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Need guidance for complex sleep apnea and leaks follow-up
#51
RE: Need adult guidance for complex sleep apnea follow-up
Jmayer, do you have a medical opinion on your very irregular respiration? Your tidal volume and minute vent are fine, but the pacing and consistency is a wreck. I have seen this pattern from your charts for years, and just have no idea how to deal with it. Your ASV relies on averaging your last 90 seconds of spontaneous respiration to pace respiration and maintain the minute volume, but you have no consistency from breath to breath for it to target. I don't know what causes this or how to resolve it. It is unique in my experience and I don't even think it falls within any definable pulmonary issue.
Sleeprider
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#52
RE: Need adult guidance for complex sleep apnea follow-up
I feel similar to Sleeprider but can't help but wonder if unique mouth breathing and leaking is confusing both the data and machine operation. There is no way this machine is operating ideally and targeting the correct ventilation with the constant large leaks and until we see data without leaks I feel like we can't draw any conclusions.

One more idea to try and determine what is going on is to record yourself sleeping with some sort of camera (phone, webcam or whatever you have available). You would have to do it with the lights on (use a blindfold) unless you have or buy a night vision camera. This can give you information as to how the leaks occur and also give an indication of what is going on with your breathing (if obstruction will see body trying hard to breath, if central will see lack of breathing effort). In strange/difficult situations sometimes video recording is the best option to figure out what is going on so you can figure out how to improve it.
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#53
RE: Need adult guidance for complex sleep apnea follow-up
One thing I was always told was never to be a "good case," medically speaking! I haven't mentioned my first visit with the new sleep doc. My old one was a Pulmonologist and followed me for 6 years. He found only the complex sleep apnea. Of course, something may have changed over the year since he last saw me. He retired and the only local option is one with a Pediatrics background. Maybe I tried to give her too much information on a first visit, but she did not inspire in me confidence that she wanted to deal with anything more complex than a prescription renewal. And as I mentioned, we live near the edge of the universe with the closest med center 40-50 miles away which for us geriatrics with bad joints a long distance to go doctor shopping.

Anyway, I'll try again some full-face mask choices and futz with the mask liners and chin straps.

The naive thought occurred, could it be at all helpful just to get a few hours recordings while awake? Could that show any respiratory quirks?
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#54
Leaks, Revisited
I'll try not to beat a dead horse and I know there is a wealth in information in the archives, but it never seems to answer my questions, or perhaps that is only my brain functioning as a dead horse?  Over the years I have always had significant mask leaks.  Early days, I was prescribed high BiPAP pressures (20/24) before the Complex Sleep Apnea DX was made and I ultimately was put on ResMed AirCurve 10 ASV (Auto).  I've had several fairly good years, SX control-wise with AHI in the single digits to low teens.  I've tried the usuals to minimize leaks - neck collar, lip-taping, fabric and silicone liners, supplementary elastic straps.  I've found the smaller the mask the better - never found a full face that doesn't increase leaks; best result has seemed to be ResMed Activa LV nasal.  

Now over last year or so my daytime nap-attacks and sleepiness seem increased as does reported leak rate.  My total AHI's consist mostly of hypopneas, but I've been told due to large leak rates in my reports it is difficult to interpret the true wave forms??  I do not understand the unexplained reference to "ResMed's VSync algorithm."  I only half, dimly remember that ResMed does not report "Leaks" at lower, compensatable rates of leak.  Yet when the rates of "Time over leak redline" is reported as "3.694%" for example, that doesn't look so scary.... only 3-4 % of the time is affected by significant leak?    

Have any of the pros or semi-pros looked at ResMed's "My Air" program (for dummies, 
apparently).  I get page after page of how many hours per day the machine is on, how happy I am with the tube humidification, and only very seldom do I get a frowny-face emoji for leaks no matter that Oscar and ResScan show huge numbers of LL's.  According to MyAir I have nothing to worry about as my "scores" are nearly all 100%.  Never mind that anyone who has struggled to interpret my more recent charts might argue.  

