Pokey49 - Therapy Thread

[Pokey49]

Sounds logical to me Dave. This  
Is the doctor who refused to order/do a home study but then after I went and did  a home study on my own said she could work with the results. I figured she didn’t want to do a home study because not as much $$$ in it for her.

[super7pilot]

Truth be told, Home studies are fine to do a simple OSA or no OSA. But it lacks the ability to deal with the details of what sleep stage you were in at what time and for how long. What sleep stage elicited more apnea events and more critically. Ruling out true Central apneas.

I would defer to a sleep lab every time. But then with all my military years, truck driving and traveling to over 20 countries. I can lay my head down and sleep anywhere.

[Pokey49]

You are a lucky guy Super Pilot. I’m a very fussy/anxious sleeper. I would have never made it in the military. Had a high lottery # in 1971 anyway……. I’ve had 4 in lab studies. 2 were normal.    But I could only sleep because they gave me Ambien. The other 2 studies I had no sleep med help and I was awake most of the night and got no useful data. As for knowing what stage of sleep you have apneas I don’t understand what difference that makes, the treatment is the sameAP

[ejbpesca]

Some take their computer to their doctor (if laptop) or print out some OSCAR reports.  I will next time to show I qualify for a BiLevel machine due to flow limitations.  May as well go for a better machine than the APAP.

You are not alone in being overwhelmed with the terms and manipulation of OSCAR.  It has taken me two years to find my way to better therapy by learning to use and read OSCAR, making adjustments, and experimenting to find what works.  In my first 16 years of PAP, I had no adjustment or help at all.

Advice here often leads to more questions.  I often have had to ask questions about an answer only to get a reply I do not understand but with time the frustration has gone down and my learning has gone up.   You are moving there quickly.

OSCAR can be sooo frustrating as clicking here and there changes the screen and you can't get back to where you were.  If that happens you can click to close it and then reopen it to get it back to start.

I hope you now can click just to the left of the numbers on the left side of the Flow Rate graph to adjust it.  This will make it more clear to view and allow you to zoom in on individual breath wave shapes.  If not.  Please reply.  Here's how I do it:

To adjust what part of the whole night/sleep session is viewed I have found it easiest to use the arrow keys.  I click and drag over a portion of the Event Flag graph or the Flow Rate graph, about an inch or so.  I then use the up and down arrow keys to change how narrow or wide the selected area is.  I use the left/right arrow keys to move the selected area across the graph. 

1. Adjust the Y axis on the Flow Rate graph. (double click between the Flow Rate label and the numbers to the right of the Flow Rate label) 
2. Click and drag on the Flow Rate graph to select a bit of it.
3. Use the Up arrow key to narrow the selected area which also is zooming in.
4. Use the Left and Right arrow keys to move the selected area on Flow Rate graph.

This above is one way to explore around zoom in on the Flow Rate or any graph on OSCAR.  Press and hold the Down arrow key and the entire night's graph will quickly appear as it zooms back out.  This works well if the Y axis has been adjusted by double-clicking on the left side of the Flow Rate graph.

By holding down the left or right arrow keys you can see your breathing like a movie playing with various wave shapes giving information on how well you are breathing.  

1. Flat top ones indicate Flow Limitations. (I get a lot of those) 
2. Round-top ones are smooth breathing.  
3. Tiny jagged ones may be Hs, (hypopneas).
4. No wave areas, a flat line, can be marked by an OA or CA, and indicates no breathing at all. 

The machine does not perfectly detect events.  There will be missed events and false flagged events.

Hopefully, as you adjust and adapt to the machine your breathing will be smooth waves you see by zooming in on the Flow Rate graph of OSCAR, but perfection will most likely not be accomplished.  A small amount of CAs, Hs, OAs, are part of normal breathing while asleep.  I go for an AHI of <1.00 but do not consistently get it.  Some are happy with <3.00 or even <5.00 which is the common goal of PAP therapy, but for many not good enough so fine-tuning of pressures and other actions are taken to get AHI and Flow Limitations down.

[Pokey49]

Tried my 2nd night on a P10. Didn’t go well. I kept having pain on the inside of my left nostril. It apppears I have discovered for the first time that I have a slightly deviated septum. No doctor has ever mentioned this. The cartilage is somewhat more prominently extended out into the nasal canal on the left side which causes the left pillow pressure to be more pronounced there. After a while it just plain hurts which is not conducive to sleep. This deviation is likely why I mouth breath and feel starved for air when I can’t breathe will my mouth. So I think I’m back to either an F30, F40 or N30i. Other recommendations????
I see my sleep medicine/neurologist today and will she if she has any wisdom to offer.

