So, Why Is It I Feel So Good?

By all objective measures, the night did not go well; nor did the two nights before.

After waking at midnight with a stomach full of air, it slowly dawned on me this was likely caused by nasal congestion which allowed me to breathe in OK, but prevented me from breathing out.

To prevent leaks, my Ultra Mirage Full Face Mask was cinched down so tight that I may now have permanent indentations across the bridge of my nose.

Since I couldn't breathe out nasally very well against a pressure of 6 cm, I opted to just open my mouth. This worked so well that I woke up gasping for air throughout the night more times than I can count.

MyEncore tells me AHI = 22.9 for the night, up from AHI = 12 for the nights at 4 cm pressure.

The oximeter tells me 14 desats, with the longest at 60 seconds; more and longer than any previous night using xPAP.

Yesterday, Encore Pro showed me that my AHI for the prior night was high but that the auto-BiPAP had not increased pressure to the allowable maximum to resolve this. Consequently, yesterday I began seriously considering the possibility of CSDB.

Despite this, and contrary to my own expectations, I felt good when I got out of bed this morning. Maybe it's because my dreams went well despite the choppy night's sleep. Just another of many things which don't make much sense I suppose.

I gotta resolve the nasal congestion thing; hopefully today. Otherwise, I'm not sure how much the rest of the data means.

Regards,
Bill

Bill,

Without getting too technical, never look a gift horse in the mouth. If you're feeling good, that is what counts. Forget the numbers for today. If you continue to see a downward spiral consistently, then speak with whoever is handling your care and treatment of this condition, especially re the desats. But for now, ignore those numbers and enjoy feeling well. Have a great day!

NightHawkeye wrote: MyEncore tells me AHI = 22.9 for the night, up from AHI = 12 for the nights at 4 cm pressure.

The oximeter tells me 14 desats, with the longest at 60 seconds; more and longer than any previous night using xPAP.

Yesterday, Encore Pro showed me that my AHI for the prior night was high but that the auto-BiPAP had not increased pressure to the allowable maximum to resolve this. Consequently, yesterday I began seriously considering the possibility of CSDB.

Bill,

I am curious about your new auto bipap. I have a bipap, but not the new auto one. And so I am curious about how it works. And like you wondered, why hadn't the auto bipap not increased pressure to remedy the apneas. I would like to know more as well, in case one day I need to get a new bipap and would consider getting an auto one. I think it is good you're documenting what's happening. At least that way, with further explanation you will get to understand what's happening. This is a new type of bipap. You never know, they may upgrade the machine, or work the kinks out of it. I'd be interested in knowing what more you learn about the machine.


Linda

I am curious about your new auto bipap. I have a bipap, but not the new auto one. And so I am curious about how it works. And like you wondered, why hadn't the auto bipap not increased pressure to remedy the apneas.

At first I blamed this on a large leak which was present for a good part of the night, but now I'm not so sure. When I started looking through all the numbers provided by Encore Pro I noticed that the machine counted all the apneas on EPAP not IPAP. I believe Encore Pro listed 0 apneas on IPAP; not a single apnea occurred on inhalation.

What I think apnea on EPAP means is that I took a breath in but then didn't exhale for a long time. Would this then mean that a machine pressure increase wouldn't have helped the situation? I'm guessing that it does. Can't fault the machine's programming if that's the case. EPAP was already operating at the minimum programmed pressure of 4 cm.

So this is where my observation of nasal congestion and having difficulty exhaling nasally against the pressure. Exhaling through my mouth was no problem; after I started breathing through my mouth, the problem with air getting into my stomach quit as well.

I still have high confidence in my new Respironics Auto-BiPAP and believe the data it provides is accurate. My challenge is interpreting exactly what it means.

I'm learning though; slowly, but surely.

Regards,
Bill

Bill,

I too use a BiLevel & an Ultra Mirage F/F mask but at much higher pressures than you have mentioned.

I am very surprised that you have to clamp the mask so tight to prevent leaks. My own experience is that above 14.5 cms IPAP I start to get some leaks and these increase significantly with any further increase in IPAP cms.

