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Skypony's therapy-time to ask for help
#1
Skypony's therapy-time to ask for help
I started CPAP in late Sept and started using OSCAR a little over a week later so I have about a month of OSCAR data. I studied the case reports on the forum and used what I thought I learned to form a plan. You can see my progression in the overview file.

I noticed that early on my pressure always hit the ceiling that I had set so I believed I needed to increase pressure until my setting was above what my ResMed wanted to use. Then I would not see the pressure flatline at the ceiling. You can see the ceiling in detail from Oct 8 file and see when I finally reached above the ceiling in the Nov 1 file. My plan was to increase pressure with EPR 3 until I got above the ceiling and then gradually decrease and eliminate EPR in an attempt to lower CA's.

The problem I have is that the high pressure hurts my lungs. It feels like they were overinflated. I lowered the pressure 1cm on Nov 2 but the overinflation feeling remained. The ache has diminished some since Nov 2 but has not completely resolved yet. Since I was still well below the 5-20 pressure that was prescribed, I hope my lungs weren't damaged.

After that, I drastically lowered the pressure so I could be comfortable. That, however, has increased my hypopnea.

I can use a nasal cushion with lower pressures but need a full face at higher pressures to eliminate mouth leaks. The nasal cushion is more comfortable.

My sleep study showed zero CA's but OSCAR has found many. I've been hoping they would diminish as I continued CPAP. My sleep study also found a lot of snoring but I suspect the microphone was detecting my wife. I only snore if I'm on my back in a recliner. I never sleep on my back in bed because I always get a headache within minutes. OSCAR confirms no snoring.

Many of the nights, I cannot fall back asleep for up to 2hrs so SWJ is probable. The same for if I wake early, I lie there trying to sleep and sometimes do sleep but usually I get up. That means SWJ near the end of most of my daily data.

I am attaching my sleep study files as well as the files mentioned above. I'm only allowed three attachments so there will have to another post.

I'll also include last night's details. I woke three times because I got leg cramps and had to stand up to relieve them.

So now I'd like to ask for help. I wish I could keep my pressure high but the sore lungs are a problem. I don't know which direction to proceed. I won't give up.

Here are the other files mentioned in my first post.


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#2
RE: Skypony's therapy-time to ask for help
My 2 cents - Your best charts were at 12 -15 pressure.  I have no idea why that much pressure would cause your lungs to hurt.  The pressure is what it would take to blow into a straw in a coke can and have bubbles come up.  It not the type of pressure to even blow up a balloon.  I would think it had to do with something else maybe a chest cold.  If that much pressure is really causing your lungs to hurt, you need to see a Dr.

I would use 12-15 pressure without the EPR so min=12 max 15 and epr=0.  Changing the EPR should help with the centrals.
Apnea (80-100%) 10 seconds, Hypopnea (50-80%) 10 seconds, Flow Limits (0-50%) not timed 
Cervical Collar     Dealing w DME     Chart Organizing
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#3
RE: Skypony's therapy-time to ask for help
The majority of your events are central in nature I think ultimately you will need an ASV machine but in the first instance I would suggest reducing EPR to 1 and see if the amount of CA’s reduce.
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#4
RE: Skypony's therapy-time to ask for help
With CA still being elevated like this after 2 months, I agree that first EPR needs reduced to either 0 or 1 and see if it helps lower them. If not, then it is possible you need to address CA with doc. It could be pre-existing on the sleep study, but this is more like a summary report so the breakdown of apnea events is missing. Even so, CA may be idiopathic or medical cause unknown.
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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#5
RE: Skypony's therapy-time to ask for help
Thank you all for the suggestions.

Although I was apprehensive about the lung ache at higher pressures, I went with the suggested 12-15 pressure with EPR 1.

I had read an article that said that increasing the hose temp and humidity level might help with the lung ache. I had been using the auto climate setting with my heated hose. I changed it to manual with humidity 6 and temp 83.

Unfortunately, at about 3:40, I woke up to a strange gurgling noise. There was water in my mask and hose. After draining them, I was awake for quite a while.

The good news is that my chest did not hurt.

