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Sleep Fragmentation
#41
RE: Sleep Fragmentation
Rcgop, you need to zoom in closer so that the flow rate wave form can be viewed. This 25 minute segment is just too far out. Try for 2-4 minutes.
Sleeprider
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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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#42
RE: Sleep Fragmentation - CPAP vs APAP
Hi Guys

I have tried to reduce the fixed pressure to 12 as well use an APAP of 9-13 and APAP of 10-13 as suggested.

Questions...

1. What's the advantage and disadvantage of using CPAP against APAP ?
2. Based on the three charts, what would be the recommended pressure to use now as compared to my previous CPAP of fixed 13 ?
3. I cant seem to find the turn on /off RERA flag as mentioned by Rcgop. Is it the same as the UA ( unknown apnea ) flag of which I have already turned on ?
4. CAs were higher than my OAs except when it was at 10-13. Ideally how are the CA's supposed to be compared to OA ie lower, higher or must be zero ?
5. Hypopneas were zero except when it was at 10-13. I believe that it is still ok as long as the H index is less than 5.0 right ?
 
P/S : I have resized the charts to include only the relevant. Hope that they are fine
      : Although I still experience wakes up, but I am no longer getting up but remain lying down until sleep comes without resetting the button. Feeling much better than before. 

Many thanks to all those who have commented. Hoping for continued support for this post as well.


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#43
RE: Sleep Fragmentation
So glad to hear that you’re feeling better. Therapy optimization can be a long road.

Ideally you want a pressure high enough that the OAs and Hypopneas don’t happen, but low enough that you dont trigger CAs. That’s the sweet spot.

It’s possible that you’re experiencing RERAs that your machine’s algorithm isn’t flagging. That’s been my main problem. I think it would be helpful to see a closer view of one of each kind of event.

Could you zoom in far enough that the timeline fits 2 minutes, and possibly pin Minute Vent and Mask Pressure next to flow rate? That will help us see if your events are real or are happening during an arousal.
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#44
RE: Sleep Fragmentation
(02-03-2020, 08:19 AM)geauxdbl Wrote: So glad to hear that you’re feeling better.  Therapy optimization can be a long road.

Ideally you want a pressure high enough that the OAs and Hypopneas don’t happen, but low enough that you dont trigger CAs.  That’s the sweet spot.  

It’s possible that you’re experiencing RERAs that your machine’s algorithm isn’t flagging.  That’s been my main problem.  I think it would be helpful to see a closer view of one of each kind of event.  

Could you zoom in far enough that the timeline fits 2 minutes, and possibly pin Minute Vent and Mask Pressure next to flow rate?  That will help us see if your events are real or are happening during an arousal.

sorry..may need some help on how to zoom and pin.....
new to oscar actually
is there any place i can refer to for a quick guide ?
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#45
RE: Sleep Fragmentation
There is!

http://www.apneaboard.com/wiki/index.php...Daily_Page
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#46
RE: Sleep Fragmentation
Your experiment in variable pressure came in with a strong preference for pressure near 11.0 cm, and resulted in lower AHI and better leak rates. For variable pressure, your ideal range is a very limited 10 to 12 cm. Clearly, your objective needs to be to use your settings to accomplish the best comfort possible. These results look very good to me, and my only recommendation is to do what works and feels best.

I see you maintained therapy through any awakenings. How did that work out for you?
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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#47
RE: Sleep Fragmentation
Eishan, 
The switch is to the left of the date and time at the very bottom of the screen shot. 
The button currently has LL as the first of many events that can be turned on or off. Click the down arrow to see the other events.
CPAP is a journey like “The Wizard of Oz”. It’s a long slow journey. You will face many problems and pick up many friends along the way. Just because you reach the poppies, it doesn’t mean you are in Kansas. 
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#48
RE: Sleep Fragmentation - CPAP vs APAP
(02-03-2020, 07:30 AM)Eishan Wrote: Hi Guys

I have tried to reduce the fixed pressure to 12 as well use an APAP of 9-13 and APAP of 10-13 as suggested.

Questions...

1. What's the advantage and disadvantage of using CPAP against APAP ?
2. Based on the three charts, what would be the recommended pressure to use now as compared to my previous CPAP of fixed 13 ?
3. I cant seem to find the turn on /off RERA flag as mentioned by Rcgop. Is it the same as the UA ( unknown apnea ) flag of which I have already turned on ?
4. CAs were higher than my OAs except when it was at 10-13. Ideally how are the CA's supposed to be compared to OA ie lower, higher or must be zero ?
5. Hypopneas were zero except when it was at 10-13. I believe that it is still ok as long as the H index is less than 5.0 right ?
 
P/S : I have resized the charts to include only the relevant. Hope that they are fine
      : Although I still experience wakes up, but I am no longer getting up but remain lying down until sleep comes without resetting the button. Feeling much better than before. 

Many thanks to all those who have commented. Hoping for continued support for this post as well.

1) The advantage of APAP is that it can adjust pressure if it believes you are having trouble breathing. If you have an obstructive apnea, hypopnea, snore or flow limitation it will increase the pressure to try and avoid future issues. This allows the use of a lower starting pressure and the machine will raise pressure when it is needed. They aren't perfect though and sometimes takes too long for them to get to an effective pressure level, also in some cases kind of like yours they can drive your pressure level too high causing central apneas. CPAP supplies a set pressure so it needs to be set a bit higher but because the pressure doesn't fluctuate that helps some patients (especially as earlier discussed if shutting machine off). 

2) I'd probably stick with CPAP of 10 or 11. It seems you do a bit better at that pressure and if you go higher than you encounter central apneas. 

3) Your OSCAR isn't showing RERA's because none are being flagged. Don't worry about this.

4) Some number of central apneas is normal so don't be alarmed if you are seeing some. It is when you see them in higher numbers or if they occur in groups of centrals that they are more to worry about. 

5) It is fine to have the odd apnea and hypopnea. Some of these are again normal (for example you often hold your breath when changing position to sleep on side etc). Doctors consider AHI of 5 to be normal, most users find they feel best when AHI is below 2. 

I am glad you are feeling a bit better. I think increasing the pressure helped a bit and remaining in sleep mode is probably making the biggest difference. This is something called sleep hygiene which is good to research and try to follow. Hopefully things keep on improving even further.
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#49
RE: Sleep Fragmentation
Hi Guys

Have been experimenting the last few days with the various pressure settings.
Feel slightly better and have fewer wake up incidents.
Nevertheless I am still unable to pinpoint the reasons for my wakes up
I noticed from the charts that there a few fuzzy lines in terms of the FL and Leak rate charts.
Are these a cause of concern and probably the reason for my wake ups ?
MY UA's are also nil , does that mean I dont have any RERA's ?

Appreciate some feedback. Thanks


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#50
RE: Sleep Fragmentation
RERA is a breathing pattern where flow limited breathing suddenly ends with larger amplitude recovery breathing suggesting arousal. If ou look through your respiratory flow rate chart zoomed in close enough to see flattening from flow limitation, then where it goes back to normal or larger flow rate than normal, that may be RERA. Whether that corresponds to an awakening we can't say. Arousal are just sleep stage changes and may or may not be awakening.

Your results look great, and you've done a very good job of optimizing. I don't see how settings might be contributing to arousals as the pressure is nearly steady and appears to control events and flow limitations well. About the only way to improve on this would be with a Vauto bilevel machine...maybe. I hope you will continue to feel more refreshed as you continue to use these settings, however keep in mind "perfect sleep" is elusive, whether you use CPAP or not, and it doesn't seem to get better with age.
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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