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There it is again. 1st hour of problem therapy then smooth from there. Pull out that 1st hour and boom...good therapy of exceedingly low AHI. If it were OAs it would probably be called out as positional apneas. Why the CAs are there is a mystery to me. A look at the individual breaths as waveforms can help clarify if any of the CAs are bogus flagged events.
I gave up on heating the hose and humidity. When I used it I adjusted heat/humidity until I liked the temperature and no rain out was occurring. Factors of temperature and humidity of the room and personal preference guide manual settings. I have not tried automatic settings.
I only give suggestions from experience as a fellow CPAP user, not professional advice.
The wave forms at the end of the nights use was ragged when the CAs were occurring. I had big leaks at the beginning of the night, perhaps causing CAs??. Is that what you guys call sleep/wake junk??
It could very well be sleep-wake junk and now you mention it...I vote yes it is. And, with that being the case then a very good night of therapy occurred and AHI is actually <1.00.
I only give suggestions from experience as a fellow CPAP user, not professional advice.
04-12-2025, 11:41 AM (This post was last modified: 04-12-2025, 11:42 AM by super7pilot. Edited 1 time in total.)
RE: Pokey49 - Therapy Thread
Yes! sleep wake junk. SWJ can happen anytime one is aroused from sleep. But like a lot of things with pap therapy, it can differ from person to person.
I had EPR2 on Thursday night and I had 5 CA's, 2 of which were SWJ. But also had 3 Hypopnea's and zero OA's.
Last night I used the same pressures but EPR3 and I had 13 CA's.
8 of them were from SWJ and 5 from deep breathing just before the CA. zero Hypopnea's or OA's. So it's certainly a trade off. But as I understand it, CA's from low Co2 via deep breathing are not/less harmful than H's or OA's are.
So, the experiment for tonight is to raise my minimum pressure by 1cm and use EPR3 and see what that does. As I'm happy with my numbers. This is just a bit of experimentation to keep the H's at zero and limit the CA's.
I’m not clear on your statement about CAs from low CO2. They are more harmful or less harmful than Os & Hs ?? And what would cause your CO2 to drop and when you refer to a drop in CO2 are you referring to an internal level or that which you expel upon exhalation? I’m not trying trying to nitpick. Just trying to understand.
04-12-2025, 12:41 PM (This post was last modified: 04-12-2025, 12:54 PM by super7pilot. Edited 2 times in total.)
RE: Pokey49 - Therapy Thread
When we are sleeping. Our breathing is controlled by the brain. The brain uses a detector network in our blood stream to determine when to breathe. These detectors measure blood ph and Co2 levels. The whole idea of breathing is to off gas deadly Co2 in exchange for Oxygen. But we have a safe range of Co2 we can tolerate. If we are at rest and Co2 is at a minimal level. We breathe slower. If while we are sleeping we start to breathe deeply or rapidly (hyperventilate) We change the blood ph and Co2 levels enough that the brain says. Dude, You got rid of way too much Co2. You can take a break in breathing to raise those Co2 levels to the proper range. That is when you have a low Co2 Clear Airway event.
The other scenario is when we start to wake up. The brain then shift gears to awake breathing mode. This mode allows us to have some control over our automatic breathing. Like taking big breath(s) and then holding our breath while swimming under water. So, SWJ is just the brain not handing over control cleanly.
Have you ever been sleeping so soundly that when you were suddenly awakened, you had no idea of where you were or what time it was? That is just like sleep wake junk from a bad hand off of the breathing control system.
Then there is a third and most troublesome scenario. And that is a true Central Sleep Apnea. Which is where the brain just pulls the power cord and doesn't send an electric signal to one's diaphragm.
And all this is why I'm not a fan at all of a home sleep study that doesn't have an EEG involved to differentiate between a Central and Clear Airway event. I had 2 true centrals in my study. Which is clinically a non-issue and are/can be attributed to a glitch (just like SWJ) We aren't perfect machines and can be very buggy at times..
