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Plmnb's Never Ending OSA Journey (Data)
RE: Plmnb's Never Ending OSA Journey (Data)
Well, I did have two more but I can't post them because I reached the maximum Sad

Share them tomorrow I guess.

Thanks,
PLMNB
Huhsign  WARNING: It may take a while to sink in...I tend to get befuddled at times.
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RE: Plmnb's Never Ending OSA Journey (Data)
Plmnb you can delete your attachments from the beginning of the thread that aren’t needed anymore. Then you’ll have more room for new attachments. In userCP
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RE: Plmnb's Never Ending OSA Journey (Data)
Oh. I wondered about that. I thought though maybe the way message read, that you could only post 3 attachments a day. Duh.

I’ll have to post remaining tonight.

Thanks Osiris357.
Huhsign  WARNING: It may take a while to sink in...I tend to get befuddled at times.
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RE: Plmnb's Never Ending OSA Journey (Data)
Here's my "Hey Doc" narrative for the complete night..

I marked three different areas as A, B, C. I could have added more around 7:15 to 7:20.

For each area the narrative is the same (reading from bottom to top like before)

1) Notice how my flow limitations are severe and almost reach 1.0 (which represents total blockage)
2) Notice how my Respiratory Rate is usually 14 (look at the median in the statistics table) but in these areas my resp rate gets spiky showing that I am "struggling"
3) Notice how the machine pushes the pressures to maximum in each of these areas trying to clear my airways
4) Whenever the pressures get high I am breathing out against 17 pressure which feels like a claustrophobic brick wall to me
5) You will see (later) on the zoomed plot that my Flow Rates become non-rounded showing the severity of the flow limitations
6) Lots of events happen in these areas
6a) Notice the RERA arousals that are all marked in yellow on the event flags area
6b) I also get hypopneas (in zone B)
6c) I get OAs Hyponeas and RERAs in zone C

Don't fret about the CAs... I suspect these will end up being misidentified OAs if you zoom in close.

The BiPAP should hopefully help to deal with all these by allowing me to get extra pressure support without feeling the uncomfortable brick wall.
The ENT referral will help to look in my mouth and nose to see what might be causing this.  (Septum, Turbinates, Polyps, Tongue, soft palate)
During my sleep study.. please pay attention to all the events (as you usually do) but please also pay special attention to flow limitations on my Flow Rate curves.

We will have similar comments on the zoom plots giving a more convincing story for item #5

Hope this makes sense.

P.S. Notice I made essentially the same comments (for the same reasons) several days ago on your previous all-night chart.


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RE: Plmnb's Never Ending OSA Journey (Data)
One thing I didn't mention is the possibility of positional issues.
The sleep study camera will see if you are on your back or your side etc. if/when this happens.

The other thing I didn't mention is the possibility of chin-tucking (neck collar) whenever the events are clustered.
Again, the cameras may spot that too. They tend to be dark and grainy images though...not much detail.

I like to sleep in a side foetal position (probably tucking my neck as I do so).  I need to set up a camera to check that for myself.

Looking forward to the final two zoom images.
Two minutes would be ideal... you got close with the 6 minute image.

Don't sweat the little stuff if what I am about to say is a new concept to you and confuses you..

If it's easy for you to do... try to exaggerate the y scale on the flow chart by changing the min/max range.

You can change those scales (using windows jargon not apple jargon) by right clicking on the y-axis and changing y-axis to "override" and typing in values that look closer to the actual values you see on the flow rate.

... if that totally blew you away... ignore it.  :-)
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RE: Plmnb's Never Ending OSA Journey (Data)
You should have plenty of attachment space, but there is a limit of 3 attachments per post that we put in to try to reduce some of the enthusiastic posting of attachments we were getting.  You attachments help us to interpret the periods of high flow limitation as being pretty severe, and resulting in hypopnea and RERA. The inspiration flow rate barely climbs above zero. In this case they are occurring at the maximum pressure your Resmed Airsense 10 CPAP can produce, so a BiPAP is a given medical necessity and there is very little need for explanation.

In addition, we know from your sleep study that you experience apnea in  both supine and left side sleeping positions, so positional therapy is not going to resolve this problem.  We have tried the soft cervical collar and gotten nowhere.  Where we want to go is with lower pressure and much higher pressure support. This is consistent with treating hypopnea, flow limitation and snores with bilevel, and should be easy enough to explain.  I'll post the titration protocol for Resmed Aircurve Bilevel machines below. Note the appropriate titration response for the event type. This titration protocol is for the VPAP S which is fixed pressure, however you want to have automatic EPAP adjustment as provided by the Vauto. We want to set the minimum EPAP pressure to stop most obstructive apnea, but allow the machine to go higher as needed so you don't have that pressure all the time.  We will titrate for pressure support to stop Hypopnea, RERA and snoring, and that will be a fixed value.

[Image: attachment.php?aid=4203]
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
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How To Deal With Equipment Supplier


INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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RE: Plmnb's Never Ending OSA Journey (Data)
Good morning board friends. Hope everyone is having a nice holiday.

Thank you Sleeprider and ApneaQuestions (and Osiris357).

I am going to have to agree with Sleeprider that the collar is not making that much of a difference after all.  Last night I slept with the collar the entire night and my AHI was just a smidge below 5.  I reviewed all my other nights just now and my AHI is quite varied, with an average AHI of just over 7.5, this includes entire nights without the collar, entire nights with the collar, and nights with & without the collar. (Average may be off a tiny bit because for one night the data is missing).  And, as for my back or left side position...yeah, doesn't seem to be something I'm going to be able to change and realize better sleep.  As it is, the generally recommended "best to sleep on left side" & "worst on the back" situation is not of help to me since even my original sleep study says my apneas are worse on my left side as opposed to on my back.

