Please Review The Data & Give Recommendations

[Hojo]

I have to ask,  Can you please repeat the test with a new hypoallergenic filter, a different package if possible.  Would like to see if that causes the issue again.  Not questioning you but am looking for a repeat occurrence (the analyst in me).

That said I have never heard of this happening before.

Fred

Not sure I want to try that again, I may do a light rest.  I don't have a different package, but I do have 2 others that can be tested.  I will say that the filter texture is not like a screen filter, it feels like the white (center part) of a bandaid that is very slick and doesn't appear to be able to allow much air flow.

[Hojo]

I'm wondering if somehow some of the filter was covered with plastic.

You made a very good point, it doesn't LOOK like plastic is placed on it, like an extra wrapper, but it does have that feeling of plastic...the way my wife liked to describe it, is like the way some bandaids have an extra thicker material (less absorbent).

I went back and looked at the data and the new filter went in a few days before the acute increase in resp rate went up, my respiratory rate started to climb when it peaked at 50 for the 95% mark, for 7 days straight. I really don't want to experience that again!

[Hojo]

The night before;
Pressure 8/12
EPR 2
Ramp 10

The results are a few screens up on this thread, for last night, I changed the EPR down to 1, everything else stayed the same and here are my results.  About last night, I just happened to wake up at 2:40ish feeling just great and ready to start the day even though it wasn't time.  I usually have difficulty falling asleep and since something happened at work prior to bed time, it remained on my mind and my mind is constantly working so I went ahead and got up and stayed up....I don't want to sit there breathing while wide awake, it won't give a true picture of my AHI.  Again, I felt like a new person, even my resting heart rate was good throughout  the night; 38

https://imgur.com/a/6VzrN

I need a few more days, but going up to 8 (from 5) should help with the slow response that has been seen with my OA's, and with the reduction in the EPR, my CA's were down too, but again, I need more results before a trend is validated.  I think I will leave the EPR at 1 for a few nights before trying to go to 0.

Thoughts?

Thanks!

[Hojo]

Last night was the 4th night with the settings of 8-12 and EPR 2, and the 3rd night at 8-12 and EPR of 1.  I was a little surprised that the number of OA's went up, but I guess I was hoping that I wouldn't continue to see bad nights. 

Now that I see that a pressure of 12 isn't stopping the OA's, and I've cut down on the EPR from 2 to 1, I'm wondering about my next adjustment.

Last night my 95% pressure was 12 and 95% EPAP was 11, so if I stay at max of 12 and drop the EPR to 0, my EPAP 95% would be 12.   Or I could bump up the pressure to 14, keep the EPR at 1, and the EPAP would be 13.

I think I eventually want to shut off the EPR to see if helps to reduce the CA's even more (it seems that going from 2 down to 1 has helped some), but I really want to see the OA's go away too. 

I know I had more leaks last night, it might be because I didn't tighten the mask as much, my nose was a bit sore and I was hoping it wouldn't leak too much.

Thoughts?

[Hojo]

Forgot to include the Sleepyhead report;

https://imgur.com/a/JB0WB

[Hojo]

I went up to 8/14 last night, kept EPR at 1 and didn't have any significant improvement with OA's.  Looks like it times for me to move on from the board here.

[Sleeprider]

I think you've made good progress, but don't overlook the fact your respiration rate remains very unstable for reasons we can't begin to guess, but appears mostly related to expiratory time. Your obstructive apnea occur in clusters, and don't appear to respond in a predictable way to pressure. I think I recall you have also tried a cervical collar. I think you may benefit from a clinical titration, but the technician needs to be tuned into the occasionally abnormal respiration. You had a significant improvement after changing out a filter, but results are erratic. I'd love to help, but haven't any idea what to suggest, at least with CPAP.

[Hojo]

Some notes on my study the last week or so;

I have noticed an inverse relation between EPR and my respiratory rate; every time I lower the EPR my RR goes way up.

After over a month on CPAP I decided to give a cervical collar a try.  One thing I noticed when I put on the FFM that in order to stop the leaks, I have to cinch down the lower strap which seems to pull my lower jaw downwards towards my chin, I could be wrong but I started to think that this could aggravate my OA's.  Bare in mind I was told I have more CA's than OA's.  One of these days I'm going to get the actual report.  I was also told during the CPAP titration study that I needed a pressure of 10 to prevent OA's.

So, the results:

Without the collar for 6 nights at 8/14, EPR 1 for 4 nights and 2 for 2 nights.

AHI 4.78
# CA Events  11.5
#OA Events  12.33
#H Events   5.17
Total # Events 29
CA Index 1.87
OA Index 2.01
H Index  0.84
CA&H Index 2.71
95% Pressure 12.27
Apnea Time  9.41 min
Hours of Use 6.13

With the Cervical Collar on for 4 nights at 8/14, EPR 2 for 3 nights and 1 for 1 night.

AHI 4.47
# CA Events  25.25
#OA Events   1.75
#H Events   9.65
Total # Events  28.5
CA Index 4.01
OA Index 0.08
H Index  0.43
CA & H Index 4.44
95% Pressure 10.21
Apnea Time  8.0 min
Hours of Use 6.25

The AHI is very near the same in both studies, the number of Total events are also similar (average of 29 vs 28.5).  The biggest change is that the # of OA events dropped from 12.33 to 1.75 with the use of the collar. 

This tells me that I need to continue to use the collar, I still have CA's and I will more than likely need to be tested on BIPAP (first), but now I am going to start lowering the peak pressure to see if I even need the pressure of 10 that the original titration study said I needed (without a collar).  Could it be that with wearing a cervical collar, I just need a little push of air from a BIPAP and not much pressure to keep my airway open, next study on the way.

[Hojo]

I have a few more weeks before my schedule follow up appointment when we expect I'll be sent for a BIPAP titration study.  I'm feeling good, had a good night sleep last night, AHI wasn't bad, but was disturbed to see CSR lasting 26 minutes.  

While I know some CSR can actually be moving or rolling over in bed where you take a deep breath and then hold it while you roll over and unfortunately, it shows up as "CSR".  What I'm wondering about is the pattern that can be seen in the attachment below, while doesn't have a big crescendo pattern, it does have some wax and wane pattern to it so I'm wondering if I should run this to the office tomorrow for evaluation...I do not have CHF.

Thank you.

https://imgur.com/a/EOLlP

[Sleeprider]

I'm sorry hojo, but this is not a good image, and is classic Cheyne-Stokes Respiration at all zoom levels.  I have no idea why this is affecting you, but fortunately, is is a relatively brief period and not characteristic of of your night, or other therapy shots I have seen.  Show the doctor, I have no idea what causes this in the absence of other serious health issues.  Normally this pattern is seen in individual with an AHI in the 20-50s, and suffering from heart failure. I don't think that is the case with you, and hope I never see this in your results again. I am glad to see your respiration rate median and 95% drop into normal levels.

I continue to believe you should be evaluated for ASV.