Pokey49 - Therapy Thread

[jdougc]

Sorry you had a rough night.

Disregard the junk breathing as you woke up and were failing back to sleep around 2 am.

You got slammed by CAs after the REM or deep sleep around 3:40 am. Must have been a good dream. Even some marked flow limits. I bet it looks worse if you zoom in.

You can zoom in around the CAs and see if you had large breaths or any else going on.
Post 3 minute zooms if you get a chance.

Your flow limits keep bumping your pressure up, causing leaks and who know what else.
You might want to try as a test, setting the minimum and maximum very tight and see how you do for a few nights.
Minimum 11.0 cm and Maximum 11.4 cm. see how you feel. 
Might take a night or two to have the anxiety settle down.

[Pokey49]

When I have the CAs the flow waves are ragged & asymmetrical. Something is going on then, no idea what. It does seem the nights I get by with few to no CAs I wake up feeling much better than the nights I have a couple clusters of them. They seem to occur early in the night and at the end. 

I’ll have to look closer at my AS11  but Ive not seen where I can set my pressures to anything other than whole numbers.

[Pokey49]

Here is a zoom of the period I was having all those CAs. As you can see the flows are ragged and the pressure is elevated to 13+. Does this mean I was waking up? why does waking up cause your flows and pressures to go haywire? Could these CAs be due to nasal congestion and not getting enough O2 on board, or it being a CO2 imbalance? It seems its a bit impossible to get things dialed in so one can have a consistent therapeutic result??  Parameters change from night to night. One night is great and you wake up feeling rested, the next night is lousy and you wake up feeling like warmed over dog poop. Ive got 2 friends on CPAP and they seem hunky dory all the time. Its maddening. 

I did figure out how to set decimal pressures on my AS11. But I have a question. Wont there be times you need a higher pressure to prevent an apnea? Isnt there a trade off for setting ones pressure limit so tight?

[ejbpesca]

Something for Pokey to consider:

I am writing this to suggest that if you must go full face, the nasal mask that covers your mouth is an option you may find tolerable if covered with a liner.  It is a welcome thing each time I install a liner.  I seem to breathe easier with one on.  I will seek one out that is easier to install and feels even better than the Silent Night.

Last night I put a Silent Night liner on my F40.  It was time.  By day 10 (Apr. 10) the cushion begins to leak, I strap it on tighter and the discomfort rises.  By day 16 I apply a liner to it enabling me to loosen the straps.  The leaks are still there but due to the liner, I don't feel them blow to my eyes. May 1 I will install a new cushion to the headgear and repeat the process. 

The Silent Night liners are ridiculously difficult for me to install on my F40.  The adhesive does not stick well to silicone and barely to hard plastic.  The liner lies loose on the cushion but manages to stay in place when taking the mask on and off.

With a liner installed the F40 has a very different feel to it that maybe Pokey may find tolerable.

[ejbpesca]

I am glad you found your decimal values for pressures.  I am sorry you are not feeling well after a night of therapy.  I can empathize with that.  I am into year 19 with PAP therapy and only feel well a few mornings here and there.  For me, lack of quality sleep comes from several sources not just sleep apnea.  You may want to consider what factors may affect your sleep besides apnea.

PAP therapy itself disturbs my sleep.  I have never adapted well to masks, headgear,  the tube, and air blowing into my mouth and nose.  That alone keeps me from decent sleep. The reason I continue the discomfort is because my AHI goes as high as 70.00 for over an hour without PAP.  Even though I feel bad much of the time, with PAP I don't feel as though I will pass out during waking hours from lack of oxygen and quality sleep.  Not all of us can expect to feel "hunky dory," consistently due to PAP therapy.  It can take time..lots of time... to find your best settings but then things can change and new settings may be needed again.  

APAP settings allow pressure to rise as needed.  Some feel a steady pressure (CPAP mode) is a better therapy.  You will have to decide which works best for you.  Your OSCAR reports can guide you.

