Newbie - Victory Dance .... AND a question

[Miss Emerita]

Great that you're using Oscar! I'd recommend that you stick with your current settings, except that you might want to turn off your ramp. That way you can get the full benefit of your EPR right from the start of your night.

The preponderance of events that you're seeing are central apneas -- pauses of 10 seconds or more in your breathing that occur even though your airway is open. They may just reflect your having somewhat restless sleep, and with a little luck they will subside as you and your body get used to PAP. At any rate, increasing your pressure wouldn't help, and I don't really see a case for lowering your maximum at this point, while you're still adjusting.

[MattS]

small update ... things continue to progress well. Made the changes to ramp (this really was appreciated.). Mostly good sleep, had one iffy night feeling wise ... but the AHI was good, chalk this up to getting shingles and TDAP vaccines that had my body really cranky, better after a couple days. Here is data from last night, first time I have had an issue with mask leak (nasal pillows) that I attribute to wearing the mask with straps too high on my head and affecting the seal. To my untrained eye, it looks like mask seal, rather than mouth breathing, would appreciate any opinions on that theory.

The SPO2 drop during the night still is still a mystery.



Thanks again for everyones help.

[Pugsy]

To my untrained eye, it looks like mask seal, rather than mouth breathing, would appreciate any opinions on that theory.

There is no way to differentiate between mouth leaking and mask movement leaking just by looking at the leak graph.
The machine just reports a leak.
We can make educated guesses by taping the mouth shut to eliminate mouth leaks from the equation but just by visually looking at the leak graph....no way to know with any amount of certainty.

Did any leak wake you up?

[MattS]

Thanks Pugsy.

"There is no way to differentiate between mouth leaking and mask movement leaking just by looking at the leak graph.
The machine just reports a leak."

Any possibility one might see cyclical movement in the data if a mouth leak associated to respiration, rather than a mask leak, cyclical that may not exactly match system pressure changes during exhale? (if I am grasping a newbie straws just tell me so ... lol)

Did any leak wake you up?

I think so, but not as often as shown in the data.

My previous nights leaks have been much much lower, so for now I am thinking it may be some sort of anomaly.

[Pugsy]

(if I am grasping a newbie straws just tell me so ... lol)

Consider yourself told.

I have been on cpap 14 years now. Trust me if there was a way to tell mouth from mask movement leak from the leak graph data....I would have done it years ago.

Absence of any dry mouth might be a clue but it's not absolute because we can have dry mouth happen without any mouth breathing.

When leaks wake you up reach over and turn the machine off and then right back on again. That way you will have a break in therapy showing where you were awake and if leaks preceded that break in therapy then you can evaluate the leaks.

You can also tape your mouth shut one night and see if that resolved the leaks. Scares people sometimes...myself included but I ended up doing it and I realized fears were unfounded.

Though I do agree...I would suspect mask movement leaking in your situation since you are so new to therapy and getting everything dialed in can be a bit of a struggle.
But I can't say with certainty that it is mask movement....and that was your question.

I will say at this point that if the leaks aren't waking you up all night then I wouldn't worry a whole lot about the amount of leak shown on this last report. It's an ugly leak line but you probably still had Mr Smiley show up on your machine for leak management last night.

I don't worry much about leaks (no matter the cause) as long as they don't wake me up and I don't spend half the night deep in large leak territory.

Now any leak (big or small) that causes wake ups needs to be worked on but more from a disturbing the sleep side of things than amount of leak.

[MattS]

Pugsy,
Thanks for the experience and wisdom.

I did dig into a few other sources of data available that also track my movement (watch and O2 ring) and was able to make some swags ...

1) most of the longer plateaus we after some sort of movement, each of which flagged by the devices as movement, those I am gonna "guess" are mask leaks induced by my movements (exacerbated by the improper position of the mask straps)

2) there were a couple, that were shorter in duration, that had movements (and some not) near the tail of the leak event that I am going to further guess as mouth leaks as it would make sense that those would more likely trigger a body movement at the end vs. the beginning.

Either way, they are guesses, and the net result is I still feel pretty good today, so aside from my engineer tendencies to need to over analyze data and understand all things, I still think I am in a pretty good spot being only a week in my journey. I am counting my blessing that "nerding" over some data intricacies to be my biggest issue

Thanks again ... and I have a few experiments I want to try this week if I have time .... sniffing away at some things I saw in the data between the shape of leaks from my AS11 ... and correlations in the Tidal Volume. May be nothing, but nerds gotta nerd.

