djam's therapy thread

[djams]

Maybe not perfectly accurate, there's a brief period around 1:00 and around 2:30 where it looks like the flow was greatly depressed, maybe to the point where, for a few minutes, the machine may not have been able to detect breathing... maybe, you'd have to zoom in and look.

When doing so, also look at the mask pressure line, and see how the measured pressure shows... was it dropping of significantly? As far as the rest of the night, you can zoom in and look at your breathing, if you're breathing, you're not having an apnea....

I'm happy to report that I'd already done most of these things. Sign of progress on my part. At no point did the machine fail to detect breathing. During the UA at the 0100 time, the leak rate is over 80. There's tiny amounts of flow and mask pressure changes(very tiny here). Mask pressure doesn't drop below min pressure - EPR 2.

The 24lpm line from Resmed is where they're *sure* that their machine can determine what *kind* of apnea you've had... (and usually, they're able to differentiate it up into the 30's)... not whether or not you're having an apnea at all.

Good information. Thanks.

Question about my flow rate chart - the whole thing is a mess once the leaks start, but from 23:45 to 00:45 it's un-centered to the low side. Normally pretty equally distributed about the 0 line. Does this mean anyhing significant?

It means you were exhaling more forcefully than you were inhaling.

Hopefully this is nothing ominous.

I don't think so. after all, that was *before* your leaks started happening... it'd be interesting to see what the breath shapes look like.. (make sure the zero dotted line is turned on when zooming in.

See below for a shot of the breath shapes while this was going on.

Don't know if you were looking for charts of all this stuff, but here they are.

01:00

0100.PNG (95.22 KiB) Viewed 16545 times

02:30

0230.PNG (98.14 KiB) Viewed 16545 times

Breath shapes during unequal flow. Worst case in this snip is -70 / +43 at 00:07:35

BreathShapesUnequalFlow.PNG (21.8 KiB) Viewed 16545 times

[palerider]

You can see, with the lower flow rate, that what's going on becomes more muddled, but it's still able to sense *some* breathing, so no apenas.

The fact that the mask pressure trace wasn't dropping off means that the machine was able to maintain therapy pressure, if the leaks are terrible, then you'll see the mask pressure trace dropping off.

Good that you're doing that digging, you're understanding more about what's happening.

If it weren't for the leaks, I'd call it a good night.

[djams]

You can see, with the lower flow rate, that what's going on becomes more muddled, but it's still able to sense *some* breathing, so no apenas.

The fact that the mask pressure trace wasn't dropping off means that the machine was able to maintain therapy pressure, if the leaks are terrible, then you'll see the mask pressure trace dropping off.

Good that you're doing that digging, you're understanding more about what's happening.

If it weren't for the leaks, I'd call it a good night.

"If it weren't for the leaks" is the story of my life right now.

I appreciate your continued advice!

[djams]

I had my 6 month follow up appointment recently. Went with a bit of trepidation, because this was my 1st visit since I started changing settings. Brought my laptop long, so I could show how we're making decisions.

She was looking at her Resscan printout and first thing she said was "You're minimum pressure is 11.4 - we always set to whole numbers. How did you change it?" So that started the discussion about the fact that I'm self-treating (well, forum-treating). I explained that I am making changes, and that I'm researching/educating myself. "But why 11.4?" - so I explained that I had trouble with large pressure increase, and was gradually stepping up the min pressure. "That makes sense", she says. And "Well you're 30 day AHI was 2.8 at last visit, and now it's 1.2 so that's better". I asked to to look at the month of June, when my AHI was between 6 and 10 pretty regularly - "I don't have that - just the last month."

At this point I told her that I'd like to show he the data I'm using to make decisions if she had the time. She did, so I got the laptop out and opened Sleepyhead.

She was really blown away, and impressed - had no idea something like SH is available. We looked at June - there is no doubt that nobody at the doctors office had taken any notice that things were getting off track. At the end of my "demo" I showed here the AHI overview chart that I posted not too long ago in this thread. "Well, you're doing a great job, just call us when you make changes so we can update our records". Of course, all the credit for me "doing great" belongs to the folks who've spent so much time helping me here.

I already knew that I was doing well due to all the help/advice I've gotten here - and would have continued on my(our) own regardless. But I'm glad they're on-board.

Also during this visit I witnessed a patient standing at the reception counter, SD card in hand, trying to get a pressure change on his machine. They appeared to be resisting, because a RT was still sitting and talking with him in the waiting room when I came out from seeing the PA. Felt sorry for the guy. Guess he could've been asking for something stupid.

[zonker]

that's GREAT that your doc was willing and able to learn something new! i read from time to time of this happening, but not often.

and, of course, it's equally great that you are doing so well on your therapy!

[djams]

that's GREAT that your doc was willing and able to learn something new! i read from time to time of this happening, but not often.

and, of course, it's equally great that you are doing so well on your therapy!

