[Treatment] May be Too Late for Me Too

[Walla Walla]

You might want to limit the maximum pressure to around 14cm. It looks like it was a positional cause for that large group of events. Limiting the max pressure should help keep leaks down.

[Tubaman]

I don't know what you mean by "positional cause" -- is that something to do with my changing physical position while sleeping?

Way back when I was first starting CPAP I continued raising my pressure's until I obtained the fewest AHI events.  At that time 17 cm seemed to minimize my AHI event frequency.  I suppose my body is changing and maybe I should start gradually experimenting with lower maximum pressures.

Tonight I shall reduce my high pressure to 16 cm to see what happens.  I agree that my high pressure may now be too high and actually causing more events instead of reducing them.  It may take a few nights to find out if there is any effect.

Thank you!

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[Sleeprider]

Walla is referring to the fact your events are clustered tightly, and you are free of apnea most of the night. These clusters can often be avoided using a soft cervical collar or Dakota Snore Stop wedge that prevents the chin from tucking, which shuts off the airway, even with high pressure. See the OptimizIng therapy wiki for more details. http://www.apneaboard.com/wiki/index.php...ng_therapy#

On your charts, please minimize the calendar by clicking the triangle in the date line. We want to see Events, Flow rate, Pressure, Leaks, Flow Limits and Snores.

[Tubaman]

Thank you for the information.  I don't think anybody has referred me to the "optimizing therapy wiki" page before, maybe I'm wrong as my memory is not very good any more.

I rapidly skimmed the "optimizing therapy" information trying to understand what was being discussed.  I had difficulty understanding much of the information.

I noticed that the CPAP starting point should have been the results of my original sleep test results.  I never received that information (documents) until about a year after my sleep tests.  All my sleep doctor had released was something about how to lose weight.

I had been using a %SpO2 pulse oximeter (my meter) from the start of my CPAP usage and discovered that the AHI events and my %SpO2 levels had virtually no correlation.  On nights where my AHI level was acceptable (5, or lower), my %SpO2 levels were 200 to 300 minutes below 88%, sometimes more.  It took me about 2 months to get my sleep doctor to give me another sleep test, this time monitoring my %SpO2.  That test never was completed because time ran out and only part of the sleep cycle was completed when the sleep test operator's shift ended.  I was subsequently given a %SpO2 portable monitor (more exotic than mine, they didn't believe the results I was getting) for a home test.  The %SpO2 levels their monitor obtained were over 300 minutes below 88% (I ran my own pulse oximiter on another finger that same night and obtained over 200 minutes below 88%).  That's when they finally added oxygen assist to my CPAP system.  The oxygen concentrator was initially set for about 1.5 and the initial %SpO2 results were negligible.  I started cranking up the oxygen rate until I reached 4.5+ and finally  started seeing repeatable %SpO2 level improvement.  My AHI levels did not improve, however.  I then, with many good suggestions from this forum (you've literally become lifesavers to me) started playing with my low and high pressures and eventually wound up with 9.2 to 17 and that's where I've kept those pressures for over a year -- with very good AHI results (usually below 1.0).

That is until recently when the AHI levels started climbing (I've changed nothing until yesterday when I dropped my upper pressure to 16 (from 17).  I had a wedge under my back (because of back problems) for a long time and I had to remove it and replace it with pillows a few weeks ago (injured rotator cuff hurting too much) so that changed my head positioning somewhat.

The cluster of OA events the last couple of nights could very well have been due to the way my head rests while I'm sleeping.  I will have to experiment to see what I can do to keep my "chin up" and still maybe get a few hours of sleep (very difficult for me lately).

Off my soapbox.  Sorry I've bored you folks to death, you have much better things to do than listen to my ramblings.

Below are my results from last night.  Another cluster of OA events, not quite as bad as the night before.
Thank you!  Tubaman (Carl)

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[Tubaman]

I've included my CPAP & %SpO2 results for last night.  This is my highest AHI event frequency since October 2016 so I don't think lowering my upper pressure was the right thing to do.  Unless you folks have other thoughts I am raising my pressure back to 17 for this evening -- and maybe higher.  I shall put up with the mask leakage.

