previously diagnosed, expertise requested for data interpretation

previously diagnosed, expertise requested for data interpretation - Printable Version

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previously diagnosed, expertise requested for data interpretation - nappyhair2 - 11-19-2017

This board is very helpful, thank you for the info and sleepyhead.
I was diagnosed in 2008, in 2012 with most recent sleep study, got a new and current CPAP (Resmed S9, Quattro Air and Slimline hose), this was great for quite a long time with AHI between 1-5. Past months have seen significant, rapid, and random AHI from 4 to 19 accompanied by headaches and the sleepyhead message of major mask leaks (sometimes but not recent) and either horrible or technically treated.

Many new supplies last month (except for tank and headgear) with good results (appears to have corrected major leak problem), specifically the hose to mask connection valve is now functioning correctly whereas before the flap seal/press fit connection at the mask leaked to the point that during operation the CPAP sound was the same as when no hose or mask was connected. New supplies have reduced AHI with most recent 3-4 weeks AHI from 3 to 7.

Unfortunately the new mask seal flutters and squeals frequently (although less than before) especially when I attempt to sleep or do manage to sleep on my back. Headgear requires constant adjustment (and has been stretched for a long time, which does not help. replacement headgear will be ordered next week (currently supplier = Lincare).

Constant leaks and squeal causes me to flop from right to left side throughout the night also causing mask seal to be compromised (but not as much). Most recent session AHI returned to over 10 but no major mask leaks.

I have had some weight loss and have reduced bodyweight ~25 lbs since diagnosed. I do notice that my bottom jaw drops after I fall asleep. The mask leaks seem to occur at any area on the seal, also the skin on my face sometimes becomes very moist which contributes to more leaks.

I am humbly requesting expertise from the Board on interpreting data, random AHI over both the weeks and months listed above and any other suggestions
Thank you for your expertise!

RE: previously diagnosed, expertise requested for data interpretation - Sleeprider - 11-19-2017

We have seen where a person with obstructive sleep apnea, well treated with auto CPAP has morphed into a mild complex apnea case. This could be sleep disturbance that is causing arousal centrals, or the centrals may be the real deal. The first think we need to ask is if there are other health issues that coincide with this change. Your description of issues with the mask could explain this, if the events only came up after that change.

Since most events are central apnea, you should consider reducing EPR. If the centrals persist past EPR at 1, then we might need to look at other options, but usually CA can be nearly eliminated when EPR or pressure support is reduced or removed. Also, you can probably reduce your maximum CPAP pressure to 12. You seem to have fewer events when pressure is less than 10. I think reducing EPR may help.

For the mask seal, you can try cleaning the cushion with Dawn or similar detergent, or perhaps replacing the cushion, or even trying a new mask model or size. Your pressures are not so high that maintaining a seal should be an issue.

RE: previously diagnosed, expertise requested for data interpretation - Walla Walla - 11-19-2017

For the jaw dropping you can try either a chin strap or a soft cervical collar. Both help keep the jaw closed so the mask won't slip up to your mouth.

RE: previously diagnosed, expertise requested for data interpretation - nappyhair2 - 11-19-2017

sorry lost the post on imgur here it is

RE: previously diagnosed, expertise requested for data interpretation - nappyhair2 - 11-19-2017

and a similar night

RE: previously diagnosed, expertise requested for data interpretation - jaswilliams - 11-19-2017

First thing I would suggest is turning down epr to 1 from its current setting of 3

RE: previously diagnosed, expertise requested for data interpretation - nappyhair2 - 11-20-2017

I feel that changing EPR to 1 from 3 is better (note only 1 night see below). Did a mask fit and adjustment in the afternoon so the Sleepyhead data looks strange but AHI is 4.77. Any ideas on how to get back to <2.

RE: previously diagnosed, expertise requested for data interpretation - Sleeprider - 11-20-2017

To even out pressure, I think you need to increase the minimum to about 10. Take your time and do this as you are comfortable with it. Your median pressure is already at nearly 11, so it's really just how you start out. There is a lot of pressure variation through the night, and I'd like to get this to where pressure only changes by 3 or less cm. It might be interesting to zoom in on the flow rate during these events and see what's happening at the wave-form level.

RE: previously diagnosed, expertise requested for data interpretation - nappyhair2 - 11-20-2017

Focusing on the hypopnea (19) event we have these waveforms

and on subsequent CA events

RE: previously diagnosed, expertise requested for data interpretation - Sleeprider - 11-20-2017

Can we get in a bit closer, like no more than 3 minutes each? I think I'm seeing flat-topped and downward sloping inspiratory peaks, and if so, that is obstructive, not central.