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[Treatment] Noob; wondering about equipment, info dump below
RE: Noob; wondering about equipment, info dump below
(06-28-2020, 07:52 PM)bonjour Wrote: Your chart implies that you may, only may, be able to lower your settings.  Do you want to try, or stick with your doctor's settings?
I am going to try to stick with the prescription for at least a week or two. It's just making it very difficult to fall asleep, although some of it is just general discomfort / inexperience with the whole process... But I feel like lower pressures might make it easier to adjust? Huh

How "pissy" do insurance companies get if they see you making changes? Or do they generally only care about hours of therapy + AHIs below some target?

Quote:Start your ramp at a higher pressure, better don't use it.  You lose therapy time while in Ramp.  At least work on minimizing the time you use the ramp.
Yeah, I used it twice, once when I first tried to sleep, and then once again after waking up in the middle of the night with a dry mouth (I also turned up the humidity at that point, although apparently OSCAR doesn't note that... I started at 2 and was up to 5 by the end).

It's just so hard to fall asleep when this thing is forcing 21cm at my face. I get "chipmunk cheeks" from it at times. I feel like it is forcing me to inhale more deeply than I normally would, which is a discomforting sensation, and then I have to work harder to exhale as well.
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RE: Noob; wondering about equipment, info dump below
No problem.
A couple things to do try
1. Use the machine at pressure before bed, read a book, watch TV, play a game on your phone, anything normal and enjoyable.
2. Chipmunk cheeks.
A. Make them happen, yes intentionally. Then unmake them. Learn how to both make them, and unmake them. At first you may have to cycle power on your machine to do so.
B. Talk while you are under pressure
C. Have a drink, ok, you need a nasal mask or pillow mask to do this.

As an FYI a couple things to get familiar with how much pressure you are dealing with.
Get a tall glass of water and a straw. Now put the straw near the bottom of the glass and make like a kid and blow bubbles. At 8 inches that was the max pressure, ok in your case 8.5 inches is 21 cmw your max pressure. That was 0.28 psi if memory serves me correctly. Any trouble? 1 didn't think so.

Point is our really high pressures are, in reality, very low pressures.
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RE: Noob; wondering about equipment, info dump below
Well, night two, OSCAR screenshot attached. Went to bed much later to allow my wife time to zonk out (hoping it wouldn't disturb her as much).

Did not use ramp, just went straight to full mode. (My unit has auto-on enabled, so once I got strapped in for a few seconds it kicked in.)
Mouth & throat still like a desert this morning, and I woke up a few times mid-sleep with dry mouth as well, plus I was struggling with leaks a lot during the night. Don't think tightening straps will help, because I tried pressing the mask into my face more and it wasn't helping a ton. Seem to get a couple "pinhole" leaks where my nostrils meet my face, kind of between nostril and cheek.

I'm thinking that based on this evidence, maybe a "dual nostril" mask ("split pillows"? Are there standardized names for the mask types around here?), plus a chinstrap might be in order? I even made a concerted effort to try not to mouth breathe, but I must've done it some at least. My one fear is that I tend to get congested a lot in the fall (super allergic to ragweed) and winter (dry air / dust allergies too), but I suppose I can always fall back to the full-face if my nose is clogged?

I woke up around 8:30 and shut it off, used the bathroom and putzed around on my phone a bit, but then went back to sleep around 9:30 (no machine) until 10:30, when I was rudely awakened by our dog puking on my wife's side of the bed... Too-funny Shock-2

I definitely still feel better overall than I have in the past, so it's certainly helping, even though the AHI number is higher last night.

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RE: Noob; wondering about equipment, info dump below

I am not one of the gurus, so take my observations with a grain of salt.  

You don't seem to have lots of centrals in both of your daily reports. That would make me question the accuracy of your sleep study. Of course, centrals are meant to be inconsistent but then I'd expect to see more of them in the beginning of the therapy, especially with the very high pressure levels you are being treated with. That could also mean you might not need an ASV, however more data would probably be required for this conclusion.

Your leak rates are very high. High leak rates decrease therapy efficiency and also can result in the device missing events, so your final AHI might not reflect the real AHI. Obviously this mask is not (at least yet) working for you. This is also the mask I am using right now and I practically have no leaks (but my pressure levels are very low compared to yours, so it won't be a fair comparison), so maybe you can try a different size (they have S, M, MW and L size, so you can try them if you want. I had to buy all of them before settling on one size). Nasal pillows may be able to seal better, however not everybody can use them effectively, especially if you have hard time breathing through your nose. Also, if you are mouth breathing, you probably are going to have problem with mouth leaks, where the air being pushed through your nose will leak through your mouth and the high pressure levels you have will also facilitate this. Then you'll have to try mouth taping or chin straps, which are not comfortable for everybody.

Even with all the problems, your AHI scores seem to be really good compared to what you had on your sleep study and you also mention feeling better physically, so the therapy is definitely helping. 

Good luck....
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RE: Noob; wondering about equipment, info dump below
Third night of sleep... I felt like I had a lot of leaks. Plenty of "farts," honks, and squeaks from around the mask, which woke up my wife and drove her to sleep the last 20% of the night on the couch. Sad But the machine didn't record any "large leaks," unlike Sunday night.

