Any Recommendations to Improve Therapy

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
Snorynomore
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Any Recommendations to Improve Therapy

Post by Snorynomore » Mon Apr 09, 2018 10:07 pm

So I am finally back to using my machine after figuring out the right hose temp and humidity to fix the water in the nose pillows. I am able to use the cpap for about 4-6 hours a night but my AHI still a bit high. Any recommendations for what I should do to improve my numbers and time on CPAP. I have woken up a couple of nights with severe dry throat so I know I've had mouth leaks.
Here is my graph for one night. I usually wake up at 2 am and then at around 4 have to take off mask because it has become uncomfortable.
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Ron AKA
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Re: Any Recommendations to Improve Therapy

Post by Ron AKA » Mon Apr 09, 2018 11:08 pm

About the first time I have been stuck for making any recommended changes. You are quite well optimized based on the SleepyHead results. Can you say more about what makes you uncomfortable and wanting to take the mask off? If you are feeling short of air, I think you could increase your minimum pressure a bit -- say up to 7.4. Your maximum is fine. You might want to consider putting your humidity in full auto if you have a heated hose. I like the auto ramp in the A10, and would turn it on and set a Ramp Start of 5.5 cm. However that is not going to do anything for issues in the middle of the night.

As for the AHI most of your apnea is centrals, and the A10 will not respond to centrals. Your leak data is not on the screen capture, so it is possible that leaks are causing some false indications of events. About the first attempt to stop leaks from the mouth is a chin strap.

That's about all I can think of without more info.

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Pugsy
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Re: Any Recommendations to Improve Therapy

Post by Pugsy » Mon Apr 09, 2018 11:14 pm

The bulk of your AHI (which isn't all that high anyway) is central and there's not much we can do about centrals with your machine in terms of making changes to anything to reduce centrals.

Maybe turning EPR down or off....might affect the central count but it's not something I think is likely to happen.
That only happens when EPR is causing the centrals and if that was the case I would expect to see more centrals than we are seeing here.
But you could try it and see what happens.

As for improving sleep quality or hours of sleep made longer....hard to offer anything because we don't know what is causing the wake ups.

Next time you do wake up though and each time during the night if you can get awake enough to remember it...reach over and turn the machine off and then immediately back on again. This will show up as a break in therapy line and we can then look at the timing of those central flags to see if they are being flagged at a known awake time. If they are awake events...they don't count and nothing we can do about them except improve your sleep so you don't wake up so much....and that's easier said than done.

To be able to have a chance at fixing a problem we have to first identify the problem and the cause of the problem.

If you are mouth breathing...it didn't show up enough to be a problem in terms of therapy at least on this report.
The highest leak only went to 15.6 L/min and that's well below large leak territory.
We don't really need to see the leak graph...from the statistics we can see it never even made it to large leak territory for much if any of the time.
Now not saying that a little mouth breathing won't dry out the mouth but if you are doing mouth breathing...it sure isn't very much.

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Snorynomore
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Re: Any Recommendations to Improve Therapy

Post by Snorynomore » Tue Apr 10, 2018 10:30 pm

Thank you for your recommendations. I will turn machine off and on when I wake up to start figuring out the why. I have tried changing EPR to 2 and that made my breathing feel rushed so I went back to 3. I am glad to hear the leaks do not appear bad.

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palerider
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Re: Any Recommendations to Improve Therapy

Post by palerider » Tue Apr 10, 2018 11:06 pm

Snorynomore wrote:
Tue Apr 10, 2018 10:30 pm
Thank you for your recommendations. I will turn machine off and on when I wake up to start figuring out the why. I have tried changing EPR to 2 and that made my breathing feel rushed so I went back to 3. I am glad to hear the leaks do not appear bad.
The lower the EPR, the *LESS* 'breathing effects' that the machine has. at an EPR of 3, the machine drops the pressure by 3 when you start to exhale, and raises it by 3 when you start to inhale. At EPR 2, it does the same, only by 2cm pressure.

It's *ENTIRELY* driven by your breathing rate, any feeling of being rushed has nothing to do with the machine.

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jennmary
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Re: Any Recommendations to Improve Therapy

Post by jennmary » Tue Apr 10, 2018 11:26 pm

Your numbers look fine.

If you really want an actual recommendation to improve therapy I will give you one. STOP TAKING YOUR MASK OFF AT 4AM AND GOING BACK TO SLEEP WITHOUT IT.

How do you think it is ever going to get better if you just take it off when it isnt "comfortable"? Leave the mask on.

Also.....you could try taping your mouth if you really feel like you are dealing mouth leaks. It DOES have its risks and it isnt something I am going to totally recommend.....but it is something you could look into yourself. It worked well for me many years ago when I was first trying to move from a full face mask to nasal pillows.

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booksfan
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Re: Any Recommendations to Improve Therapy

Post by booksfan » Wed Apr 11, 2018 8:42 am

As a relative newbie, I understand the feeling of having to take the mask off, but agree that you really do need push past that to progress. What I found helpful was to got ahead and turn off the machine, take off the mask, go to the bathroom, wash my face...whatever I needed to do for a few minutes to be able to go back to bed and put the mask back on for another few hours. I found that the brief respite/attitude adjustment really helped. It might be worth trying!

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Snorynomore
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Re: Any Recommendations to Improve Therapy

Post by Snorynomore » Wed Apr 11, 2018 10:11 pm

Here is a new screenshot from last night where I did turn machine off and back on when I noticed discomfort and wanted to take mask off. I don't remember times that this happened except for the obvious 2+ hour break BUT I did put mask back on and am patting myself on my back for doing that.