[jdougc]

Did you use lanolin to protect the nostril?
Hope things go well with your sleep medicine/neurologist.

[ejbpesca]

Pokey,

I woke today with a terrible AHI of 8.30 (at times AHI 65) yet feel not too shabby.  Upon waking I left my F40 on for a while and thought, "Why does Pokey feel the sensation of not getting enough air with this headgear and mask cushion?" I came up with:

1. The sensation of something covering your nose and mouth tells the mind air is being blocked.
2. Nose/nostrils not aligned with air holes in nose cradle.
3. My EPR is off so there is air forcing against exhaling.
4. The headgear gives the sensation of being held, gripped by something over and around your face and head.



Have you tried putting on the F40 or other mask and sitting awake for a while watching TV or reading etc?  Get your mind off the mask.  Then after 20 minutes or so, if all is well give thought to, "I'm breathing just fine."

Do that enough and the mind/body may accept the mask to stop the not getting air feeling.  I had to pretend my life depended on the mask to breathe.  Doing that each night for several nights got me to the point where I stopped yanking the headgear off while I was asleep.

I get the feeling I breathe better with the mask on because I do.  The filter in the machine keeps allergens from my sinuses so they don't swell shut. It also inflates my nose to keep it open, not collapsing when I take a rapid breath, especially on the left side where my septum deviates.

Maybe seeing your breathing in action will help to let you know you are getting enough air.  

Look at your OSCAR with the instructions I gave and you will see your breathing.  You can animate breathing on the Flow Rate graph by clicking the Y axis in dynamic mode, selecting (click hold and swipe) a bit of the Flow Rate, use the up arrow to narrow it down to 1-3 minutes, left or right arrow held down to scan over the Flow Rate graph and see an animation of each breath during your sleep.  The start/stop time you slept is at the bottom.

If the line on the graph flattens out that indicates no breathing or very shallow breathing and that is what happened to me last night for a couple of hours out of 6.  I was not getting air but didn't wake from it.  It was not the mask's fault, nor the AS 10, I was having OAs, Hs, and one after another for periods of AHI 65.  That is severe sleep apnea.

Pressure maxed to the top of the graph.
Flow Limitations graph during the two rounds of AHI 65 went to the top.  I was not breathing so of course the Flow of Air was limited.
Large Leak graph shows no Large Leak issue. 
The snore graph was blank.

That's what I found on my OSCAR this morning.  I hope yours looks much better.  I get these hour-long clusters once in a while, sometimes for a few days before I get back to <5 AHI.

You are doing well except for finding a mask you will tolerate.  F20 jet pilot type is an option.  Some like it because nothing is touching under the nose.  There is a true full-face type that actually covers the entire face.  It is almost round.  It touches around the face up to the forehead.  I cannot remember its name and it is hiding from me on the net right now.

I guess you have tried the pillow nasal mask.  Some find it less irritating, some find it more irritating.

Whichever you try next please try to give time to get used to it.

[super7pilot]

Maybe try the N20. Which looks like a fighter pilots full face. But is reduced to only covering the nose. I have one coming to try out.

When i first used the P10 my nose was sore as heck. You don’t need to cinch it down tightly, which is what i was doing. Too tight and my nostrils hadn’t toughened up yet. And that equals pain.

As you say you are a super fussy sleeper. Could it be that perhaps some of this is from a negative feedback loop in your sub-conscience?

Confession, i start therapy in a couple of weeks because i’m not dealing well with getting older. And i go through periods of deep depression and just wanting to stop my meds and cpap and let nature take its course and die. Yet i can plainly see when i go to the VA there are a lot of guys doing much worse than i am.

[SarcasticDave94]

Search over the face CPAP mask. There's a Philips Respironics FitLife that extends to the forehead to chin. See image. That's what you were referring I think, ejbpesca.

   

[Pokey49]

I saw my sleep medicine/neurology MD this morning. She was able to sign in to my machine and she made some changes with explanations for which I can’t regurgitate. She changed my pressures to 9-20 EPR 3. I came home and took a catnap this afternoon and at first I still had that “air starved” feeling but I relaxed and eventually my breathing started to feel “normal” 
I was wearing a P10. Yes it hurts my nose and I used lanolin. More of pressure pain than irritation. When I got it Monday I got ghe medium pillow and that’s what hurt last night. So I picked up a small today. Think I should have got a large so the pillows sit a little further out on the outside oc the nostril thinking the less contact of the pillow in the inside of the nostril the less likelihood of it irritating the interior if the nose but I might be all wet. I hope I can make the p10 work as it seems pretty leak proof to me. Although my doctor this morning said don’t worry so much about the leaks. As I told her it’s when they wake me up is when they are problematic and then can’t get them to stop.