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New to Therapy - Starting on BiLevel
#41
RE: New to Therapy - Starting on BiLevel
You have issues being caused. No question about it. They NEED to be eliminated. Your current pillow situation needs to be changed. Since you can't or won't change them try sleeping without one or double them up just to see the difference, doubling them up should make it worse. If you want to try either a cervical or a CPAP pillow go for it. It could be as simple as moving the foam so there is a deeper hollow. I usually say to make them flatter, less firm, thinner. Try a buckwheat pillow or an old school feather pillow from your grandmother. We really don't care how you eliminate this, just that you do.
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#42
RE: New to Therapy - Starting on BiLevel
(10-02-2021, 04:26 PM)Zeliox Wrote: I'm honestly not sure that changing pillows would do much. My pillows aren't particularly thick. They're about 3-4 inches without my head on them, so presumably about 2-3 inches once compressed which I wouldn't imagine should cause issues? The cervical pillows I see online seem to unanimously be thicker and/or firmer.

Zeliox, high bed pillows can encourage head positions in which the chin tucks down toward the chest. The height of the cervical collar discourages chin-tucking by keeping the head up.  Just wanted to make sure that’s clear.
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#43
RE: New to Therapy - Starting on BiLevel
Zeliox, just adding to the encouragement you are already receiving about pillows and collars.

My sleep doc said he prefers some neck extension during sleep rather than flexion.
I ran into serious trouble with sleep apnea while on holidays overseas in super comfy soft hotel beds with lovely stacks of fluffy pillows.
Definitely to be avoided.

I use one pillow and slide it down so at least at the start of the night it reaches down to my shoulder blades.
This allows the neck extension, but would depend on whether the shape of your neck would allow this.

Lastly, this board brought me to the soft cervical collar a year ago and since using a soft cervical collar the pressures I need are much less.
This in turn avoids many of the side effects of higher pressures.

Collars are cheap. Much cheaper than fancy pillows. If I have the collar too loose my chin tucks and I pay the price!
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#44
RE: New to Therapy - Starting on BiLevel
@Gideon - I don't know where you're getting the idea that I can't or won't change my pillow situation or anything about my sleeping situation for that matter. You vaguely alluded to "the pillow modification" with little context and I was simply asking clarifying questions to see what you meant. I appreciate you explaining them now, so thank you. To provide further clarity to my current situation I currently and have always used "old school" pillows I guess. I have feather pillows that compress quite a lot when I lie on them which is the point I was trying to convey earlier when I said they compress. I didn't realize that I guess most people use foam pillows now? I've honestly never even seen anyone use one of those in real life.

@Dormeo - Thanks for the clarification. I recognize that high pillows can encourage problems relating to head tucking but the thing I'm confused about is that mine aren't high. I am absolutely open to trying a cervical collar since they're like 10 bucks on Amazon. I just want to understand the situation better and clarify points about my own situation since things aren't making sense to me.

My whole problem here is that I fail to see how my setup could be causing issues given that my pillows are fairly low profile and when I attempt to position my chin as close to my neck as possible I am still easily able to breathe even when following the example given on the wiki page linked by Dormeo. I don't know why it would drastically change while asleep. I will regardless be attempting some of the things you all have mentioned and I greatly appreciate the advice. I'm just searching for clarity.

I have another question I'm wondering about. With positional apnea, would I expect to see flow limitation readings during these apnea events? I don't see hardly any flow limits for the past 2 nights which seems strange to me. I'm still learning this tool so maybe I'm mistaken, but isn't this weird for obstructive apnea?
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#45
RE: New to Therapy - Starting on BiLevel
Many flow limitations are not flagged by the available algorithms. As you suggest, your best bet is just to try a cervical collar and see what happens. Let us know; I’ll be curious.
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#46
RE: New to Therapy - Starting on BiLevel
So I've been doing a lot of reading regarding flow rate and apneas and I'm growing more convinved that almost all of these apneas that were detected are centrals. I've yet to see a single chart that looks like mine that isn't central apnea related which doesn't make any sense to me. I'm going to attach some closeups of the events, but don't these nearly flat lines indicate centrals? Wouldn't you expect to see at least some wave-form for obstructives?

