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Alwyn - Treatment Analysis
#1
Alwyn - Treatment Analysis
Hi there,  there's a lot to say and I don't know how to say it without making a mess of it,

Initial diagnosis: ~2013/14.  Had high Hematocrit and they suspected apnea.
Usage: Every night
Machine: Resmed 10 still on the original, but I bought a replacement online.  Won't rule out that original machine contributes to issues.
Apnea level: mild
Pressure: 7
EPR: 3 since 2 years ago (configured without me knowing).  I was fine without it.
Side-sleeper, or try to be.  I move a lot from one side to the other, probably because it feels as if I wake up often.
Mask type: Dreamwear with the slit. Going to use pillows on new machine.
Age: 51 male


Until this year, my events were mostly OA's and H's with CA's being infrequent.  Since this year (and the start of health issues) my CA have steadily increased and now make up the bulk of my events.  I suspect that part of it is treatment induced, but I'm concerned that it might be a sign of bigger issues.
Other concern is my median tidal volume has dropped from 440/420 to 360.

I also feel like I am awake the whole night lately.

Health issues.  About a year ago I fell on my roof and have trouble sitting for long periods (bad since I am a programmer).  Doctor now thinks pain might be to a back muscle.  Due to me sitting weirdly for a year I have pain in my rib area which sometimes make me think I'm having a heart issue, saw a cardio who thinks I have a blockage, but I'm not sure.  That issue is subject to long delays in being able to see cardiologists.

Apart from that I ended up in the hospital with sepsis near start of March.  They put me on ciprofloxacin for 2 weeks.  AHI was awesome in that 2 weeks, BUT near the end of the treatment I started getting a dry cough (not hackish) and constantly have bubbly clear mucus which sometimes is white and slimy.  So I'm wondering if I may be developing interstitial pneumonia or something, but they have been unable to hear anything with stethoscopes (probably ineffective).

So a lot of things that could affect my upper chest, but I'm concerned that my the CPAP treatment with EPR might have weakened my lungs, along with inactivity since my fall, and that I might now have some lung condition too.

Due to the events of the year I have decided to lose weight, I used to be between 230 and 240 pounds at 5'8" (male).  I have dropped down to 187 pounds now over 3-4 months (neglecting muscles though Sad).  Could be why my OA's are dropping.  Went to see a sleep doctor at Mayo (unimpressive) and they want to run a sleep study to see if I might be able to stop using CPAP.  I am not very optimistic about that since I have recently had to stop for 2 weeks and ended up with BP of 180/100.

I want to try my new machine tonight, but they set it up to be autosense 5 to 8 with EPR 3.  Does that mean that minimum pressure will be 2? I'm not so sure about these settings...

The attached 2 nights plus a report to show how the different values have changed over the last 12 months.

Please help me.


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#2
RE: Alwyn - Treatment Analysis
The machine cannot go under 4cm of pressure. if you want to use the full 3cm of epr you need a min pressure of 7.

https://ap.resmed.com/knowledge/what-is-...relief-epr

don't you want less pressure relief to try to reduce CA's? i would try epr 2 if their settings aren't working, but i would at least try their settings. once you get some data in apap mode you should be able to fine tune the pressures.
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#3
RE: Alwyn - Treatment Analysis
Indeed I do want to reduce the CA's and is open to lowering EPR.

I'm a bit worried about trying APAP for the first time with these other issues, never tried autosense.

Also thinking of turning off onramp, because its just irritating especially if you need to get up for whatever reason.
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#4
RE: Alwyn - Treatment Analysis
i would turn off ramp i doubt you still need it after a year. you must be used to it by now Smile especially with that amazing compliance.

don't worry about it, autoset is good. it will only give you the pressure you need and you can easily change back if it doesn't work for you.

can you zoom in on a 2-3 min zone of your most recent oscar graph? your flow rate seems very "spikey" could indicate recovery breaths i think? not sure but it looks quite different from mine.
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#5
RE: Alwyn - Treatment Analysis
I have attached 2 spiky ones and 1 more 'normal' one.

