Josephina - Therapy Assistance

[jdougc]

Josephina,
Sorry to hear that you are still sleepy. 
I don't think you are "micro-managing" your events, you do not have many events, but you are tired.
Being tired might be the result of all the time you had untreated apnea and it does take time to recover and feel rested

Your obstructive apnea events are well controlled. Try lowering the maximum pressure to 10.0 cm. Reducing the pressure swings may help with getting you a more restful night.
Your early flow limitations drove your pressure high and may have contributed to your 1st few CAs.

The middle chart shows flatten breaths that are flow limitations, not scored. Then a gasp and a short breath hold and then 2 larger breaths and a clear airway event. CAs don't have a pressure bump so it was marked ok, but it was after an arousal so a sleep tech might say don't count it then. I would have look a little more back in time to see what was happening before 23:57:00.

The last chart might not be an arousal as you went back right away into the same breathing pattern. Though the squiggles are indicative a slight snoring vibrations. Those are Class 6 flow limitations, with vibrations

Your Flow Limitations are not being treated even though EPR is set to 3.  Keep an eye on them, by scrolling around the Flow rate chart. 
You have both the flatten tops and the class 6 Flow Limitations.
If they still look like this in a few days and your obstructive apnea events are still ok, you could try raising both your minimum and maximum pressures. You might have a few more CAs until your body gets used to this new pressure range.
Sleep well and i hope you get rest

On a final thought, scroll around the Flow rate chart and look at the many,many larger breaths that you take, see what is happening before and see if you go back to the normal breathing pattern. Post a few of them and see if they lessen in the future

[Josephina]

Hi there!

a few nights later and last night very different of those before, with a large cluster of CA's preceded by what seem to be leaks, at least one of which was a large leak.
           

I understand I must react by a large breathing/arousal without awakening and then go on to a CA (hypocapnia induced?). Not all leaks went into CA's even if most leak events were associated by a change in flow rate. How does Oscar analyse the bias created by leaks, in other words, those disordered breathings are real? And hence my questions with the leaks, are those changes in flow rate seen the real changes of are the artefacts induced by the leaks?

I went through the videos you posted in another thread (the beginning of mugen4's last one) and understand those CA's would not be counted as such by a sleep tech because they occured just after another event (turning? Mask adjusting? sighing?) and reflect simply the body's response to that change. So I might not be very concerned by them. The tech also said something about mask leaks or mouth openings, I understood spikes are more mouth openings but last night leaks are neither long stable leaks nor spikes... so no idea of what to make out of them.

I have to look at how to adjust to daylight saving settings, my oscar readings do not take this into account.

My partner noticed I have been making a lot of noise last night, I was quite tired. My new collar will arrive soon, and I thought of getting through some exercise for the soft palate and tongue muscles, I think it never can make things worse.


Thanks anyway of helping me my way through all those data which tell something and which I need to learn how to read (making a transfer for me talking to new parents of how they have to learn to read their newborns  )

[jdougc]

The large leaks were probably when you chin dropped and your were mouth breathing. 
It is impossible to control our chin and mouth as we fall asleep. 
The CPAP machines can not compensate for these large leaks and your therapy is compromised.
The soft cervical collar may help.
A soft thin pliable device that fit in the mouth may help also, SomnoSeal. 
I use it and still use a 2x 5 strip of mouth tape. Except for last night, my leaks have been minimal.
[attachment=77681]

[Josephina]

Thanks for the insights!

I might have badly put the collar for the last post, last night I put it tight enough (2 fingers between) and I just discovered how that looked like...
   

I had a few events which were not even scored... smooth night of sleep!
   

I've  looked at the somnoseal, interesting but I do not find it here in Europe. I'll see how things evolve before actually ordering it (and have lots of taxes to pay...)


Sleep well all of you!

[jdougc]

A "smooth night of sleep!", that is awesome.
If you have similar experiences, well rested,  after a few nights, consider lowering your maximum to just above your 95% pressure .

When you zoom in, try a 3 minute window for more detail.

Great work.

[Josephina]

thanks for your help!

Here is a 3 minute view of smooth few things happening...


   

some small things happening. I will lower the max pressure a little if I see things stay this smooth. 

Is this the process which is called titration?

Thanks for your quick responses!

[jdougc]

See the details of the breaths, a very slight flattening of some of tops and some fairly slight vibrations, hard to see unless you  zoom in this much.  Also the class 6 flow limitations. Nothing scored.
I will let others, more experienced mention titration.