My clinician's manual mentions "AirView" program for use with Aircurve 10.  I haven't found a source for this??  

   
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#55
RE: Leaks, Revisited
If I have it correct, AirView is for medical professionals.

As for MyAir, yes I did use it when I first started PAP therapy. It was void of consistent, detailed data for me. The grinning or frowning ghoul was not enough info compared to Sleepyhead then OSCAR with a leak chart and the averages on the left. I could not dial in my mask or my therapy on MyAir alone. Most of my therapy had been on ResMed ASV, and I've found the ASV does not like leaks that are less than well controlled.

Given the OSCAR chart you posted, your leaks are in fact bad. The 95% was 36, with the 99.5% at 51.6. This tells me your leaks are bad enough to act to get them in control. I can see in the leak trace, it was not a few spikey leaks scattered but nearly constantly through the session. There was a lower constant and some increases yes, but the lower amount was still too high to ignore. As a bonus, with high consistent leaks, I'm thinking your actual AHI is higher than reported.

With all those Hypopnea, I'm wondering if some are Positional Apnea, meaning your chin tucks and kinks the airway. It could be a thick pillow causing it. If it's not Positional, your settings need edited. An AHI of 12.x, leaks all night, Hypopnea frequently all add in to not well rested.
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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#56
Complex Apnea, leak artifact, etc follow-up
After the obligatory first few years of struggle, I was finally prescribed ResMed AirCurve 10 ASV (Auto) for complex sleep apnea.  I had several good years but now feel increased SX's and struggle with large leaks.  I have tried numerous masks (still looking for the magic one), use a cervical collar, now with lip-taping, sleep on my side, and finally of all things seem to be having better leak control with a ResMed F10 full face which must be worn as tight as is tolerable. (Loosening the straps increases the leak. Period.)  I've had no luck with chin straps or liners; my theory is the problem is aggravated by my facial fat.  

Anyhow, before this glimmer of hope fades, I thought I would try tp post a few snapshoots and see if any of the moderators could perhaps interpret the waves now - artifact vs. central hypopneas vs. what-the-heck.  (I have trouble comprehending how in a night filled with events, the brief, two-minutes zoom-shot of one tiny part of the events can help!?!?)  

   

   

   


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#57
RE: Complex Apnea, leak artifact, etc follow-up
(03-07-2022, 12:27 PM)jmayer180 Wrote: ...if any of the moderators ...

(I have trouble comprehending how in a night filled with events, the brief, two-minutes zoom-shot of one tiny part of the events can help!?!?)  

Well, I'm not a moderator, but IMO a two-minute window is the ONLY way to answer your question (BTW that's like a 12 minute window and worthless).  Also IMO you've got a TON of events buried in there. Pressures and flow are all over the place and they really shouldn't be.  In ASV-treated CompSAS the EPAP should have taken care of all the obstructive apnea events, and the ASV should have broken the CompSAS cycle.

Should have broken the CompSAS cycle.

If your machine is constantly wailing on events there's a major malfunction going on.

BTW you've spoken of "not being at ideal weight".  What exactly is your weight?  And neck size?

Should have broken the CompSAS cycle.

[Image: mKacUhB.png]

I mean really?  REALLY?

[Image: kRdNtnW.jpg]
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#58
RE: Complex Apnea, leak artifact, etc follow-up
In reviewing some of your older stuff (a lot of the links are broken)  here's a 2-minute window.

[Image: ugg9voW.png]

What I think is significant here is that in spite of very high driving pressures, often little or no flow actually gets through.  So I'm thinking this is beyond obstructive apnea--  this is all the way up to obstructed airway.
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#59
RE: Complex Apnea, leak artifact, etc follow-up
BTW can you tie in some oximetry?
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#60
RE: Complex Apnea, leak artifact, etc follow-up
And also tidal volume and minute ventilation waveforms (although a trend, should still be helpful) cause they still look ridiculous.
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