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Remember2Breathe's First night new machine
#11
RE: [split] Remember2Breathe First night new machine
Here's my most recent OSCAR data.  Please let me know if you want more data.  Neither of my Sleep studies (HSTs Watchpat and ResMed) showed any central apnea (which I assume that you are calling CA).
So I guess I'll have to go into Clinician's Menu to reset the pressure to 8 and to set the EPR to 2 or 3.  I asked DME to enable Essentials Plus so that I could adjust EPR, Smart Start and Run Warmup; but I've never seen anyplace to adjust EPR or Pressure Relief, so guess I will have to do in Clinician's Menu.  Also, as mentioned above, I set the Ramp to 5 - should I turn it off?
I guess I will try the Medium Pillows again tonight.  I think they were more comfortable than the small, which made me feel somewhat claustrophobic. I don't have large pillows as I have a small mask frame and indeed a very small head (often hard to find hats small enough).  DME said he thought I would be a medium and definitely not a large for pillows.  Sometimes it seems like it is leaking near the pillows, but I think that it is just the vent there and not a true leak.  The first hour was so uncomfortable.  Kept feeling like it was hard to breathe.  Needed to clear my throat and swallow.  Usually I'm asleep within 5 minutes; but since so uncomfortable, I don't think I fell asleep until after the first hour.  I do have GERD and mild obstructive airway disease.  I suspect that I might prefer the nasal cushion (N30i) but thought I'd give the pillows the old college try.
There is a slight crack in my humidifier chamber; but don't think it is an issue.  Attaching photo - it's on the upper right, well above the water level.  I didn't drop it or anything.  If you run fingernail across the crack you can't feel it on the outside.  Only on the inside of the chamber.  And if there is condensation in the chamber, it doesn't feel moist on the outside.  Should I try to exchange it anyway, even though it doesn't seem like an issue?

Techie stuff:  BTW, F12 only works for screenshot on PC.  My screenshot of report was 800 or so, so I had to change to a jpeg and resize in Lightroom.  Couldn't adjust the left column to display Session Information without scrolling down on my MBPro, so there's an extra shot of those.

Dave, OK, I'll try with no Ramp.  I do have copies of both sleep studies and neither showed any centrals.  Should I post the studies here?  Watchpat's is 3 pages long and I think ResMed's might be 6 pages.

Hoping for a better sleep tonight!

Remember2Breathe


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#12
RE: [split] Remember2Breathe First night new machine
You can post when you can, but the CA sounds like treatment emergent with your above comments. And yes CA is Central Apnea and the same as Clear Airway on OSCAR.

You may want to mention the issue on the humidifier tub. Maybe you can snag a replacement.

FWIW if you've got the N30i mask, just get the P30i cushions and swap in to change from nasal to pillows. I've done it myself.

I've got GERD as well. Maybe try a little torso and head elevation and maybe a left side sleep position. They help mine.

Lung Obstructive issue like COPD? Got it. Yes really. It alone may require a different machine, but we'll need to delve into your therapy trend.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#13
RE: [split] Remember2Breathe First night new machine
You can make changes to clinical settings including Essentials. https://www.apneaboard.com/resmed-airsen...setup-info

Get your own copy of the clininician setup manual at the top of this page.
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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#14
RE: [split] Remember2Breathe First night new machine
Ok.  Here's my sleep studies below.  

I guess second night Oscar results don't change your recommendations, Sleeprider?  So, I'll try with recommendations tonight.

Dave, re: GERD.  Have tried elevation of head with a wedge.  It does seem to help both GERD and mouth breathing somewhat; but it is not nice for my back, neck or shoulders.  The folks that made my bed don't think elevating the head of the bed on blocks/risers would not be good either, since the springs are designed to support downward (not raking pressure).  They have a wonderful adjustable bed (can raise head or legs or both to any degree with remote) but I can't afford it. :-(

Thanks for your support!!

Remember2Breathe


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.pdf   201024_SleepStudyR2Breathe.pdf (Size: 68.9 KB / Downloads: 0)
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#15
RE: [split] Remember2Breathe First night new machine
My recommendations are unchanged. You need to get rid of ramp as much as possible, use a minimum pressure of 8.0 and turn on EPR at 2. You brought up Essentials Plus which is an easy setting to change. If you can't stop the leaks, ask your supplier about a full face mask. Your flow limitations are very high. Let's get a look at a close up of the flow rate where we can see the typical inspiratory wave and just how flattened it is. I am concerned that you may need to add an oximeter to better understand where you stand on SpO2. Your test results show you had a lot of oxygen desaturation, even though AHI was mild. We now can see that it is probably related to upper airway resistance.
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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#16
RE: [split] Remember2Breathe First night new machine
Ok, Sleeprider Guru, was so happy last night (a much smoother ride) and when I first got up this morning (and after 7Hrs 14min of therapy my AHI was 1.x, events per hour way down, and for the first time on Mask I got a smiley face).  But my leak rate, though better, was still bad.  I didn't experience mouth farts from feeling air in my mouth like balloon.  

