Need Some Advice Please

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

Post by Pugsy » Tue Nov 10, 2015 8:02 am

How about minimum of 14 cm tonight?

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AcedDublB
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Re: Need Some Advice Please

Post by AcedDublB » Tue Nov 10, 2015 8:18 am

Pugsy wrote:How about minimum of 14 cm tonight?
Will adjust to 14 minimum this evening.

Are we making progress?


Brian

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Re: Need Some Advice Please

Post by Pugsy » Tue Nov 10, 2015 8:34 am

AcedDublB wrote: Are we making progress?

Hmmmm...let's see...AHI of 25 vs AHI of 7....I think leaps and bounds progress.

I think you can see where we are going here....more baseline pressure to help hold the airway open and give it head start for when there is a need for more pressure (you can see that happen on the pressure graph).
At some point you could probably used fixed cpap if you wish but I don't see the need (you would have to use MUCH higher like almost 20, all night long) if you can get good results using apap mode.
This is where apap mode shines...when there are substantial differences in pressure needs and those needs are up in the high teens.

14 cm minimum might get the job done or we might still need a little more. I think we are close to where it falls into the "tweaking" stage where adjustments are 0.5 cm and we allow more time at each setting to get a feel for what is happening. Normally I wouldn't suggest day by day adjustments like this but I knew all along that you were going to need up around 14 or 15 minimum and I see no need to give it at week at something that is obviously not close to optimal.

At some point we probably should consider reducing the dosage on the sleep aid and/or giving it up because we don't want to get too dependent on it but until the AHI is better we want to eliminate the OSA as the cause for poor sleep (those truckloads of events). We have to have decent sleep to evaluate the pressure needs and we have to evaluate the pressure needs to figure out how to best deal with the OSA. There's a time and place for sleep aids sometimes...and your doc gave you the meds...let's use them to our advantage. It makes finding the optimal pressure go faster and gives you better sleep in the meantime.

You are getting real close to finding that optimal pressure.

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Re: Need Some Advice Please

Post by AcedDublB » Wed Nov 11, 2015 8:04 am

]Here are my results from last night, four perfect sleeps in a row, absolutely amazing.

I go to sleep almost instantly, rather than hours later, and I sleep continuously without moving or dreaming and my hours of sleep are now approaching 9 hours.

AHI is up slightly from previous evening.

Even with Jay's advice I am still not inserting images correctly.

anxious to hear pugsy's recommendations as I really believe he has me close to where I need to go, all within one week.

[imghttp://imgur.com/a/C2yB2][/img]

http://imgur.com/a/C2yB2


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Re: Need Some Advice Please

Post by Pugsy » Wed Nov 11, 2015 8:09 am

Your link is incomplete...some brackets missing...I tried to fix it but there must be something missing besides the brackets.

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Re: Need Some Advice Please

Post by AcedDublB » Wed Nov 11, 2015 8:21 am


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Re: Need Some Advice Please

Post by Pugsy » Wed Nov 11, 2015 8:39 am

That 1 AM cluster could be supine sleeping or REM. It's pretty ugly but otherwise things look pretty good and there's really only one other very small cluster right before 4 AM which if that was all there was...wouldn't do anything but raise an eyebrow.

I don't know for sure (and there is really no way to tell) what caused that ugly cluster..at this stage of things I tend to think..."is this something we are going to have to just anticipate and prepare for" or "is this a fluke that might not happen for 6 weeks".
Do we increase the pressure again...or give it a few nights to see if it repeats sooner than later.
There's no doubt it will repeat at some time though.
I still think you are most likely going to need 15 cm minimum at least...do we go there now or wait a few nights?

What are your thoughts based on what you have learned so far? I am hoping you are learning and not just blindly following me. I want you to understand what and why so you won't need me.

Oh...could you get me a screen shot of the statistics columns on the left? You can turn off the pie chart and hide the calendar and the statistics will move into easy viewing...or in this situation since we already have good graphs on the right side...just grab me a screen shot of the statistics.

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AcedDublB
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Re: Need Some Advice Please

Post by AcedDublB » Wed Nov 11, 2015 9:07 am

Finally starting to get these images published.

