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suggestions to lower ahi
#11
RE: suggestions to lower ahi
Good luck and keep working at it. When you're ready with your new mask, post an OSCAR and see how things are progressing.
Dave

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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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#12
RE: suggestions to lower ahi
If your CPAP has a pressure relief feature, turn it on. It should help with the hypopnea and flow limits that are probably there. Something looks suspicious about this data due to the very uniform timing of events. I would need to see closer views of flow rate which is not part of this data stream. If you can switch to a Resmed Autoset, you would be a lot better off.
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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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#13
RE: suggestions to lower ahi
[attachment=32204] original mask

To update my thread and ask for further comments especially on the events shown in my 3rd graph (bottom right) would be helpful.

I've first tried using a small pillow underneath my chin with my current mask (as I've experienced my jaw dropping out of the mask) , my ahi improved somewhat, still got leaks although they were fewer. I've ordered a soft cervical collar to try (not arriving for a few days). 

My order of a ResMed F10 Air Touch arrived and I tried it last night. It was very comfortable. Although my ahi was better and the leaks improved according to Oscar, something strange happened and I believe these lower numbers aren't the real story. I woke up several times and felt I was gasping for air and heard no machine sound like a blackout. However, there was no blackouts last night.  I tugged on the bottom of my mask which had collapsed against my chin and the machine resumed. When I looked at the graphs from Oscar, it shows periods where there was no apap, the machine was not working. (The only time I've seen this was when I shut the machine off if I can't get back to sleep.) I did not shut the machine off at all deliberately last night and I'd have to reach to the bottom shelf of my night table to turn it off. Each of these periods where the machine stopped are preceded by an apnea event. It seems to me that the apnea events lasted so long, the machine decided my mask was off and it shut down. This is not good as my untreated apnea was 87. 

Is it possible for positional apnea to do this? I've a long term cpap user (13 years) and this has never happened to me before with any mask. I feel terrible this morning and my husband complained my mask was noisy so I don't think the low ahi reflects what was really happening (long apneas so long the machine thought I'd taken my mask off.) 

I can send it back to try another mask (because of Covid, they don't process it for 5 days so I'd return to my old mask temporarily until another new mask arrives). Probably I'd try the Fisher & Paykel Vitere next since it supposed to good for restless sleepers with leaks. I don't want to try this mask again as it was an awful experience and I think I should write this mask of as a total failure. 

Any comments, assistance on the weirdness of the third graph would be helpful. 

Here's my three graphs. The first at the top of the thread is my original mask Fisher & Paykel FlexiFit 432, the second is my original mask with a small firm pillow underneath my chin, the third is with the ResMed f20 Air Touch and these periods where the machine stopped responding.


Attached Files Thumbnail(s)
   
Core Products Foam Cervical Collar
Canadian, diagnosed OSA in 2008 with 87 AHI
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#14
RE: suggestions to lower ahi
The OSCAR report shows that your leak rates are significantly greater with the Airtouch F20 mask than before. The leaks are why your mask was noisy. Could the leaks have been large enough that your machine thought the mask was disconnected and automatically turned off? I don't know what threshold DeVilbiss has for shutting off.

Mask fit is very individual. I've read good reports about the Vitera though have not tried it myself. I use the Airfit F30 and have been happy with it.
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#15
RE: suggestions to lower ahi
(05-13-2021, 09:52 AM)GuyScharf Wrote: The OSCAR report shows that your leak rates are significantly greater with the Airtouch F20 mask than before. The leaks are why your mask was noisy. Could the leaks have been large enough that your machine thought the mask was disconnected and automatically turned off? I don't know what threshold DeVilbiss has for shutting off.

Mask fit is very individual. I've read good reports about the Vitera though have not tried it myself. I use the Airfit F30 and have been happy with it.

I dug out the manual and checked to see if I could find the threshold for shutting off. According to it, the threshold for turning off the machine is 30 seconds or more. This means with this mask, I got 6  apneas longer than 30 seconds and the machine shut off. 

It appears that this mask is not for me.
Core Products Foam Cervical Collar
Canadian, diagnosed OSA in 2008 with 87 AHI
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#16
RE: suggestions to lower ahi
I've talked to the mask vendor re: the return process for mailing it back. I explained the reasons and they were fine with it. (I'll post a review for it in the mask review forum.)

I sending it back today and exchanging it for a Fisher & Paykel Vitera. As a result of Covid, they set it aside for 5 days before opening it & processing my return. So I'm back to my original mask until the Vitera arrives. I hope it works better.
Core Products Foam Cervical Collar
Canadian, diagnosed OSA in 2008 with 87 AHI
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#17
RE: suggestions to lower ahi
Update:
Last night was my first night with a new machine, a Resmed Auto Sense Autoset 10 For Her I'm still awaiting a new mask (exchanged the f20) but because of the pandemic, it will take a while for my Fisher & Paykel Vitere to arrive in the exchange. I've also ordered a cervical collar as I suspect I have positional apnea (arriving in a few days).

(For background, I've been using an old apap Intellipap for 12 yrs, I was diagnosed at 87, 12 years ago.) Recently I suspected a lot of mask leaks. 

I set the pressure at 14 to 20 (my previous setting was 15-20), epr 3 and using the "For Her" algorithm.

This morning I feel quite good. However, my number is absolutely terrible.

Any suggestions - should I change the epr? the algorithm?


Attached Files Thumbnail(s)
   
Core Products Foam Cervical Collar
Canadian, diagnosed OSA in 2008 with 87 AHI
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#18
RE: suggestions to lower ahi
Purr3k,
I'm hoping you can find a mask that works for you. Your high leak rate definitely affects therapy.
It's also hard to advise on settings with the positional apnea.

The one thing I notice is that you are using the "For Her" mode. I think in time, when you get the mask and positional apnea worked out, is to switch to the "Standard mode".
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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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#19
RE: suggestions to lower ahi
UPDATE:

I made the following changes last night:. 
- I switched to regular autoset mode (heard it's better at high pressures) & used a cervical collar for the first time (it arrived in the mail).

Huge difference - from over 16 to under 2 (see attached). I must have a lot of positional apnea. I've been told by several anesthesiologists that I have a very small throat so I don't know if that is the reason why it has such a big effect on my results.) 


 According to my husband, I moved less in my sleep last night as well (I woke up on the same side, I went to sleep on). The only issue is one of our cats woke me early. (I'll have a nap later on with my mask and collar.)


Attached Files Thumbnail(s)
   
Core Products Foam Cervical Collar
Canadian, diagnosed OSA in 2008 with 87 AHI
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#20
RE: suggestions to lower ahi
That is quite a difference. We can see where you had some chin-tucking that increase airway resistance, flow limitation, RERA etc, but at least the machine is responding appropriately and you're getting better therapy.
Sleeprider
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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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