First time, needing advice

[00derek]

Monday night, 12/12/22
DME gave me a new mask after I complained about leakage from the Airfit F20. The new one is an Airtouch F20 which has a foam and silicone seal. I used it last night but it didn't eliminate leakage - I took the mask off after 2 hours, I also experienced some breathlessness.

I started off well and was comfortable, but eventually breathlessness and leakage stopped the show. I'm not sure if I got to sleep; are there any indicators on the chart that I did?


   

[Gideon]

Standard charts please. The Flow Rate especially. I can use mask pressure in lieu of pressure. Bu please use the standard charts unless we ask otherwise.

[JoyD.]

HOW TO ORDER THE DATA CHARTS (Standard)

The most useful charts for diagnostic purposes are:

Event Flags
Flow Rate
Pressure
Leak Rate
Flow Limit (Resmed only. Respironics includes Flow Limitation in Events)
Snore

The chart order can be set to the recommended order in OSCAR v1.1.0+ by clicking View -> Reset Graphs -> Standard.

[00derek]

Monday 12-12 in the standard order

   

[00derek]

Tuesday 12-13

I started with the mask a bit tighter in anticipation of leaks but it still leaked after 2 hours. I was awake to remove the mask but the pressure still felt high and I can see that it WAS high at the end of the chart; why is the pressure near 20 when I'm awake and breathing normally? I also had some breathlessness at that moment.

I have a mild heart arrhythmia called premature ventricular contractions (PVC); the onset is random, but one of the symptoms is breathlessness. But I also think they are triggered by the circumstances around the mask leak - I've been having palpitations at the time I have to remove the mask, more than once

   

[JoeP]

New user with full face mask here too. It took me at least three weeks to get used to the mask without feeling like I was getting smothered.
So as long as you are getting pressure from the machine, that is almost all fresh air so it might be mental that you get the impression you are re-breathing exhaled air.

At least it was in my case. I had to pretend I was either on a scuba diving trip or using an O2 mask while piloting an aircraft in order to get my mind off it so I could drift off to sleep. 

Another thing that helped was to turn off the heated hose I was using so that the air was cool coming in from the machine which made the air seem cooler and fresh and not so warm and humid. Also turned down the humidity from 4 to 2 which also made the air seem less like warm, exhaled air.

[Sleeprider]

All of your charts are filled with central apnea artifacts and breathing patterns. You need ASV. If your insurance is good, get in touch with the doctor and let him know you're aware that CPAP is not effective in treating central apnea. If your insurance sucks, ask the doctor for a copy of your test, a diagnosis of CSA and a prescription for ASV (adaptive servo ventilations) therapy. We will help you source a reasonably priced or used machine.

[mesenteria]

Tuesday 12-13

...
I have a mild heart arrhythmia called premature ventricular contractions (PVC); the onset is random, but one of the symptoms is breathlessness. But I also think they are triggered by the circumstances around the mask leak - I've been having palpitations at the time I have to remove the mask, more than once

Your heart arrhythmia is almost certainly a result of your breathing/sleeping troubles, not the cause of them.  I myself have atrial fibrillation (AF) that comes and goes, and it was eventually attributed to my own obstructive sleep apnea after all other diagnoses had failed to find a cause.

You are possibly being awakened by the sensations accompanying PVCs, but my guess is the PVCs are a side-effect of the duress in which your body resides at about the time you awaken and find you need to remove your mask.  In turn, you are having central sleep apneas in great numbers.  Simply put, your brain ignores signs that you need to exchange carbon dioxide for oxygen, and you can go many long seconds without taking a breath.  If this pattern repeats for several minutes, eventually your brain, your sympathetic nervous system (your arousal system), and your heart will begin to squawk, at which you come awake clawing at your mask....with a clumpy heart beat.

I have read sleeprider's reply to you before posting this. Please read and chew on his advice.  You do have fierce numbers of apneas, both central and obstructive.  The obstructive might only be related to your head's position, with chin tucked down close to your chest for much of the night.  If this is so, a soft foam cervical collar snuggly fit around your neck will help to control this defect in your sleep.  The rest, though, requires advanced PAP treatment that your current machine cannot deliver to you.

[00derek]

OK, this is a bit of a shock; I had never heard of ASV before. 

I am in a bit of a pickle at the moment, because the DME therapist won't return my calls for help. I called my doctor and left a VM complaining the DME is not returning calls - they left me a VM this morning which boils down to " we can't help you with the machine, call the DME". Quite infuriating actually. I think I would be very worried if I was wasn't getting advice from this board, so thank you again, very much indeed.

So due to the lack of response from my so-called health care providers, I was looking at switching to a different DME, but in the list of 26 providers near me, covered by my insurance, only 2 of them have better-than-terrible reviews on Google maps. Not scientific, but how else do you find a good one?

When starting CPAP therapy, presumably the prescribing doctor is going to follow up and see if it's working. I received the machine on 11/23. How long would a doctor typically wait to review results?

But this new opinion changes the game a bit. I already know it's not working for me, and you guys are explaining why. I guess I need to see the doctor sooner rather than later. 

One other question you could answer - how can you tell the difference between obstructive and central apnea from the charts, and what is the medical difference?

[00derek]

[quote pid='461725' dateline='1671133335']
One other question you could answer - how can you tell the difference between obstructive and central apnea from the charts, and what is the medical difference?
[/quote]

I did some reading while looking at my flow rate chart.

OA - flow falls to zero followed by recovery WITH a corresponding increase in pressure

CA - flow falls to zero followed by recovery with NO change in pressure

also it looks like recovery flow is higher after an OA than a CA

are my guesses correct?