Need Some Advice Please

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
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AcedDublB
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Re: Need Some Advice Please

Post by AcedDublB » Fri Nov 13, 2015 9:56 am

I moved the Minimum up to 16.0 for this evening.

The Aflex is set at 3 and is On. Is that significant?

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Pugsy
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Re: Need Some Advice Please

Post by Pugsy » Fri Nov 13, 2015 10:16 am

AFlex at 3 will at most give 2 cm reduction during exhale. Flex exhale relief is based on air flow or the force of your own exhaled breath. If you tend to be a rather shallow breather you may not be getting the full 2 cm reduction.
While the slight reduction could maybe be allowing the airway to collapse a bit..it also might not and at your pressures doing without Flex might be uncomfortable.

Up to you if you wish to try either reducing Flex setting or turning it off. In all honesty I don't think it is going to make that big of a difference in your situation but it is an option to try.

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Re: Need Some Advice Please

Post by AcedDublB » Sat Nov 14, 2015 7:42 am

Did not adjust AFlex, didn't bother with Ramp feature last night.

Slow going to sleep but fair night.

http://imgur.com/a/RvJ7h

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Re: Need Some Advice Please

Post by AcedDublB » Sun Nov 15, 2015 8:53 am

Saturday night results.

Good sleep but AHI and Graph results disappointing.

http://imgur.com/a/gRCZm

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Re: Need Some Advice Please

Post by Pugsy » Sun Nov 15, 2015 9:07 am

Ouch.
You are running out of pressure options. Maybe try another 1 cm increase in that minimum?

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Re: Need Some Advice Please

Post by AcedDublB » Sun Nov 15, 2015 9:18 am

Will do tonight. Max 20 Min 17

Discouraging as I am finally feeling quite comfortable with mask, never frustrated and wearing it close to 9 hours.

Thank you for your continuing interest and advice.

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Re: Need Some Advice Please

Post by Pugsy » Sun Nov 15, 2015 9:33 am

Well at least we have made progress in the wearing of the mask and getting some better sleep departments.
I had hoped that the OAs wouldn't be so stubborn and hard to resolve but that's the way life is sometimes.
I know you are on vacation and this machine is a loaner so we are biding time until you can get a permanent machine. Definitely want to try to get a bilevel machine.

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Re: Need Some Advice Please

Post by AcedDublB » Mon Nov 16, 2015 8:22 am

Bad night, couldn't get to sleep and pressure seemed too high and I removed mask after 4 hours, more minor leaks than normal.

Very discouraging.

Will drop Minimum Pressure down to 15 to see if that helps.

I use a full tank of water each evening, is that an issue?

Also wondering whether my Amara View mask is blocking my nostrils too much as the hole is fairly small.

http://imgur.com/a/SkRkC

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Re: Need Some Advice Please

Post by Pugsy » Mon Nov 16, 2015 8:31 am

Amount of water used isn't unusual at all.
Water consumption will vary with ambient humidity, pressures and even leaks.
So the higher pressures will use more water.

I don't think that the 1cm higher pressure would have been any earth shattering improvement.
So yes, go back to something that is more comfortable and let's you sleep decently.
Maybe stay at 15 cm longer and then maybe try 0.5 cm more first.

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Re: Need Some Advice Please

Post by AcedDublB » Tue Nov 17, 2015 8:04 am

Monday evening, a reasonable and comfortable sleep of good duration but not good numbers.

Max pressure still at 20 and minimum dialed back to 15.

Propose to leave these settings for a few days as advised.

Comments welcomed as always.

My Amara View Medium mask rubs on my septum but is tolerable.

http://i.imgur.com/flKmgXv.png

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Re: Need Some Advice Please

Post by Pugsy » Tue Nov 17, 2015 9:27 am

Last night was as we would expect it with the way things are right now.
At some point you might want to revisit the sleeping position experiment but don't do it if you simply can't go to sleep with the change. It's more important to get to sleep at this point.
Maybe after a week or so at this pressure your body will be more adjusted and able to accommodate a little higher starting minimum.
Alternately if you can handle the pressure okay....you might reduce the exhale relief setting and see if you can get a little higher overall average pressure that way.

