How to handle leak and other questions

[st8728]

Trying to understand these flows here from last night. I watched the videos regarding CAs and awaking and noticed some examples I have attached below. I am trying to understand what if any of these are real CAs and what is actually happening here.

Example 1:

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Example 2:

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Example 3:

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[st8728]

Should I also be getting obstructives like this? Should I perhaps request my pressure to be raised slightly or ask for APAP with a more limited range 8-20 perhaps? I will continue to monitor over the week:

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I have attached last night also here:

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I am running into some trouble with being able to test out taping my mouth as my wife is refusing to let me do so at this moment and she is worried I might die or something. Would it work if I used a crepe bandage to kind of wrap around my head to keep my mouth closed perhaps?

Also note I turned off ramp last night it was no issue going right to pressure. EPR is still on. Still using p30i one small section on the right of my nose is painfully sore and red raw but I have been putting lanolin on it hoping it helps and my nose gets used to this.

[Pugsy]

Maybe the first CA on the example number 3...might be real but it's iffy.
All the rest looks like you weren't asleep. When you see big arousals before a flagged event then that usually means awake or half awake and when I see stuff like that I put them in the "wasn't asleep" basket which I ignore.
Like that big breath at 03:19:40. We don't breathe like that when asleep. Something caused an arousal...now what we don't know.

Yes, you could try some light weight wrap bandage. Anything that will sort of keep lips together.

[st8728]

Last night I used a headband I use for running to keep my mouth shut most of the night. Maybe it is mouth leak the results look much better right

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I will try for a few more nights to see how it goes. I might buy one of the resmed chin straps because this headband is somewhat uncomfortable

[st8728]

I went to the sleep place to buy a chin strap and they gave me a resmed chin strap for free. Hopefully the leaks continue to stay low.

Regarding the arousal followed by apnea is this something that would potentially go away over time? I see lots of people who post great results under 1 AHI and I wonder if I would ever get to that. Is an arousal followed by an obstructive legit or not?

Edit: Also I have attached a copy of my sleep study report I don’t know if this is helpful or not

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[LeonardoDR]

If the Resmed works for you, great. But that design wraps around the tip of the chin and forces the jaw into the joint, which is uncomfortable and cause even cause joint damage in the long term, and is not really an effective angle for rotation anyway. You might want to look into the Knightsbridge Dual Band, which lifts vertically from below the jaw. Or try mouth tape, like the SomniFix brand.

[Julie]

Tell your wife your 'system' wouldn't allow you to suffocate even if you wanted to, if you wear tape (as so many others do night after night). You're programmed to wake up long before any damage would be done and let your doctor tell her. Whatever you wrap around your head may lead to other issues more problematic than the little tape piece ever would.

[st8728]

Had a few more nights, I asked if the lady could change me to auto with a higher pressure that 5-20 to see how that goes. She set me to 8-20 this time (I was on 8.6 fixed)

Friday night

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Saturday night

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Sunday night

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My med pressure seems to be 9.3-9.46 now I guess this is because my starting pressure is higher?

Thoughts on any potential things that these results indicate? Anything that could be tuned? This is the last week of my trial however I will be renting for another 3 months because I want my sleep doctor to see the results before I commit to buying anything and I don't see him until the end of January.

[Pugsy]

My med pressure seems to be 9.3-9.46 now I guess this is because my starting pressure is higher?

Partly higher because of the higher starting point but more because the machine wants to go higher.

I wonder what would happen with those centrals/CAs if you reduce your EPR to 1?????

How was your sleep quality these last 3 nights? Sleep soundly or wake often?

[st8728]

I mostly seem to wake up from 6am > 10:30am and drift in and out of sleep I think, sometimes its hard to remember.

I still feel exhausted I think, I usually get 3-4 hours into the day and want to pass out from being so exhausted. I realise my stomach feels a little full I don't know if maybe I am swallowing air or not? Also not sure if it is because I changed the iron pill I take messing with my stomach.

I change EPR level in the clinical menu right? Might change it and see how it goes

[Pugsy]

You might need to access EPR from the clinical menu or you might be able to access it from the normal settings menu.
It depends on how it is setup in the clinical menu.

If you reduce the EPR and it makes your belly feel worse...don't continue with that experiment. Come back sooner if that happens.
If you are having aerophagia or belly issues from air ....reducing EPR could make that worse.

If you aren't sleeping enough hours then you can't expect to feel so great. 4 or 5 hours of sleep that is fragmented simply isn't enough sleep no matter how well your sleep apnea is controlled.

The centrals/CAs could be false positives but if they are real then reducing EPR might (stress the might) reduce the number of centrals.

If they are false positives though...we have to try to fix the poor sleep quality issue which very well could be unrelated to apnea and no amount of tweaking of the settings will fix a sleep problem that isn't related to airway issues.

[st8728]

I put EPR down to 1 for the past 3 nights to see what would happen

9 Nov

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10 Nov

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11 Nov

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I think my hypopnea went up slightly. My stomach still feels a little bit odd. It doesn't feel any better or worse vs EPR of 3 I don't think. I might go back to EPR of 3.

Thoughts about what I could do from here? Would it be worth going to 9 cmH2O minimum?

[st8728]

I saw the sleep lady today (the one at the CPAP shop) and she said my treatment is completely fine because my AHI is under 10 so that means I am fine now (I thought under 10 and over 5 would still mean I have mild sleep apnea? my week med would be 5.76 AHI). I asked her if my pressure or anything needed to change and she said no She said I spent most of my time at around 9.5 to 9.6 cmH2O (I am on 8-20 currently). I have noted she never really looks at things when I take the card in. She just checks if the leak is under 25 avg and if the AHI is under 10. She doesn't bother to really check anything else as such (no zooming in and checking each day etc).

I don't have to see her for a few months now so I guess I have to handle this on my own (And with the help of you kind people )

[Pugsy]

Where are you located?

And yes...if someone gets a sleep study and their AHI is 6 or 7....guess what...they get a diagnosis of mild sleep apnea and get prescribed a machine.

That lady at the cpap shop....idiot.

[st8728]

I am in Australia. I will be attempting to manage my own now I guess. My appointment with the actual sleep doctor is not until around 20th Jan 2021.

She was nice but seemed clueless and to not really care as such. She said she doesn't need to see me for months now (Not that she did a lot anyway)