Please help with treatment review

[DaveL]

sheepless I'll reduce Pmax.

thanks for your thoughts.

If I have to go back to the sleep doc I'll be put through the ringer: sleep study/full face mask for sure/cpap only. Ontario Canada

Dave

[DaveL]

Trial mask on all night

Modified.  I inserted the Philips Respironic tailpiece recommended here by some for the P30i ResMed nasal pillows mask. (Amazon finally deliivered it last night.)

Feeling--grateful.  I've never worn a full face mask for longer than a couple of hours.

Feeling--almost rested.

Feeling concerned.  I don't have CSR. Lots of colour on the chart.

[Geer1]

Go back to 12-17 to see if results return back to what they used to be.

[sheepless]

I don't disagree with Geer1 but while I'm hopeful, I'm not optimistic it'll help and if it does, I'm not optimistic it'll last. I hope I'm wrong. your results have been inconsistent and you haven't been happy for any length of time with any settings. but that's not a reason not to try.

your ca seems to be worsening. reducing epr and a fixed or narrow range pressure setting is the usual response. many of your oa are clustered. position, low profile pillows and a collar are the usual recommendations for that. imo you might never see great results until you figure out mask fit. of course you know all this and you've tried just about everything possible with apap. short of a different machine, about all you can do is return to whatever settings produced the best results, especially in terms of how you feel, and hope you like them better this time around.

[Geer1]

He had months of better results with original mask and settings. Yes there were complaints and issues but in attempting to treat them so far the only success has been in making things obviously worse. It is time to step back to what he was doing before to stabilize results (they were fairly consistent for months so no reason to think they won't) and then continue to try fine tuning from there if desired.

Imo he has already tried almost everything and some things that should help (like using FFM to get leaks under control) failed because of his underlying aspect of central apnea being exaggerated. ASV is likely required to get ideal treatment and continuing to monkey with settings will potentially continue to make things worse not better. Dave has already spent years on this and hoping to find a solution now is unlikely. Eventually you have to accept that it is not possible to get ideal treatment with equipment that is not capable of doing so.

[DaveL]

I decided to take a power nap.

I wanted to try the P30i mask, with the Respironics band instead of the droopy ResMed strap at the back of the headgear.

Nothing else.  Good nap.

(No cushion; no tape. No pillow.)

Interesting

[DaveL]

Posted and then saw the 2 comments that written while I was asleep.

The nap was terrible. I'm going to bag the P30i and take it back.

I see your comments.I appreciate them. I have to clear my head.

Thanks.

Dave

[DaveL]

First was the power nap reported previously.
* I'm fascinated that the result was almost exactly the same as my first sleep study.  43! (35 years ago.)
* mask P30i with Respironics tail piece to stabilize the mask
* no tape
* no cushion

Second was regular night's sleep
* nasal mask N20
* tape
* soft cervical collar

I see many more flow limits on the second sleep last night

I don't know how to interpret last night's result.

[SarcasticDave94]

Would there be a benefit to operate in "avoid Central Apnea" mode after/in conjunction with going back to settings that Geer1 suggests? Ramp isn't on but EPR 3 is and probably needs reduced. Best would be closer to static PAP. This OSCAR chart is a fair representation of a CA Trainwreck.

[DaveL]

Thanks Dave.

I'll change pressures to what Geer1 suggests, and turn off EPR.

I'm thrilled it was so bad.

No messin' around.

Heard a long time ago...."Everyone has a purpose. There's no one so bad they can't serve as a bad example."