Plmnb's Never Ending OSA Journey (Data)

[Plmnb]

You have very few CAs on your OSCAR charts and only 6 central apneas with 2 mixed apneas on that report. You don't have complex apnea based off what you have posted.

Good morning JoeyWallaby.

Thank you for this observation.  I sure don't need any additional issues with this darn condition.

Plmnb

[Plmnb]

Morning all!

I ended up giving everyone a little break from my posting to the forums last night, but I'll start off today before work with some postings to catch up. 

Here is last night's data.  After speaking to my mother, I decided to try her suggestion of sleeping without a pillow.  Well, almost without.  I removed the harder, taller pillow and used my soft squishy one, which was like sleeping without a pillow. (My mom, who does not have OSA, sleeps without a pillow).  Normally, I dislike the feeling of no pillow, but it actually wasn't too bad.  Problem is, I think I had a worse night numbers wise.

Also, I had to increase my humidifier level to 8 because for some reason my mouth got very dry.  Could be attributable to the weather we are having here in East Central Florida.  Although, my ears feel pretty congested this morning, so I don't know.

I also decided to sleep the entire night without the collar.  This collar on and collar off biz is getting confusing.

If I am correctly reading my machine display this morning, my pressure went all the way up to the max pressure I have set, 20.  How does this correspond to the fact that on breathing out, I had difficulty.  I mean that I felt at times like I was breathing against a brick wall.

 

[attachment=18235]

[ApneaQuestions]

If I am correctly reading my machine display this morning, my pressure went all the way up to the max pressure I have set, 20.  How does this correspond to the fact that on breathing out, I had difficulty.  I mean that I felt at times like I was breathing against a brick wall.

 
When the pressure hits 20 you are exhaling against a pressure of 17... look at the green expiration pressure which is 3 below due to EPR=3

Maybe 17 feels like a brick wall to you

It probably felt easier at 4:10 when you were breathing against lower pressure. (Approx 9 or 10 cmw)

When you get the new BIPAP and can increase pressure support, the flow limitations may get better and the machine hopefully won't need to push pressures up so high to try to combat them. We'll see..

[Plmnb]

If I am correctly reading my machine display this morning, my pressure went all the way up to the max pressure I have set, 20.  How does this correspond to the fact that on breathing out, I had difficulty.  I mean that I felt at times like I was breathing against a brick wall.

 
When the pressure hits 20 you are breathing against a pressure of 17... look at the green expiration pressure which is 3 below due to EPR=3

Maybe 17 feels like a brick wall to you

  

I'm sorry ApneaQuestions, would you clarify for me a bit?  If the pressure hits 20 what does it mean that I am breathing against a pressure of 17?

Oooh, wait a second.  EPR has to do with how many points below the max pressure you set that you will actually have as a pressure?  So, if EPR were 1, I'd be breathing against a pressure of 19?  And if the EPR were 2, I'd be breathing against a pressure of 18?

If this is correct, why is it set up this way?

And, if I need the pressure to be set at a certain level in order to prevent apneas and things, how do I deal with the fact that exhaling seems so hard?

Regards,
Plmnb

[JoeyWallaby]

That is correct. The pressure you're exhaling against (EPAP) is whatever pressure you're inhaling (IPAP) minus whatever EPR is set to.

[ApneaQuestions]

If I am correctly reading my machine display this morning, my pressure went all the way up to the max pressure I have set, 20.  How does this correspond to the fact that on breathing out, I had difficulty.  I mean that I felt at times like I was breathing against a brick wall.

 
When the pressure hits 20 you are breathing against a pressure of 17... look at the green expiration pressure which is 3 below due to EPR=3

Maybe 17 feels like a brick wall to you

  

I'm sorry ApneaQuestions, would you clarify for me a bit?  If the pressure hits 20 what does it mean that I am breathing against a pressure of 17?

Oooh, wait a second.  EPR has to do with how many points below the max pressure you set that you will actually have as a pressure?  So, if EPR were 1, I'd be breathing against a pressure of 19?  And if the EPR were 2, I'd be breathing against a pressure of 18?

If this is correct, why is it set up this way?

And, if I need the pressure to be set at a certain level in order to prevent apneas and things, how do I deal with the fact that exhaling seems so hard?

Regards,
Plmnb

Yes
Inhale 20 means exhale 17
Inhale 19 means exhale 16
..etc..
You have EPR set at 3 to give the maximum possible "Pressure support" on the Autoset (to give the best chance of fixing the Flow limitations)
When you get the BIPAP... you will be able to adjust to a true Pressure Support higher than 3 to fix the flow limitations and obstructives.

