"Getting Hosed", Day-5, A Data View

Roger... · Post by **Roger...** » Sat Oct 29, 2005 1:47 pm

After wrestling with the Comfort Curve yesterday, a nap helped me surface the strength to use the Comfort Curve again last night. My first experience with the Curve was riddled with a lot of effort to keep it from leaking. However, last night I was so tired I let the small leaks go and just tried to get some sleep. Surprisingly, I've learned a few tricks to keep the big leaks away, but the small ones don't cooperate much when I'm on my side.

When this week began I had hoped to be at a data position that would help me define a better pressure range than my current SWAG entered into the REMStar Auto, but with the unplanned introduction of a different mask because of a size problem with the Activa, the Comfort Curve was used for the last two days. Changing the interface has been problematic and because the interface is different, it has added a set of variables that only contaminate the data.

Still, this week's data table, shown below, and the MyEncore "AHI vs. Press." graph shown below the table, Thank you Derek, indicate a higher low side setting might help improve the treatment. It also indicates a lower high side setting won't have any negative impact, but it won't have any ability to respond to a worsen condition.

With this morning's look at the data, I'm going to raise the low pressure setting to 8cm H2O from 6cm, and leave the High pressure at 14cm H2O. CFLEX is already set at position 3, most responsive, and feels more comfortable at that setting. That CFLEX setting also takes some of the dance out of the Mirage Activa when I don’t have the straps too tight or the pressure too low.

With this pressure range change daily data monitoring will continue, so if this turns out to be a problem, I should see it in the data quickly. A caveat with this approach is that as the average pressure rises, so won’t the leak rate, and with the Comfort Curve being my only mask until Tuesday, the higher pressure will only amplify the leak problems from now until Tuesday.

Comments?

WAFlowers · Post by **WAFlowers** » Mon Oct 31, 2005 9:23 am

It sure looks like 9 is the sweet spot for you. I'd be tempted to get your lower range setting off of that steep peak (not at and have it a bit higher, either 8.5 or even 9 which does seem to give you truly excellent results. Look at the dip in your OAI at that point, combined with a signiricant decrease of your HI as you go above 8.

Well, that's my opinion anyway.

Roger... · Post by **Roger...** » Mon Oct 31, 2005 1:17 pm

Hello Bill,

Thanks for the feedback. At this stage of the game, hearing other perspectives can only increase my understanding of the data.

This morning I updated the table shown above with last night’s results. Sunday’s data in the table shown above shows the minimum pressure for last night was 9cm/H2O and the max is 14cm/H2O. In this machine those settings and my conditions created a 90-percentile value of 9.8cm/H2O.

This is the latest AHI versus Pressure graph that includes last night’s results:

According to the new AHI versus the Pressure display, this image indicates running at 9cm/H2O might be okay for now. I say right now because I’m finding the data indicates the mask interface and leak rate have some impact on the numbers that need to be set in the machine. Because of this thinking, when I go back to the Mirage Activa on Tuesday I’ll need to recheck all of this to see what that mask indicates.

I’m also trying to understand what impact leaks play in reducing the titration pressure the airway gets to experience. This chart from last night’s titration report indicates even though 9cm/H2O was set at the machine, it isn’t likely that was the pressure I got to experience. If that belief is true, then a titration setting on the machine is really only accurate when the same circuit conditions that were used during calibration of the machine are emulated in practice.

This series of graphs is taken from the MyEncore PRO report, page-4:

Click HERE to Enlarge Chart.

This report was created while I was using the Comfort Curve mask. As is obvious I’ve not been successful in getting it tamed. I believe this is because I’m a side sleeper, and from what I’ve experienced with this mask, I would need a different head-harness so that side pressure wouldn’t destabilize the nasal pillow to nose connection so much.

Ideas, thoughts, etc…?

rested gal · Post by **rested gal** » Mon Oct 31, 2005 1:28 pm

This report was created while I was using the Comfort Curve mask. As is obvious I’ve not been successful in getting it tamed.

No kidding! The number of black blocks (Large Leaks) and the fact that the machine will use only your lowest pressure during such massive leaks... well, I'd think that would skew your data terribly as far as what's really happening during your sleep. I may be wrong, but I think the machine will not even record events such as apneas and hypopneas that could be happening during Large Leak episodes.

Massive leaks, whether from mouth or mask, are real treatment wreckers. Gotta have the air going where it's needed -- not out into the bedroom.

Would be interesting to see what kind of overnight data you'd get if you switch to straight cpap mode at a pressure of 9 or 10 -- and with a better mask that doesn't leak the way the ComfortCurve seems so apt to do.

Roger... · Post by **Roger...** » Mon Oct 31, 2005 1:53 pm

Hello RG,
I like how sharp an eye you have for the details. That attribute sure adds a lot of weight to your opinions.

In looking at this chart series and others, every time I see a black bar at the top, I don't see any event other than snores recorded. As for the snores, I'm almost certain my Humidifier is snoring more than I ever did without APAP.

When I turn on the machine at night I can hear the tingling in the hose even though it has been hanging open all day in our dry weather conditions.

I don't know what to think about that factor, but for certain it is another factor contaminating the results we need to understand to make decisions.

