Respiratory rate

[Fenelon]

The collar is a cheap, simple way of determining if you are keeping your neck straight. If it is indeed a solution. You may not have to use the collar forever. There are some pillows that do a good job of neck support and letting your head drop back to open your airway.

Thank you very much Ajack - the collar should be delivered tomorrow and I'll be interested to see if it makes a difference. I'll let you know how it goes, thank you again for your input!

[Fenelon]

http://imgur.com/a/Z1AsV

Not a great night of sleep but also not a great night to study the data too much. I had leak issues - I had problems for some reason getting comfortable last night (before trying to sleep), especially with the headgear and I should have taken a bit more time to secure the mask properly. I also had an unintentional break when I disconnected the hose and fell back asleep, most unusual and I'm not really sure what happened.

If the postal service works as it should today then I'll have a new mask to try, but I'll take a bit more time fitting whatever mask I use at bedtime tonight. I should also receive the cervical collar - so I'm not too despondent (and 8.5 is a vast improvement on 16.4 anyway!), plenty of things still to try!

I hope you all have a marvellous weekend!

[robysue]

http://imgur.com/a/Z1AsV

Not a great night of sleep but also not a great night to study the data too much. I had leak issues - I had problems for some reason getting comfortable last night (before trying to sleep), especially with the headgear and I should have taken a bit more time to secure the mask properly.

It is worth the time to make sure a FFM is properly fitted every night.

One other comment: The official Large Leaks start shortly after the machine has raised the pressure from 10cm to 16cm. So that may mean that whatever you did to seal the FFM at 10cm was not enough to keep the mask sealed at 16cm. In other words, it would help if there was a way to fit the mask at 16cm. I don't know enough about the Resmed machines to know if that's possible.

I also had an unintentional break when I disconnected the hose and fell back asleep, most unusual and I'm not really sure what happened.

It's enough to know it happened and to just try to be more conscious about not disconnecting the hose on the next night. There's no point in trying to figure out why you did it.

[Fenelon]

Thanks as always Robysue. There is a mask test on the Resmed, I'm not sure what pressure it goes up to but it seems pretty full blast when I've used it. I suppose the lesson learned is to use it every night!

The new AirTouch has arrived, I'll give that a go tonight. I might also wear the cervical collar, just to see. I realise the benefits of just trying one thing at a time but I've got a very busy week ahead and want to take advantage of the weekend!

Thanks again for your input.

[Fenelon]

http://imgur.com/a/4TUhQ

Not a very good night. The new AirTouch mask seemed to work ok though. It is definitely the most comfortable mask I have worn, though I still have some marks on my face, just not as bad as usual. The main thing is there was little leakage in relative terms. I tried to use the cervical collar but found it extremely uncomfortable. I'll maybe try it again but I'll have to wait until I have another free day, as I may not get much sleep when attempting to wear it all night.

But what to do now? I realise I need more pressure but the last time I upped it I couldn't sleep due to stomach problems. As Robysue mentioned I could try the ramp feature but what pressure should I increase to? 10-20 seemed to be too much for my stomach to handle. Or should I just try and hang in there until I see the sleep doctor on Thursday?

As always, any input/opinions/advice greatly appreciated!

[robysue]

Fenelon,

I saw this just as I was heading off to bed.

http://imgur.com/a/4TUhQ

Not a very good night. The new AirTouch mask seemed to work ok though. It is definitely the most comfortable mask I have worn, though I still have some marks on my face, just not as bad as usual. The main thing is there was little leakage in relative terms. I tried to use the cervical collar but found it extremely uncomfortable. I'll maybe try it again but I'll have to wait until I have another free day, as I may not get much sleep when attempting to wear it all night.

Ditch the collar. You need to focus on making things as comfortable as you can when you are lying in bed trying to get to sleep.

How long did it take you to fall asleep at the beginning of the night? How long do you think it took to get back to sleep after each of the wakes?

But what to do now? I realise I need more pressure but the last time I upped it I couldn't sleep due to stomach problems. As Robysue mentioned I could try the ramp feature but what pressure should I increase to? 10-20 seemed to be too much for my stomach to handle. Or should I just try and hang in there until I see the sleep doctor on Thursday?

The cautious part of me says wait till Thursday when you see the doc.

The less cautious part of me says that you might as well experiment with one (or two) nights with the following settings:

AutoRamp = ON
Beginning Ramp Pressure = 8
Ramp Time (if AutoRamp has a time) = 45

MinPressure = 10 (or 11 if you're brave)
MaxPressure = 16

Any time you wake up, turn the machine off and back on to restart the ramp. If the stomach can handle 10-16 when you are using the ramp to keep the pressure below 10 while awake, then you may be able to cautiously bump that max pressure up to 20 for one night just to see where the machine wants to go during those persistent clusters.

