Jonathan's ongoing list of questions, comments, concerns...

[Pugsy]

The zoomed in PB stuff looks more like arousal or post arousal breathing....you weren't sound asleep.
Doesn't surprise me too much with all the snoring and RERA flags. Better sleep than you were having with the lower settings but still not as good of sleep quality as we would like to see. Nothing to be concerned about except it points to poorer sleep quality than we would like to have. No where near like CSR breathing which is the type of PB that we stand up and take notice of.

How about a 1 cm in crease in both EPAP and IPAP? BiFlex setting of your choice if you need or want it.

[JonathanZK]

How about a 1 cm in crease in both EPAP and IPAP? BiFlex setting of your choice if you need or want it.

Alright, bumping up to 15/13. Will report back tomorrow.

Also, a question for the group: I'm developing a rash between my lip and my chin. It's incredibly unsightly. I've tried using aloe the past few days, but it keeps getting worse. Kind of looks like a hickey on a high school girl's neck. Any advice on clearing this up?

[Pugsy]

Mask liner.....either make your own out of an old Tshirt...or store bought
https://www.padacheek.com/mask-liners-full-face

Make your own would of course be faster...there's a pattern available
http://montfordhouse.com/cpap/diy-cotton-mask-liner.pdf

My old go to skin barrier stuff.....Lansinoh lanolin ointment cream...found in the baby aisle of most stores where nipples and stuff are.
Great stuff for any boo boo we might have and won't hurt the mask.

Maybe consider some other mask than the Comfort Gel Blue....it's old news. The newer masks are so much more improved.

Where are you located?

[JonathanZK]

Mask liner.....either make your own out of an old Tshirt...or store bought
https://www.padacheek.com/mask-liners-full-face

Make your own would of course be faster...there's a pattern available
http://montfordhouse.com/cpap/diy-cotton-mask-liner.pdf

My old go to skin barrier stuff.....Lansinoh lanolin ointment cream...found in the baby aisle of most stores where nipples and stuff are.
Great stuff for any boo boo we might have and won't hurt the mask.

Maybe consider some other mask than the Comfort Gel Blue....it's old news. The newer masks are so much more improved.

Where are you located?

Thanks for the links. I'll check them out. Just out of curiosity, wouldn't an old tee shirt increase leaks as the material is porous?

And as for a new mask, I'm not at all opposed. I am not a fan of the "Comfort" Gel, but at the same time, after shelling out $1400 on all this stuff, I'm not terribly eager to spend several hundred more just yet. That said, I'm open to any suggestions you have, and will keep them handy for when money matters improve.

I'm located in Dallas.

[Pugsy]

The Tshirt is to act more as a barrier so your rash thing won't get worse and can heal up.
Might increase the leaks a bit but you have a lot of room in leak management to allow a little leak if it happens.

Let me see what sort of full face mask I might have in my stash of donated stuff. I need to get in it for someone else anyway.
Don't have much but I might have something you could try for free.

[JonathanZK]

Let me see what sort of full face mask I might have in my stash of donated stuff. I need to get in it for someone else anyway.
Don't have much but I might have something you could try for free.

Wow. That is unexpectedly generous. Thank you.

[JonathanZK]

A new night, new settings, new data:





AHI is higher than the last two nights, although is still 45% lower than average. And I'm not really clear on what's considered "good." Literature says <5 is considered normal, but I admit to feeling like it should be <1 every night.

Hypopnea count is up. Obstructives are unchanged from last night. RERA's are a smidgen above average for the month-to-date. Sores are down to the third-lowest day though.

[palerider]

And I'm not really clear on what's considered "good." Literature says <5 is considered normal, but I admit to feeling like it should be <1 every night.

The literature is written by doctors and insurance companies, who decide that they ain't gonna pay for treatment at some point, and they decided that 5 was 'good enough' for them not to care.

5 is crap. 5 is like being poked by a sharp stick every 12 minutes, *all night long*... ask yourself whether you think you'd be able to get any rest that way.

Maybe it's that 5 is low enough to not cause significant organ damage due to oxygen deprivation.... but it's still crap as far as sleep goes.

My general rule is under 2 is acceptable, under 1 is better, of course.

Hypopnea count is up. Obstructives are unchanged from last night. RERA's are a smidgen above average for the month-to-date. Sores are down to the third-lowest day though.

As you increase pressure, apneas (total cessation of breathing) turn into hypopnas (partial cessation of breathing)... so apneas go down, hypos go up, then back down as pressure increases enough to prevent them too.

[JonathanZK]

As you increase pressure, apneas (total cessation of breathing) turn into hypopnas (partial cessation of breathing)... so apneas go down, hypos go up, then back down as pressure increases enough to prevent them too.

So keep going up...

My original prescription was 13/9, and I'm up to 15/13.... So go higher, you think?

As an aside, I have to wonder if the doctors actually get anything right with this stuff. If not for this community, I'd be $1400 in the hole AND would still be killing myself every night.

[Pugsy]

You can try a little more EPAP and maybe even a little more IPAP than the 2 cm above epap.
14 EPAP and 17 IPAP...bring in a little more PS to help get IPAP up and keep it half way comfortable.
For hyponeas...the usual general rule is more IPAP. We can get more IPAP either by increasing PS or simply raising EPAP.
You could also maybe try keeping 13 EPAP and just increase IPAP to be 3 or 4 above EPAP.