-Matt

[MattS]

Quick update ... last night was much better, some similar trends but with much lower magnitude. Seems some leaking starts to occur after a few hours, believe this to be mouth breathing, though much more controlled last night. Seems my body is just getting used to this new world and how not to breathe through my mouth.

I did adjust the mask to have a more proper fit.

Interesting starting pressures, then as I started to fall asleep at first, noticed an open mouth breathing event that woke me up, so I turned the machine off and back on, then a small adjustment to the headgear for the mask and things were markedly lower in pressure and no big issues.



Thanks again all for your help and insight, has really helped ease my transition to MUCH better sleep!

-Matt

[MattS]

Another question for those with more experience ...

Last night when I first went to bed, I started to get some symptoms of aerophagia that I have not experienced before. After sleeping a little while I woke myself up with a mouth leak and took the advice to shut off the S11 and back on to mark the point, and did not think much of it after that.

After looking back at the data this afternoon, noticed that the machine started with much higher pressure than normal, even higher than I generally need. Seems to correlate.

Any ideas why the machine started off with that higher pressure? (I have RAMP turned off)

[Pugsy]

Your image is too small to see well. Did you shrink your image in some way? If you did it makes it so we can't enlarge it well enough to read stuff.

Where do you see the machine starting off at higher pressures? Is it immediate or come about after a little while?

You have included graphs that aren't helpful and omitted graphs that are useful and especially the flow limitation graph which might explain the increase in pressure.
Please review the format for graph sharing here
http://www.cpaptalk.com/viewtopic/t1585 ... eview.html

[Julie]

I clicked on the chart twice and it opened right up to readable size... in Safari if it matters.

[MattS]

Pugsy,
Not sure why that last image would be any different in opening the link, using the steps provided (store in Imagr, choose large thumbnail, grab the Linked BBCode.) Let me try that last one again.



The higher pressure is for the first but bit before turning off the machine and back on to create a break point, from 22:15 to 22:55, pressure is higher than it ever gets in regular use.

(Sleep HQ link if that is of more help .. https://sleephq.com/public/d68cffba-5f0 ... 99cbd5df49)

-Matt

[Pugsy]

Did you look to see which graphs on the right we need at the link I provided?

Where is the flow limitation graph?

I still can't read the numbers and can barely make out letters. I can enlarge the report only once and it isn't big enough for my old eyes to read.

I do suspect that if you look at the flow limitation graph and the pressure graph (not mask pressure) you will see why the pressure increased.
Pressure increases come from OAs and hyponeas and snores AND flow limitations. Those are what the auto adjusting algorithm is designed to try to prevent from happening.
FLs are the most common cause of pressure increases when we don't see much in the way of OAs or hyponeas.

[MattS]

Updated to remove the pressure graph and added in Flow Limit graph. Not sure why Imagr is behaving differently, however, to properly view, if I log out of imagr then view link as not myself logged in, I click on the image and it zooms in full size.

[Pugsy]

I do suspect that if you look at the flow limitation graph and the pressure graph (not mask pressure) you will see why the pressure increased.
Pressure increases come from OAs and hyponeas and snores AND flow limitations. Those are what the auto adjusting algorithm is designed to try to prevent from happening.

My suspicions are confirmed.

As for your question about "why the pressure increased"....your answer is right there on the FL graph.

As for viewing issues. Dunno. I don't have this problem with other people's imgur images that I open in another window and zoom in on. Just yours.

Are you having any nasal congestion issues going on?

[MattS]

Pugsy,
I have not had any nasal congestion issues going on. The part that is interesting is, I was awake, had not fallen asleep yet, which is how I noticed it was different.

With regards to imagr .. here are my steps ...
1) Screen capture OSCAR view as a saved png image
2) Login to Imagr
3) Drag image into Imagr screen
4) Click on the newly dragged image in the list with others to view
5) Click in bottom right hand side to select Large Thumbnail
6) Copy the Linked BBCode link
7) Paste in to Reply of post.

If there is a step I am doing wrong, I apologize and happy to correct as I appreciate all the help and want to make as easy as possible for the free and gracious help.

-Matt