The first one is about 4-5 minutes before a CA.

It seems to differ from night to night also. 

Yesterday I had an issue where I lifted the trash bag into the outside trash and I didn't feel well for the rest of the day with slight pressure in my chest area, might have impacted the nights sleep a bit.


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#6
RE: Alwyn - Treatment Analysis
Looking at the 17th which was also higher AHI (for me) nights ago it looks more stable with some less frequent stability. Although I added 2 that were also not too normal.

Btw. none of the screenshots was during an event.


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#7
RE: Alwyn - Treatment Analysis
So last night I did 2 things, still on the old machine:

1) EPR from 3 to 2.
2) Changed mask from the Dreamwear with the slit to a Dreamwear pillow medium.

Good news is 0 CA's.

But more RERAs.
I seem to have trouble getting the nasal pillow to work properly.  It either sounds like it has a slight leak or it feels as if air is not flowing without obstruction.
I expected the mask arrangement to leak less when sleeping on side, but still had lots of leaks.

It also looks as if it was limiting flow more than that of the previous night.
Also median tidal volume dropped even further from 360 to 320.
My HRV was also down for the night.
There were some pulse rate spikes going from middle 60's to almost 100.

It did feel like I spent less time feeling awake and spent a little less time alternating between sides.

I haven't mentioned this before but I also suffer from dry mouth lately, so bad that my lips get stuck to my teeth/gums. My humidifier settings are on auto. It feels like I have less saliva production in general. I use saline to clear my passages, but still I do have daily mucus and dry cough.

For tonight I will keep EPR at 2, switch to the new CPAP machine with pressure ranging from 5 to 8.  But no idea what to do with mask and how to limit leaks (I am not aware that I open my mouth).

Please if someone can compare last nights data with the previous (from first post), provide advice and input on flow limits, tidal volume, etc it would be great! Also what can I do about the mask?


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#8
RE: Alwyn - Treatment Analysis
Reducing EPR seemed to have increased flow limits so you get a few more hypopneas.. not great but a lot less events overall but still quite spikey.

i believe you now need more pressure to lower the flow limits? I would try cpap @8cm or apap with 7-15 see if the algorithm can figure out the right pressure for you. this autoset algorithm is really the best feature of your machine you should at least try it!

hopefully someone more knowledgeable can look at your charts because you've been using it much longer than me!

tidal volume seems low to me but i'm no doc, hopefully more pressure will bring it back up.

dry mouth would indicate mouth leaks, common with nasal pillows/masks. might need a chin strap or mouth tape if you want to stick with it.
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#9
RE: Alwyn - Treatment Analysis
Give me screenshots of all the data from your last night of sleep and I'll throw it into ChatGPT-4o

Check my thread to see what kind of information it provides. I am playing with the prompts to ask for very detailed feedback and it seems to be working.

You can only give it 3 screenshots, a 4th one will be rejected IME. I think you can use GPT4o a couple of times per day, max (for free).
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#10
RE: Alwyn - Treatment Analysis
Agree on the spikey, was. looking back at some nights in November and the flowrates looked so much better shaped and regular back then.

Even though I've been using the machine so long I never really had an issue with my stats, so never really looked into it, until now.


I am going to try autoset, although I'll probably move up with the ranges slower since 15 feels like a lot.  Should I keep EPR at 2 or maybe go back to 3 to make it easier?

Wondering if the dry mouth isn't maybe because I seem to constantly create mucus at the moment.  I don't feel congested, but maybe it blocks the nasal passages to a degree?

The tidal volume and shapes of the flow rates bother me a bit (inconsistency and changing all the time).  

Have a sleep study with Mayo in Jacksonville FL next month, but I don't feel like the specialists assigned to me are top notch.  I'd really like to find a good pulmonologist that can look at my lung function and check if something might be wrong.  

Are there any resources on this board or otherwise that could assist me in finding somebody with good references?

@PerplexedTom I have added 2 additional screenshots to this reply.  The first screenshot is in the comment you replied to initially.


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