With all these side issues surfacing, this effort in "Getting Hosed" is becoming a life changing event, it is also taking on a life of its own. Of course that last part is because of my analytical affliction. I've know for a long time that my propensity to analyze everything has housed me in a world of uncertain probabilities and doubt. After writing that, maybe I should have worked on getting my head examined before trying to deal with the sleep problem. That last revelation happened because when I'm tired, I don't care as much about being analytical.

Thanks for the reflection RG!

rested gal · Post by **rested gal** » Mon Oct 31, 2005 4:06 pm

it is also taking on a life of its own

LOL, tell me about it! From the first several nights on the noisy old Healthdyne Tranquillity machine I had borrowed, I realized I'd do just fine on simple straight cpap, probably 10 cm H2O. Even a full face mask was ok. I could wear that ok. So, was I content to feel good every morning?

Noooo. By then, I had dug through several message board archives so much, I was intrigued by the subject of "sleep apnea" and the way various machines and masks work.

For a non-insured somebody who started out needing to save money by foregoing a sleep study, I've shelled out quite a bit over the past two years - simply because this has turned into a kind'a crazy hobby! "Ooooh, I want to try that...and this....and that!" I just like to use other machines and masks for the heck of it.

I'm not very analytical. I missed the important details on my own charts -- thank goodness for a poster named -SWS who kindly steered me right in my own treatment. Missing things reminds me -- are you sure you're not leaking air out your mouth while you sleep?

You'll whip everything about your treatment into shape, Roger. I'd bank on it.

Good luck!
____________________________

P.S. Go to Walmart or K-Mart. Buy a pair of ladies pantyhose tights. Not just pantyhose...gotta be "tights" for the best kind of soft, stretchy material. Get Queen-size tights so there's plenty of leg.

Cut off one leg as high as possible (reminds me of an old joke, but I digress...lol.) Use that leg as an extra strap around the front of your Comfort Curve mask, tying the loose ends behind your head or down at the back of your neck with a doublestart knot. That will be a very flat knot, not bulgy at all; easy to tighten, loosen, and take off. "Ian's shoelace site" - pictures of doublestart knot

That leeeeetle bit of extra support right across the front of any mask can be the tad of stabilizing that will prevent leaks all night. Worth a try, anyway.

Better yet, just get yourself the nasal pillows mask made by Aeiomed. The Aeiomed "Headrest with nasal seal", formerly known as the Aura.

Roger... · Post by **Roger...** » Tue Nov 01, 2005 10:53 am

Hello RG,
We were out this weekend shopping, but when I mentioned I wanted to go look at pantyhose the bride got a real strange look on her face and said, "Do Not Go There!" I then tried to explain, but she cut it short and said, "Let me see what I can make or find before you start roaming the woman's stocking isles." Soon after we were all done shopping so I'm now awaiting discovery.

I think your idea would work, but I don't know how well it would stay in place. Right now I'm moving around enough with my head to wiggle out of the headgear without noticing it. This is why I need to dig into the pillows to get it back. Still, if I just put a little pressure on the center of the mask before I move, the seal stays in tack and I don't need to fiddle with it as much. The side pads are still a problem because when I'm on my side, they push the mask away from the nose unless I lift the lower pad and move it back a little.

Overall the mounting gear of this mask is the real problem. The nasal pillow and tubing are just fine, but the side pads are unconfortable and the main source of instability for the air seal.

I looked at the "Headrest" approach and like how it looks, but I couldn't tell if the connection to the nose was an insert or a pillow. Have you tried this mask?

mikemoran · Post by **mikemoran** » Tue Nov 01, 2005 11:07 am

Roger,

I tried to make the CC work tiem and tiem again. The only time I kept a good seal was when I was able to position the pads under my cheek bones. That way when I went on my side the pillow didn't move it. to accomplish it I had to take off the pads and use moleskin. But the pressing into my cheeks to keep it there was just to uncomfortable.

I now use the Activa and the "Headgear" (Aura) trading off between them. The "headgear" is a nasal pillow and it is perfect for side and back sleepers. Once you got the headgear adjusted it stays in place or you can add additional support with the famous RG pantyhose. Search under Aura and you will find lots of posts.

Roger... · Post by **Roger...** » Tue Nov 01, 2005 11:38 am

Hello Mike,

The "headgear" is a nasal pillow and it is perfect for side and back sleepers. Once you got the headgear adjusted it stays in place

Thanks for the feedback on the Aura. It is good to hear that the mask doesn't insert into the nostrils. I don't think I would enjoy that kind of a connection. I've had a lot trouble with my nose so I'm rather careful about abusing it these days.

My first mask was the RESMed Activa and I found that mask to work well, but the nose cover was small and abusing the area between the nostril where it meets the upper lip. I could pull the mask down a little, but it kept riding up when I was asleep and Becky at CPAP.COM said her troubleshooting guide says that is an indication of the mask being too small.

A new element for that mask is due here today. When it arrives I'll install it and get back on track. My recorded stats are a mess because of all the leaking I exprienced with the Comfort Curve. When I get the Activa dialed in, I'll ring up and grab a Aura Headrest for an alternate. Moving back and fort between two different interfaces will keep me from missing a night of titration because of an interface issue.

Not considered in all this is how to keep the mouth from leaking. One of my obstructions blocks expiration breaths so the mouth ends up being a safety value even with my mouth closed. I don't know how to harness that issue yet maybe because I don't want to think full-face device, at least not yet. Hopefully with the Activa in place, life with be different and I can run at a lower pressure and see what happen with the mouth.