Interesting that my %SpO2 did not deteriorate at all that I can see (about the same as it usually is).  I consider blood oxygen level the "bottom line" in this therapy regardless of AHI level (in my case anyway).  Also, as has been true in the past, AHI and %SpO2 levels do not correlate for me at all.  Unless I am missing something here...?

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Please let me know if you need more data (charts)...

Thank you!, Tubaman (Carl)

[Tubaman]

I think the high pressure of 17+ is probably still desirable.  I used 17 .4 cm h2o last night and the results appear to have improved.  Of course, this is only one night but my previous use of 17 cm h2o kind of backs that up.  I originally came to that pressure by trial and error as my medical support was minimal (non-existant?) at that time so I had to try to determine those values myself (with much help from this apnea forum).  Eventually I settled on 17 cm h2o and I think that is probably still a good pressure to use.

I have not found anything to try to position my head to reduce any airway pinching that may be occurring.  My 1st cousin, 1ce removed lost her husband yesterday (he'd recently had both lungs transplanted and succumbed to antibiotic resistant pneumonia which destroyed his new lungs).  Life is so tenuous.

I've included last night's SH charts.  I forgot to start my %SpO2 meter but I doubt it would have anything new to show.

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If anybody has any suggestions, please feel free.

Thank you!

Tubaman (Carl)

[Tubaman]

Does nasal congestion account for increased events, especially "OA" events?

When I awaken my nose is usually not congested -- until I shut off my CPAP.  I've had a few times when my nasal congestion immediately increases (both sides) after I end CPAP.  It takes a few minutes to clear.  I suspect the CPAP's pressure is keeping my nasal passages open so that when the CPAP stops they quickly close up.

I have my CPAP humidity set at '1', maybe it should be higher?  Can't go much lower.  Maybe 'Automatic'?

Just curious.  Air gets quite dry in the winter in our house but it usually doesn't bother me too much.

Thank you, Tubaman (Carl)

[BadGoodDeb]

You actually CAN go lower than 1, unless you are saying that you personally can't tolerate lower than 1.  I've turned the humidity off, removed the tank, and bought a fill-in side panel (<$20 so I didn't try to use insurance).   It makes the unit smaller for traveling too; bonus!

I tried using humidity several times early on, and both led to a raging sinus infection that took several weeks to get over.  So I'm sticking with dry air.  Yeah, it does clear me up pretty nicely, most nights!  When I get up and get vertical, my nose starts running again.  I'm mostly not full-on-congested (only 60% or so).

Your milage may vary, of course.
Deb

[Fats Drywaller]

You actually CAN go lower than 1, unless you are saying that you personally can't tolerate lower than 1.  I've turned the humidity off, removed the tank, and bought a fill-in side panel (<$20 so I didn't try to use insurance).   It makes the unit smaller for traveling too; bonus!

Same here. I think it's good to try all three variations to see what works: heated humidifier, passive humidifcation with heater off, and no humidification with tank empty or removed.

I seem to get a lot more sneezing without humidification, but no big difference in congestion or the lack thereof. One thing that'll bother some people with the dry air is a very slight nosebleed ... I get that only immediately after waking up and it's never enough to drip, only enough to notice when I blow my nose. It heals right away. (And YMMV again.)

[Tubaman]

Thank you Deb and Fats!!!

I think I'll leave my humidity at '1' for now.  It seems to be tolerable and the congestion is only occasional (and doesn't last very long).  The higher pressure (now at 19 cm h2o) might be helping keep down the clumping of OA events, however, it's probably too early to know for sure.  I'll give it a few more days (weeks?) before I might know for certain (or as certain as these things ever become).

Thank you again for your suggestions!

Deb: My sister lived in Lyon, ILL (near Naperville).  She's gone now (cancer, anal, metastasized to her liver -- same as Farah Fawcett and one month after Farah's demise).

Tubaman (Carl)

"We run as fast as we can.  To get as far as we can.  So that when we finally get there we have that much further to run --  to get back to where we should have been."