Here's my OSCAR report for last night. I read it as a pretty good report. I have not figured out how to change the time scale. It says I started therapy about 9pm. It was actually 10pm. I felt OK upon awakening, not great, just ok. I note my pressure spiked at the end of the therapy session about 3:45. I contribute that to nasal congestion and the reason I woke up. I couldn't breathe through my right nostril and felt somewhat SOB. I guess one option is to go back to an F40 or F30i to allow me to mouth breath when congested, but I have so much trouble with them leaking and blowing into my face and waking me up. The P10 is much less leak prone and when it does the air blows out sideways, not in my face and does not wake me up. Also I've been trying to figure out how best to set "climate control" and "Temp" on AS11 to see if that will help with preventing congestion. I don't detect any rain out in my airline. Last night I set the temp to 76 and climate control to auto. Didn't prevent the congestion. Any further suggestions?
There is a time adjustment by clicking OSCAR Preferences > CPAP. Mine adjusted to the clock of my operating system without the need for further adjustments.
I find it interesting that your red line of pressure does not move except for the first 10 minutes and at the end of the sleep session. For that time PAP therapy either works extremely well for you or you did not experience sleep apneas.
That is not much of a "spike," at the end. Just a tad up ≈1cm? Maybe due to a breif Flow Limitation since there is no Event Flag. A spike to me is when 11 shoots to 17-19. If it goes from 11 to 12 that is barely noticeable and not a spike, just a little bump up.
I at times cannot breathe through my nose, and sometimes only one nostril. I must open it up with Azelatine or Oxymetozoline. I have chronic severe allergies to everything in the air in my location where something is blooming year round. If I lie on my right side my right nostril seals up. The left side does not. At present, I am taking Diphenhydramine to help with the onslaught of spring allergens here in the Deep South.
I only have a full-face hybrid mask because I mouth breath at times. If it were not for that I would have been set up with a nasal mask. My nasal passages were clear on the nights I had sleep studies and the day of the nap study. I don't think occasional nasal congestion constitutes getting a full face mask but you may find one useful if you can get leaks under control.
I have to tighten the straps very tight with my full-face hybrid mask to get it to seal and not leak onto my face/eyes at my pressure levels of past 14cm. That's why I was glad to get the F40. The F20 was digging into the top of my nose...painful.
Your therapy is amazingly good. Hope you begin to adapt to a mask soon. It took me several months.
I only give suggestions from experience as a fellow CPAP user, not professional advice.
EJ & SUPER PILOT. I’ve been awol a couple days from here as well as cpap. I need to get back on track.
I have a question about masks & leaks however.
I’ve tried 4 different masks thus far: N30i, F30i, F40 and P10. So far the most tolerable with good results has been the P10. However in using it I have been using a chin strap and mouth tape given I am a mouth breather often. I tolerate the chin strap fine but not so much the mouth tape. I wake up feeling claustrophobic with it and end up taking it off.
What if I didn’t use the tape, only the chin strap and end up mouth breathing at times in my sleep. Leaks appear to be inevitable with all masks??? So why worry about occasionally mouth breathing???
I tried the F30i again the other night and it didn’t go well. I don’t think I’d fair any better with the F40. Both leak and blow in my face waking me up.
I have a Philips Respironics Nuance gel pillow mask coming which I think will be an improvement over the P10 for comfort to my schnoz and hopefully more stable on my face with less leak issues.
Any thoughts will be appreciated. Thanks
Pokey
Give that a try, if you can't make use of mouth tape, then go without it.
Make sure that the chin strap only sits under your chin and pulls straight up and not back at all.
There is a somnoseal device to consider. SomnoSeal is a soft, flexible mouthpiece that prevents mouth breathing and dry mouth during sleep. Mouth breathing through the night can be bad for your teeth if your mouth gets that dry.
