Four months in, needing help interpreting data

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xcountrygal
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Four months in, needing help interpreting data

Post by xcountrygal » Sat Apr 14, 2018 1:59 pm

Hi All:
I am now nearly four months into this apap journey and have appreciated all of the help I have received from forum members. I would be lost in the fog without all of you.

I am posting sleepyhead screen shots of 3 recent nights. I am most concerned about the flow limitation graph - it seems so very busy.

I currently use the N20 nasal mask with chin strap and tape while hoping to find a FFM that will fit me reasonably well (I have tried so very many - two more new applicants are currently somewhere on their way to me now!) My AHI has been under 2 pretty much from the beginning of apap use. I have increased my minimum pressure from an initial of 6 to the current 10 (with my Doctor's approval). I have also started to slowly increase my maximum pressure from the initial 14 to the current 15.6 with possibility of letting the machine go higher to attempt to take care of some of the hypopnea clusters that seem to occur during REM around 3 or so in the morning.
I do have leaks, but most nights are not too bad - some are mouth leaks, some mask leaks, but they generally don't wake me up. Hoping that if I can get a reasonable fit on a FFM that the mouth leak component will not be a factor. I have a very narrow airway and the chin strap needed with the nasal mask doesn't help as it forces my tongue further back - making the airway even smaller.
At this point, I feel as if I am sleeping better - tho still waiting for the great burst of energy!! However, from what I understand, I don't think my flow limitation graph should be so active.

Any help - suggestions would be appreciated! Thank you all in advance.
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palerider
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Re: Four months in, needing help interpreting data

Post by palerider » Sat Apr 14, 2018 2:25 pm

First, please turn off the right panel (f10) in any other screenshots, it adds nothing and just scrunches up the charts.

10 is too low a minimum pressure for you, based on the pressures you've shown, it sets the machine up to keep trying to get back down to it, even though you need more.

In fact, the machine clearly wants to go higher, to deal with your flow limitations, which lead to hypopneas, and apneas, if not headed off.

Absent other concerns, I'd set the max to 20, and see where it wanted to go. probably a minimum of 12... maybe more.

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xcountrygal
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Re: Four months in, needing help interpreting data

Post by xcountrygal » Sat Apr 14, 2018 3:22 pm

Oops! - Sorry about that - I have fixed the sleepyhead data page so my screenshot will be larger in the future.

I have been a bit afraid of increasing the minimum past 10 (had to really convince my Dr. to let me go to 10 at my compliance appointment) for fear of triggering more leaks. However, I will try to go up - slowly works best for me. With the maximum, do you suggest going to straight to 20 or going up in stages? On the screenshot from last night (April 13), I had gone up from 15 to 15.6 and had 4 centrals - I have rarely been having centrals so don't know if it is related to the pressure increase slight as it was or just random.
I will try an increase on that tonight as well and report back.
Thanks!

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Re: Four months in, needing help interpreting data

Post by palerider » Sat Apr 14, 2018 3:28 pm

xcountrygal wrote:
Sat Apr 14, 2018 3:22 pm
Oops! - Sorry about that - I have fixed the sleepyhead data page so my screenshot will be larger in the future.

I have been a bit afraid of increasing the minimum past 10 (had to really convince my Dr. to let me go to 10 at my compliance appointment) for fear of triggering more leaks. However, I will try to go up - slowly works best for me. With the maximum, do you suggest going to straight to 20 or going up in stages? On the screenshot from last night (April 13), I had gone up from 15 to 15.6 and had 4 centrals - I have rarely been having centrals so don't know if it is related to the pressure increase slight as it was or just random.
I will try an increase on that tonight as well and report back.
Thanks!
Well, your leaks are happening at higher pressures anyway, if you look at the pressure line, the only time it's at 10 is when you first start...

Pugsy would probably say to raise the max pressure in stages, because she's cautious like that... I like to get more immediate data, so I say "crank it up and let's see what happens"... there's not a lot of difference between 15.6 and 20, but it's entirely up to you.

4 centrals are insignificant. probably just breathing changes as you shift, or go into and out of sleep breathing (which is handled by different mechanisms than wake breathing.)

Also, could you go into preferences and turn off the pie chart? that way more of the info on the left will show... (no need to repost the charts you've already done.

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alextherican
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Re: Four months in, needing help interpreting data

Post by alextherican » Sat Apr 14, 2018 4:19 pm

Hi,
I'm new to the forum and I was just trying to get familiar by looking at some posts. I am totally curious how do you get the charts your looking at? I'm trying to learn more about events per hour and how it affects my treatment. I switched to a full face mask so that I can sleep on my side and now I'm getting events into the teens. Any ideas?
Sorry if I'm all over the place. :)

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palerider
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Re: Four months in, needing help interpreting data

Post by palerider » Sat Apr 14, 2018 4:23 pm

alextherican wrote:
Sat Apr 14, 2018 4:19 pm
Hi,
I'm new to the forum and I was just trying to get familiar by looking at some posts. I am totally curious how do you get the charts your looking at? I'm trying to learn more about events per hour and how it affects my treatment. I switched to a full face mask so that I can sleep on my side and now I'm getting events into the teens. Any ideas?
Sorry if I'm all over the place. :)
Read the links in my sig.