In my last 3 sleeps, it has been if I am totally unconscious, I never seem to, or recall being awake, moving or being conscious of CPAP, it is an unbelievable sensation being in that state.

I have a "Sleep Cycle" iPhone App I just installed but never used yet. It uses an accelerometer that apparently measures tossing & turning. No harm in trying it out tonight.

Are you recommending any fine tuning tonight?


Image

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Re: Need Some Advice Please

Post by Pugsy » Wed Nov 11, 2015 9:26 am

Thank you ...I was wanting to see the median pressure statistic...it sort affirms my idea of 15 cm minimum.

Don't freak out over the 95% pressure number of 20...all that means is that it was at OR BELOW that number for 95% of the time.

I know you are in Canada and they do things differently in terms of machines but you are in a range where I think a bilevel pressure machine would be a good thing to have...and they go to 25 cm which might come in handy for you during the times that we are seeing such elevated OA and the clusters.

What is the plan when you get back from your vacation and turn the loaner back in?

And yes...I would try 15 cm minimum tonight....be prepared to use it for a few nights.

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Re: Need Some Advice Please

Post by AcedDublB » Thu Nov 12, 2015 8:21 am

]Wednesday, November 11, 2015 results.

Sleep was slower to come last night compared to the 3 previous excellent nights.

Tried to sleep on my side with mixed success as I felt I was awakening more than previos nights of total bliss.

Minimum pressure was increased to 15 as recommended.

http://imgur.com/a/c2cZ7

Image

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Pugsy
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Re: Need Some Advice Please

Post by Pugsy » Thu Nov 12, 2015 8:27 am

Ouch...that was an ugly beginning to the night. Part of it is likely awake/semi awake events and tossing and turning.

Don't try to sleep in a position that you are uncomfortable doing...just sleep in any position you want (going to sleep is number one goal) and let the machine sort out what it might need in terms of pressure.

Keep the minimum of 15 tonight...last night's results too skewed by awake/semi awake stuff.
Though once you got to sleep and past all the ugly...looks pretty darn good.

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Re: Need Some Advice Please

Post by AcedDublB » Thu Nov 12, 2015 11:59 am

This is an image from an app on my IPhone called Sleep Clinic.

Just placed the iPhone under my pillow and hit Start

Pretty close to showing the difficulty I had getting to sleep last night as does Sleepyhead.

Imagehttp://imgur.com/84xd28K

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Re: Need Some Advice Please

Post by AcedDublB » Fri Nov 13, 2015 8:52 am

http://imgur.com/a/lSN22

Real bad night, very hard to get to sleep and awoke several times.

My wife said she was up with a bad cough every 2 hours but I never heard her.

Image

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Re: Need Some Advice Please

Post by Pugsy » Fri Nov 13, 2015 9:13 am

Looks like a lot of time spent at the maximum of 20 when all that ugliness occurred...it wanted to do better but it couldn't.

Other times of the night not bad...makes me wonder why that time frame isn't so good and the rest quite acceptable...wondering if it is a combination of REM sleep (that's about the time frame for 1st REM) and supine sleeping.

Just more ammunition for needing bilevel machine that will go higher than 20 cm if needed.
Plus having IPAP be a little higher might help hold the airway open better in the first place and maybe prevent that ugliness.

I don't know if having a higher minimum is going to make much difference but it might be worth trying.
We can't do anything about the 20 cm limitation at this time.
Maybe if a higher baseline minimum could maybe (lots of maybes) hold the airway open a little better then maybe wouldn't need more than 20 cm.

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Krelvin
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Re: Need Some Advice Please

Post by Krelvin » Fri Nov 13, 2015 9:14 am

AcedDublB wrote: Image
Note, http://imgur.com/a/lSN22
Is not an image link, it is a link to a web page that contains images, not the same thing. As a result using a img tag won't work. You either can not tag it at all (the forum will make it a URL link on its own) or tag it as a URL.

If I have a hard time getting to sleep after 20 mins or so, I get up, go to another room until sleepy enough to go back to bed.

If its because my mind is thinking about issues keeping me awake, a sound machine or using headphones with some music can distract me letting me sleep quicker.
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