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Skypony's therapy-time to ask for help
#81
RE: Skypony's therapy-time to ask for help
I'm back!

It was surprisingly easy to resolve the teeth alignment/pain problem. I was able to eliminate the chinstrap completely. Apparently, I have learned how to keep mouth leaks from occurring. I also changed from my old favorite mask, the DreamWear nasal cushion, to a ResMed Swift FX nasal pillows mask that I had tried earlier. This was to eliminate any pressure on the roots of my upper two front teeth.The pillow mask is much more comfortable and doesn't leak. The "elephant trunk" hose does wake me whenever I turn over though. I need to reposition the hose so that the vented air doesn't hit my pillow or blanket and make noise. I have ordered a ResMed P30i mask because I like the hose attachment on top of my head like the DreamWear has. I hope the pillows are the same as the Swift FX.

Now to my therapy progress. Overall, I have slept well since I started using the Swift FX. I did make some minor pressure adjustments. When I last posted, I was at 8.4/8.4 EPR 2. I changed it to 8.6/8.8 EPR 3. My FL's are down even though my CA's are up a bit. We have to choose our battles and this is mine. I have chosen to minimize flow limits, obstructive apneas and hypopneas. I know several of you have suggested ASV but I want to wait and see how this plays out before taking that jump.


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#82
RE: Skypony's therapy-time to ask for help
Glad you solved the teeth problem, and it's good to hear you're sleeping well. I would guess that first cluster of CAs occurred while you were asleep, ditto the cluster after your first break. Those might just be transition CAs, where your body is shifting gears in the process of entering sleep. The cluster after the OA at around 1:30 might be the same story. Transition CAs can resolve over time. More information here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3417331/

The range you've provided yourself is really just a straight 8.8, because your FLs keep the pressure plastered to the ceiling most of the time. You might try min = max = 8.6, just to see whether it's a sweet spot for you. But basically, steady as you go. With luck, the CAs will come down and you'll continue to sleep well.
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#83
RE: Skypony's therapy-time to ask for help
After reviewing this thread I'll jump on the ASV bandwagon.  That IS where you need to go
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter

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#84
RE: Skypony's therapy-time to ask for help
(11-21-2020, 12:06 PM)Dormeo Wrote: I would guess that first cluster of CAs occurred while you were asleep, ditto the cluster after your first break.  Those might just be transition CAs, where your body is shifting gears in the process of entering sleep.  The cluster after the OA at around 1:30 might be the same story.

The range you've provided yourself is really just a straight 8.8, because your FLs keep the pressure plastered to the ceiling most of the time.  You might try min = max = 8.6, just to see whether it's a sweet spot for you.  But basically, steady as you go.  With luck, the CAs will come down and you'll continue to sleep well.

The first cluster is definitely transitional. My normal routine is to get in bed, put on CPAP, read until I start to doze off and then put the book away and go to sleep. I am probably starting to transition to sleep about 15-20 minutes after I start the machine. Any cluster 10-20 minutes after turning the machine on is probably transitional (SWJ).

I will use your recommendations of 8.6/8.6 EPR 3. Is there any difference between using straight CPAP or APAP with min=max?

The reason that I was going try 8.6/8.8 is from my Nov 1 details (http://www.apneaboard.com/forums/attachm...?aid=27909). I had been increasing pressures back then because my machine always kept the pressure at the ceiling I had set. I finally got to a day when the machine was satisfied on Nov 1. It seemed to like pressure of 13.5. That has stuck in my head as where I eventually needed to be. Since I knew 8.6 was comfortable, I used that as a min and thought the max would increase slowly to ~13.5.

I now think that there is something wrong with that logic and that I don't need to be at 13.5. I hope someone can tell me why my logic is wrong. I personally don't want to use such high pressure and would like to avoid a full face mask.

Thanks again for you advice.
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#85
RE: Skypony's therapy-time to ask for help
It should be based on how you feel. in addition to input from your numbers, but how you feel is very important
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter

Download OSCAR
New to Apnea? Helpful tips to ensure success
Soft Cervical Collar
Mask Primer
Dealing with a DME
Organize Charts
Optimizing Therapy
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#86
RE: Skypony's therapy-time to ask for help
Last night was not great but it was not the fault of CPAP. I had several mouth leaks that woke me. I haven't had mouth leaks for a while. I also had several incidences of leg cramps starting about 3:45 and intermittently until I got up. I had to walk to relieve the first one. I was able to relieve the others without getting out of bed but they did wake me. The legs cramps were because I was on my feet all day yesterday working in the garage and outside.

I'll attach the full night details and just the first 4 hr session (before the leg cramps). I'm happy with my progress.


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#87
RE: Skypony's therapy-time to ask for help
That first session shows some progress with the CAs. More striking to me are the less ferocious levels of FLs -- I hope that will continue. If you were awake for much of the second session, perhaps some of those CAs were actually awake events.

Your reasoning about your maximum doesn't take into account the fact that your FLs were driving your pressures up. (Your machine is quite responsive to them.) But the higher pressures weren't actually resolving the FLs, so those pressures aren't optimal for you, especially as you try to see whether CAs will come down.

Very knowledgeable people are suggesting ASV, and that may be where you wind up. For now, though, steady as you go, keep track of how you feel, and let's see what happens.
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#88
RE: Skypony's therapy-time to ask for help
Success!
Too-happy-2 Too-happy-2 Too-happy-2

Finally got below AHI 5 which was my Dr's goal. Slept very well.

Thank you, Dormeo, for sticking with me.  Thanks


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#89
RE: Skypony's therapy-time to ask for help
What is the answer to "how do you feel?" after this session. Again, numbers alone are not the whole story. If I were to go by what the chart looks like, I'd give the opinion that this is a rather ugly looking 4.99 AHI. Oh yes it's treated by 0.01. By the looks though, I wouldn't accept it for if it were me. If you slept well, OK that is your call. Do remember the consistently inconsistent CA will always be up/down per night with avoidance gameplans. The point I am attempting to make is you might not see this barely treated 4.99 again for some time.
Dave

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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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#90
RE: Skypony's therapy-time to ask for help
Very glad you felt you sleep very well -- as Dave suggests, that's a key measure of progress. He is also right that CAs are consistently inconsistent, so you may see them bounce around night to night. It's the longer run you'll want to keep an eye on.

I would tend to discount that cluster of CAs that occurred after your break. And looking at the general trend, your CAs are coming down, which we will want to see them do some more as time goes by.

Keep us posted!
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