5 Month Check-in - SleepyHead Data Review Request

[MDee]

I am at my 5 month mark using biPap. Still not feeling great but have managed to find a mask that works and a pressure that keeps the aerophagia at a bearable level. I'd love someone to look over my SleepyHead data and give me a read. My doctor will not see me until the 1 year mark and feels my numbers are fine. My body is still massively tired. Am hoping to understand and brainstorm for tips.

I've picked two sample nights. One night with a bit more leaks and one less.

(full size http://i.imgur.com/7rhwy6b.png)


(full size http://i.imgur.com/uPrOvmv.png)


PS. I've tried updating my profile but it seems to be lagging.
My machine: ResMed AirCurve 10 Vauto
Mask: Swift FX Nano
My current setting is: IPAP 10, EPAP 4, PS 4 VAuto mode

[palerider]

you need a bit more epap to cut down on the obstructives, it's *possible* that less PS would cut down on the centrals... sometimes it happens.

also, it sucks that doctors have such low standards of treatment.

[Pugsy]

A little more than half your AHI is Clear Airway/Central events so if we remove them from the calculations the AHI is acceptable...and even with them included it is technically acceptable.

I don't see anything that just stands out and screams "fix me".
Your leak rate is well within the machine's ability to compensate...are the leaks (even minor) causing wake ups?

How many hours of sleep are you averaging?
Are those hours of sleep fragmented by multiple wake ups? If so, approx how many wake ups and any idea as to why?
Do you take any medications of any kind? If so,what?

Hey, PR...if more EPAP is used it might make aerophagia worse.

MDee...have you tried more EPAP? Did it make things worse?

I don't know if the centrals are important or not...they could be related to wake ups though...hence the fragmented sleep question.

My body is still massively tired

Still need to nap during the day???
Have the usual range of suspects for fatigue been eliminated....like thyroid, Vitamin D, etc?

[MDee]

Your leak rate is well within the machine's ability to compensate...are the leaks (even minor) causing wake ups? How many hours of sleep are you averaging?

Are those hours of sleep fragmented by multiple wake ups? If so, approx how many wake ups and any idea as to why?

I wake up usually 2-3 times a night. Sometimes it is because the mask straps are hurting or the mask is rubbing against my septum. (my next post will probably be about my ongoing mask experiments). Sometimes it is because of the leaks. Sometimes it is a stuffy nose. And just...sometimes.

So a typical night is:
Bed: 11:30pm
First wake: 2am
Second wake: 4am
Third wake: 6:30am
I get up at 7am.

My sleep is better because beforehand I was waking every 30 minutes with the snoring/gasping. MY AHI was 60.

Hey, PR...if more EPAP is used it might make aerophagia worse.

MDee...have you tried more EPAP? Did it make things worse?

I don't know if the centrals are important or not...they could be related to wake ups though...hence the fragmented sleep question.

My original settings were: IPAP: 15, EPAP:10, PS 4 and things were terrible. My belly swelled up so bad (and stayed swollen) that I had difficulty breathing during the day. The other factor was that the pressures were causing my Eustachian tube to open and air was blowing into my middle ear. I had surgery in the area years ago and they think that there is structural weakness in the area that has created a "void" which makes my tube open and close more easily.

But to answer your question: I have kept the new settings: IPAP 10, EPAP 4, PS 4 the same and have not experimented. Was not certain what to start to tinker with and what to focus first on. If I assume my centrals are sleep wake induced, then perhaps I should focus on the obstructive and....change what settings?

My body is still massively tired

Still need to nap during the day???

Not only nap but I fall asleep after eating. I am still driving, but keeping an eye on fatigue. there are days where I don't feel up to driving.

Have the usual range of suspects for fatigue been eliminated....like thyroid, Vitamin D, etc?

Full workups with my PCP and everything there is fine.

[Pugsy]

Take any medications?

If I were in your shoes I would maybe concentrate on the obstructive stuff first along with working on the mask and leak issues that are causing the wake ups. The centrals could just be awake/semi awake breathing. Next time you wake up during the night...and assuming you are alert enough...reach over and turn the machine off and right back on again.
It will show as a break in therapy and you can then look at the timing of the centrals and see if they correspond anywhere close to the break in therapy.

With the history of aerophagia issues I would be very careful with the pressures and in this situation the only thing I would maybe change is that minimum EPAP of 4. Maybe try 5. It's going to give you a really tight range for the auto part but that's okay.

I don't know that your unwanted symptoms will change all that much with a reduction in the AHI but it's worth trying as long as you don't trade AHI for belly pain.

[MDee]

Take any medications?