I am very pleased by this. I actually like the sleep operation that my PCP hooked me up with, and would have been disappointed if the outcome were different. I was able to show that I've attained a basic level of competency about APAP therapy. I think that helped.

At the same time, it's disheartening to me that not a person there was aware that the wheels were coming off in June. I understand that they've got a LOT of patients and they can't/don't watch the daily details. Pretty sure I would have gone 3 months that way with no intervention if I hadn't taken the reins. And then who knows whether or not they would have taken enough action. My opinion, they *should* watch all the new patients very closely for the first few months. I know there's a ton of patients not getting the most from their therapy because of this "high volume" approach that is... necessary? (big ? here), due to the high number of patients. At any rate, I'm glad that it didn't get contentious.

I yes, I really feel I'm doing well - thanks to this forum and the members willing to spend so much time helping.

[palerider]

Also during this visit I witnessed a patient standing at the reception counter, SD card in hand, trying to get a pressure change on his machine. They appeared to be resisting, because a RT was still sitting and talking with him in the waiting room when I came out from seeing the PA. Felt sorry for the guy. Guess he could've been asking for something stupid.

Shoulda told him about us.

[djams]

Also during this visit I witnessed a patient standing at the reception counter, SD card in hand, trying to get a pressure change on his machine. They appeared to be resisting, because a RT was still sitting and talking with him in the waiting room when I came out from seeing the PA. Felt sorry for the guy. Guess he could've been asking for something stupid.

Shoulda told him about us.

I would have if I'd gotten a moment where he was alone.

[djams]

For the past 2-3 weeks, I've been cruising along really well AHI-wise. It's gotten to the point that I'm disappointed if I see AHI over 0.5

Additionally, my pressure needs seem to be decreasing - for no apparent reason. I initially attributed it to the Dreamwear FFM I was trialing, but the trend has continued with my Airtouch F20 after returning the loaner Dreamwear.

I decided to try the Response setting at "Soft", to see the effect. To be sure, the setting *could* be named "Slow", because the pressure increases in response to flow limitations are VERY slow. Additionally, the high pressure reached in response to FL's is considerably lower than standard response.

I've been using this mode for 10 days. I've had a total of 3 nights now that show that this mode is ineffective for me. AHI's of 2.2, 3.1 and 7.7 - I continued on, as these higher AHI's don't make me feel bad the next day, interestingly enough. Even last night's 7.7 - I don't feel like crap right now. Tired, but I only got 5 hours of sleep.

I'm posting a couple of examples of soft response. I'm particularly interested in hearing thoughts on last night's 7.7 pressure graph. After the initial slow pressure increase, pressure then decreases during the entire 45 minutes of UA's. I can only guess that since these are classified as UA's due to the large leaks, they're not treated the same as OA's. But then again,there are significant FL's happening throughout the pressure decline. So I'm stumped. Zooming in, the UA's have the classic OA shape - fishtail and all, but I can see that I wasn't completely obstructed. Note that the pressure never did get to my max setting on either night. Standard response will jump right up there when I need it.

On last night's chart (the 7.7 AHI), I'm only showing the session where I was asleep. I had an hour of laying awake, 2 hours out of bed doing something else, and then the session shown. Tough night - work on my mind.

To be sure, this trial is over, as soft response doesn't work for me when I have increased pressure needs.

[djams]

Looking at last night's charts, I noticed that my flow rate was using more range than normal. I keep the chart scaled to +/-70, so it's obvious when something looks unusual. I've seen this before, but not for the length of time as last night.

Then I look at my respiratory rate. Normally in the mid to low 20's, and I see it's way elevated. And at around 02:45 I'm hitting 50. I look at my respiratory chart all the time (it's a useful indicator of arousals for me) and I've never seen anything like this. Occaisional brief run ups into the 30's, yes. But never anything like this.

Any thoughts on this? I find it pretty alarming. I know sleep is different every night, but this seems extreme.

I feel just fine today, for what that's worth.

[palerider]

Interesting dreams?

[djams]

Interesting dreams?

Not that I recall.

[palerider]

Interesting dreams?

Not that I recall.

Well, no, not if you slept through them, but it could be REM related.

How about a zoom in to a couple minutes when the RR is really high?

[djams]

Interesting dreams?

Not that I recall.

Well, no, not if you slept through them, but it could be REM related.

I thought about REM too, but even so - certainly not the norm.

How about a zoom in to a couple minutes when the RR is really high?

Your wish is my command...

[palerider]

Yeah, that's a legit high rate, not just sleepyhead getting confused and double counting breaths.

As long as it's just an occasional thing, I woulnd't think it's something to be concerned about. (mind you, that's a guess, not substantiated by anything... but I'd just look at it and go "huh, weird" if it showed up on mine.)