Can you experts tell from graph when I turned machine off and on and what if anything could be causing the discomfort and me wanting to take mask off?
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Ron AKA
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Re: Any Recommendations to Improve Therapy

Post by Ron AKA » Thu Apr 12, 2018 10:02 am

Snorynomore wrote:
Wed Apr 11, 2018 10:11 pm
Here is a new screenshot from last night where I did turn machine off and back on when I noticed discomfort and wanted to take mask off. I don't remember times that this happened except for the obvious 2+ hour break BUT I did put mask back on and am patting myself on my back for doing that.
Can you experts tell from graph when I turned machine off and on and what if anything could be causing the discomfort and me wanting to take mask off?
Your machine is actually quite well set up. The data stops at 1:00 AM and starts up again at about 2:35. That must correspond to when you had the machine off. You had a large leak, so perhaps some mask issues at about 3:30. At about 11:50 you had a central apnea flagged, and the machine does not respond to those. Just before midnight you had an obstructive apnea flagged, and the machine correctly increased pressure in response to that. After that the machine starts a slow ramp down in pressure as it is seeing no events to respond to. About all I can think of is that you took the mask off when the pressure was about 7 cm, and you may feel that is not enough air pressure for comfort. My suggestion would be to increase your minimum pressure from 6.6 to 7.6 cm and see if that helps. And I know it is hard, but try to remember what you were feeling if you feel you have to take the mask off in the middle of the night.

Hope that helps some...

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Pugsy
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Re: Any Recommendations to Improve Therapy

Post by Pugsy » Thu Apr 12, 2018 10:19 am

We can see when you took the mask off but can't really tell much as to why.
You might zoom in on the flow right immediately before you turned the machine off and see if there is anything there but I have my doubts as to whether it will be all that exciting.

You don't show the leak graph but there's nothing flagged as large leak at 1 AM...so maybe it was a 23 L/min and thus not flagged but enough to wake you.

Leaks don't have to be large to wake a person. It's why I tell people that any leaks no matter how big or small that wakes us up...needs to be fixed.

So maybe leak....but that's a big maybe. If you zoom in on the flow rate it also zooms in on the leak graph at the same time.

I wouldn't change the settings at all if you are comfortable with them as they are. On paper they are doing a a great job.

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Ron AKA
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Re: Any Recommendations to Improve Therapy

Post by Ron AKA » Thu Apr 12, 2018 10:32 am

Pugsy makes has some valid points. I would suggest you put your cursor over the wake up time and keep clicking the up arrow until a fairly narrow range is shown that has the wake up on the right. The left and right arrow keys let you move this window along the time scale. You want to see the mask and flow graphs look like clear waves. Also click and drag up the leak rate graph so it shows too. Then post that screenshot and it may give some more clues as to what was going on and why you may have woken up.
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palerider
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Re: Any Recommendations to Improve Therapy

Post by palerider » Thu Apr 12, 2018 12:46 pm

The best advice I can give you is to listen to Pugsy.

Ron is a retired "manager", and thinks he knows far more than he actually does... and has no idea about the limits of his knowledge.

All the things he says aren't necessarily wrong, but they do have to be examined closely.

Pugsy you can trust... she knows her stuff, and she knows what she doesn't know.

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Snorynomore
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Re: Any Recommendations to Improve Therapy

Post by Snorynomore » Thu Apr 12, 2018 9:56 pm

Here is an image with the time right before I take off mask expanded. Anything unusual? I also posted an image of last night and I had another challenging night but I made myself remember what I was feeling and it felt like I couldn't get enough oxygen and felt like I was suffocating so I had to open my mouth to breath. I was also having condensation issues again so I had to wipe mask and sometimes that took care of problem.
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Pugsy
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Re: Any Recommendations to Improve Therapy

Post by Pugsy » Thu Apr 12, 2018 10:04 pm

I see absolutely nothing all that exciting right before you took the mask of.
I see nice normal airflow and breathing...leak is so tiny you can't even find it on the graph....pressure isn't moving around.
No flow reductions or even minor flow limitations.
Not a hint of something that might cause a wake up.

My best guess...spontaneous arousal from lord knows what or the aliens came by with the probes again. :lol:

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Ron AKA
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Re: Any Recommendations to Improve Therapy

Post by Ron AKA » Fri Apr 13, 2018 8:41 am

Snorynomore wrote:
Thu Apr 12, 2018 9:56 pm
Here is an image with the time right before I take off mask expanded. Anything unusual? I also posted an image of last night and I had another challenging night but I made myself remember what I was feeling and it felt like I couldn't get enough oxygen and felt like I was suffocating so I had to open my mouth to breath. I was also having condensation issues again so I had to wipe mask and sometimes that took care of problem.
You had me really puzzled for a while, until I realized you were posting two different nights. That second trace would indicate you were breathing normally and probably asleep, and then it stops. Kind of strange. In any case the symptoms you describe indicate you are not getting enough pressure - "it felt like I couldn't get enough oxygen and felt like I was suffocating so I had to open my mouth to breath". Based on that and the pressures I am seeing, I would suggest the following changes:

1. Ramp Start - Set this pressure to 6.6 cm in the Clinical Menu. The current 5 cm is too low for most people. This will give you more air when you are falling asleep, and in the night if you take off the mask for any reason and start treatment again, you will get this as the minimum pressure to start the ramp.

2. Minimum Pressure - I would set that to 8.4 cm to give you more air when the machine automatically ramps back down in pressure when you are asleep. That may be a touch high, but I think it is a good starting point to determine how much you need to feel comfortable.

Try those two changes and see if that helps some.