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Pugsy
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Re: Four months in, needing help interpreting data

Post by Pugsy » Sat Apr 14, 2018 4:32 pm

Actually in this situation...I would increase the max to 20 and leave minimum at 10 just for now. Evaluate the minimum again a little later based on what happens with more max and how the FLs respond.
I would like to see if letting the machine go higher will deal with the FLs well enough.
The machine is going to go up and stay up most likely for the bulk of the night anyway.
Yeah a higher minimum is probably a more ideal thing but in this situation and nervous doctor...starting at 10 and going up and pretty much staying up there might be a viable option.

And yeah...those are some ugly FL graphs BUT...just because FLs are ugly and the machine is maxing out doesn't mean that we just HAVE to go nuking the FLs.
If those FLs are maybe nasal congestion they probably won't respond to letting the machine go higher and we won't be able to kill them anyway.

And just because the machine wants to go higher doesn't mean that we always have to let it go higher.
I would at least try the 20 max though...see what happens and if the FLs change much or leaks change much or sleep quality changes much.

If someone has a reasonably low AHI and they are reporting sleeping good and feeling good...nuking those FLs and letting the machine go higher isn't always urgently needed especially if the going higher part creates less good sleep and less feeling good.

So all I would do for now is just open up the max to 20 and see what happens.
I may have to RISE but I refuse to SHINE.

zonker
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Re: Four months in, needing help interpreting data

Post by zonker » Sat Apr 14, 2018 5:04 pm

alextherican wrote:
Sat Apr 14, 2018 4:19 pm
Hi,
I'm new to the forum and I was just trying to get familiar by looking at some posts. I am totally curious how do you get the charts your looking at? I'm trying to learn more about events per hour and how it affects my treatment. I switched to a full face mask so that I can sleep on my side and now I'm getting events into the teens. Any ideas?
Sorry if I'm all over the place. :)
welcome to the forum!

look closely at the bottom of palerider's post above. see the two links regarding sleepyhead? click on those and start reading.

if it's overwhelming (if you're as dumb as me!!), please feel free to start your own post asking questions about it.

zonker
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Re: Four months in, needing help interpreting data

Post by zonker » Sat Apr 14, 2018 5:09 pm

xcountrygal wrote:
Sat Apr 14, 2018 1:59 pm
I have a very narrow airway and the chin strap needed with the nasal mask doesn't help as it forces my tongue further back - making the airway even smaller.
if i may be so bold as to make a suggestion; sometimes that chin strap can be a bit of overkill. or at least it was for me. you might try this-

viewtopic.php?f=1&t=112758&st=0&sk=t&sd ... i#p1086296

xcountrygal
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Re: Four months in, needing help interpreting data

Post by xcountrygal » Sat Apr 14, 2018 6:01 pm

Hi All:
I will increase the maximum - leaving minimum at 10. I think I will feel more comfortable going up to say 17.5 and then up to 20 on succeeding nights. With the higher pressure do you think that it might trigger either more centrals or aerophagia (something I fortunately haven't had to deal with yet.), or is it try and it and see what may happen?
Pugsy: - I don't think all of those flow limitations are nasal congestion. My nose has been relatively congestion free this past week. Keeping the humidity up on the machine is very helpful for me. However, nasal congestion can rear it's ugly head on me suddenly and is something I battle frequently especially during the winter.

Zonker: I have tried the headband trick, but will have to try it again - just don't want to change too many variables at once until I can figure out what might work or not.

Thanks all!

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Pugsy
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Re: Four months in, needing help interpreting data

Post by Pugsy » Sat Apr 14, 2018 6:14 pm

Chances of centrals popping up...slim. If you don't have them with 15 cm pretty much all night I doubt that you would have them even if you did 20 cm all night.
If you are more comfortable going up only half way..that's fine. Heck it might not even want to go much above the 15.
It won't go where it doesn't think it needs to go without a good reason.

Chances of aerophagia rearing it's ugly head...no way to know...Remember some people get it bad at 7 cm...and others use bilevel at pressures over 20 all night long and never get it.
If you do have issues with it you will know real quick and then we re-evaluate the need to go higher.