You simply need a bilevel device...both for pressure needs and overall comfort.

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Re: Need Some Advice Please

Post by AcedDublB » Thu Nov 19, 2015 7:53 am

Some Good Results IMHO

http://imgur.com/GoS0qi6

AHI finally below 10! and I was diagnosed as 'Severe'

Upped Minimum Pressure to 15.5, Maximum at 20

I don't bother with Ramp

Taking all of Pugsy's advice, slow steps on upping minimum pressure, Sleep is your Number 1 priority and sleep on your back if you need to.

Last night, went to sleep quickly, never woke that I know of and no crazy dreams or thinking I was awake all night.

Feel comfortable with my chinstrap and mask setup although slight soreness on my septum but just apply Polysporin.

Nose runs like a tap in morning for 5 minutes but that is no big deal.

I sent a copy of my Sleepyhead results and Pugsy's latest comments to my Sleep Doctor and nurse immediately replied and said she would show them to Doctor which I felt was positive.

Purchased an Amara View mask & headgear on Amazon for $65 versus $250 back home.

Also ordered a neckor cervical collar to try instead of chinstrap.

I know I have a long way to go to achieve what others have done but I believe I can get there especially if I can get bi-Level machine if my Doctor agrees with Pugsy's analysis.

This forum has been a huge help to me and others. Thank you for sharing your advice and experiences.

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Re: Need Some Advice Please

Post by Pugsy » Thu Nov 19, 2015 9:19 am

Now last night looks more like REM stage sleep cluster patterns or when we would expect REM stage sleep to be happening.

And for anyone reading this and not the entire thread...the reason I said go ahead and sleep on his back was because we weren't for sure that supine sleeping was the culprit (it could be REM sleep that is the culprit for needing more pressure) and more importantly he wasn't able to sleep well at all in other positions.
Gotta get the sleep first and if that means supine sleeping then so be it and let the machine just do its job.
In this situation more pressure is needed and now I wonder how much impact REM is having on those pressure needs. We can't control REM anyway.

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Re: Need Some Advice Please

Post by AcedDublB » Sun Nov 22, 2015 10:30 am

http://imgur.com/fQWjUHM

Strange result last night, AHI less than 1 for first time!!

Removed chinstrap and had large leaks.

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Re: Need Some Advice Please

Post by Pugsy » Sun Nov 22, 2015 10:49 am

When your leaks were up over 100 L/min there is the possibility that there were some apnea events that happened but the machine couldn't sense them. I don't think that they missed enough events to make as big of a difference in that AHI though. It's not like you were in big leak for half of the night.
So it's possible (but not a certainty) that some events happened and weren't recorded during the large leak time. With Respironics machines and your pressure the large leak boundary is probably around 90 L/min but it will still likely sense something up to around 100 L/min. Over 100 L/min and the machine gets pretty much clueless so we can't trust the data.

18% of the time in large leak..is 86 minutes broken up into 7 or 8 segments of various duration. Not real pretty but not horribly horrible because some of it was between 90 and 100 L/min anyway where the machine can still do a fair job of sensing.

If you were using a ResMed machine you would still get Mr Smiley for leak report because ResMed doesn't give a Mr Frowny until a person hits 30% or more of the time in large leak. While I will let a little big leak slide (if it doesn't wake me up) I think 30% isn't something I would let slide routinely.
My own personal line in the sand is 10% of the time in large leak.

If you slept well and feel decent and didn't wake up a lot from those leaks, maybe worth going for a period of time without the chin strap and see if this holds and maybe the leaks reduce a bit so things are not quite so ugly. It's not like the entire night was in the toilet....just a small part of it and if the trade off is feeling better and sleeping better it might be worth it.

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I may have to RISE but I refuse to SHINE.

If you want to try the Eclipse mask and want a special promo code to get a little off the price...send me a private message.