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Therapy-Airsense 10 Autoset to Aircurve 10 Vauto
#31
RE: First night with CPAP: Suggestions?
Hi,

I've tried the Dreamwear nasal pillows saturday (in addition to taping). I normally use M size or S size nasal cradles with the Dreamwear, so I've bought an M size for pillows. It seals much better compared to the nasal cradle and doesn't get displaced easily when side sleeping but I somehow felt less oxygen was being sent to my nose, so the feeling was not that pleasant. Also, yesterday, I used the full face Dreamwear again, with mouth taping. It may sound silly using a full face mask with taping, but my video recordings and sound records show that I was able to snore with the full face mask when my mouth was opened, so I wanted to try with taping. This time, I didn't tape fully, and left a 1 cm gap in the middle of my lips (as has been suggested in one of the posts), because taping the entire length doesn't let air getting out and blows your cheeks (the chipmunk effect). It worked better compared to full taping and also I practically didn't snore. My AHI was around 2 (better than the 7 I got on my  first try with the full face). However the pressure levels were still higher compared to nasal masks. This is a problem, because with the nasal mask my maximum pressure hovers around 8-9, with the full face it goes up to 16 cmH20. That's a huge difference and it is a problem, because while the mask seal is ok around 10-11 cmH20, going up to 15 breaks the seal and I wake up continously to adjust the mask, so it was not a very comfortable sleep.

1) So far, my favorite has been the nasal cradle, very small, lightweight and consistently produced low (under 1) AHI scores, however gets displaced quite easily when side-sleeping, so I have to wake up a few times to reseal it. Do you think the nasal cradle for the ResMed N30i has any advantage for this purpose? I am considering giving it a chance but this means I'll need to buy practically the same mask again and would prefer not to if the difference isn't important.

2)The same question for nasal pillows. Is it worth trying P30i? Or should I try a smaller or larger size pillow on the dreamwear series? I am happy with the M size's seal and stability, but not happy with the feeling of lack of air.

3)I am also planning to buy a smaller or larger size full face Dreamwear. I can't be sure which one will provide a better seal. I used the Philips template for chosing size and I am M but it is closer to S size. If I make a whistling motion with my lips, air starts leaking from both sides (I am not whistling in my sleep :Big Grin  , just trying to describe the actual mask fit, so that I can decide if I need a larger or smaller size.

I quite liked the hose from the head kind of masks, so I guess that's the extent of what I can try. I am open to other suggestions....

Thanks
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#32
RE: First night with CPAP: Suggestions?
Hi,

I've started using an oxymeter to see how my sleep incidents  are affecting my oxygen saturation:

   
   

Do you think these are important? Do you think I need a modification for the therapy?

Thanks...
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#33
RE: First night with CPAP: Suggestions?
Hi,

Here's tonight's OSCAR chart:

   

No obstructive events. I have used a soft neck collar for the first time. It wasn't one of the recommended ones, so it was a little bit hard to wear but I think it was useful for decreasing some obstructive events. I'd expect flow limits to be somewhat lower, so my assumption that flow limitations are mostly related to chin tucking might not be true. I am still having some centrals. According to video recordings, most of them are generally preceded or followed by some kind of arousal. I think I tend to breathe with higher amplitudes during sleep transition periods and that creates centrals. Shall I decrease EPR (which in my case would mean turning it off). Would it help with the centrals that happen during transitional periods. My pressures are generally on the low values, so EPR may not be really required for comfort. However I also fear that it can decrease my saturations. I don't know why I have these desaturation periods....
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#34
RE: First night with CPAP: Suggestions?
Try raising the EPR from 1 to help reduce flow limitations they looked better on earlier days when you were using an epr of 2
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#35
RE: First night with CPAP: Suggestions?
What is the cause of flow limitations? Is there a pointer to see what is creating them? Won't increasing EPR increase the centrals? It seems that I only had centrals with my current setup, so how would increasing EPR help in my case?
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#36
RE: First night with CPAP: Suggestions?
Hi,

My AHI values have somewhat increased in the last 2 weeks. They are around 2-3. Centrals constitute the majority. What is worrying me is the occasional saturation drops that I get. The duration of these desaturations are not very long fortunately, so I don't know if they have an impact or if I should try to address them somehow. 

Last night I had an interesting experience: I removed the mask in the middle of the night. I remember removing it and thinking it was time to get up but it was still very early in the morning and when I realized that I put the mask back. What is funny is that I thought those 2 actions (removing and putting back) were nearly instantaneous or not very far away from each other, but my Oscar chart demonstrates that there was a period of around 50 minutes where I slept without the mask. Very interesting but I assume your perception of time varies when you are sleepy. This 50 minutes period also helped me to demonstrate an interesting thing: My desaturations are not related to CPAP use and they are worse if I don't use the CPAP. It was also interesting to note that I was able to snore very loudly, despite using mouth tape. I don't know how it happens but I think I am able to snore using my nose only, so mouth taping has only a limited amount of benefit.

I increased EPR to 3. It didn't have a huge impact on the number of centrals.

   
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#37
RE: First night with CPAP: Suggestions?
Also note that where your flow rate looks 'grassy', your Tidal Volume looks 'grassy', and your SPO2 looks grassy.  These are the periods where you/everyone, are likely to have frequent but very brief desats.  These are mostly harmless. it is sustained desats that must be managed.
I would also discount 6 of your (I believe) 10 CA events as SWJ (Sleep Wake Junk).

Should the moving 'average' SPO2 be below 88 for an extended period that would be an issue.  OSCAR doesn't report that.
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
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#38
RE: First night with CPAP: Suggestions?
It's interesting and a bit unsuaual that centrals have more impact on SpO2 than obstructive events.  The oximetry does not reveal any urgent issues, but thee is certainly significant desaturation from time to time that is not doing your sleep much good.  I think the reduction of EPR has resulted in a reversal of therapy efficacy.  If you look back at your results from May 26 and earlier with a minimum pressure of 7.0 and EPR 3 you had lower AHI and more stable respiration.  The purpose of this thread was to overcome OHS and it has become avoiding central apnea which was only an intermittent problem.  I think we're on the wrong track with lower pressure and less EPR.  I'd like to get back to this, where the respiration rate is higher, fewer events and overall better results.

[Image: attachment.php?aid=23292]
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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#39
RE: First night with CPAP: Suggestions?
Thanks. When I look at the chart on May 26th, the minimum pressure is at 7, with an EPR of 3. The pressure from last night has 8 as minimum pressure and an EPR of 3, so technically I have a higher EPAP (4 vs 5) which should be better for fighting with obstructive events. Should I increase the minimum pressure to 8 and decrease EPR to 2?

Also another question: One major difference for the last 1.5-2 weeks is mouth taping. I am using int every night and I definitely snore less but is there a way that it can increase my AHI? My best results were obtained with no mouth taping with a nasal mask. I was definitely snoring with that setup and woke up a few times with my mouth open and leaking air, so I'd expect therapy efficiency to decrease but with mouth taping and very low leaks I consistently get higher AHIs. I don't know if it makes any sense....
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#40
RE: First night with CPAP: Suggestions?
Set yourself up for comfort, turn off the alarms and sleep as best you can. We can sort things out in the morning.
Sleeprider
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____________________________________________
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Organize your OSCAR Charts
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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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