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A pressure of 4.4 could certainly be a therapeutic level. Your sleep study showed moderate apnea, but it doesn't follow that you would need moderate pressures to address it. I think the only way to tell whether the collar has adequately addressed your apnea is to have another sleep study during which you wear it for at least part of the night.
BTW, most people don't use pressures as low as 4.4 because they feel starved for air. Was that a problem for you?
And now that you are comfortable changing your settings yourself, might you consider the earlier suggestion that you turn on EPR? This is not a comfort question but a question about your very active flow limitation graph. To benefit from EPR, you'd need to have your minimum pressure at 7. Then you'd get 7 on inhale and 4 on exhale. Might be worth a try; it could make you feel more rested during the day, since FLs mean it's a lot more work for you to breathe at night.
I don't have a good understanding of flow limitations. Is this something caused by the mask or did I have it all along before cpap? I have made an appointment with my family doc to ask about getting an ENT appointment. I figure if this is going to be a life long thing, I want to make sure my nose is good (I don't snore).
Yes as a matter of fact I did feel a bit air starved with a pressure of 4.4 but I thought it was because one of my nostrils was partially plugged (one or the other often is). I did notice that a pressure of 15, kind of blew my nose clear.
I am going to go with your exact suggestion tonight ERP of 3 with max contant pressure of 7.
I will send the results.
I am wondering if anybody else has an opinion about tracking O2 saturation during the night as a way of knowing if apnea is causing a clinical/health problem.
My technololgist did not know anything about wearing a collar for positional apnea but I have read quite a bit about it on this forum. That is surprising to me.
(08-20-2019, 09:22 PM)howeyb Wrote: Thank you Dormeo,
I don't have a good understanding of flow limitations. Is this something caused by the mask or did I have it all along before cpap? Nothing to with the mask and you had it pre-CPAP. Think of it this way It's the same as apnea or hypopnea but with less restriction
I have made an appointment with my family doc to ask about getting an ENT appointment. I figure if this is going to be a life long thing, I want to make sure my nose is good (I don't snore).
Yes as a matter of fact I did feel a bit air starved with a pressure of 4.4 but I thought it was because one of my nostrils was partially plugged (one or the other often is). Most adults have a problem with this low of a pressure, I needed 10 minimium.
I did notice that a pressure of 15, kind of blew my nose clear. This just takes time, but it does work.
I am going to go with your exact suggestion tonight ERP of 3 with max contant pressure of 7. This is just what I frequwntly suggest for initial pressure
I will send the results.
I am wondering if anybody else has an opinion about tracking O2 saturation during the night as a way of knowing if apnea is causing a clinical/health problem.
A good idea if you suspect issues. Check OSCARS welcome page for the Oximetry Wizard, it has recommendations for oximeters that are compatible with OSCAR
My technololgist did not know anything about wearing a collar for positional apnea but I have read quite a bit about it on this forum. That is surprising to me. I was an ENT in my past. The concept of using a soft cervical collar to treat apnea was obsurb. in 2016 a user of this forum was desperate and tried to to stop mouth breathing. It worked. Then we noticed that it was clearing up some odd patterns of obstructive apnea and we were puzzled. It took quite a while to put all the pieces together. The only positional apnea your technologist is aware of are the basic sleeping positions, front, back, right side and left side.
Thanks again.
Gideon - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter
So with EPR at 3 I do think I slept better and felt less air deprived. I think I will stick with these settings for a while unless anybody has suggestions for improvement. Still rarely getting more than 2 hour chunks of sleep though which is been going on for years so I think it might take a while to break that. My FL were a bit lower (see attached), but not sure what is normal.
One thing I still don't understand is why pressure of 4 would make me feel o2 deprived since without cpap there is NO air being forced into me.
In a rush but thanks for your help and comments Dormeo and bonjour. I will check out the oximetry wizard. In my sleep study I went down to 84 once, so it is something I am concerned about. I think this is what does the main damage for cognition and heart no?
An update: my AHI numbers are so much better having added a cervical collar. I attached some summary data and last nights OSCAR data.
I think my flow limitations have gone down a bit since adding the EPR but my sleep is still quite fragmented with mostly 2 hour chunks. Are there any suggestions for improvement?
I am seeing the sleep technician today and I think I am going to rent for another month. I am still thinking that I would like to get my hand on an all night oximeter so I can compare using a sleep collar with and without the cpap machine.