For the sake of argument.. let's say you get a pressure support of 5 on the BIPAP...
Then those numbers could change as follows..

Inhale 20 means exhale 15
Inhale 19 means exhale 14

... so your exhalation will have less of a brick wall to fight against.
Going back in history... that's essentially why BIPAP was initially invented to help with exhalation claustrophobia and the resulting anxiety.

Make sense?

[Sleeprider]

Reviewing the past few pages, I'll start with the comment that regarding your sleep report. you have only 6 of 155 events that are central. That is not central or complex apnea, so I think we can leave that concern behind. Your untreated AHI is over 48 events per hour and your treated is less than 10, so you are 80% improved. You would be surprised how many doctors will try to persuade you that is "success". Clearly there is plenty of room for improvement, but we have exhausted the options with CPAP and need to move forward with a more advanced therapy like BPAP, and better understand the source of obstruction from a medical or physical viewpoint.

In order to help your doctors better understand what is going on, let's gets some new images together. In these images we are going to zoom into 2-minute segments of your sleep where the leak rate is low. The objective is to contrast your flow-limited breathing (Flow Rate) vs times when flow limitation is much less. For example in your last posted chart, we can use the time from 5:30 to 5:32 as a period of low flow limitation. We can use 03:15 to 03:17 to illustrate your flow limitation. Chart should include Events, Flow Rate, Pressure, Leak Rate, flow Limitation and Snore, in other words, just use the same chart organization. Once you post this, I'll help you understand what we're looking at so you can discuss with your doctor. We can then start looking for additional examples. I'd like you to discuss these with your doctor ahead of the sleep test so can use these examples of what to look for in the respiratory flow trace during the test.

[Plmnb]

That is correct. The pressure you're exhaling against (EPAP) is whatever pressure you're inhaling (IPAP) minus whatever EPR is set to.

Thanks JoeyWallaby for confirming this.

So, what should I do?  Leave the Max at 20 with EPR 3 in order to get control on these apneas and things?  But according to my results chart from last night even at 20, EPR 3 I had bunches of apneas and stuff.  Do I need higher pressure?  But How do I get used to the "BRICK WALL" feeling?  

OR

Do all these things get cleared up when I go onto the Bipap and I should just leave things the way they are now even though I am so uncomfortable?

Anyone have any additional comments or observations about last night's charts?

Most gratefully,
Plmnb

[Plmnb]

Reviewing the past few pages, I'll start with the comment that regarding your sleep report. you have only 6 of 155 events that are central.  That is not central or complex apnea, so I think we can leave that concern behind.  Your untreated AHI is over 48 events per hour and your treated is less than 10, so you are 80% improved. You would be surprised how many doctors will try to persuade you that is "success".  Clearly there is plenty of room for improvement, but we have exhausted the options with CPAP and need to move forward with a more advanced therapy like BPAP, and better understand the source of obstruction from a medical or physical viewpoint.

In order to help your doctors better understand what is going on, let's gets some new images together.  In these images we are going to zoom into 2-minute segments of your sleep where the leak rate is low.  The objective is to contrast your flow-limited breathing (Flow Rate) vs times when flow limitation is much less. For example in your last posted chart, we can use the time from 5:30 to 5:32 as a period of low flow limitation. We can use 03:15 to 03:17 to illustrate your flow limitation.  Chart should include Events, Flow Rate, Pressure, Leak Rate, flow Limitation and Snore, in other words, just use the same chart organization.  Once you post this, I'll help you understand what we're looking at so you can discuss with your doctor.  We can then start looking for additional examples.  I'd like you to discuss these with your doctor ahead of the sleep test so can use these examples of what to look for in the respiratory flow trace during the test.

Oh boy Sleeprider.  

I feel so dumb, I am having difficulty understanding what I need to do.  Let me sort out in my mind what you are saying and if you don't mind my posting follow up questions to your instructions...?

You don't think it is silly or a waste of time to try to get more answers?  I mean if I am 80% improved should I be happy enough with that?  I don't understand why if I am 80% improved I still feel awful?

PS.  I definitely won't waste any more time on the Central biz.

[JoeyWallaby]

You can't only look at percentages... you need to look at the raw numbers. Let's look at your last posted OSCAR chart which is the one above http://www.apneaboard.com/forums/attachm...?aid=18235

AHI 9.17, round to 9. 60/9 = 7 rounded.

You're suffering an event every seven minutes, obviously this is a significant improvement over without CPAP but still... being disturbed every seven minutes isn't exactly the path to good sleep.