Remember2Breathe's First night new machine

[SarcasticDave94]

Yep, best practice is delete oldest first. And OSCAR has the ability to turn on/off PAP use segments. You can look at individual segments up to all for the night and see the chart data.

[Remember2Breathe]

Thanks, Dave,

I deleted some attachments that seemed redundant or not important.  

Not sure I get what you mean by segments; but I've read the organizing Charts section.  Now reading beginner's guide to Sleepyhead, hoping it may make clear how to interpret some of the different parts of the charts.

Remember2Breathe

[SarcasticDave94]

Near the bottom left, this image from OSCAR wiki has a yellow and then a gray rectangle. These represent session segments and if they're clicked onto they toggle that segment on or off from showing up on the right chart side. In this image, these segment buttons are below the calendar. The segment buttons should have duration times marked on them.

[attachment=29881]

[Remember2Breathe]

Thrilled to get under one for AHI last night.  The way I look at it: Leak Rate/Large Leak and CAs seem to be improving too.
But, Sleeprider, I think you might say that my Flow Limitation is still bad.

Last night I slept with a down pillow under my chin, which maybe helped.  
Still looking at soft cervical collars and snore collars online and need to pick one.  
A bit leery though as I don't like memory foam (like natural products, so don't like latex or foam either)  and I never could stand to wear turtlenecks.

I'm fairly comfortable with the nasal pillows.  I do have a sore under my nostril and wonder if the nasal cradle be an improvement in that regard.  Or maybe could switch between the pillows and cradle to see if that makes the sore vanish quicker.  Can live with it - just an annoyance. 

Any comment on my Oscar charts?

Remember2Breathe

[sheepless]

just a word of encouragement regarding soft cervical collars. I refuse to wear neckties and turtlenecks; can't stand anything around my neck really. I won't sugar coat it: collars aren't particularly comfortable and I'd much rather not wear one. fortunately it turned out that it didn't take long to get used to it and for me there's just no substitute that'll reduce my lip/mouth leaks and clusters of oa. I literally can't successfully pap without it.

if you have issues that a collar will help, try it and stick with it for, idk, maybe at least 2 weeks before concluding it's too uncomfortable. try different sizes and styles if you have to. we can get used to a lot, particularly if better sleep is the result. $20 at the local big box pharmacy. or fashion a facsimile from stuff you have at home to experiment with. Gideon suggests rolling a towel around a necktie, for example.

not sure how long you've been using the nasal pillow mask. I had sore nares for about the first week and never since. it's given me a bald spot in my mustache but of course that's not something you need to worry about. :-)

[Sleeprider]

It's clear your trend is in the right direction, and I am not the one that should judge whether your flow limitation is adequately treated, since that answer really relies in your comfort   level.  It's high, but perhaps low enough.

[Remember2Breathe]

Thanks for the encouragement, Sleepless!!  Yes, agreed I need to try.  

I just got up from a long post-2nd-vaccination-fatigue nap.  I didn't use CPAP but did use something under chin.  Recently, I was gifted some goose down and feather booties.  They are shaped like a rounded capital L.  I don't walk on the floor with them (so I can wear in bed and not gross).  I put them under chin during nap - not bad.  Would be too hot in summer and no tie to keep in place but pretty good backup if I just can't stand a cervical collar I get online.

I've only been doing CPAP therapy for 12 days.  My sore might be around the same place as your mustache bald spot.  Of course not visible to the public now, as I wear a mask.  :-)  My gut says pillows will probably work better than cradle; and I'll still have plastic in the same area; but like to try too.

Remember2Breathe

[Remember2Breathe]

Thanks for your reply, Sleeprider!

It's most uncomfortable for me the first hour after my head hits the pillow.  It's a bit of a struggle:  to be comfortable, to avoid lip leaks, and to breathe calmly, and it seems like a very light sleep with even more events (incl leaks) that first hour.  Also difficulty swallowing.  After that first hour, I feel more comfortable.

I'm hoping that will improve as I get more used to CPAP.  Prior to CPAP, my first hour of sleep would be deeper.

Is the discomfort I describe it also perhaps largely influenced by flow limitation?  Or hard to say?

Might the cervical collar help with flow limitation?  Anything else?  (or only FFM or BIPAP)

Remember2Breathe

[Remember2Breathe]

It's been awhile.  I got a soft cervical collar - releaf.  I think a few nights I wore it just too loose, so I've tightened it but can still fit fingers inside.  It does seem to help me keep my mouth closed, which is just my perception more than anything else.  But often my mouth is really dry, so I wonder. Also wondering if mouthguard for bruxism encourages dry mouth.
Though online it seems to say it might make you drool (much more rare for me than dry mouth).

My AHI has been good.  I also got some nasal cushions and tried those.  Quite comfortable but I think the pillows offer a better seal (jury is not totally out).  So still wear the Medium pillows the most frequently.

Some days my Leak Rate is better, and some days not.  A tough one to solve.  My Flow limitation has not improved that much.

For awhile I went from a pressure of 8 up to 8.2.  And changed my EPR from 3 to 2.  But have gone back down to 8 for the last few nights (keeping EPR at 2).

I saw my cardiologist today.  He suggested that I try setting the pressure to 6.  He thought that might help the leaks.  Suggested I do that and see if my Apneas still stay low but leaks get better.

I will try it tonight but have my doubts:  If I set it at 6 and leave the EPR at 2, that would put my expiratory pressure at 4 and that's pretty low.  Certainly couldn't do with EPR at 3.

I think your suggestions might be to increase the pressure rather than lower it.  But I'm not sure I can tolerate much above 8.2.  The one night I had it at 9 both my AHI and leak rate were bad (had EPR set at 3).  

BTW, I've been trying to keep track of which nights I wore cushions (and which size) and which nights pillows (since both show up as pillows on machine).  It was too much going on though, so decided to stick with medium pillows for awhile while trying to stabilize leaks and flow limitation.  A frowny face 8 days out of 29 seems way too often!  So hard to predict what the machine is going to say vs. how comfortable I feel.

I'll just post a recent overview and daily for now.

Remember2Breathe

[Sleeprider]

I think your cardiologist is completely overlooking your very high flow limitations and low tidal volume. My best guess is you actually have complex apnea, or a severe upper airway resistance based on the predominately central events when pressure is higher and you use EPR. Your leaks have been bordering on large leaks on average throughout your experience. I don't know that I can suggest anything better than the suggestion of your doctor in view of the leaks and tendency for higher AHI with more pressure or EPR. I don't think your therapy looks very good or comfortable at all, but the suggestions of your doctor may help with leaks. You should probably keep a personal journal of your comfort and sleep experience on a nightly basis, and record any changes you make in the notes. Eventually a pattern may emerge.