Tylenol and ibuprofen. I do have access to Ambien but have not been taking it as I have no problems falling sleep.

If I were in your shoes I would maybe concentrate on the obstructive stuff first along with working on the mask and leak issues that are causing the wake ups. The centrals could just be awake/semi awake breathing. Next time you wake up during the night...and assuming you are alert enough...reach over and turn the machine off and right back on again.

It will show as a break in therapy and you can then look at the timing of the centrals and see if they correspond anywhere close to the break in therapy.

I've been checking my fitbit when those wake ups happen but I have found no pattern. In the past, I've woken because of Centrals, OA and just...because. But with more targeted data I may be able to pinpoint more precisely.

With the history of aerophagia issues I would be very careful with the pressures and in this situation the only thing I would maybe change is that minimum EPAP of 4. Maybe try 5. It's going to give you a really tight range for the auto part but that's okay.

The EPAP spends a lot of time at 5 so it seems like a small change to make and should not make the aerophagia worse.

I'll start working on my next post: the quest for a full face mask.

[palerider]

I'll start working on my next post: the quest for a full face mask.

keep it in this thread, so all your history/issues/info is in one place... makes it easier to help ya.

[MDee]

I'll start working on my next post: the quest for a full face mask.

keep it in this thread, so all your history/issues/info is in one place... makes it easier to help ya.

OK, here is my first mask question

Current Mask: Swift FX Nano Standard size mask with chinstrap and paper tape. I like it a lot (still need to work on some of the mouth leak issues. )

Goal: A Full Face Mask that I can wear when I am sick or have allergies. Also, the Swift FX Nano irritates my septum on occasion so I need to give it a break 1-2 time a month.

Current issues with full face masks: The lower part of the full face masks seem to push my lower jaw back and aggravate my TMJ. The lower straps around the back of my neck create cervical pain. I am a back sleeper.

What I have tried: ResMed Quattro™ FX For Her Full Face (Medium size) with Padacheek antileak strap
http://www.padacheek.com/PAC_AntiLeak_Strap.html

The Padacheek allowed me to use the lightest pressure on the lower strap, but it still causes pain.

I am having to do this out of pocket because my insurance only allows me one mask at a time and will not allow me to try different masks.

[Pugsy]

The lower straps around the back of my neck create cervical pain.

This is likely going to be an issue with just about any full face mask just because those masks need an anchor point for the bottom of the mask.
It's one of the reasons I pretty much couldn't wear any full face masks for the longest time. I have a bad neck (have a metal plate in it to give you an idea how bad) and pretty much all those FFM would aggravate my neck and I would end up with a neck ache and a headache from the neck ache.

I was able to finally try and use successfully the Amara View without those lower straps playing hell with my neck.
Last time I looked it still came with free return insurance from cpap.com so you might take a look at it.

[MDee]

The lower straps around the back of my neck create cervical pain.

This is likely going to be an issue with just about any full face mask just because those masks need an anchor point for the bottom of the mask.
It's one of the reasons I pretty much couldn't wear any full face masks for the longest time. I have a bad neck (have a metal plate in it to give you an idea how bad) and pretty much all those FFM would aggravate my neck and I would end up with a neck ache and a headache from the neck ache.

I was able to finally try and use successfully the Amara View without those lower straps playing hell with my neck.
Last time I looked it still came with free return insurance from cpap.com so you might take a look at it.

Thank you! I had considered the Amara View but was not certain. What was different about the lower straps that they did not strain your neck?

[Pugsy]

The lower straps seem to ride just a wee bit higher at the back of my head and not directly at the base of the skull.
Also they don't have to be very snug at all for the mask to seal well.
They don't seem to put much tension at all on the lower area of the mask.
At least not near as much tension as the regular full face masks that I tried and when first starting therapy I tried on a lot of them but quickly abandoned them because I would have neck discomfort in as little as 5 minutes or less.

I went 6 years without a full face mask. Always was able to get my nose cleared up enough to wear the nasal pillows even when I had a cold. I don't have allergies all that much though. I found the humidity (lots of it) seems to help me breathe better and often I wake up with the nose clearer than when I went to bed.

I tried the Amara View just to be trying something new and it looked interesting. I actually used it probably 2 weeks which for me is saying something. If I hate it...there's not usually a second night.
I kept it just in case I was ever in a situation where I couldn't use my usual nasal pillows. I don't know if or when that will ever happen....it didn't happen in over 6 years but I figured since I knew it would work for me without causing a lot of discomfort that I might as well keep it handy. I think it was last winter that I tried it.

I will try a newly released mask just for fun if it looks interesting to me. Just for fun mainly. Helps with the boredom and after 7 plus years...this therapy is rather boring.