I should have turned off the machine then and quit while ahead at 10:12:21; but alas, I got back in bed and connected again at 10:23:07 but was reading emails, NYT, voicemails, and called back to listen to pharmacy recording and they asked questions and I talked with mask on.  That really messed up my OSCAR results and I went from an AHI of 1.x (don't remember exactly) to an AHI of 3.81 and in that last half hour I had tons of "CAs" and it pushed my events per hour way up too and totally screwed up a stellar performance.  So I would disregard that last 1/2 hour session.

Last night, I had following settings:
Ramp - off
EPR - 3
Min Pressure - 8
Max Pressure - 8
and used the Medium Pillows

I have a pulse oximeter but it's just a regular one and I don't think possible to record its results.  It makes sense that EPR would help because on my PFTs they showed moderate obstruction and Air Trapping.  I'll go on the Forum and look at Oximeters.

What causes Leak rate?  Is it mouth breathing?  I have a slight impediment to feeling the full suction of the tongue trick since I have to wear a mouth guard for bruxism.  I am hoping that part of the cause of bruxism is OSA and that I might eventually be able to ditch the mouth guard.  That is BTW, why I had 2 sleep studies done.  I was convinced that having the mouth guard on my upper teeth was encouraging me to mouth breathe.  The first study was done with the mouth guard and we did a second study without the mouth guard; but alas the results were almost identical.  Could the minor crack in the humidifier chamber effect the leak rate?

Please don't say the words Full Face Mask yet.  Should I try tonight with the chinstrap provided by the DME?  It's a Phillips Respironics chin strap (not what I would have chosen but all he had).

I tried to zoom in on flow rate, as best I could on my MacBookPro.  It's the only machine that I have OSCAR on since the OS on my desktop is too old.  Typical Mac tricks like command+ don't work for zooming in.  Your mouse instructions worked somewhat but didn't have the control I wanted.  I tried to zoom in on areas that were hours that I believe I was truly asleep for CAs and zoomed on a RERA too (but don't think I zoomed in on a Hypopnea or an Obstructive), so let me know if you want different shots.

First attachment - daily results (1_OSCAR_210207).  

2nd attachment - Session Info and irrelevant period when was awake, on phone, etc. (2_OSCAR_210207)    

BTW, the first 3 sessions were me experimenting with EPR at 2 and at 3 and going into clinical settings, etc.  Is there a way to work on settings with mask on with pressure without having it recorded as part of your daily sessions?

3rd attachment - 1 shot of several zoomed in time periods in Flow Rate. (3_OSCAR_210207)

Thanks again for sharing your wisdom!

Remember2Breathe


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#17
RE: [split] Remember2Breathe First night new machine
I'm wondering if your Obstructive breathing issue is adding into the flow limits. Otherwise deducting your late "CA" while awake area it didn't look bad by the numbers.

Would you say that the PAP session was more rested feeling or not? If it was an improvement over non PAP therapy sleep, it's headed the right way then.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#18
RE: [split] Remember2Breathe First night new machine
Hi Dave,

Thanks.  Definitely headed in the right direction!  I could breathe without struggling last night and didn't have to fight to keep a bunch of excess air from escaping from my mouth.  Altogether a much more peaceful experience.  And I do feel more rested.  My nose is running a bunch though today since waking.  Is that normal when getting used to pillows?

I just tried on the chinstrap from the DME and tried to take it off without having all my hair being ripped out with the velcro.  Think it's a bit of a joke of a chinstrap.
Reminds me of those turn-of-the-century lithos of kids with toothaches or some such and their heads tied with rags.  I'll attach photo.

Remember2Breathe


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#19
RE: [split] Remember2Breathe First night new machine
Encoraging results! I agree with Dave. Any chance you can zoom in on the flow rate and get us about a 3-minute segment?
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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#20
RE: [split] Remember2Breathe First night new machine
Hi Sleeprider,

I don't think I can zoom in that much; but I'll try again.  I'm used to more control with zooming on a Mac friendly platform.  Is there a specific time in my sessions that you suggest zooming in on or a specific event (CA, or RERA or Hypopnia) that I should zoom in on?

For tonight should I keep settings as they are? (Pressure 8 (Min & Max), EPR 3, Ramp off) or should I decrease EPR to 2?  

Should I try using that chinstrap or try again without chinstrap?

Thx,

Remember2Breathe
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