I did have to adjust my mask quite a bit. It would fart and sometimes it seemed to inhibit my inspiration until I adjusted it. When I use the full face mask, I always wake up with bilateral periorbital edema.


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#6
RE: Skypony's therapy-time to ask for help
I had forgotten to comment on the lung discomfort. I had a similar situation to deal with when I started BPAP and again when I started ASV treatment in 2017. The feeling went away in about a week without addressing pressure changes to reduce or avoid the feeling. My theory on why I had the feeling is I breathe shallowly pretty consistent due to my COPD. No, I'm not saying you have COPD, but it could be that for some unknown reason, you tend to breathe more shallowly and the PAP makes you breathe deeper than you're normally used to doing. I think your comment seems to indicate you're getting used to the change in breathing deeper already.

With condensation water collecting in the hose, either lower humidity or increase heated hose temperature. The water in the hose is moisture falling out of the airstream before you can breathe it in. It's much like the glass of ice water in summer having condensation on the outside. Raising the heated hose temperature should keep more moisture in the airstream so it gets breathed in instead of dropping out into the hose or your mask. Another step is to have your machine lower than your bed and making the hose travel uphill to you and your mask. Water would drain back to the humidifier tub.

EDIT: The chart doesn't look very good. The AHI is high, with almost all being flagged as Clear Airway which is CA/Central Apnea. Flow Limits are up to 0.25 for most of the night. To correct, opposing actions would be called for. Others can offer opinions, but as these 2 conditions are ongoing, it appears you need to sit down with doc and start talking about these CA and testing to get an ASV for treating Central apnea. A regular BPAP without backup rate will be even worse for you. Try to get the full sleep study to post here redacted if you have not done it. I'm looking back to be sure, but your CA are trending to stay high, and at this level are likely disrupting sleep.

EDIT 2: Are you in high elevation being in Colorado? This can affect CA levels also. High CA on all charts that I saw.

So I'll end with a question, did you actually sleep well on that sleep session or not? What symptoms and complaints need addressed?
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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#7
RE: Skypony's therapy-time to ask for help
Skypony, you have some ferocious flow limitations and a tendency toward hypopneas, with a dusting of RERAs. This is consistent with your sleep report, which showed no CAs, very few OAs, and a lot of Hs and RERAs.

The usual way to address FLs, RERAs, and Hs is to use EPR, but the high central index you're showing makes that problematic, as EPR can induce CAs by washing out CO2, which then reduces the drive to take a breath.

So you're between a rock and a hard place. Furthermore, given that you spend a lot of time awake, it's hard to know how much of the CA action is happening while you're asleep and how much while you're awake or semi-awake. (Awake breathing is much less regular than asleep breathing and include many pauses between breaths that are longer than 10 seconds, the trigger for a CA flag.)

I'm incline to think step one is to assume that at least some big chunk of the CAs are treatment-induced and get them way down. For that reason, I recommend reducing EPR to 0. I also recommend capping your pressure. You might consider min = max = 8. You will probably see a lot of hypopneas, RERAs and FLs, but what you'll be trying to find out is how this affects your CAs.

The reason I think this is step one is that people do adjust over time to the CO2/CA problem. If you can get the CAs down for a while, then you can experiment with re-introducing EPR.

You may indeed need a different kind of machine down the road: and ASV if the CAs are very persistent at high levels, or an ordinary bi-level machine if the CAs settle down but EPR of 3 doesn't help with the FLs, hypopneas, and RERAs that are trashing your sleep.

Do you consider using tape on your mouth to help you use the nasal mask interface?
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#8
RE: Skypony's therapy-time to ask for help
Dave, my lung discomfort did not happen last night and I solved the water in hose problem. I live at 4700 ft elevation. Even though I woke more times than usual, I feel like I slept well when I was asleep.
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#9
RE: Skypony's therapy-time to ask for help
Skypony, was your sleep study conducted at the same elevation?
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#10
RE: Skypony's therapy-time to ask for help
OK got the info. Yes it would be interesting to learn about the altitude of the sleep study and to have all the detailed parts to see the test results in full.
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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