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Newly diagnosed severe CSA & OSA (AHI=108) seek advice
#81
RE: Newly diagnosed severe CSA & OSA (AHI=108) seek advice
@Brazen thanks for your comment and effectively bumping my "neglected" thread. Briefly as you asked, 2nd follow up with sleep Dr - she was very pleased with improvement in large leaks.

@Gideon thanks for your brief expert comments, and perhaps you can cut my learning curve further:
1) In other threads forum experts seem to want the 95% Flow Limit stat to be at or below 0.10, preferably 0.03 or below, BUT if I understand your comment with ASV I can mostly ignore Flow Limits? What FL type of stat or pattern/trend if any would be a concern?

2) While I mostly have substantially improved Large Leaks since beginning to address this Aug. 8th there are still nights (or sub-session within a night) with LL > 15%.
I believe I had read that Large Leaks can distort the validity of AHI and other stats, is that true? What % of large leaks should be a concern? While many consecutive nights they are <3% or even zero and while one of my goals is to keep them very low, given the vagaries of mask and my mouth taping and interactions with side sleep position and pillow (even though I am not that active in my sleep) I don't expect that I will be able to eliminate virtually all of them. At sleep dr recommendation for a while I am changing nasal cushion # 10 days for a while so that an "old and worn" cushion is not a factor in what might be leading to leaks.

3) While subjectively I am feeling a good deal better (more energy, less desire or actually taking brief afternoon nap) I still feel there might be room for improvement and health benefits. Any data category that I might monitor and look toward improving (or if already good, keeping constant)?

Separately but related I have begun to use Wellue O2 ring and while too soon to say, so far ODI seems to be OK but too much variation in my few data nights.
I am also addressing the very dry mouth that I get with CPAP and have separate thread about that as while it is aspect of my treatment side effects it does not seem related to data and possible machine setting changes that I reserve for this thread.


=======
I note that in my comment #75 point 2 above, I alerted moderators that I had inappropriately started another thread on treatment and upon reading forum guidelines to keep most everything in one thread and moved that info to this thread and suggested the other superfluous thread be deleted. As of this comment that other thread has not been deleted.

Thanks for your (or anyone else's) assistance.


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#82
RE: Newly diagnosed severe CSA & OSA (AHI=108) seek advice
(09-22-2022, 10:02 PM)Liteheart1 Wrote: I note that in my comment #75 point 2 above, I alerted moderators that I had inappropriately started another thread on treatment and upon reading forum guidelines to keep most everything in one thread and moved that info to this thread and suggested the other superfluous thread be deleted. As of this comment that other thread has not been deleted.

There were already some responses in that other thread.  I placed a note in the last post with a link back to this thread.
Jeff8356

MacBook Air (2017, Intel) | macOS Monterey (12.7) | OSCAR v1.5.1 | VM = Win10/Win11 |
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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#83
RE: Newly diagnosed severe CSA & OSA (AHI=108) seek advice
ASV works on a different principle than most other BiLevels. That is while CPAPs, APAPs, and most BiLevels work by using air pressure to prevent FUTURE obstructive events increasing pressure IAW its algorithms, ASV maintains a steady volume, ResMed Minute Volume, Phillips Tidal Volume to eliminate all events on the same breath they are occuring on. It does this by, at times, applying very high amounts of PS and stoping the event as it forms.
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#84
RE: Newly diagnosed severe CSA & OSA (AHI=108) seek advice
Thanks Gideon, this adds some info to the Wiki on ASV, but gives me no hints about what aspects of Oscar data it might be worthwhile for me to monitor. So far all that is clear to me is that with ASV some of the typical things (Flow Limit, etc.) that we are asked to post in our comment are mostly irrelevant (and perhaps also true of some of the side bar stats as well. Educating me (and the many other ASV) users about this core topic probably would teach us a bit of how to fish and reduce the requests for review.

I do understand that you and other experts have limited time and must choose your priorities. I appreciate you for your many very useful posts.
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#85
RE: Newly diagnosed severe CSA & OSA (AHI=108) seek advice
           
