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Help with settings - Hamish McTavish - 01-20-2019

Hi everyone...
Been lurking for a while and reading quite a bit, still having a hard time understanding all of the ins and outs of Cpap and apnea, but I think I am slowly starting to get a bit of a grasp on some of it with help of all the knowledgable helpers on this board. So finally decided it might be time to ask a few questions. 
So here's my story so far. I have been fighting insomnia and daytime sleepiness for many years and finally went and discussed with my doctor after my wife told me that I was stopping breathing in my sleep. Diagnosed in November with mild obstructive apnea with an AHI of 13 using a home sleep test. I saw the graphs of the results of the test and it scared me a bit as my oxygen level went down to 78% and at some point during the test my heart rate went to 130bpm, the worst readings came when I was sleeping on my back. After a month of testing on one of their CPAP machines with them adjusting the settings I wound up buying the Resmed Airsense 10 Elite and that is what I am using. I was using a Mirage Quattro ffm but I couldn't get any seal on it at all because of my beard, even when using liners it was pretty much a zero score on the leaks every night.  I was told not to worry about the leaking as long as my AHI was good, which I am finding out was not really the best advice. So I thought I would try the new Resmed N30i nasal pillows to try and the leaking under control. The leak rate is down quite a bit but still not great and my AHI has gone up with a lot more CA's.  With the Mirage Quattro I had an average AHI of around 1-2, since starting to use the pillows that has gone up a bit and I am having way more CA's according to Sleepyhead, last night my AHI was over 8. I find the pillows quite comfortable but I'm fighting the hose a bit so I am getting a Hose Buddy to help with that. I also have a deviated septum and chronic sinusitis, but I seem to be able to breathe through my nose not too bad, but I think I leak through my mouth quite a bit when I am sleeping. Just wondering if someone could have a look at my settings and data and see if there is anything I might do or try, either maskwise or different settings to help get my AHI back down into the 1-3 range. Also wondering why I am getting a lot more CA's since starting to use the nasal pillows. 
Since I started CPAP in November I do feel somewhat better some of the time but so far it doesn't seem to be helping my insomnia and daytime tiredness a lot, still about the same as before CPAP. 
Thanks for you assistance Smile .

[attachment=9901]


RE: Help with settings - Big Guy - 01-20-2019

I started using a CPAP on Sept. 10th. I was told that it could take several months before I started to notice an improvement in how I felt. 

My AHI is way below 5. The highest since I started was 4.4 (one time only) and the lowest so far has been 0.3 (a couple of times).

There are times when I still feel like a nap. My therapy is going very well, with 0 complications and/or issues. I had a follow-up visit with my sleep doc in Nov. He said everything looks good. He told me to be patient. 

I can't help you with any settings. Others though, will be able to. I just chimed in to say be patient and stick with it. I'm hoping by the 6 month mark, I will feel better still.


RE: Help with settings - bonjour - 01-20-2019

Welcome to the Apnea Board Forum and Thanks for the chart it helps a lot here.

See the leak chart and the flat tops on many of the peaks, that is a sign of mouth breathing, not enough to be overly worried about but not a bad thing to get under control.  See the very jagged Leak chart centered on 0040, that is a mask leak, not a mouth leak/mouth breathing.  

Read the Mask Primer, especially on Mouth_Breathing
The quickest way to fix that is to Tape your lips, the concept is not to keep your mouth shut just to keep the air from leaking. Again read the Mask Primer

You said "I'm fighting the hose a bit so I am getting a Hose Buddy to help with that."  a good solution,  I use a simple velcro strap on the CPAP hose that is clipped to either the pillow or PJs.

Looking at your event chart your OA events look like they might be clustered together. (I say might because your obstructive rate is low), A loose fitting soft cervical collar to prevent this Positional Apnea or "chin tucking" may help you.

I would also drop your pressure to 7 to try and manage the Central events a bit better.

The truth is that a CPAP, any CPAP, and even Bi-levels without backup cannot, and will not manage any Centrals, thus the action is to try to avoid them which is why to lower your pressure.  The fact that your Obstructive events are fairly well controlled is a contributing factor in this choice.  

Charts.  Read the Organize Link in my signature.  Events (OA and Hypopnea), Snores, and Flow Limits can all lead to obstructive events, so much so that on Auto CPAPs they result in pressure increases to manage.  It will help us to help you if you would organize your future charts in this manner.  


Fred


RE: Help with settings - Sleeprider - 01-20-2019

Something strange in the flow rate chart that looks like exhale is missing. It correlates with the periods of high leak and most likely you are exhaling orally around the mask. Could you provide a zoom of about a 2-minute section of that flow rate? I think leaks are your biggest problem at this point and that a good bit of the therapy is missing the mark as a result. Beyond that a respiration rate of 7.6 is very low if not unlikely. The closeup should give us a better look at what is happening. Given the leaks, I think the AHI is meaningless.


RE: Help with settings - bonjour - 01-20-2019

Sleeprider I don't know how we keep doing this.


RE: Help with settings - Sleeprider - 01-20-2019

We have some kind of timing where we just post simultaneously. The fact we come up with the same or similar ideas might mean there is a method to our madness. Smile


RE: Help with settings - Hamish McTavish - 01-20-2019

Thank you all for your responses...
I had already ordered a soft cervical collar based on what I had read up to today. I got a Caldera Releaf coming soon. I have also 
ordered an Airtouch F20 memory foam mask to see if helps with the beard thing as shaving it off is a last resort, but I will if it comes to that, or if I can't get the leaks under control with the pillows.
As far as my low breathing rate, I have always been a slow breather and I seem to take long pauses between breaths. I talked to my doctor about my breathing rate after looking at my charts on Sleepyhead and he didn't seem too concerned. However, I am seeing a respiratory specialist in February and I will bring it up again with him.
I am attaching a 2 minute sequence from a couple of different times on my graphs and hopefully have them organized properly for you. If you need any more from just let me know. 
I will try reducing my pressure to 7 tonight and see what happens. Should I leave EPR as is?
Thanks

[attachment=9928][attachment=9929]


RE: Help with settings - Sleeprider - 01-20-2019

If your resp rate is less than 8 BPM, you will have apnea recorded. At an average cycle of 7.8 seconds per breath, you are only 2-seconds short of an apnea. The screenshot closeups you provided show extremely flow-limited inspiration and long expiration times. Do you have a COPD or other restrictive pulmonary issue you are aware of? This is not a breathing pattern I have encountered.


RE: Help with settings - Hamish McTavish - 01-20-2019

No Sleeprider, don't have any lung issues...my wife has COPD so I know what it looks like. I went to my GP the other day and he listened to my breathing/lungs and did not notice anything out of the ordinary. This may be just when I am sleeping, not sure...deviated septum and chronic sinusitis and GERD are about all I have going on besides the apnea.


RE: Help with settings - Hamish McTavish - 01-20-2019

I went back through my Sleepyhead charts and this is what I found...
When I was on the Mirage Quattro full face mask my average respiratory rate was 8.6 over 20 days.
It went down when I switched to pillows...since January 10 I have averaged 7.9