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New To Apnea Board [confirmation of my data analysis]
#31
RE: New To Apnea Board [confirmation of my SleepyHead data analysis]
Hmmmm ...... just noticed that but I want to make sure I know what I'm looking at. I think the graph you are seeing this at is Flow Rate. I can't correlate this so much looking at the pressure graph.

If I understand EPR settings correctly, if EPR is off, there is no reduction in flow rate (mask pressure) on exhalation; at 3 there is maximum reduction. Do I have that right? Mine is set at 2 so, I'm getting a pretty good bit of reduction in flow rate (mask pressure) on exhalation that produces "CO2 washout" and a CA. 

I also want to make sure I understand the term "CO2 washout." let me try ...... the term applies to the process of clearing CO2 from the mask that accumulates in it during exhalation. This is accomplished by both the force of respiratory exhalation and by the air from your xPAP that passes through the mask to designed vents in the mask. With EPR at 1-3, CO2 levels are not only low in the mask because it's getting flushed out, but also inappropriately low in your lungs. Respiratory drive decreases or stops altogether and a CA appears to try to retain CO2. 

Accompanying this washout, I'd expect to see a momentary decrease in both respiratory rate and minute ventilation. You can't see it because the screen shots I post don't include that but that is exactly what I see very well correlated with my CAs. (see screen shot below)

So, yeah, I'll shut it off and see what happens tonight. News at 7am tomorrow. BTW, this is all very cool mental gymnastics that are routinely associated for you guys with Pulmonary and Respiratory/Sleep medicine. For me, it's all new and I'm enjoying the learning process.


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#32
RE: New To Apnea Board [confirmation of my SleepyHead data analysis]
With new settings of min 8 and max 12, EPR Off, I had a great night regarding AHI (1.34) but terrible mask leaks and increased CAs. Turning EPR off was supposed to decrease CAs (it didn't but suspect leaks is behind that). Worked on OAs by bumping min pressure up from 5 to 8 and max from 10 to 12 (this did reduce OAs). The leaks may render this conclusion faulty.

I had my usual and unwanted number of awakenings (3 of them, most likely due to mask leaks/CAs and arose at 5am after 7h of restless sleep - too early). I also went back to my hard TempurPedic neck pillow which may or may not have had an impact on mask leaks - I was pretty careful to let the mask hang over the side of it. I think the pressures (Min 8cm and Max 12cm) are probably close to right for me. I'm going to try to cut down on the mask leaks tonight before making any other changes. My sense is that this huge number of leaks renders conclusion about any setting questionable. I could see bumping up EPR to 1 from Off as this may have contributed to the leaks but, I think the best approach is to work on the one big problem - mask leaks - without changing any other variables for now.

Comments welcomed.
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#33
RE: New To Apnea Board [confirmation of my SleepyHead data analysis]
Since your pressures are higher now anyway why not try the fixed pressure at 10cm? Some times a steady pressure can also help reduce leaks.
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#34
RE: New To Apnea Board [confirmation of my SleepyHead data analysis]
Hmmmmm ...... the last time we thought about doing this, ajack thought it might be a bit early to jump to CPAP mode and then another poster suggested that I set min and max the same in Auto (10cm) to support normal data collection and display in SleepyHead while obtaining the same result (CPAP constant pressure). I'm for it but I'd like to hear some more perspective on that move to CPAP constant pressure. I agree a constant pressure may help leaks but I think that is such a huge problem, my sense is that I need to work on leaks for a night or two first.

Thoughts?
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#35
RE: New To Apnea Board [confirmation of my SleepyHead data analysis]
I agree with setting up the fixed pressure using auto mode and setting the minimum pressure and maximum pressures the same. As far as fixing the leaks first I think it would be easier from a fixed pressure. But of course like always it's your call.
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Advisory Members serve as an "Advisory Committee" to help shape Apnea Board's rules & policies.

Membership in the Advisory Members group does not imply medical expertise or qualification for advising Sleep Apnea patients concerning their treatment.



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#36
RE: New To Apnea Board [confirmation of my SleepyHead data analysis]
That was me that suggested auto mode at the same minimum and maximum pressures. It works well, and CPAP pressure has its place in minimizing events for some people that are sensitive to pressure changes. I thought that it probably applied to you at the time.
Sleeprider
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#37
RE: New To Apnea Board [confirmation of my SleepyHead data analysis]
OK, I'll set my machine to Auto but effectively create CPAP by setting Min and Max at 10cm. I tend to agree with the notion changing pressures associated with Auto may be causing some leaks and that leak fixing might be better done at a constant, not changing pressure. I'm also going to set my EPR to 1 from Off. I changed this before last night from 2 to off. Besides a rather minor set of pressure changes, this is the other variable I changed. It seems to make sense to me that the increased exhalation pressures associated with EPR Off may be another factor in the big jump in leaks. We'll see. I'll report back tomorrow morning. Thanks for the help.
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#38
RE: New To Apnea Board [confirmation of my SleepyHead data analysis]
I can't help but think that some of the CA events may be caused by the leaks which probably increases the amount of air flowing into your mask and out (leak), which will drive down your CO2, which makes your brain want to retain CO2 by holding your breath.
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#39
RE: New To Apnea Board [confirmation of my SleepyHead data analysis]
Agree with that, Hojo. That is definitely one of the possibilities. In looking at several of my last SleepyHead Reports though, with leaks not so pronounced, I was still producing CAs. That being said, it was supposed that the CAs were caused by low CO2 in the lungs (wash-out) not associated with leaks. So, was it the EPR causing this by subtracting exhalation pressure that might paradoxically subtract from lung CO2 with it? Were high leak rates responsible for that last night - I think they were last nigt at least. Maybe not on other nights. Lots of variable at play here it seems.

I'm going to try Walla's suggestion to go CPAP at a constant pressure (using the trick Sleeprider suggested to keep data recorded for later interpretation in SleepyHead). Admittedly, I'm changing two variables here. (1) Going to constant pressure to see if leak rates decrease and (2) putting a touch more EPR in the mix - going from Off to 1 - to see if I can keep AHI below 3 (I've done this plenty of nights) and cut down on OAs.

Comments welcomed.
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#40
RE: New To Apnea Board [confirmation of my SleepyHead data analysis]
Just a quick comment about the results of the adjustments above. They worked great ...... until the leak monster hit. At a constant pressure of 10cm, EPR at 1, I slept restfully for about 2.5h with one CA, no OAs and a low leak rate! Then there is a large leak, probably due to movement on the mask from sleep position (I'm a side sleeper), a series of 3 RERAs and I'm wide awake. I fidgeted with the mask fit, changed from medium to small mask, spending close to an hour doing this and not being able to fall back asleep. Frustrated, I took the mask off and fell back asleep for a solid 6h.

Having read ajack's link on masks, I'm starting to think the Amara View is not for me. In fact, a full face mask may not be for me (It's what I got from the VA and I didn't know enough to ask about others at the time). CPAP, when I'm not experiencing leaks works fine to prevent OAs and snoring. The leaks, when they occur, are causing a lot of CAs and awaken me too many times preventing a good night's rest....... rather defeating the purpose of xPAP altogether. So, back to the drawing board .......

I'm going to start trying different masks and when I have something useful to report here, I'll do so.

Any advice on masks would be greatly appreciated.
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