Since CAs are triggered by the brain not an obstruction, they are a mystery.  You may hear again that when beginning PAP therapy they can occur and then slowly reduce.  I cannot tell you how long the waiting period is for them to stop emerging from beginning therapy.  I feel a cluster of them at the beginning of a sleep session is a sign of "therapy emergent," CAs.

It may help to review your thread.  Go back and read the questions asked and answered.  Review your OSCAR reports.  Look for a trend or lack of one.  

I hope you find better results in the way you feel from therapy but that may take a lot of time to get there.  I read of plenty of others who are experienced with PAP who have good and bad nights, even pro polysonographers.  You may find PAP settles into a consistently effective routine but that is not the case with everyone.

[jdougc]

Pokey,
It might be time to try the Bleep eclipse.
It takes some skill to get the bandage doohickey around the nostrils, but if you get it, it is way better than the P10. 
If I had a hose hanger in my temporary bedroom i would be using the Bleep Eclipse

I like that nasal type masks put the air right at your nostrils, unlike the full face masks that I used for over 4 years.
I won't go back to a full face mask and the leaks unless something changes.

I watched a youtube video that said change the settings from pillows to full face mask, it made the air come very gently to my nose.

Since I have move to a bilevel machine with better pressure support than EPR, the machine has not been my issue at all. It is like I am on EPR of 4.2 with rapid recovery after exhalation, unlike ResMed's EPR issue. My breathing shapes are many times better, but still with the occasional weird flow limitation.

I got a cheap lightly used one on faceBook Marketplace.

I don't think I have the nose issues that you are dealing with, but I think the pillow type mask are better at overcoming them, IMO.
I have my first visit soon with my ENT to look at my airways
I hope you get some good rest.

[super7pilot]

Your Minute Ventilation (liters of air moved in 60 seconds) is 8.5 to 18. (4 to 6 is normal) Your Tidal Volume  of 520 is also "just a bit" above the average males of 500 . It went up to 1320. Of course PAP treatment can cause an up tick in TV from forced air induction.

For comparison, On my chart last night. my Min Vent was 6-10.3, Tidal vol was 400-980, Resp rate 14-21 & FL's .02-.13. I had one OA ans 4 CA's last night.

When I read up on this this morning. High tidal vol and high minute ventilation points to anxiety related hyperventilation. There was only one illnesses (diabetic related ketoacidosis) as a "medical" connection to hyperventilation. Based on the things you have told me and the group. I say it's more related to the anxiety side. 

Here is a link to what I found. high tidal volumes

Other than those CA's. Your OA's and H's are being controlled.

[Pokey49]

Oscar report for last night 4/17/25. This was the first night I used the Phillips Respironics gel pillow mask. Its much more comfy than the P10. Leak rate appears modest. My AHI remains mostly comprised of CAs towards the end of therapy it appears. I assume when I am starting to wake up. I woke up about 5am, felt like I had a nights worth and took my mask off, and fell back asleep which is atypical.  I have also included the bottom 1/2 of the Oscar report which shows tidal volume etc which I don't know what to make of all those other graphs. Time will tell if I have finally found my mask preference

As I recall  it was either you EJ or JDoug in a recent post that was going to try a large pillow for a P10 because the medium was hurting your nose. That was the case with me is why I tried this Phillips pillow mask. Maybe its an option for you. It is much more comfy. I still have to tape my mouth but I have ordered Somnoseal to see if that comfortably replaces the kinesiology tape which I am not a fan of. Im hoping I can use that without a chin strap as well. The less stuff the better

[ejbpesca]

Super 7,

Thank you for the Minute Vent and Tidal Volume information.  I have not pursued that area of OSCAR but will now. ejb

[SarcasticDave94]

I would think the respiration rate might be a bit higher than normal, but possibly not pertaining your median rate. The anxiety aspect sounds like something you've got to look into.

My respiration rate is borderline extra slow, with my COPD that's expected. I think mine would be around 8 to 10 on RR.