Paula's - Therapy Thread

[paulag1955]

I almost never have positional apneas. They are an aberration. Maybe five nights since October 4th.

[paulag1955]

Charts from a couple of more typical nights.

   

   

[Gideon]

OK Paula,
set EPR=3, Fulltime

That will say a lot about if another machine will help.

[paulag1955]

I've had it set to 3 full time with a fixed pressure of 9 for the last 14 days. I haven't tried EPR 3 with a fixed pressure of 8, which is where I get my lowest AHIs. I'm attaching a summary of all of my data going back to 10/4.  This is what I've been using to make decisions regarding settings because the daily charts are random enough that you can't get a good feel for what's really happening. I apologize that the charts I posted made it confusing, but I was looking for nights with the most typical mix of CA and OA events.

   

[paulag1955]

Not all positional apneas are caused by chin tucking. 

My left hip was getting sore last night so I rolled over onto my back. Pre-CPAP I would have rolled to my right side, but I haven't been able to figure out how to manage the hose for that so that it doesn't bother me while I'm sleeping. 

Before I fell back asleep, I carefully arranged my soft, flat pillow so that my head was tilted back into a neutral position, as if I were standing. When I awoke, I was still in this carefully contrived position but, as you can see in the chart below, I still experienced the expected positional apneas. I assume this was caused by my overly long tongue relaxing back and blocking my airway.

And if anyone has any tips on managing that roll to the opposite side, now would be the time to share them.  

   

[paulag1955]

So this is unprecedented for me. I've had four night's in a row with an AHI under 2 AND flow limits at acceptable (albeit barely) levels. Nothing has changed; it's random.

Something I've noticed that has me thinking is that on night's when I use the CPAP, my Vivosmart records less fragmented sleep with more deep sleep and REM sleep than when I do use it. Not sure how accurate the Vivosmart really is.

I know I always say I feel fine, but I wonder if that's just because I don't actually remember what it's like to feel good. My husband has Stage 4 renal cell carcinoma. When we're over this hump, I'm going to try to get another sleep study as a baseline. With any luck, I'll get a different sleep doctor on a second go round.

[paulag1955]

A couple of charts with questions.

How do you interpret it when you see a grouping of events like the following?

   

Why would my flow rate suddenly drop like it did around 4:35?

   

[BoxcarPete]

First cluster looks like a position change followed by a breath hold, then some obstruction from a bad position, more tossing and turning and breath holding, then you finally got it all sorted out and started sleeping again.

Zoom in on that segment, could be mouth breathing/palatal prolapse.

[paulag1955]

It looks like this. Very uniform throughout the entire segment.

   

[BoxcarPete]

Yep, definitely expiratory mouth breathing. Palatal prolapse is a possible cause of that, where the soft palate acts as a one-way valve that lets air through the nose on inhale and directs it out the mouth on exhale. Your machine is not detecting any flow on exhale because it's not happening in the CPAP-mask circuit.