I get that the machine is logging them as OAs, but the waveform just doesn't seem to match anything I've seen in my searching that isn't central. I'm really lost on this.


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#47
RE: New to Therapy - Starting on BiLevel
(10-02-2021, 10:43 PM)Zeliox Wrote: I have another question I'm wondering about. With positional apnea, would I expect to see flow limitation readings during these apnea events? I don't see hardly any flow limits for the past 2 nights which seems strange to me. I'm still learning this tool so maybe I'm mistaken, but isn't this weird for obstructive apnea?

In general, if something is logged as a more serious event, it won't be logged as a less serious event. So a hypopnea is a 50% reduction and an apnea is 80% -- so while 95% is certainly "greater than 50%" it only gets called an apnea not both.

"Flow limit" is detected via subtle and complex changes in flow rate signals. During hypopneas, ResMed machines will flag high levels of flow limits. During apneas, though, the signal basically disappears entirely, and so the machine will register the flow limits as zero. During the wild up and down that you see during movement, arousals, and recovery breathing, again, nothing subtle is detectable. I have a problem with how the machine records zeros for FL, the zeros mean three different things: well-formed breaths (true zero); no breaths (apneas); breaths which are not even remotely sinusoidal. I think that the machine should flag the 2nd and 3rd of those as No Data (ND, traditionally flagged as a -1 or -99 for data which can only be positive or zero.) Because of how the machine doesn't tell you when it's ignoring FLs entirely, the FL statistics get calculated as much lower than they really are.
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#48
RE: New to Therapy - Starting on BiLevel
Thanks for the insight regarding flow limit Cathyf! That would explain why I've seen such varied reports and why little is being logged for me.

Also, just to add to the previous post I made about being confused about the OAs and CAs. I know that the machine sends a pulse of air to detect for OAs, but I don't get why my flow rate would be flat-lining like that. It seems like for OAs there's usually something of a ramp down and back up from episodes and they seldom seem to just completely flat-line. I haven't seen this sort of behavior in anyone's chart that isn't just CAs but maybe I just haven't seen enough.
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#49
RE: New to Therapy - Starting on BiLevel
Sorry for all the posts, I just keep finding things that are worrying me.

So, I just tried to sleep but I woke up out of very light sleep because I wasn't really breathing a couple times. The machine is logging them as obstructive, but since I was kind of awake for them, I feel pretty confident they were central since I was perfectly capable of breathing without trying or any obstruction I think it was more that my body wasn't automatically doing it. Does that make sense? Should I decrease me pressure or something? I'm honestly kind of scared to use it after experiencing that a couple times. It wasn't a great feeling waking up noticeably without air.

I'm going to set the machine to CPAP mode with the pressure at its lowest I think. I want to see what it will say there to try and determine if any of this is due to the pressure or whatever. Please let me know if this isn't actually useful, but I'm honestly kind of wondering if everything it's logging is treatment-emergent at this point. I've never experienced waking up due to lack of air like that and I have no history of centrals so I'm getting worried this is just making things worse.


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#50
RE: New to Therapy - Starting on BiLevel
Sorry you are having all this trouble. Getting a restful sleep is crucial.

Your Flow charts are kind of squashed down and hard to read but flow rate does appear to be falling prior to those obstructive events and the machine is ramping up the pressure for you.

I have yet to see either my AutoSet for Her or Vauto respond to CA by ramping up the pressure, so would have thought it unlikely in your case that these are CA. Happy to hear other comments about that.

I am fascinated by Cathyf's comment about the ResMed deficiency in recording/plotting the FLs. This gives us some idea of the complexity of trying to get to grips with the nitty gritty in our charts. On my own charts I have many cases of falling inspiratory pattern/flow but not indicated on the FL graph.

One other thing: I don't think ResMed is good at displaying Flow Limits that are expiratory flow limits. I think on some of your zoomed-in charts the expiratory flow is also decreasing leading up to the OSA.

A really good way to look at your Flow Rate more closely is to add the zero line and narrow the range on the Y-axis, in your case maybe -60 to +60 will help you zoom in more.
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