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[Treatment] John70's Therapy Thread
#31
RE: John70's Therapy Thread
John, the relatively high CA count is being caused by the presTsure support of 5.0 cm. I see several issues we can now work on. First, your pressure range of EPAP min 7.0, max pressure 12, looks fine, however at your current settings, that is fixed pressure. Lets keep EPAP min at 7.0, max pressure 14.0 and PS 4.0. In your settings set the trigger sensitivity to high, cycle medium, Ti Min 0.3, Ti Max 2.3. This will give you some variable pressure and lower the pressure support to a more tolerable level. The clusters of OA are an indicator of positional apnea (chin-tucking). I don't recall if you have tried a soft cervical collar or taken a look at positional apnea as we understand it, however here arre links to some wiki articles.
Positional apnea: http://www.apneaboard.com/wiki/index.php...onal_Apnea
Soft Cervical collar: http://www.apneaboard.com/wiki/index.php...cal_Collar

Let me be clear, a bilevel does not have any capability to address CA events unless it has a backup rate to switch to IPAP when apnea occurs. That is a capability of ST and ASV machines, not the S or Vauto. The CA events generally arise out of a reduction of CO2 due to increased ventilation from pressure support. This results in hypocapnea which can reduce respiratory drive. Basically, you pause breathing until CO2 builds back up and your respiratory sensors send a signal to breathe. This can be reduced by lowering pressure support and/or by increasing CO2 by providing some enhanced expiratory rebreathing space (EERS) in the mask and tubing. http://www.apneaboard.com/wiki/index.php...ace_(EERS)
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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#32
RE: John70's Therapy Thread
Hello Sleeprider,

Thank you for your response. I just made the changes. Lets see what happens.

I purchased all 3 recommend collars, the only one I can tolerate is the Caldera Releaf as I mention in prior posts. 

I have been a little congested with allergies hence I am using my F30 mask. Ideally, I like to go nasal or pillow if it were not for major leaking. I can make them work with Cover All 2" tape. I have the P10, Swift FX, Evora & DreamWear cushion, does it matter what type of mask I use? 

I will post my Oscar report tomorrow morning here. I will stay with the Apnea Board until I have improved my AHI's to the best of my ability.  

Thanks for your support.

John 70

PS My appointment with my Sleep Doctor yesterday lasted about 7 minutes. Just enough time to ask questions for Medicare to justify using a BiPap machine. Lincare called yesterday to let me know they received the order. Once I have good AHI's using BiPap, I will then connect myAir reporting to the Sleep Wake Center via AirView so as to keep my doctor in the loop.
As far as Lincare goes, I will call on them if I have a problem with my purchased BiPap or need a ST or ASV machine. I am bound and determined to feel good after a good night's sleep!
Sleep Apnea is a fight I need to win! 
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#33
RE: John70's Therapy Thread
Good Morning Sleeprider,


The attached Oscar report shows 27 Large Leak events. I used my P10 with mouth tape. The mouth tape has a slit that is apparently leaking.

Only 2 Hypopnea and 4 Obstructive Events, I used a very soft pillow which apparently made a difference with chin- tucking. I am still experimenting with cervical collars

The most disturbing are the 41 Clear Airway Events. Do you think lowering the PS to 3 would help?

Yesterday I messaged you regarding Mask. Also I purchased another chin strap and cervical collar from Amazon that may help with mouth leaking rather than using the mouth tape.

Please, let me know your thoughts.
 
Thank you and have a Great Friday,
John 70

   
Sleep Apnea is a fight I need to win! 
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#34
RE: John70's Therapy Thread
I would consider doing that PS drop. Most of your events are now Central.
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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#35
RE: John70's Therapy Thread
Sure, no problem with a bit less PS. Flow limits are very low, the lower PS is where you need to go to reduce CA. Remember, unlike the CPAP we can fine-tune by 2-tenths increments. Go for PS 3 for now.
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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#36
RE: John70's Therapy Thread
Hello Sarcastic Dave,

I appreciate your feedback. It is great you and SleepRider are monitoring my progress using BiPap. 

I will be posting everyday to see what tweaks can be made with Oscar data. Does anything change with the type of mask I use.

Thank you,

John
Sleep Apnea is a fight I need to win! 
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#37
RE: John70's Therapy Thread
FYI, they are not the only ones.
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#38
RE: John70's Therapy Thread
Sleeprider and Gideon are pressure guru class, I'm padawan. Even so we'll all help you get it right. Keep at it, never quit.

Mask cause changes? If the mask changes like type, it's good to edit your mask type in the PAP settings. Mask type is Pillows, Nasal, Full Face.
As in what changes if you change type, brand, model... Some fit better, can control leaks better, and so on. If it controls leaks better and fits better, comfort and therapy results should increase.
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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#39
RE: John70's Therapy Thread
MASK CAUSES CHANGES:
 
My journey here on the apnea was to see what I can do to breathe though my nose and not have to use a FF mask. The 2” cover all tape with a nasal pillow p10 is what I used last night.

Apparently there were still some leaks, none considered events.

What is amazing my chin-tucking has been eliminated with using a very soft pillow I got from Costco (Beautyrest Black) My OA clusters may have been caused from using a contour neck pillow?

I have tried over 10 CPAP masks. The one I have used the most is the F30. I do not know how long I can continue using the mouth tape while using a nasal or pillow mask. I will continue working on an alternative so I can use a nasal or pillow mask long term.

I only had 11 CA events last night with a PS of 3 a 75% improvement with a PS of 4. Should with try a PS of 2.8? IPAP 14, EPAP 7 looks good now. Will my pressure settings change if I change to another mask?

I will do my best to continue with P10 and mouth tape. What is optimum therapy, with what mask?

I understand breathing through my nose is preferable. Especially since breathing through my mouth causes dry mouth, hence causes tooth decay of cavities.

Many thanks to Sleeprider, Gideon, Sarcastic Dave and everyone who taken an interests in these post. 

John70

   
Sleep Apnea is a fight I need to win! 
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#40
RE: John70's Therapy Thread
Your OSCAR data looks good there. I see a bit of CA between 2:30 and 3:00. Maybe you were starting to wake a bit and this is sleep wake junk.

How would you say you felt after that sleep session? Good fair poor... If there's any negatives you think are associated with the sleep session list them. Leaks aren't bad on the numbers. Did they bother by disturbance or maybe not at all? I'm thinking the therapy is looking good but we'll grade it on how you feel.
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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