[palerider]

My original prescription was 13/9, and I'm up to 15/13.... So go higher, you think?

As an aside, I have to wonder if the doctors actually get anything right with this stuff. If not for this community, I'd be $1400 in the hole AND would still be killing myself every night.

Well, It's a sad fact that if doctors "got it right" most of the time... this community wouldn't exist. We're mostly all here because we've been failed by doctors (and a few of us are here because we saw other peoples experience at the hands of doctors and sleep centers, and decided to go rogue, and treat ourselves.)

As to going higher... I'll put it this way. If you had an auto machine, it'd raise the pressure.

[JonathanZK]

Well, It's a sad fact that if doctors "got it right" most of the time... this community wouldn't exist. We're mostly all here because we've been failed by doctors (and a few of us are here because we saw other peoples experience at the hands of doctors and sleep centers, and decided to go rogue, and treat ourselves.)

Indeed. It is a sad fact, but the real tragedy is that so many people just trust what the doctor says blindly. I wonder how many suffer as a result, or die due to related complications.

You can try a little more EPAP and maybe even a little more IPAP than the 2 cm above epap.
14 EPAP and 17 IPAP...bring in a little more PS to help get IPAP up and keep it half way comfortable.
For hyponeas...the usual general rule is more IPAP. We can get more IPAP either by increasing PS or simply raising EPAP.
You could also maybe try keeping 13 EPAP and just increase IPAP to be 3 or 4 above EPAP.

I'm not sure what you mean by "increasing PS," and couldn't find it in the CPAP Wiki.

Anyway, onto last night's report...

Not a good night. I went to 17/14 and there was an increase in apneas, hypopneas, and snoring. But I'm not sure if it was due to the settings, or other factors. My back was hurt from earlier in the day. The mask was leaking and woke up me up around 12:30. I broke off the forehead pad while trying to readjust, and had to Google how to fix it properly. Etc. So not a good time.



Wondering if I should try the same tonight, or lower EPAP back to 13.

[Pugsy]

PS is pressure support.
Simply the difference between EPAP and IPAP. IPAP setting minus EPAP setting equals PS.

You had a bad night last night...probably would have been a bad night even without changing anything. It happens.
Lots of awakenings perhaps...so some of that higher AHI might be SWJ events. Not a good night in terms of evaluation process when we have "bad" nights and don't know for sure why they are bad. You had mask issues and leak issues....could have happened even if you hadn't made such a small change in the settings.
Zoom in on that first cluster of OAs at the beginning of the night....were you asleep or awake when they happened to get flagged?

Would it be possible to try one night with you staying off your back as much as possible just to see how much impact sleeping position is a factor? It's hard to do...I know from personal experience.

[JonathanZK]

PS is pressure support.
Simply the difference between EPAP and IPAP. IPAP setting minus EPAP setting equals PS.

You had a bad night last night...probably would have been a bad night even without changing anything. It happens.
Lots of awakenings perhaps...so some of that higher AHI might be SWJ events. Not a good night in terms of evaluation process when we have "bad" nights and don't know for sure why they are bad. You had mask issues and leak issues....could have happened even if you hadn't made such a small change in the settings.
Zoom in on that first cluster of OAs at the beginning of the night....were you asleep or awake when they happened to get flagged?

Would it be possible to try one night with you staying off your back as much as possible just to see how much impact sleeping position is a factor? It's hard to do...I know from personal experience.

I'm reasonably sure I was awake during that time. It's hard to tell actual awake time from dozing in and out of consciousness. But I do know I didn't fall asleep quickly. The pressure didn't bother me (aside from some ear popping), but I have a lot on my mind this week.



I can try sleeping on my side. I'm not a natural back sleeper, but with the mask and machine, it's become the least uncomfortable.

As ever thank you for your insights and feedback. You're very much appreciated.

[palerider]

Well, It's a sad fact that if doctors "got it right" most of the time... this community wouldn't exist. We're mostly all here because we've been failed by doctors (and a few of us are here because we saw other peoples experience at the hands of doctors and sleep centers, and decided to go rogue, and treat ourselves.)

Indeed. It is a sad fact, but the real tragedy is that so many people just trust what the doctor says blindly. I wonder how many suffer as a result, or die due to related complications.

At the time of the interview, 54% were still using CPAP and most reported an improvement in symptoms. 15% had abandoned CPAP after using it for 10.1±15.5 months, 31% had never commenced therapy after initial diagnosis and CPAP titration.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2679572/

A lot. not died, but don't get any benefit.

You can try a little more EPAP and maybe even a little more IPAP than the 2 cm above epap.
14 EPAP and 17 IPAP...bring in a little more PS to help get IPAP up and keep it half way comfortable.
For hyponeas...the usual general rule is more IPAP. We can get more IPAP either by increasing PS or simply raising EPAP.
You could also maybe try keeping 13 EPAP and just increase IPAP to be 3 or 4 above EPAP.

I'm not sure what you mean by "increasing PS," and couldn't find it in the CPAP Wiki.

PS is the difference in EPAP and IPAP.