If you aren't having nasal congestion then we probably can't blame that ugliness on the nose.
But then it should improve with more pressure...so good and bad. :lol:
I may have to RISE but I refuse to SHINE.

xcountrygal
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Re: Four months in, needing help interpreting data

Post by xcountrygal » Sun Apr 15, 2018 8:15 am

Hi All:
Last night I upped the maximum pressure to 18 (from 15) with the thought of trying out the machine max at 20 tonight. I had alot of mask leaks - this time I think the leaks woke me up twice as I remember two separate dreams which I don't usually recall. I did experience some minor aerophagia - but not bad. However, I don't see that my flow limitation graph is any different. See attached screen shot.
Screenshot (7).png
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At my first appointment with the PA in the Sleep Dr. office, she took one look at my mouth and told me that my apnea was a direct result of my lousy oral structure. She had suggested at the time that if I could find a FFM that worked for me - perhaps I could combine it with my existing MAD and use both together - possibly reducing the amount of pressure needed. As I have said previously, I have yet to find a FFM that will work for me - but am still in the hunt.

As reference I am including two other random nights from the past - both at lower pressures. My flow limitations graph while never pretty, does seem to fluctuate from night to night for no reason that I can think of. I have a pretty standard evening/bedtime routine and have had no changes in meds etc.
Screenshot (5).png
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Screenshot (6).png
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Any thoughts, suggestions? Go up to the 20 as planned to see what happens - or increase minimum pressure - or both?

I am scheduled at the sleep dentist office for impressions for a new MAD (as backup) - so would have a current MAD soon to combine with a FFM. Current MAD no longer fits well (once I started on apap, I quit wearing the MAD and now my bite seems to be changing back. :?

Thanks for any help or insight!

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Pugsy
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Re: Four months in, needing help interpreting data

Post by Pugsy » Sun Apr 15, 2018 8:23 am

How much time do you think you might end up sleeping on your back?
I may have to RISE but I refuse to SHINE.

xcountrygal
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Re: Four months in, needing help interpreting data

Post by xcountrygal » Sun Apr 15, 2018 9:14 am

Hi Pugsy:
I don't think I sleep on my back much at all. I mostly sleep on my right side. Sometimes will shift to left, but that side isn't as comfortable for me. I usually fall asleep on my right side and if I awake in the night I am still on my right side. I used to be a restless sleeper (probably as I wasn't breathing well) but since apap I find I don't move much once I fall asleep. I may angle my head slightly off the horizontal (toward my back) in an attempt to keep the mask in place, but not sure about that. I try to make a depression in the pillow I use so I can fit the mask in without squishing it.
(Under the TMI category, I was a stomach sleeper for much of my life, but 18 yrs ago had breast cancer (left side) with reconstruction - saline implant - chemo - the whole 9 yards). This altered my sleep pattern and both stomach sleeping and left side sleeping are no longer comfortable - this is also when I started to have sleep issues. First sleep studies years ago showed little oas, but much oxygen desats ( I think this would be called UARS now). So fast forward to today, lousy oral structure - narrow mouth, large tongue, long soft palate resulting in itty bitty airway :( :(
Sorry - such a long answer for a simple question :D

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Re: Four months in, needing help interpreting data

Post by Pugsy » Sun Apr 15, 2018 9:35 am

I have my doubts as to whether your Flow Limitations can be improved much with more pressure...they may simply be related to the crappy airway since we can't blame congestion in the nose.
And if you don't go on your back much...we can't blame supine sleeping. Kinda limits the potential culprit list.

You are fast closing in on the max your machine will go to and it's not helping the FLs much if any...and more minimum is unlikely to help much because it (the pressure) really isn't dropping down all that much once it goes up.
The drop in pressure last night...most likely the machine trying to help you fix those big leaks.

If you look at other nights minimal leaks...the pressure pretty much went up from the minimum rather quickly and never really dropped much.
In all honesty all increasing that minimum will most likely do is just get you higher a little quicker and it's still going to end up being where you are spending most of the time anyway.

I am betting that even if you could use 20 cm without leaking that it wouldn't do a remarkable job on those FLs anyway.
I don't think that increasing the minimum is the silver bullet and letting the machine go to max probably isn't the silver bullet either...especially if the leaks start becoming a problem.

Now you could try anticipating the higher pressures by fitting the mask at 15 to 20 cm (use the mask fit option so that it gives you a time at the higher pressures to anticipate the higher pressure) instead of the 10 minimum but I have my doubts as to how much that will help...worth trying though.

At some point I think you need to sit back and really take a hard look at what you can reasonably expect to obtain here..and what you can do in terms of your own sleep quality.
I know you want to kill the FLs but killing them may not be possible and trying to kill them may create more problems than the Fls are causing.
Your AHI is nice and low....and if you are sleeping decently and feeling decent...killing the FLs may not even do anything except clean up the reports.

Let it go to 20 tonight...see how much time it wants to be up there and see if there's any real change in the FLs.
Keep the minimum at 10 or maybe try 12...but to be honest it's most likely not the problem here and I have my doubts that even a minimum of 15 would do much to improve things but it might make the sleep quality and aerophagia issues become more of a problem. If your pressure was dropping often to the 10 maybe but it's not...once the machine goes up it pretty much stays up and creates its own new minimum of sorts.
You have to omit that drop during the big leak last night. I think that drop was the machine trying to help you get the leaks better managed.
I may have to RISE but I refuse to SHINE.