THX
re fragmentation: without going into detail, start with 3 things. first, scroll through the last few minutes of each session for a number of nights in a 2 minute view window. look for anomalies and patterns that might explain your arousals. second, pay attention to what you are feeling and thinking when you wake and turn the machine off. write or record these things if you have trouble remembering the next day. third, bone up on sleep hygiene practices.
personally I think many / most cases of fragmentation are caused by identifiable factors like flow limitations and in my case periodic limb movements. however, some suspect fragmentation may be due to 'conditioning' if our bodies/minds are used to awakening from apnea. cognitive behavioral therapy seems to be the common recommendation.
Thanks, I am going to figure out how to record a few quick comments when I wake up. I also suspect I have been conditioned to get up to go to the bathroom. I still go but I don't think I HAVE to. I'll have a closer look at my data too. I just got back from vacation so I will work on getting back to a regular sleep schedule and good sleep hygiene. I know what I have to do.
Do flow limitations affect your blood oxygen levels or are they too minor? I think I read somewhere on this forum that they don't.
I suppose super severe flow limitations can lead to some drop in O2 but IDK the answer. however, common sense suggests flow limitations would be much less likely than full apnea to cause desat. they do cause arousals though and we know those can set us back.
Hi all: update - 50 days of CPAP - overview graphs attached.
After reporting to my technician my experimenting with the collar and pressures (collar pretty well eliminated my OAs as of Aug12 - thx forum), she wanted to titrate me again and now I am now on constant pressure of 12 EPR 3. We are trying to get my flow limitations down which we believe are fragmenting my sleep.
There are all kinds of things I am wondering. Am I now dealing with residual UARS. My sleep is still fragmented although it is getting better since I am forcing myself to stay up until midnight and get up at 7 so I am tired at night and fall asleep quickly (sleep doc recommendation; I will gradually go to bed 15 minutes earlier every week until I am getting 8 hours sleep or can still fall asleep easy). I am getting more 3 hr chunks which is good for me (norm is 2 hr).
I have a lot of the indicators for UARS. My dentist says I grind my teeth. The sleep doc says my jaw/mouth physiology makes me a candidate for sleep disordered breathing. I have a bit of an overbite and you can't see my uvula at all when I stick out my tongue. I am not overweight and don't have many of the drastic symptoms that many others have such as needing to nap, falling asleep in the car etc. My main complaint was having to get up every 2 hours to go to the bathroom and fatigue on exertion (like stairs and walking uphill). After ruling out all kinds of other things (thyroid, anemia,kidney), my family doc suggested sending me to a sleep clinic where, with a take home test, I was diagnosed with moderate OSA - AHI 22 (more details on my firsts post) - much to my surprise I might add!
Has anybody read this recent paper in the Lancet (e-version) by Dr. Krakow et al. I think it would be of interest to many people here. Research Paper Aug. 2019 - Prospective Randomized Controlled Trial on the Ef[font=AdvTT5235d5a9+fb]fi[/font]cacy of Continuous Positive Airway Pressure and Adaptive Servo-Ventilation in the Treatment of Chronic Complex Insomnia Barry Krakowa,b,[font=AdvTT5235d5a9+20]⁎[/font], Natalia D. McIver a,b, Victor A. Ulibarri a,b, Jessica Krakow a,b, Ronald M. Schrader c
Anyways, I guess I am wondering if I will eventually need to go to a bilevel or ASV since with my settings now, I am getting almost only CAs (which the tech said aren't really CAs...is this true??...they seem to occur in the middle of my sessions in my deepest sleep I assume).
The summary graphs tell my journey. The flow limitations have gone down a bit since I was re-titrated but is that worth the CAs?? How long do you wait assuming the CAs might disappear over time?
I also decided to post my respiration graphs for the first time. Can somebody have a boo and assure me there is nothing too drastic happening? Are my tidal volumes ok (I weigh 150 Lbs and am 5'6)?
I also, in the last week, started using a nasal steroid spray since one or the other of my nostrils is often partially or fully blocked. That seems to help. I think I am mostly nose breathing at night but I also have some gas and bloating so I am mouth breathing sometime too.
I decided to rent for another month but have to make a decision about a machine by the end of the month or shell out another $200.
Thanks for your input and let me know if you need to see any close-ups. I added the last attachment in the next post.