My update and more ?s

  1. Data: large leak stats; fairly typical low leak rate night; two large leak nights
  2. I feel increasingly good and wake up refreshed; what had been 6 months ago need to take afternoon nap several times/week is virtually absent. I continue with same original settings for ASV, using nasal pillows, and mouth taping, and consistently sleep on back (as part of my strategy to reduce air leaks) but continue to be plagued by night to night variation in large leaks - sometimes quite good numbers, sometimes horrible. Large leaks are focus of this ask for help. Data below.
  3. I am not very active in my sleep, use hose caddy (and today centered it more on my sleep position so that force from any hose movement would transfer to mask more symmetrically. I use pillow of buckwheat which allows me to create a small indentation for my head/neck interface so that any friction on back of headgear would seem to be symmetrical. I went into CPAP provider who confirmed from measurements that size of frame and pillow size (medium) are all correct and that I don't fall at the boundary of two sizes. I use the mask leak test feature. I do not have facial hair, and facial structure is not weird in some way. 
    The night to night changes seem unrelated to how new the pillows are (change at least @18 days); and recently replaced hose even though no evidence of leaks in it. Before writing this I did more checking/tweaking of mask fit, and while awake and in my standard sleeping position the data was excellent, but clearly facial muscles were not as relaxed as when sleeping. {Several months ago I tried different brands and styles of masks but return to same nasal pillows believing that since there is minimal perimeter of pillow/face contact that this might be better approach to finding what works consistently. Other masks gave consistently poorer data for leaks and AHI.}
  4. Does the shape of my large leak data suggest that there are NO mouth leaks? My taping extends beyond my lips and with mask leak test even with considerable force on my part I am not able to create a leak from mouth movement and attempting to mouth breath. If there is evidence of mouth breathing and especially if it significantly contributes to large leaks then I will again experiment with chin strap but find it and/or cervical collar a bit confining.
  5. I am not woken up by large leaks but understand that reducing them is desirable to reduce mini arousals and improve sleep quality. What might be a reasonable goal for large leaks? <7%??


    Much thanks and happy New year ...
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#86
RE: Newly diagnosed severe CSA & OSA (AHI=108) seek advice
Last of data for now.
   
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#87
RE: Newly diagnosed severe CSA & OSA (AHI=108) seek advice
In my opinion the leaks are mouth leaks. Note the taping your mouth doesn't make moth breathing impossible. If there are little wrinkles, e.g., in the tape the air surely will find its way out. You have a *very* dry mouth -- that's a strong sign for mouth leaks (together with your "spiky" leakage). Ever considered using an FFM instead using your machine as a leaf blower? Wink

I know about the dogma: "Flat leakage is mouth leakage, spiky leakage is mask leak", but that's only, well, a dogma. In my experience it's just the other way round. (Not that I'm about to propose a new dogma ...)

Mike
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#88
RE: Newly diagnosed severe CSA & OSA (AHI=108) seek advice
(01-07-2023, 05:14 AM)multicast Wrote: In my opinion the leaks are mouth leaks.  Note the taping your mouth doesn't make moth breathing impossible.  If there are little wrinkles, e.g., in the tape the air surely will find its way out.  You have a *very* dry mouth -- that's a strong sign for mouth leaks (together with your "spiky" leakage)....

Mike

Thanks Mike ... this prompted me to do a forum search and found Jan 2021 thread in which you and SevereApnea discuss Oscar data pattern and her waking intentional creating leaks and annotating Oscar data. Understanding meaning of data is new for me, but it seems that much (but not all ?) of my Flow Rate pattern is similar to your own in that thread, when it crosses the zero are quite flat - thus indicative of mouth leak. My expanded Oscar data below.

I am surpirsed that I am having mouth leaks and while I appreciate your description of the negative impact of slight wrinkles allowing for mouth leaks. Why surprised? While I previously used Somnifix in part due to expense for last 6 months have used 3M Nextcare 1" vertical dimension and with a single horizontal strip going past the edges of my mouth. I also ever so slightly push on the tape where my lips would part to adhere a portion of tape to that potential opening. No central gap in the tape. Testing with Mask Fit Test and intentionally trying to forcibly breath thru mouth for 20 seconds seems like tons of effort and no sense of air escaping or coming in. Similarly with distorting my lips and trying to mouth breath. None of that triggers mask fit test red failure face. But the proof is in the pudding and I have no idea of what I actually do in my sleep even though I typically wake up in very similar on my back position. But the data pudding sure seems to point to at least some (perhaps predominantly mouth breathing).

I usually when falling asleep do some of the Tongue/mouth trick and take as confirmation (not sure whether it is valid confirmation) that if I feel some pressure in ears that I am at least at that moment pretty well sealed up. There is no moisture on tape when I wake in the morning.

This past summer I played with FFM or Hybrid and expect I will explore that again. Because of the greater perimeter for sealing for the about a week that I played with things I ended up with horrible large leak scores.

The other mystery for me based on assumption that even with taping that I have significant mouth leaks is the huge variability with LL from night to night. My taping technique and ritual is fairly standardized, but it is certainly possible that what I think is consistent taping is from night to night is actually quite inconsistent. I only mention this, as if the taping is consistent night to night "why" does my body do lots of mouth breathing some nights and very little on other nights.

Ultimately I am pragmatic and want to improve my therapy, however having the solution be based on a reasonable hypothesis and explanation of what is going on, and why X versus Y solution might be effective seems like a preferred strategy.

And while many on the forum are data driven which I appreciate, the good news for me is that my subjective experience of feeling more refreshed after sleep during the past year is a plus. Again thanks for your input ... this forum is great and a life saver.

Mike if you do comment further please cut my learning curve by pointing to specific timing that to your eye is the flat pattern you look for as telltale of mouth leaks, thanks.

   
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