ApneaQuestions, When I spoke to Dr.Duck AND the sleep lab tech, I repeatedly asked and tried to confirm that the study would be video taped because I wanted to see the sitting up action my husband told me I was doing.  I believe I mentioned this in one of my gazillion posts.  My husband says that he often finds me sitting up in bed, Indian style, with my head slumped forward almost to the mattress.  I told them I wanted to see this for myself.  I'm pretty sure Dr.Duck, in his lousy approach to me indicated there would be video.  The sleep lab lady looked at me like I had 5 heads.  I asked and asked, and she finally seemed to indicate that video would be taken.  No mention was made of this after the study.  But did they video?  How else would they be able to report in the result report that I spent more time with events on my left side and less time in events on my back?

Don't want to beat a dead horse here, but even I realize that I should be on BIPAP.  Before I met with my current doctors on this go around, I did a little research, I don't believe I had found this board yet...not sure..., but I specifically told DR.Duck that based on all my previous experiences with CPAP, I wanted a Bipap system.  Annoyed-and-disappointed

At the end of this post I will have posted the last two charts I worked on that I mentioned I would post.  But at the moment I am wondering:

The new, up coming, sleep study/titration for BIPAP, is as I have mentioned, going to be before the visit with the ENT.  (I believe we have discussed a little about this already, but just want to clarify).  What are the chances/or what happens, that once I get put on the BIPAP, and have all the settings figured out, that when I visit the ENT afterwards, he discovers I do have something that needs to be addressed in my nasal/throat areas?

IF he says I need surgery to address issues in those areas, and have the surgery, shouldn't that make it so that I wouldn't need the BIPAP after all and could stay on CPAP or maybe no pap therapy at all?  Does this type of situation happen?  I am very leery, because I WAS examined by an ENT, two of them actually, around the time of my first go around with CPAP over 7 years ago. One said I had polyps that needed to be removed. (This was a dr. I saw for another reason, too confusing to explain).  I had the polyps removed.  Now, this was so long ago that the sequence of events are probably messed up, but between seeing that first ENT and the second ENT who did my Uvulectomy, one of them also did my turbinates and was SUPPOSED to do my septum.  I say supposed because when I had a dr. recently in the urgent care center look in my nose, quickly in passing, she or he said I had a hole up there.   Thinking-about

Do turbinates usually become an issue even after having them done?  I suppose I could have developed a hole years after the septum was supposedly corrected?  Perhaps I have polyps again, I have heard this can happen.  BUT, maybe these questions really don't matter because EVEN after having the surgeries, I STILL continued to have a terrible time trying to use the CPAP back then.  Did they have Bipap 7 years ago?  Perhaps it wasn't mentioned to me because it didn't exist?

I guess what I am asking is this entire situation being addressed correctly and/or in the proper order?  I am quite confused.

At any rate, here are those remaining charts.  It is hard to tell if I have zoomed enough.  I am unable to find anything that alerts you to the zoom percentage? (ApneaQuestions, I will see what I can do about your suggestions regarding axis stuff).

[attachment=18342]

[attachment=18343]

 

Anxious  Rolleyes to hear answers to my many questions,
Regards,
Plmnb
Huhsign  WARNING: It may take a while to sink in...I tend to get befuddled at times.
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RE: Plmnb's Never Ending OSA Journey (Data)
Your ENT appointment will evaluate opportunities to correct any physical malformations that are contributing to obstruction. You should ask if sleep endoscopy would be helpful. If the ENT recommends a surgical correction, you are not going to loose the need for CPAP/BPAP, and bilevel will be more effective and comfortable in the long run. I would consider a successful outcome to be more consistent ability to breathe freely at night with positive air pressure at a lower setting. Not very many walk away from surgery free of the need for PAP. More important is to understand the risks and drawbacks of surgery. You are hoping for the simplest smallest possible correction, NOT UPPP.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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RE: Plmnb's Never Ending OSA Journey (Data)
Taking a few of your questions in turn..

1) Turbinates - When these are reduced, the surgeon tends to be conservative to avoid taking out too much and risking "Empty Nose Syndrome". That is not pleasant.. google for it.
In my case, I told him up front I don't want any risk of that condition...my reduction helped but did not turn me into having a totally clear nose.  Can turbinates regrow?  Not sure, but the body has a remarkable way of rebuilding itself when damaged and revascularizing when blood vessels block.

2) Septum - When I had my surgery I specifically asked the anesthetist to keep me alert. There was no doubt for me that we were changing things. I was joking with the surgeon about hammers and chisels. If you were totally out for the count... then you have no evidence except what the surgeon told you. No comment on the hole except to say that rock stars (Francis Rossi from Status Quo) have used so much cocaine that they can pass a baby bud in one nostril and out the other. Nice party trick.
This video is not for the squeamish : https://youtu.be/nLO-y9trUQ8?t=838

3) Polyps -Yes they can grow back (in the colon). That's why we have multiple colonoscopies. I assume they are similar biological processes. It's amazing just how big nasal polyps can be for some people. Google for example images (not for the squeamish). https://www.google.com/search?tbm=isch&q...LzXlE3TwvM:

4) Sleep camera - On the three studies I have had there was always a camera and my reports sometimes have a single image taken from the night-vision camera. That image doesn't have much value except to show that a picture was taken. The cameras are very easy to spot. I'll attach a photo from my latest study last week. See the camera in the room and the image on the technician's console. Usually the technician will tell you about the camera and you may even sign a waiver to allow it.
Images from google: https://www.google.com/search?q=sleep+st...20&bih=926


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RE: Plmnb's Never Ending OSA Journey (Data)
I believe she has already had UPP done sleeprider along with another respiratory surgery also a long time ago if I remember correctly.
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