New to Therapy - Starting on BiLevel

[SarcasticDave94]

OK now I know the flattening you're referring to. This is a Central Apnea pattern, it's mostly flat but not entirely. You're dealing with treatment emergent CA. With time, these diminish for most.

1 setting change at a time. Try PS 2 if you're really wanting to see what happens to the CA. No other edit.

[Zeliox]

So I've done more reading about treatment-emergent centrals and I didn't realize that they often go away after someone adjusts to treatment. I guess I'll just leave my settings as they are and hope that it improves as I get accustomed to the machine.

I'm still confused about the flow limit flattening because it happens for both CAs and OAs, so it seems like whatever the problem is it shouldn't be categorized differently? Every single event that was logged has the same pattern of 10+ seconds of a flow rate near zero but maybe those will go away as I adjust?

[cathyf]

First note -- in order to be classified as an event, it has to last at least 10 seconds. (yes, it's an arbitrary cutoff!) Counting events is also somewhat arbitrary. OSCAR has several tools that try to give a fuller picture of what's going on. You can define a User Flag #1 and User Flag #2 -- I use it to flag "sub-events" where I set the time minimum to 7 seconds, and one where I set the percent of restriction to 30%. Another nice feature is the "total time in apnea" since long events are more serious than short events.

So the clustering of events that's so characteristic of positional apnea might come from more than just too many pillows. I've figured out that when I haven't got the mask fit well I can spend the entire night chasing the mask around my face, and bending my neck at bad angles is part of that. Getting your particular mask to fit on your face is going to be an individual task! You can get good hints and tips here, but some of that just comes from experience.

[Gideon]

A couple of things.
Order of attack. First is the obstructive clusters.as these tend to hide other things. I see significant clusters of in flagged Flow limited breathing, perhaps significant enough to reset what the machine thinks is normal. The breathing pattern on both sides of your CAevents looks to me to be obstructed breathing and I'm seeing little evidence that these centrals are treatment emergent. With all the restricted. Testing near them and even with the lack of a recovery breath I think these may actually be obstructive events, just not restricted enough for your machine to I'd with a FOT pulse.

Second, once we eliminate the obstructive clusters then we can better tackle what remains which we would expect to be mostly centrals.

Note that the medical community would see these charts and say obstructive events and to raise pressure. So if you would like to take that approach go ahead, just realize that is against the collective experience here.

[Zeliox]

A couple of things.
Order of attack.  First is the obstructive clusters.as these tend to hide other things.  I see significant  clusters of in flagged Flow limited breathing, perhaps significant enough to reset what the machine thinks is normal.  The breathing pattern on both sides of your CAevents looks to me to be obstructed breathing  and I'm seeing little evidence that these centrals are treatment emergent. With all the restricted. Testing near them and even with the lack of a recovery breath I think these may actually be obstructive events, just not restricted enough for your machine to I'd with a FOT pulse.

Second, once we eliminate the obstructive clusters then we can better tackle what remains which we would expect to be mostly centrals.

Note that the medical community would see these charts and say obstructive events and to raise pressure.  So if you would like to take that approach go ahead, just realize that is against the collective experience here.

I see what you're saying, and I see what you're saying you wouldn't recommend and maybe I missed it, but I don't see what your proposition is to fix this? Do you think I should increase PS or something? I'm also unsure what you mean in regard to resetting what the machine thinks is normal. Are you meaning that I'm experiencing such a long period of limited flow rate that the machine may be thinking that's just normal for me?

[Zeliox]

So I just had my second night with the VAuto and it went much better than the first. I don't feel amazing by any means, but I actually felt rested for the first hour or so after I woke up which is miles better than yesterday and actually a little better than normal. I still only managed to get about 5 hours of sleep, but I'm glad I managed to keep the mask on for the majority of the night and didn't have any big interruptions. On my first night I had to take the mask off multiple times and kind of unwind before I could go back to sleep. This last night, I did end up taking the mask off but it was kinda involuntary and didn't really interrupt my sleep until I woke up realizing I took it off and put it back on about an hour later.

Anyway, it looks like I still have the clustered apneas. I have some closeups before the cluster and in the cluster as well.

Also, I get what people are saying about positional apnea, but I'd really like to work with this machine as much as I can for at least a bit before throwing in new variables like cervical collars and stuff.

[SarcasticDave94]

If I've followed accurately, Gideon doesn't say change settings but attack the Positional clusters. This is listed as priority action 1. Keep attacking that only for now.

Again, this does not involve setting edits as that will not help. Positional Apnea clusters are created by external airway kinking, and the answer to address them is physically eliminating the opposing, kinking force. It sounds like your pillow isn't too high, didn't include several pillows stacked. Then next up is adding a physical device to oppose the neck bending and kinking that's forcing airway restrictions. This is where you introduce a soft cervical collar into your arsenal.

In a comparison to try to enlighten, suppose your radio and PAP are equal in this weird comparison. You're trying to tune in a station, I don't know let's say AM 580. But where you are there's a physical thing, maybe a tree or tall building that blocks the signal. No dial turning, no antenna manipulation, no volume setting, nothing can change the lack of reception because it's not related to your radio. There is no signal to control.

Parallel

Your PAP is attempting to transmit a signal but there's something in the way, some physical blockage that it cannot get past. This is Positional Apnea. There's times your PAP has no possible way to help because there's no connection to your lungs. It's being blocked off.

[Gideon]

I'm seeing what could easily be long term physical restriction that we look for because you have the clusters which in our opinion indicate a physical bending or kinking of your airway. And yes, this extended period of unflagged restricted flow will cause your machine to think that is your normal. For this reason you must overcome this obstruction. The best method is with a cervical collar. To be clear, I do not like suggesting more stuff (collar) to use so I suggest the pillow modification first. I don't see what you are using so when you say those mods either don't work or you cannot use them for whatever reason you have to try what works and that is a properly fitted collar.

To be clear, I do not recommend the medical community method of raising your pressure to fix this. IMHO that will fail.

In my estimation the collar works for over 99% of its users.

[Dormeo]

Check out the information and before/after graphs in the AB wiki:

http://www.apneaboard.com/wiki/index.php...cal_Collar

[Zeliox]

I see. Thanks for the responses and the link to the wiki. I'm better understanding what this is and how it presents itself in OSCAR. I definitely will try to relieve this soon.

@Gideon - When you mention "the pillow modification" what exactly are you talking about? Just using a thinner pillow? I know there are cervical pillows. Is that what you're talking about? 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.