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hookedonstitch - Therapy
#71
RE: Angela P Therapy
One thing I'm noticing is that your leak graph is suspiciously aligned with your flow rate graph -- the breathing is gyrating around, and the leaks are, too.

Is it possible that you are fussing with the mask trying to control the leaks, and you are holding your breath to do it? Central apnea is more-or-less "holding your breath" and it's one of those things which is totally normal awake behavior. If you are mostly asleep, though, it can get really out of control.

Especially if it's a combination of holding your breath to fuss with the mask, to change position trying to make the PLM stop, those are all waking you up, and then the Centrals wake you up some more, in between the flow limits kicking your butt every couple of minutes.

The other thing -- everybody else here will tell you not to worry about little leaks, but my data often looks wrong during little leaks. As in I'm willing to believe that the machine is still doing it's thing when the leaks are small, but I'm suspicious that while it's adjusting the therapy to make up for the leaks, it's not correcting the data that it's recording. 

Here's my sample, my infamous (to me anyway Wink ) June 19th flow limit extravaganza:

Here's the whole night:
https://www.dropbox.com/s/k9o70gbdltc36c...M.png?dl=0

There are 3 crazy flow-limit sh**-shows which really ought to count as something -- but how do you count a continuous 1-1/2-hour hypopnea? That brings a whole new meaning to "events per hour" or maybe "event-without-the-s per hour"! But notice that the first one, which crashes at around 2am has a little leak under it. The second one -- no leak.

First crash around 2am:
https://www.dropbox.com/s/wsnvyul7yd0ad0...M.png?dl=0

Second crash about 3:45:
https://www.dropbox.com/s/3z2wyrytjs62ui...M.png?dl=0

That second crash is bad -- a very long, sustained flow limit where the inspiratory peak goes from ~20 to ~10, punctuated by arousals every couple of minutes. The first crash, though, is more than bad -- the peaks go down to freaking FIVE!

There's a lot of things screwy about that -- I'm wearing a pulse-oxymeter, and my oxygen stays rock-solid stable. Ok, we don't need a pulse-ox to know something is "off" -- cause I'm still here posting on the internet, and that 2am graph is somebody who died!

Which is where my little suspicious self says -- ok, maybe those leaks were causing the machine to mess up the accounting?

Part of the reason that I've gone back to a full-face mask is that I can be virtually leak free. When I'm wearing pillows I'm waking up to mess with the mask, or because I'm worried that my mouth is open, and that wrecks my sleep. But it's also that I know that the jerk of a sleep doctor would point to the leaks and say that the data is meaningless and my AHI is wonderful and nothing is going on.

Anyway, all that aside, to reiterate what everybody else is saying about the vauto-- here's what a bad flow limit looks like on bi-level:

https://www.dropbox.com/s/rcl898yn6tq4us...M.png?dl=0

The machine just fixes it!
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#72
RE: Angela P Therapy
(08-10-2021, 11:18 PM)cathyf Wrote: One thing I'm noticing is that your leak graph is suspiciously aligned with your flow rate graph -- the breathing is gyrating around, and the leaks are, too.

Is it possible that you are fussing with the mask trying to control the leaks, and you are holding your breath to do it? Central apnea is more-or-less "holding your breath" and it's one of those things which is totally normal awake behavior. If you are mostly asleep, though, it can get really out of control.

Especially if it's a combination of holding your breath to fuss with the mask, to change position trying to make the PLM stop, those are all waking you up, and then the Centrals wake you up some more, in between the flow limits kicking your butt every couple of minutes.

The other thing -- everybody else here will tell you not to worry about little leaks, but my data often looks wrong during little leaks. As in I'm willing to believe that the machine is still doing it's thing when the leaks are small, but I'm suspicious that while it's adjusting the therapy to make up for the leaks, it's not correcting the data that it's recording. 

Here's my sample, my infamous (to me anyway Wink ) June 19th flow limit extravaganza:

Here's the whole night:
https://www.dropbox.com/s/k9o70gbdltc36c...M.png?dl=0

There are 3 crazy flow-limit sh**-shows which really ought to count as something -- but how do you count a continuous 1-1/2-hour hypopnea? That brings a whole new meaning to "events per hour" or maybe "event-without-the-s per hour"! But notice that the first one, which crashes at around 2am has a little leak under it. The second one -- no leak.

First crash around 2am:
https://www.dropbox.com/s/wsnvyul7yd0ad0...M.png?dl=0

Second crash about 3:45:
https://www.dropbox.com/s/3z2wyrytjs62ui...M.png?dl=0

That second crash is bad -- a very long, sustained flow limit where the inspiratory peak goes from ~20 to ~10, punctuated by arousals every couple of minutes. The first crash, though, is more than bad -- the peaks go down to freaking FIVE!

