One week's treatment results

[Pugsy]

Read what Perrybucsdad said about deviated septum and full face masks and his transition to nasal mask.
viewtopic/p663440/Mouth-Breathers.html#p663440
I had to about twist his arm off to get him to at least try a nasal mask. He was just so sure it would never work because someone told him he couldn't ever use a nasal interface mask.

[mrCanoehead]

Your deviated septum, might be important.

I had to have a septoplasty and turbinate reduction to tolerate CPAP.

I have read that septoplasty does SFA for sleep apnea, but you probably know more about it than I do. I have no problem with my CPAP machine, should have got it years ago.

Pretty darn good, but not optimal yet.

You are saying AHI can be driven to zero? I used to sleep 10 hours, now I sleep 7 or even less and I feel fully rested. I am elated with where I am now.

Right now you're being titrated to discover your optimal pressure. The spread between your min and max is pretty high, and not optimal yet. The next step, in Ontario, is for them to order you a straight CPAP machine and set it to what they believe is your optimal pressure.

I think the unit I have has a closed loop feedback control system. Looking at the graph, it increases pressure on event, then slowly ramps it down after the situation is under control. You are not setting a static pressure, the unit is constantly hunting. Right now it has a license to hunt between 6 and 16 cm, but it will attempt to use the least pressure it can.

The initial pressure was set to 4 cm, but I changed it to 5 cm because I thought I was not getting enough air. After the closed loop kicks in, it seems to peak out a little under 10 cm.

I think it is working fine, don't see any need to tinker with it. I might set an upper limit around 10.5, because there is no evidence I need anything higher, at least if I don't have some type of infection.

I wanted to just go out and buy one of these APAP machines. Now that I have a diagnosis, I am uninsurable according to what I am reading, so I can never leave my current life insurance company.

While using their loaner, during my titration they ordered my machine. They wanted to order me a straight CPAP machine, don't accept that one. Get a ResMed AirSense 10 AutoSet for Her. It's the one you're using now, even though it's an APAP machine, it qualifies as a CPAP. See the topic Pugsy directed you to.

Yes, that is why I am going to call the doctor's office on Monday to ask if I can get an earlier appointment before the Autoset for Her gets taken off the list. Right now my appointment is for late March.

The doctor is being threatening, he implied he would take away my driver's license if I don't buy/use the CPAP machine. Honestly I never had any problem with falling asleep while driving. I want to get the Autoset right quick and close off the risk.

The bill had the price of the machine after the OHIP / ADP reduction, plus other incidentals. I then submitted the bill to my insurance where they covered 85%.

Nice. My insurance should cover a similar amount.

I buy all my supplies online at CPAP Outlet (cpapoutlet.ca). They're in Markham, quick delivery and competitively priced.

Perfect. Thanks.

[Jas_williams]

Thanks Pugsy. I like the mask (Philips Respironics DreamWear Full Face CPAP Mask). I was thinking of putting duct tape over the centre vents and drilling holes at +/- 45 degrees with a Dremel?

The Resmed F20 is a full face mask that now comes with a quietair elbow which provides diffused venting it is availiable with a memory foam pillow or a silicone pillow. Not sure which would be best for you as everybody’s view is different

[zonker]

Pretty darn good, but not optimal yet.

You are saying AHI can be driven to zero? I used to sleep 10 hours, now I sleep 7 or even less and I feel fully rested. I am elated with where I am now.

i'll be rude and step in here for dogslobber.

he is saying your ahi can go lower. you CAN go to zero. however, that's not to be your goal. your goal is to feel good after a night of sleep. many of us here feel best when we are under 2. some of us feel better under 1.

i can actually feel the difference in the morning if i have an ahi of about 1.5 and above.

none of this means that YOU have to "chase zero" as we say. whatever makes you feel best is optimized therapy for you.

good luck!

ETA- just went back and looked at your numbers. you are pretty much where *I* feel comfortable for an ahi.

[kismet210]

Hi there

I normally use a True Blue nasal mask except if I have a cold...then I switch to my Phillips Respironics ComfortGel Full Face so I can mouth breath and get my sleep. The hose attachment rotates a full 360 so you can position the ports wherever you want the stream of air to go. I tend to put the hose up behind my head on my pillow so the ports are blowing away from my face. Hubby says its also just as quiet as my True Blue (I know some masks can sound like wind tunnels lol). I hope this helps you somehow!

[Dog Slobber]

i'll be rude and step in here for dogslobber.

he is saying your ahi can go lower. you CAN go to zero. however, that's not to be your goal. your goal is to feel good after a night of sleep. many of us here feel best when we are under 2. some of us feel better under 1.

You're not being rude at all, Zonker.

Your deviated septum, might be important.

I had to have a septoplasty and turbinate reduction to tolerate CPAP.

I have read that septoplasty does SFA for sleep apnea, but you probably know more about it than I do. I have no problem with my CPAP machine, should have got it years ago.

Pretty darn good, but not optimal yet.

You are saying AHI can be driven to zero? I used to sleep 10 hours, now I sleep 7 or even less and I feel fully rested. I am elated with where I am now.

You should be elated, your initial numbers are terrific, and you're feeling better. I haven't hit a 0.0 yet.

