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[Treatment] Please review my data.
#11
RE: Please review my data.
Thanks for the replies. They were very informative. The only reasons my doctor gave me a BIPAP are:

1) I was still feeling tired on CPAP.
2) I am a mouth breather. I was having air leaking from my mouth. This is still happening with BIPAP.

I recently went back to my doctor and saw the head of the clinic, Dr. Avram Gold. He wasn't very pleased with BIPAP, so he told me to switch to 8cm on CPAP mode. Air was still leaking from my mouth, and I was still tired. Then I discovered my machine has VPAP mode, so I just decided to try that with numbers I guessed at.

I'll see about getting those flags turned on and posting all of the data you've asked for.
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#12
RE: Please review my data.
Sleeprider Wrote:I  think your OA event flags are not showing on the event chart.  That can be turned on at the lower right corner of the graphs, or in File/Preferences/Events.  I think your minimum pressure of 5.0 is not doing you much good. Your settings are pretty wide open at 5-25 PS 5.0. The pressure support does not appear to be a problem, and since OA is not flagged, we can't see the pattern for those events.  OA is managed by the EPAP pressure, so it's pretty clear that needs to be higher.

At PS 4 over 10/5 you had AHI of 6.4.  At PS 5.0 over 25/5 you got 4.6, 9.8 and 8.3.  The problem is not maximum pressure or PS, but the minimum pressure.  You need to raise it until OA events are essentially gone.  I think you need to set EPAP min to 9.0, PS back to 4.0 and IPAP max at 20.  If you need more PS to deal with hypopnea, we an revisit this.  I would really like to see a chart that includes the OA events so we an see what is going on, and I'd really like to see why pressure is not increasing ahead of events, so we also need Flow Limitation and Snores.   My guess is you don't have much in those charts, or the pressure would rise.  It would also help to know how you ended up on a bilevel machine.  What was going on in the sleep study that you got bilevel?

I think Sleeprider may have been looking at the first batch of images rather than the second. These images include the flags, but not the other graph data you\'ve asked for. I will upload those images tomorrow.

https://imgur.com/GfopIxM

https://imgur.com/HbslAz1

https://imgur.com/HT4k2Ot
https://imgur.com/BXwEnhg
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#13
RE: Please review my data.
Quote:The only reasons my doctor gave me a BIPAP are:
...
2) I am a mouth breather. I was having air leaking from my mouth. This is still happening with BIPAP.

Changing the machine won't change the fact that you're a mouth breather. If you want to continue with the P10 mask, you'll need to only breathe through your nose, and control the flow of air coming out of your mouth. Some people have mastered the "tongue stick method", where you push your tongue against the hard palate to form an air-tight seal. Otherwise you could try a chin strap or soft cervical collar to support your jaw in the closed position. Some people tape their lips. You could try any of the above, but I would not recommend anybody use tape at the same time as a collar or chin-strap.

In my view, it's not worth all the messing about - get rid of the P10 and get a proper full face mask, then you won't need to worry about mouth-breathing.
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#14
RE: Please review my data.
Yeah. I had a nice full face mask, but Dr. Gold is 100% against using those because he thinks they don't work. One reason he gave is that the full face mask doesn't allow a higher pressure behind the tongue. It's a good time trying to get him to solve the mystery of the mouth leaks.

I've tried the chinstrap. No good. I've tried the tape. No good. I've trained my tongue to do a number of things while I'm fully conscious, but I don't think I can control it while I'm asleep. I'll look into the soft cervical collar.
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#15
RE: Please review my data.
"Yeah. I had a nice full face mask, but Dr. Gold is 100% against using those because he thinks they don't work."

That is going to be a surprise for a lot of people, including me.
Hopefully you misheard, if you didn't I would change doctors. If he can make a simple mistake like that, I wouldn't trust him.
mask fit http://www.apneaboard.com/wiki/index.php...ask_Primer
For auto-cpap, from machine data or software. You can set the min pressure 1 or 2cm below 95%. Or clinicians commonly use the maximum or 95% pressure for fixed pressure CPAP, this can also be used for min pressure.
https://aasm.org/resources/practiceparam...rating.pdf
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#16
RE: Please review my data.
What Ajack said.
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#17
RE: Please review my data.
I do not trust him. In fact, I flatly told him that I had no confidence in him or anyone in his office. He actually wagered one dollar that setting my CPAP machine to 8cm would alleviate the mouth leak and I countered with a $3,000 wager. He refused to take that bet.
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#18
RE: Please review my data.
Quote: He actually wagered one dollar that setting my CPAP machine to 8cm would alleviate the mouth leak

Mouth leaks are not the underlying problem here. Looking again at your charts, the leaks are reasonably controlled for most of the night(s). However it's very obvious that a pressure of 8cm is not sufficient to control your obstructive apneas. In addition, the high PS is not helping your central apneas. I echo the previous advice - increase your min EPAP and reduce the PS.
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#19
RE: Please review my data.
(10-28-2017, 02:05 AM)fakename1845 Wrote: I do not trust him. In fact, I flatly told him that I had no confidence in him or anyone in his office. He actually wagered one dollar that setting my CPAP machine to 8cm would alleviate the mouth leak and I countered with a $3,000 wager. He refused to take that bet.

Hiya

What a silly doctor!! 

Any PAPer knows mouth leaks are not dependant on pressure. Really high pressure may contribute to it but is not the cause. Others have written about ways to keep ones mouth closed. Being an ex mouth breather my leaks have been helped by a neck collar and the tongue trick. In combination with slowly turning EPR off through 6 months and a lowering of EPAP, this has resulted in an optimum balance which has helped the leaks but if I went to sleep without my collar I will wager that leaks will return. But I am not prepared to sacrifice a nights sleep.
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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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#20
RE: Please review my data.
I really appreciate the additional background on your VPAP use and where the settings come from.  Let's solve your problems.  

Your AHI is pretty high in this graphic using PS 5 over 5-25 pressure.  You need less PS and more minimum EPAP.  this will reduce both the OA and CA events.  Lets move to PS 3 over EPAP min 10, IPAP max 20.  I'd also suggest the soft cervical collar may really hep you with the positional apnea.  Your events, leaks and snores are all clustered in a way that makes positional apnea likely.  Leaks are mostly a function of movement and briefly dislodging the mask.  These are not large enough leaks to disrupt the therapy, but may be disruptive.  I think the soft cervical collar will help here as well.   The goal is to significantly reduce your OA and improve sleep comfort and therapy efficacy.  The CA events should resolve on their own as that happens, and without so much pressure support. 

[Image: BXwEnhg.png]

[Image: HT4k2Ot.png]

[Image: HbslAz1.png]

[Image: GfopIxM.png]
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

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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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