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Skypony's therapy-time to ask for help
#11
RE: Skypony's therapy-time to ask for help
(11-07-2020, 11:53 AM)Dormeo Wrote: 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.

Do you consider using tape on your mouth to help you use the nasal mask interface?

I will post my 3 best AHI scores since I started on OSCAR. They are all using lower pressures and Oct 9 is similar to your suggested pressure although EPR was 2. The lower pressures do seem to agree with your theory.

I have tried mouth tape without much success. I use a chinstrap and nasal cushion with middle pressures. At lower pressures, I have learned to use the nasal cushion with minimal mouth leak and no aid.


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#12
RE: Skypony's therapy-time to ask for help
My home sleep study was done at this same 4700 ft elevation. The sleep study report the I posted is all I have. Both the hospital where I picked up the home sleep study device and my regular Dr sent me the exact same report.

I will attach an overview of my entire OSCAR history with better layout than I originally posted. If any of you see a day that you would like details, I can post it.

Thanks for the feedback!


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#13
RE: Skypony's therapy-time to ask for help
It does appear you do better with lower pressure sets as you mentioned. It does make the CA drop under 5 AHI, and it sounds like you're getting some benefit by the therapy. Realistically, it is best to only change settings to enhance benefits and feeling well rested. So if you'd describe your sleep as such, run with it as is. If it's not producing well rested results, then we discuss resolutions.
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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#14
RE: Skypony's therapy-time to ask for help
(11-07-2020, 03:22 PM)SarcasticDave94 Wrote: Realistically, it is best to only change settings to enhance benefits and feeling well rested. So if you'd describe your sleep as such, run with it as is. If it's not producing well rested results, then we discuss resolutions.

This brings to mind a question that I have not been able to answer. If the sleep quality is similar, which is the highest priority:
lowest total time in apnea?
lowest AHI?
lowest flow limitation?
lowest central apnea?
lowest obstructive apnea?
lowest hypopnea?

How would you rank these from highest goal to lowest goal? Once we can answer that, we can clearly see a direction to proceed.

I feel like my sleep quality is generally better than before CPAP although I do have bad nights. I wish I could sleep all night long but that has only happened rarely for decades. Before I started this, I expected that I would sleep all night with CPAP.
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#15
RE: Skypony's therapy-time to ask for help
(11-07-2020, 04:14 PM)skypony Wrote: ...

This brings to mind a question that I have not been able to answer. If the sleep quality is similar, which is the highest priority:
lowest total time in apnea? 6
lowest AHI? 5
lowest flow limitation? 4
lowest central apnea? 3
lowest obstructive apnea? 1
lowest hypopnea? 2

How would you rank these from highest goal to lowest goal? Once we can answer that, we can clearly see a direction to proceed.
...
[/quote]

I've added my personal rank numbers of events to consider 1 being first within your quote in bold red.

Reason for ranking, Obstructive and Hypopnea (if obstructive) tend to disrupt most, I tend to place CA below these, and then followed by Flow Limit, then I placed AHI next at 5, and finally time in apnea because I'm guessing if you solved all the other 5 when you get to total time it shouldn't be much 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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#16
RE: Skypony's therapy-time to ask for help
(11-07-2020, 05:05 PM)SarcasticDave94 Wrote:
(11-07-2020, 04:14 PM)skypony Wrote: ...

This brings to mind a question that I have not been able to answer. If the sleep quality is similar, which is the highest priority:
lowest total time in apnea? 6
lowest AHI? 5
lowest flow limitation? 4
lowest central apnea? 3
lowest obstructive apnea? 1
lowest hypopnea? 2

How would you rank these from highest goal to lowest goal? Once we can answer that, we can clearly see a direction to proceed.
...

I've added my personal rank numbers of events to consider 1 being first within your quote in bold red.

Reason for ranking, Obstructive and Hypopnea (if obstructive) tend to disrupt most, I tend to place CA below these, and then followed by Flow Limit, then I placed AHI next at 5, and finally time in apnea because I'm guessing if you solved all the other 5 when you get to total time it shouldn't be much then.
[/quote]

Thank you Dave! This is amazing info that gives me direction. I'll look at my overview and choose days when I had low OA and low H. Most days, my OA and H have been low so I'll also look at CA's and choose settings based on those days. Then, I'll use EPR 0 in an attempt to minimize CA. Oct 9 seems like a good place to start. I'll use 8-9, EPR 0. That is very similar to what Dormeo suggested. I'm excited!

I had been trying to see where my ResMed auto pressure peaked, thinking this setting would cure all the apneas and minimize my flow limits. Obviously I was heading in the wrong direction!
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#17
RE: Skypony's therapy-time to ask for help
OK hope it works to get you the rest you need and a definitive answer certainly helps too. Report back how things are going.
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: Skypony's therapy-time to ask for help
I'm ashamed to post last night's details.

I thought I sleep fairly well for the first half of the night with pressure 8-9, EPA off. When I woke about 2AM, I saw the AHI was 13.7 so I decided to try a different setting 9-12, EPR off. I never slept again from 2AM until I got up at 5:45. I just laid in bed hoping to sleep for almost 4 hrs. It's possible that I may have dozed for short periods but basically, I tossed and turned.


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#19
RE: Skypony's therapy-time to ask for help
Oh, what a night! I do recommend keeping your pressure lower for now, at 8. The first step is to see whether you can get those centrals down. If you can, then you can start re-introducing some EPR to address the FLs, RERAs, and Hs. If they don't come down with 8, you might even want to drop down to 7 to see whether that does the trick.

Basically, we would be trying to identify your "apneic threshold," the point at which treatment washes out enough CO2 to mess with your drive to breathe. This threshold will be different for different people, and it can change in the same person over time, as the body acclimates to CPAP. Once we have this information, it will be easier to figure out what the next step should be.

You ask an interesting question about priorities. I would answer more holistically. If the measures in these categories are below a rough cut-off, then it doesn't really matter whether you reduce them further, so long as you are feeling rested during the day. And for some of them, if you feel rested, it doesn't even matter so much whether they are below the rough cut-off. For example, some people don't have problems with levels of FL that for other people would be disruptive to sleep.

I would say the two big things you want to avoid are whatever causes you significant O2 desats and whatever disrupts your sleep "architecture" (the progression through sleep stages throughout the night). Frequent and longish apnea events, both OAs and CAs, can certainly do the former, and they generally do the latter as well. Concerning disruption, I think there's probably more individual variation among people with low-ish OA and CA indexes.

A combined CA + OA index under two is good and under 1 is excellent. But there's a caution: Oscar will flag events whether you are awake or asleep. The events you should be looking at are the asleep events. So, for example, much of what you see on last night's chart after 3 a.m. is probably meaningless; it just reflects the natural irregularity of awake breathing. It should not be factored in as you think about how to treat sleep apnea.
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#20
RE: Skypony's therapy-time to ask for help
Thank you Dormeo! I have learned my lesson last night. Tonight it is 8-8, EPA off for the entire night!

I'm hoping for another "Oh, what a night!" but with a much better outcome.
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