My EPAP cms is 8 which seems delightfully soft to breathe out against.

Like you I get bouts of nasal congestion and will often mouth breath for a while but so often on any waking I find I have usually reverted to nasal breathing. Sometimes waking or changing position seems to cause the nasal congestion to return for a while.

I also determined that in my case I was slowing my breathing & often stopping breathing. The download data from the machines I had then showed this was occurring at sleep onset and again just before waking.

My BiLevel has a feature called A/C Assisted Control (I think other BiLevels call this Timed) - I have set a min of 6 BPM (6 Breaths per minute). If my breathing slows any more than 6bpm the machine will cycle to IPAP without waiting any longer than about 4 secs for me to begin an inhalation by myself. This seems to work very well & since I went onto this BiLevel my therapy has returned to the best I have ever been getting.

The aerophagia (wind in the stomach) can be very frustrating but while that was a big problem before I went onto a BiLevel, that has all but gone away now.

Good luck with your efforts - very challenging but the rewards are great

Cheers

DSM

Sleepless on LI wrote:If you're feeling good, that is what counts. Forget the numbers for today. ... But for now, ignore those numbers and enjoy feeling well.

I 2nd that opinion. I read alot of people tweaking the machines and following thier reports, but sometimes it just comes down to how you feel. I do understand the affect of any apneas/hypopneas, and trying to limit them as much as possible. (Apneas = Bad) But, if you feel good, what else matters?

Remember the feeling you had today, because surely you will have bad days down the road. Upon waking on those bad days, keep yourself motivated by the feeling you had today. Congrats!

I need to correct my earlier statement about the Auto-BiPAP apnea detection on exhale. I now understand that I do not understand the Encore Pro data tables for IPAP and EPAP. It looks like the various events have been arbitrarily placed into either the IPAP or into the EPAP table. Hypopneas, Flow Limitations, Snores and Non-Responsive events are grouped in the IPAP table. Apneas, Snores and Non-Responsive events are grouped in the EPAP table.

This format stays the same for the few days that I collected bilevel data. Apneas appear to be grouped in the EPAP data only while hypopneas appear to be grouped in the IPAP data only; the other events appear in both EPAP and IPAP tables. I guess I just don't understand Maybe someone else here can explain.

Regards,
Bill

I am very surprised that you have to clamp the mask so tight to prevent leaks. My own experience is that above 14.5 cms IPAP I start to get some leaks and these increase significantly with any further increase in IPAP cms.

DSM, Part of it is facial hair. I have a full beard and am reluctant to part with it. (I have trimmed it somewhat though.) I'm pretty sure this is the cause of most of the leakage. The other thing is that I have a tall, narrow nose bridge and the only way I've found to eliminate leakage around the eyes at 8-10 cm pressure is to clamp the upper portion of the mask tightly.

This mask tightening may be a short term thing for me though if present trends continue. So far, the most effective therapy for me has occurred at the low pressure of 4 cm. At that pressure, although Encore Pro says I have a significant number of apneic events, oximeter data looks very good with very few desats and of short duration. Of even more importance is the fact that I've been able to get up feeling good in the morning.

Tonight I'm going to try saline solution and see how that works for decongestion; just seems like a better way to go about decongesting, rather than using one of the commercial preparations (which can only be used for a few days at a time anyway). I may also turn up the humidifier another notch.

Good luck with your efforts - very challenging but the rewards are great

Thanks DSM. I'm what you might call highly motivated. The problems I've had with xPAP are minor annoyances compared to what I've endured without it. I've already experienced the positive effects and I'm at the tweaking and trying to understand things phase now.

It's beginning to look like my response to xPAP therapy is not quite the norm, so I really would like to understand as much as possible in case other adjustments are warranted.

Regards,
Bill

Remember the feeling you had today, because surely you will have bad days down the road.

Hey, give me a break Swordz. I just started this xPAP therapy! Seriously, though, I understand and appreciate your thoughts. Thanks for the encouragement.

Regards,
Bill