Right now you're being titrated, you minimum is set really low and your sleep therapists are going to determine the best minimum to start it off. As attractive as setting the minimum wide open may sound, it's not. When an APAP starts detecting events, it starts increasing pressure, the pressure change isn't immediate a slow ramp up. When minimum pressures are too low, in the time it takes to get to pressure apneas might be missed.

Continue your titration period, then when they give you your machine, set it up and send you on your way post some more graphs and the experts here will see if they can dial it in even closer.

[zonker]

i'll be rude and step in here for dogslobber.

he is saying your ahi can go lower. you CAN go to zero. however, that's not to be your goal. your goal is to feel good after a night of sleep. many of us here feel best when we are under 2. some of us feel better under 1.

You're not being rude at all, Zonker.

hat-tip.gif

and one of these days, i'll get the hang of this danged quote feature....

[mrCanoehead]

Thanks for the replies! I read every one.

I tried a nasal mask last night, it is a Resmed N20. I got a Respironics Premium chin strap to keep my jaw closed ($42, ouch).

I jacked up the pressure floor to 8 cm H20 based on data from previous nights. The tech said she was not allowed to do it, only the doctor can change it. I just changed it myself.

It seems to have been a good night, 0 AHI, until I took the whole rig off around 03h30 because the chin strap was hurting the sides of my head. I sleep on my side and the way the rear-of-head, horizontal strap attaches to the rig causes bumps and these were causing pain. Does anyone have any suggestions for a jaw strap for a side-sleeper?

screenshot-20190210-153903.png (212.25 KiB) Viewed 882 times

[zonker]

Thanks for the replies! I read every one.

well, now, look at you!

applause.gif

(this image via chicago granny. used with permission)


may i suggest using a foam cervical collar to keep your chin up rather than a chin strap?

[palerider]

I jacked up the pressure floor to 8 cm H20 based on data from previous nights. The tech said she was not allowed to do it, only the doctor can change it. I just changed it myself.

Technically *THEY* can't change it without the doctor's orders.

No such restriction applies to the patient, (you).

Good on you doing what's best for you!

[mrCanoehead]

I left the chinstrap off last night. Maybe my jaw opened around 3:45 but I think actually I just had the mask on too loose. I find I turn my head into the pillow and it dislodges the mask - maybe I can get one of those CPAP pillows. For now I think I will just try adjusting the straps.

I do not remember waking up around 3:45.

Do you think I need to make any changes at all, at this point though?

screenshot-20190212-083848.png (209.28 KiB) Viewed 839 times

screenshot-20190212-085824.png (196.21 KiB) Viewed 836 times

screenshot-20190212-090435.png (194.95 KiB) Viewed 836 times

[Pugsy]

If that were my report and I slept decently....I wouldn't be making any changes in the settings.

Leaks are a war we never truly win. Sometimes we win a battle...sometimes the leak wins the battle.

If those leaks didn't wake you up...I wouldn't even give them a second thought. They are brief and the worst it went to was 30 L/min and the machine is still going to be accurate in terms of sensing, recording and responding at 30 L/min. Now if you went up to say 45 L/min and stayed up there for 30 minutes...maybe a different story.
A small amount of large leak for any reason...not the end of the world by any means.
It's been nearly 10 years now for my cpap use...and I still on occasion get some ugly leak lines. Sometimes I win the battle and sometimes the leak wins. Unless they wake me up...I simply don't care because they are brief and rarely go deep into large leak territory and when they do...always very brief deep into LL territory.

Now if any leak...no matter how big or small.... wakes you up and disrupts your sleep then it needs to be dealt with.
Anything that disrupts our sleep is unwanted.

[mrCanoehead]

Thanks. Is the third screen grab what a true CA looks like? To me, it just looks like I took a big breath and didn't breathe for a while. I don't think blood oxygen would have dipped too dramatically, and not for long.

In the polysomnography test (no CPAP), I had 24 AHI and the oxygen went down to 86%, no further.

On a related point, and I will ask the doctor this too, if I had something like 30 AHI in the past for about 5-6 years, with oxygen dips to the 86% range, would that cause heart damage? I used to weigh about 25 lb more than my present 182 lb (height: 5'8") before I started exercising 4 years ago.

[Pugsy]

You have zoomed in a little too close on that 3 rd image with the CA flagged for me to get a good idea if it was real or not.
I can't see enough of the breaths preceding the flag and in the scale that is more normal.

Needs to be more like this scale. These appear to be real to me...nice boring asleep breathing with no ragged or big gulps.


I have no idea how much prolonged desats might be a factor in heart damage. So many variables to consider...how often, how much stress on the heart, how healthy was the heart to start with, how prolonged the desat...etc.
If it's any consolation to you...mine went to 73% and I had probably at least 2 years with no cpap therapy to fix it..and I have no heart damage. Of course I have no way of knowing how much time I spent at 73% untreated.
Definitely something to have a chat with your doctor about and maybe some testing to learn the status of the heart now ....like an echocardigram or maybe stress test of some sort.

[mrCanoehead]

Let's try this:

You can see, in the second screenshot, that there are other events which do not seem to meet the time threshold for reporting. Probably because the short duration will not cause an oxygen dip of any magnitude.

screenshot-20190212-183749.png (198.23 KiB) Viewed 798 times

screenshot-20190212-183540.png (204.22 KiB) Viewed 799 times