There's a lot of things screwy about that -- I'm wearing a pulse-oxymeter, and my oxygen stays rock-solid stable. Ok, we don't need a pulse-ox to know something is "off" -- cause I'm still here posting on the internet, and that 2am graph is somebody who died!

Which is where my little suspicious self says -- ok, maybe those leaks were causing the machine to mess up the accounting?

Part of the reason that I've gone back to a full-face mask is that I can be virtually leak free. When I'm wearing pillows I'm waking up to mess with the mask, or because I'm worried that my mouth is open, and that wrecks my sleep. But it's also that I know that the jerk of a sleep doctor would point to the leaks and say that the data is meaningless and my AHI is wonderful and nothing is going on.

Anyway, all that aside, to reiterate what everybody else is saying about the vauto-- here's what a bad flow limit looks like on bi-level:

https://www.dropbox.com/s/rcl898yn6tq4us...M.png?dl=0

The machine just fixes it!

Thanks for this Cathyf, I'm not sure what I am doing but I do notice that I am tossing and turning all night which makes the p10 shift around on my face.  I might try a full face mask but not sure which one to get.  I am a side sleeper and I change sides a lot throughout the night.  I was looking at the F20 or the Vitera but I just don't know if I would be able to wear it.  The P10 bothers me and that is so minimal.

I'm going to talk to my sleep doc about UARS, flow limits, how bad I feel during the day, how awake I still am at night and see if I can at least get her to trial a VAuto or would asking for a titration on a VAuto be worth it?  I am going to ask her what my RDI is and see how receptive she is to everything.
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#73
RE: Angela P Therapy
This was last night, between 8-9 am I was messing around holding my breath to see if it would increase the AHI.  That whole cluster is me basically awake.  

I slept for a few hours without the machine but the tossing and turning was driving me nuts so I gave in and put the machine on.  

If my AHI increases over 5 will the sleep doc pay more attention to my concerns and will it make my case stronger to try a bipap?  Or am I just wasting my time and she will know what I am doing?


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#74
RE: Angela P Therapy
This is last night, I know my AHI is still in the acceptable range but in all seriousness (last post was frustrated joking)  this is causing me huge anxiety because my numbers/events are consistently getting worse.  I've always had under 1 AHI for months and months,  I even tried to pay attention to breathing even when I was switching sides and whenever I felt like I was awake.

This is the highest total of events in a single night I've had since starting therapy.  What am I doing wrong?  

September is feeling a long way off to talk to my Doctor  Sad  Pressure is 7,0-9.4 with EPR 3


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#75
RE: Angela P Therapy
Some of the events flagged Centrals but I'm not sure if they really are centals?


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#76
RE: Angela P Therapy
This is a closer look at my RERA and large leak.  If I am understanding a RERA is the flow limits that I am experiencing being flagged?  Or is it a step up from a flow limit?


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#77
RE: Angela P Therapy
A closer look at some of the OA events, again not sure what I am looking at.

Also why is MyAir reporting a higher events # at 2.4 per hour and OSCAR gave me 1.96?  I know MyAir is garbage but that seems like a big difference.


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#78
RE: Angela P Therapy
Angela, are you aware of the flow resistance? Can you identify if it is nasal, or deeper in the respiratory track? I wonder if an anti-inflammatory allergy medication like Flonase (fluticasone propionate) might be helpful.
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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#79
RE: Angela P Therapy
(08-12-2021, 08:21 AM)Sleeprider Wrote: Angela, are you aware of the flow resistance? Can you identify if it is nasal, or deeper in the respiratory track?  I wonder if an anti-inflammatory allergy medication like Flonase (fluticasone propionate) might be helpful.

Not aware of it but I do suffer from nasal congestion sometimes.  I've been on Avamys Nasal Spray for about 2 months now at bedtime before using the CPAP.  

I've also been dealing with shortness of breath (with exertion) for over a year that must be related to the Iron Deficiency Anemia because I've had multiple tests done on my lungs/heart and everything else has been ruled out.

I'm just done.  I appreciate everyone trying to help.  I will be taking a break until I talk to my sleep doc.
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#80
RE: Angela P Therapy
The Avamys Nasal Spray is in the same category, so glad to see that base covered. Good luck with the doctor. Be sure to emphasize that it is your continued fatigue in spite of apparently good AHI that you want to resolve, and that it arises from the chronic flow limitation that can be better resolved with bilevel therapy. Your Autoset's EPR was helpful, but falls short of relief.
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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