Centrals appear to be up as well (20 events per OSCAR), although I feel like some of them (around 4:45a or so) were while I was awake and screwing with the mask, possibly swallowing.

Humidity was actually at 4 most of the night (I turned it down right after starting)... didn't matter, tank was bone dry this morning. Is there a way to get a larger capacity tank? RH in the house is around 50% per my thermostat, so it's not like "desert dry" in here. My mouth was once again totally parched. I just ordered two different nasal mask setups from Amazon, a chin strap, and the next two larger sized full-face masks ("medium wide" and "large"). Hoping maybe I can force myself to nose breathe and solve many of these issues...

Still feel like a lot of the dryness and honking/leaks come from having such (relatively) high pressures, but these are what they titrated me to with a PSG, so I guess they didn't think lower would help the problem enough.

Other than waking up super bloated and gassy, I feel decent, mentally. Definitely better than pre-machine. Waking up happened pretty naturally and I didn't feel all groggy and crappy like pre-machine time.

(I'm starting to run out of attachment space so here's an imgur link to last night instead...)
[Image: Zcrqf7l.png]
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RE: Noob; wondering about equipment, info dump below
I would start reducing pressure or using auto mode keeping PS 4.0 until enough OA appears to compete with CA. As you reduce pressure the CA and leaks will diminish and eventyOA will appear. You were not titrations with PSG but with a machine capable of producing different pressures. I would want to see the test results before concluding they are right.
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RE: Noob; wondering about equipment, info dump below
After this mess last night, I got pretty fed up with my "therapy" (or lack thereof). I did not get much actual sleep during this image. I ended up going back to sleep without the machine from about 11a-4p. (I'm happy to provide zoom-ins of any segments if anybody would like to see them.)

In any case, I've adjusted my settings for Auto BiPap, with PS set at 4. Going to give it a try tonight and see how I do. I'm having a very difficult time actually falling asleep when the machine is blowing in my face.

I want to use a full-face mask because my body wants to mouth breathe, but I was getting so much aerophagia and dry mouth, plus the leaks (around my nose and to the sides of my mouth) were driving me crazy. So I'm using a DreamWear "nasal pillows" mask now. I really like how it seals, better than the full face and better than the "nasal canoe"... but keeping my mouth shut is difficult. I've tried using a chinstrap, but the only way to really keep my mouth closed is by making the strap so tight it's uncomfortable. I'm also waking up with sore front teeth, which leads me to believe my tongue is pushing against them, which I know my dentist won't like.

I have some medical tape coming so I'm gonna try the "tape my lips shut" technique when that arrives...

[Image: JvXUx9T.png]
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RE: Noob; wondering about equipment, info dump below
Watch your Central Apnea. This last chart would call for lowering your PS but previous charts at the same settings have not. No change now, but if this persists than a change is called for.
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RE: Noob; wondering about equipment, info dump below
So here's last night's data... I had a much better night than I have had since starting this.
It still took me a while to actually drift off, but I didn't feel like I was fighting to exhale or forced into a strange breathing pattern, which made it far easier to deal with.

I find it interesting that my IPAP never goes above 12 and EPAP only ever hits 6...
My mouth was not parched either, and apparently with the lower pressures I didn't have a hard time keeping it shut. I remember swallowing wasn't nearly as difficult either.

I'm going to stick with the auto-bipap unless y'all have suggestions on tweaks I should make? Wasn't sure about the "Flex level" (I left it at the default of 2), and if I should change "PS" in the future? (It was at 4 during this night.)

Re: the VS and VS2 - is there a description anywhere of how the machine determines these, and what the difference between VS and VS"2" is? Worth noting, I don't have a hose cover, and my hose loops up over a metal (hollow square tubing with a "crackle" finish powdercoating) headboard, so if it's looking at straight vibrations, I can imagine how movement in the hose might read as "vibratory snoring"...

Oh, one final thing I don't understand at all. The machine apparently broke this data into 2 "sessions." Any ideas why? I do have "Auto-start" enabled, but I do not have auto-stop enabled, so I don't know why it would create a second session arbitrarily? The only time I touched the "power" (start/stop) button was at the very end to shut it off. It has done this "multiple session" thing several times even when I haven't shut it off at night, so maybe it's just some internal record/file limit or something?

Again, happy to provide zoom-ins of any portion of the graph if they'd be helpful, but with only 10 CAs and 5 OAs it doesn't seem like there's a ton to be worried about here?

[Image: E34ADUQ.png]
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RE: Noob; wondering about equipment, info dump below
there's a tiny gap in flow after your last ca and before the second session of ~31 minutes. this doesn't explain why there are 2 sessions but oscar will combine sessions closer than some period of time I used to think was 1 minute but may actually be more like 3 minutes. presumably you 'unconsciously' turned the machine off for a brief time or the auto off/on function was triggered somehow.

weird though, I don't see corresponding gaps in the other graphs. maybe at a closer zoom but no gaps might tell us the machine never actually turned off. I do see a huge respiration rate spike that appears to correspond to the ca that precedes the gap in the flow rate. not sure what that tells us though other than maybe your machine has a breathing not detected function before or after the spike causing it to stop recording flow (I'm not familiar with pr machines)? if that was the case you'd think it would occur with other ca events though. all speculation.
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