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[Treatment] Am I on the right track?
#11
RE: Am I on the right track?
As mentioned previously, your AHI is fine. I think we might learn more by looking closer at the flow rate. Please post a couple 2-minute segments so the respiratory wave form shows clearly. These can be random, but would prefer sections where you believe you were asleep. The purpose is not to specifically look at an event, but to see what your "normal" respiration looks like and verify the machine's error in calculating I:E.
Sleeprider
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#12
RE: Am I on the right track?
Sleeprider, Here are 3 random 2 minute sections from last night that I believe I was asleep. I did wash the reusable filter and replace the fine filter to try to get the best data. I know I briefly woke up a few times to change positions like normal but it seems odd that there was no A/H events.

bonjour - I don't have any known heart or breathing issues right now other than high blood pressure. I did have something last year that we think was myocarditis caused by an infection but couldn't prove it, and I was given the all clear last fall. Any examples of drugs that might cause PB? I'm pretty boring, just take supplements, blood pressure med, armodafinil, caffeine, and occasional drink. Unfortunately I don't have a sleep doctor, just my GP (internal medicine).

FWIW I browsed through the entire night last night and there were a few PB-like events that weren't flagged by my machine. Must not be bad enough to register. Usually they are near some other event, ie RERA, VS, FL, and other unflagged events.


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#13
RE: Am I on the right track?
Breathing pattern is normal, but the Philips is counting the low or zero flow at the end of expiration as the start of inspiration. This is quite common. So low AHI, normal respiration with good volume, rate and timing.
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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#14
RE: Am I on the right track?
Something sounds off... I was a bit higher AHI but  CPAP lowered my AHI to near zero on night 1. Time will tell how I react under it. Are your seals good?
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#15
RE: Am I on the right track?
Generally speaking I don't have much problem with leaks, but part of that is because they wake me up as air blowing across my face or eyes really bothers me. Also know dramatic increases in pressure have woken me up many times and even the noise of the air vent on my mask. So I wake up and adjust, and go back to sleep as best I can. I went ahead and bought a ResMed Autoset for her and I'm trying that, the "for her" algorithm sounds like a better fit for me as I think about these things since it initially responds quicker but makes smaller adjustments. Hopefully that will disturb me less and let me sleep better. I'm also going to try replacing filters weekly, anecdotally I feel like I usually sleep better the few days after replacing them monthly so hopefully that'll help.

The only other thing I can think of off hand is that I don't always feel like I can get quite enough air through my nose as I "want". I've tried nasal rinses and can't really tell if that helps much or not. I think I'll ask my doctor to look at my nose and see what he thinks, but I don't really think I have a deviated septum. Maybe there's another issue there.



I really don't know what else to do. AHI seems pretty good as noted but I just don't get as much sleep as I want and still feel tired. Maybe if the times I wake up due to leaks & pressure changes were included in AHI it would be more obviously a problem but I don't know how many times it happens a night. I read recently in an ebook that some people take some time to sleep long enough because their bodies aren't used to feeling rested and wake them prematurely. Maybe that's part of what I'm running into as well.

Anyway thank you all for your thoughts. I'm going to try the new machine over the next week and see how that goes.
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#16
RE: Am I on the right track?
Just wanted to post an update, I got the new ResMed Autoset for her and have used it a few nights now. Also I had a sleep tech review my data with me and he pointed some events out that are "maybe" really subtle RERA's; the days we looked at ranged from every 5-10 minutes part of the night. Going from that and reading about treating UARS I decided to play with the EPR last night upping it from 1 to 2. I also changed the pressure which I probably should have only changed one thing at a time but oh well.

Anyway I don't feel a lot better today (just normal variation from day to day) but I am really exited about the apparent difference just visually comparing the flow limitation part of my chart. It seems like with EPR @ 2 there's less going on there and I'm really hoping that bumping up to 3 tonight will improve things more.

I'm also going to try a full face mask when it arrives because I sometimes have random congestion in my nose despite nasal rinses, etc, etc. I have tried a nasal pillow mask several times but wasn't really impressed with that.


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#17
RE: Am I on the right track?
I've got a few days now with EPR @ 3 and the flow limitations have gone down but still not totally gone. Screenshots are attached, I left out one day that I tried a different mask and those results aren't useful. Snore & leak rate are very low but let me know if they are needed for my circumstance.

Does this look like I need bi-level? Should I up the pressure more? Ideas?

Thanks!
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#18
RE: Am I on the right track?
(05-19-2019, 11:54 AM)alshayed Wrote: I've got a few days now with EPR @ 3 and the flow limitations have gone down but still not totally gone. Screenshots are attached, I left out one day that I tried a different mask and those results aren't useful. Snore & leak rate are very low but let me know if they are needed for my circumstance.

Does this look like I need bi-level? Should I up the pressure more? Ideas?

Thanks!

This looks great number wise I would not Change anything. But the machine does not Change it’s settings automatically or report for UARS all you can go by is how you feel.


So how do you feel ?
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#19
RE: Am I on the right track?
(05-19-2019, 04:33 PM)jaswilliams Wrote:
(05-19-2019, 11:54 AM)alshayed Wrote: I've got a few days now with EPR @ 3 and the flow limitations have gone down but still not totally gone. Screenshots are attached, I left out one day that I tried a different mask and those results aren't useful. Snore & leak rate are very low but let me know if they are needed for my circumstance.

Does this look like I need bi-level? Should I up the pressure more? Ideas?

Thanks!

This looks great number wise I would not Change anything. But the machine does not Change it’s settings automatically or report for UARS all you can go by is how you feel.

So how do you feel ?

Mostly I just feel tired all the time, the same now as even before starting CPAP 14 months ago. If I have a bad AHI night or don't get enough sleep I feel worse the next day (headache, eye pain and dryness, etc). Switching to the AutoSet and finding the flow limitations gave me some hope again, but I don't know if I should keep fiddling with pressure here or push for a bilevel. I do think that the AutoSet using EPR is making me feel a little better but I'm definitely not there yet and am suspicious that it might be wishful thinking. From a numbers perspective the AutoSet is definitely way better than the DreamStation was for me, recent 7 day average RDI of 0.23 vs 1.07. 

On the DreamStation I couldn't really stand pressure higher than 13-ish without fully waking up. So I'm somewhat reluctant to go too much higher for the minimum setting. (9 currently)

If I understand the bilevel titration guide (S) correctly and treat the flow limitations as a RERA the next step is to increase pressure support again which isn't possible on my current device.

But I'm worried that I'm making false conclusions about the next step and am hoping for some outside opinions.
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#20
RE: Am I on the right track?
Guys, I slept 9 hours plus change last night! Normally I only get about 6.5-7 on average. 

After trying for two weeks, I finally got a bilevel (AirCurve 10 VAuto) the other day and left it at defaults (4-25 PS 4) the first night and had a number of CA's somewhat as expected due to the pressure change but still felt roughly the same compared to APAP. The second (last) night I upped the EPAP 1 cm and slept 9+ hours.

I'm tweaking pressure a little more but I'm super excited. Today I was only a little (comparatively) sleepy mid afternoon vs all day like normal.
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