask, then x-small, then decided that was too small. My Amara View never fit right because the width on those guys is size large. My Dreamwear mask was always marginal fit wise. Having a short distance from chin to chest is right in there with everything else! I know from reading here that a small head and  having a narrow airway to begin with means that the trip to a flow limitation is a very short trip...

Thank you guys!!!!
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#13
RE: Maybe I have apnea, maybe not, are all sleep doc jerks?
That's starting to look like worthwhile sleep. Incredible 95% flow limit of 0.09 is a lot of improvement. It will be interesting to see how this settles out once you get the collar that fits. The reviews forum has some collar reviews that are mostly linked from the soft cervical collar wiki. http://www.apneaboard.com/wiki/index.php...ar#Reviews
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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#14
RE: Maybe I have apnea, maybe not, are all sleep doc jerks?
Sleeprider, I posted mine before I saw yours because of the page change, which is why I didn't respond to what you said :-)

Basically, the way that this went down is that I had the sleep study on Nov 11th and felt like total crap, which I chalked up to this being the first night in 6 years that I had slept without the CPAP. So I was absolutely flabbergasted when my PA called me Nov 22nd (on a Sunday afternoon -- I was standing in the produce aisle at the grocery store) to tell me that the sleep study had shown that I was cured of apnea. I think mostly to placate me, the PA offered that she could refer me for an in-person consultation with the neurologist who heads the sleep medicine (for the entire OSF system) who read my sleep study.

I then started to do my own data collection, which consisted of turning the pressures way down and looking at the data. Except for that one night on Nov 27th, which was just puzzling -- I couldn't get much in the way of apneas, and I grudgingly came to the conclusion that they were right and the weight loss had cured me. After a couple of weeks, I stopped using the machine.

Then in mid-March they called me and said that they could schedule me for the sleep doctor consultation (yeah, right, 3-1/2 months...)

I decided to do some more data collection. And I came back to apneaboard and started reading about flow limitations, and the whole chin-tucking/positional apnea thing started to penetrate my thick skull. Because of my long-standing carpal tunnel problems that I am also trying to figure out I now had a reason that I wanted to sleep on my back -- so I connected the dots about the sleep studies telling me that I can't sleep on my back. And I finally figured out that the cluster on Nov 27th must have been me rolling on to my back for an extended period.

You guys said bi-level for flow limitations and I knew that I could turn on EPR, so I cranked that up to 3. Ok, EPR was another stupid fail on my part. When I first started CPAP 6-1/2 years ago I woke up CONSTANTLY and I perceived the EPR as throbbing and found it extremely irritating, so I turned it off and decided it was stupid. When I finally turned it back on March 19th I realized that I have no idea what bothered me about it in 2014. (I also found ramp annoying in 2014, another thing I'm not sure about now!)

A key thing is that for the entirety of this I have been completely misunderstanding what the machine has been telling me about flow limitations. And I STILL don't really understand!

Back in May 2014 the thing that sent me to the in-lab sleep study was an ApneaLink overnight at-home screen. I have that report, and it shows the following statistics:

#Breaths: 6324
Flow limited breaths without snore (FL): 3824
Flow limited breaths with snore (FS): 164
% Flow limited breaths without snore (FL): 60%
% Flow limited breaths with snore (FS): 3%

But the thing that I'm perplexed by is that the "Normal" column says that it's completely normal to have up to 60% of your breaths be flow limited without snore. It also says it's normal to have up to 40% of breaths be flow limited with snore. So if you have 59% flow limited without snore, and 39% flow limited with snore, that's 98% of breaths flow limited and that's normal?!? Also, I can tell that all of those very turbulent breaths that I have around events, arousals, etc. don't have wave-forms where the concept of flow limitation makes sense, and so the machine counts those as flow limitations of zero. So when coming up with a percent, I think that the algorithm is wrong to include those turbulent breaths in the count in the divisor, which will tend to make the statistics understate the problem.

I have pretty much all of my breaths flow limited to some extent when I'm asleep. I've got six years of data and the one thing that it shows is that for me, "flow limited" means "asleep". The machine constantly raises my pressures while asleep, and the pressure only falls when I wake up, and then it starts up again as soon I sleep again.

For me, the APAP algorithm is totally driven by the flow limitations.

As far as I can tell, neither of my in-lab sleep studies have included any data that I can connect to what ResMed calls "Flow Limitation". My ResMed machine's behavior is centered on Flow-limited breathing, and my one-night ResMed ApneaLink screen reported lots of Flow-limited breathing. But as far as I can tell from the reports, it's not something that the sleep lab is evaluating for at all.
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#15
RE: Maybe I have apnea, maybe not, are all sleep doc jerks?
The sleep lab is driven by insurance, and insurance does not cover flow limitation. You need to understand it because it is most of your problem. Flow limitation means the the inspiratory flow rate caps out but your inspiratory effort continues, so the act of taking in air requires a lot of effort on every breath. You are unique in that you have adapted to this restriction in flow rate, and you keep sucking air until your need for volume is satisfied. Many people don't and thus experience a hypopnea where the inspired air volume is reduced from normal. The flatter your inspiratory curve, the harder you are working, and that brings us to RERA, respiratory effort related arousal. You can spot them when there is suddenly an increase in respiratory volume. This can appear as a spike in the flow rate or in the tidal volume chart. RERA disrupts your sleep and has all the consequences of that. You can think of your flow limitation as being like a kink in flowing hose. It doesn't stop the flow, but slows it down, and it takes longer to fill a bucket. That's why your inspiration time is routinely longer than expiration.

EPR acts like pressure support, and it is an increase in pressure that fills in behind your inspiratory effort. This supplements your physical effort just like getting a push from behind as you try to pull something up a hill. The Autoset is limited to 3 cm, but I think you would benefit from about 5 cm if it was available, and that would normalize the peak flow rate, allowing inspiration time to be shorter and more efficient.
Sleeprider
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____________________________________________
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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: Maybe I have apnea, maybe not, are all sleep doc jerks?
(03-27-2021, 10:11 AM)Sleeprider Wrote: The sleep lab is driven by insurance, and insurance does not cover flow limitation.

Yeah, that's part of my strategy... I have a sleep study on Thursday night. My plan is to make sure that I'm really tired going in, lay down on my back, fall asleep, and let it rip! On Mar 22nd I made it to an AHI of 50, LOL.

I've zoomed in 3 pictures from that cluster that started as soon as I went to sleep on March 22nd. The second and third are close-ups of the event cluster, but I think that the first picture is more interesting, showing the couple of minutes of flow limitation breathing-through-a-little-straw thing that then collapses into the big cluster of events:

   

   

   

So this is all pressure of 20, with an EPR of 3. The machine basically can't do anything but watch and record the train wreck!
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#17
RE: Maybe I have apnea, maybe not, are all sleep doc jerks?
Gosh gee whiz! How fun must that be? Oh-jeez
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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#18
RE: Maybe I have apnea, maybe not, are all sleep doc jerks?
Yep that looks and sounds like a trainwreck so it likely is.

Hey doc look at this! Hammer
Dave

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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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#19
RE: Maybe I have apnea, maybe not, are all sleep doc jerks?
Wow.
Dancing 

This is simply amazing.

This looks like complete and total victory to me!
   

I have not had a 95% flow limit below 0.12 since I started with my machine. 0.09 yesterday, 0.10 last night.

(Now I just have to see if I can find a smaller cervical collar...)

Thanks
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#20
RE: Maybe I have apnea, maybe not, are all sleep doc jerks?
Now, the BIG question... How do you feel?
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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