kayakdannj - Therapy Thread

[kayakdannj]

First night was ok, got sleep and everything went well. Felt ok, refreshed but still blah.

Last night however, was great. I feel awesome today. Here is my Oscar report, let me know what you think. I did wake up a couple of times cause the mask was pushing off my face.

For reference, my sleep study showed an 18.3. AHI, first night was 0.7 and last night was 1.9. I usually wake up several times a night sweating and heart racing. Past two nights I have not and my heart rate on my apple watch is showing a huge improvement as well.

Originally it was set up for 4-20cm and for last night an changed it to 7-13cm.

[DaveSkvn]

Hi Kayakdannj,

Great to hear that you've got off to such a good start!

A few points:

• The pressure is going up and down a lot meaning the machine is detecting lots of events that it needs to react to. Its worthwhile considering raising your 'min' pressure further so that the events are inherently handled rather than you having to wait for the machine to detect them and react to them. Looking at the graph, a pressure of 9 or 10 would seem a good baseline. 
  
• You touched 13 a couple of times. If you don't up the max pressure (by one or two) the machine has no headroom to react further. (In time you'll probably find a pressure where air is pumped into the stomach ("aerophagia"). Set the max below that pressure - whatever it is.)
  
• You seem to have EPR set to 1. When you have a higher base pressure you can consider upping that to 2 or 3. It reduces the pressure as you breathe out and is good for dealing with the "flow limitations" (kind of mini apnea/hypopneas) which you still have quite a number of.
  
• You seem to have mask leak issues a couple of times. As you get used to it in the next few days you should probably tighten the mask straps but its worth getting used to the mask/machine before focusing on that one. The one at 0230 may well have woken you up.
  

Good luck with night 3.

[kayakdannj]

Thank you, I made some minor adjustments and I'll see if those help. 

You are correct about the leak waking me up. I checked my watch and I woke up at the same time for 10 minutes. I think I moved onto my back and the air was blowing out on my exhale from below my mouth.

[DaveSkvn]

After many years on CPAP I've only just discovered Oscar. This may be a bit advanced for night 3 but your trace about 0230 reminded me a bit of my trace last night.

If you see the blue lines (apnea / hypopnea) close together that is possibly/probably "positional apnea". That is apnea that occurs in one position - normally on your back with the head facing the ceiling. It seems from reading the posts on here that positional apnea does NOT respond well to pressure changes. That is you won't get rid the issue by increasing the pressure. This is a bit of an issue with a Auto CPAP. When you roll onto your back, and you have positional apnea, the pressure ramps up to the max and you either get woken up by the Apnea or the gale being blown up your nose (or your mask gets "blown off"). The solution suggested seems to be using a soft surgical collar to keep the chin/jaw up - You can read about that elsewhere on the forum.

Here is my trace from last night. I've been videoing myself sleep with an infrared webcam and the only times I was on my back with face up were: 22:56-23:15, 0054-0057, 04:09-04:31.

   

And look where the blue lines were. That accounts for most of my apneas and, if the positional theory is correct, won't be resolved by increasing pressure. I ordered a surgical collar off ebay and it arrived this morning. Wish me luck.

If, as things settle down, you find yourself being woken up at times with high pressure where Oscar has a cluster of blue lines, consider if you may have positional apnea and need to address it differently.

[kayakdannj]

What adjustments would you recommend? I am thinking to bump the max pressure to 15 since I topped out at 14 last night. Here are the past two nights at my current settings.

[Deborah K.]

I think you should raise your pressure to 10 to 16.  Your median pressure is just over 10, so that's a good number to set, and you need a little headroom, thus the 16.

Please raise your EPR to 3 to make your breathing more comfortable and to lower your flow limits. This is always a good thing to do.

Good luck!  

[kayakdannj]

Please recommend any suggestions based off of my Oscar data.

I have been feeling pretty good when I wake up and not tired throughout the day. Wife is happy I am not moving around as much from sweating and snoring all night. I am still waking up 4-5 times a night. I am a side/stomach sleeper and I wake up on my back with my mask leaking. Not sure how to stop it but I'd love to sleep the whole night and not wake up at all!

I have noticed I do not wake up any more to use the bathroom like I was every night. I have also been walking/jog for at least a half hour 6 days a week and intermittent fasting/OMAD and limiting calories the past two weeks and down 10lbs. I am sure that is helping to making me feel better and will continue to help.

[kayakdannj]

Anyone?

[OpalRose]

kayakdannj,

I have merged your three threads as they all pertain to your Cpap journey.  This keeps your history to one thread and all suggestions and changes made to your therapy can be easily seen and you will be less prone to receiving duplicate advice.

With thy said, I feel that your earliest charts showed better therapy that the most recent one you posted.

But your biggest issue, I believe is your mask movement.  The leaks are not bad enough to affect therapy, but certainly enough to cause arousals.  

Look at your leak rate chart.  Do you see the spikes?  This is more than likely mask movement.  The leaks from the movement can cause the flow limitation to rise to try and compensate, so your pressure rises and causes arousals.

First thing, fix the mask problem.  Read through the Mask Primer, especially this:

https://www.apneaboard.com/wiki/index.ph..._Jeffy1958

Also, do your best to stay off your stomach.  It's not going to help keep that mask in place.

I don't see any Positional Apnea, so you sleeping on your back is ok as long as you don't start "chin tucking".

Side sleeping is preferable.  Be sure your pillow supports your neck and head.  Try sleeping with your head close to the end of the pillow so that the mask hangs off the side.  

Try to pick a pressure setting and stick with it.  I recommend going back to what you were using on the December 2024 charts.  

Your median pressure is mostly over 10, so set your minimum pressure to 10cm.  Set your maximum pressure to 14cm.
Set EPR at 2 for now.  

Stick with these settings for at least a week, while at the same time work on the mask leaks/movement.  Without getting this under control, you will continue to wake up often and feel like crap.