And at that doctor's appointment, be sure to stress just how bad your stomach problems were when you tried to increase the pressure. One thing that is used here in the states to justify bilevel is patient discomfort when a pressures of 15cm or more are needed to properly control the apnea. And it looks like your max needs to be well above 15 to control those clusters.

[Fenelon]

Thank you so much for your reply Robysue, I hope you have/had a great sleep!

I'm not sure how long it took me to get to sleep as I'm trying to follow Dr Krakow's book and not think about time at all, though I most certainly did not fall asleep quickly (and again I don't think I fell back asleep quickly when I had the longest break in the middle of the night - I wasn't struggling to sleep per se then, but I was up to the bathroom and to get water etc.). At the moment the pendulum seems to have swung back to the apnea, as opposed to the insomnia, as the main culprit for broken sleep.

I will follow your suggestions. Being brave is good, so I'll go with a minimum of 11, with the ramp set as you suggested. Since I am seeing the doctor this week anyway, I think I will also change the maximum pressure tonight. It seems to me that I require more pressure or I'm going to have the OA events anyway, so I'll try a setting of 18. I'm getting used to switching the machine off/on instead of looking at the clock, so if I wake I'll be restarting the ramp anyway, which will be a major difference to the last time I tried upping the pressure.

As always your input is gratefully appreciated and I am especially thankful you took the time to reply as soon as you read my post - thank you!

[Fenelon]

http://imgur.com/a/eMc0K

A mixed night. The AHI is heading in the right direction but as you can see I was woken up several times during the night, mainly with a sore stomach or uncomfortable feeling. However, it was not as bad as previously experienced and I think when I upped pressure before (to pressures I can now tolerate) it was the same, so I'll try again with the same setting tonight. The early indications are that the AirTouch F20 is a better mask for me, both in terms of comfort and less leakage.

[robysue]

Fenelon,

I'm off to bed. But I do have one quick question: Did you turn on the AutoRamp setting? It looks like you just have the ordinary Ramp turned on.

It is possible that I'm confused about the Resmed AutoRamp feature. If there is not an AutoRamp setting in your clinical menu, please let me know.

[Fenelon]

Fenelon,

I'm off to bed. But I do have one quick question: Did you turn on the AutoRamp setting? It looks like you just have the ordinary Ramp turned on.

It is possible that I'm confused about the Resmed AutoRamp feature. If there is not an AutoRamp setting in your clinical menu, please let me know.

Hi Robysue, thank you for taking the time to reply! I'm not sure about the AutoRamp vs normal ramp, what's the difference? I can only see two settings for ramp with no mention of auto, though my menu language is in German and it may not be directly translated. There is an option to switch the ramp on/off. When I select on, there is then an option to set the time (which I put to 45 min). I can't see any other setting for ramp. Does this help?

Thank you again!

[Pugsy]

Ramp Time ...off/5-45 minutes/Auto
If Auto is selected, the device
will detect sleep onset and
automatically rise to the
prescribed treatment pressure.

https://sleep.tnet.com/home/files/resme ... -guide.pdf
Page 16

I think you have to fiddle with the time and there is a selection from within time that let's you change to auto.

I think that RobySue is thinking that Auto Ramp on the ResMed works like the Smart Ramp on her DreamStation and I am not so sure that it does.
SmartRamp stays at a lower pressure during ramp unless it senses a need for more or ramp time is used up.
Auto Ramp on the ResMed seems to still be a linear increase. Or at least I can't find anywhere that it says it stays lower until needed....what it says is that it increases until ramp time is up or you go to sleep.

There's a little difference in how ResMed and Respironics handle apnea events that happen during ramp.
Respironics machine when in auto mode have always suspended ramp..addressed the events with more pressures and if any time left in the ramp setting they go back and finish that time.
ResMed machines in the past never would suspend ramp...if you went to sleep and apnea events happened during ramp and you needed more pressure you were out of luck. Now with this new Auto ramp option...assuming it can accurately detect when you are asleep...if you have an apnea event it should already have sensed you were asleep and suspended ramp and be up to minimum pressure and ready to fight.

It's worth trying Auto Ramp though...sure wouldn't hurt anything.

[Fenelon]

Thank you very much Pugsy! I went into the ramp settings and after continuously increasing the time it eventually says 'Auto' instead of a duration of minutes. Tonight I will be on Auto. An interesting self-observation: despite waking eight or nine times last night I feel significantly better with a lower AHI. I'm completely tired still but I don't feel ill or overwhelmed. I hope I can score a low(ish) number again tonight!

As always I am very grateful and thankful for your help!

[Fenelon]

Well, I had the worst night of OA yet I feel like I've been punched in the head. Looking at the events between 11.15 and 12.15 I didn't really breathe much The only difference was auto ramp, but I don't think that was to blame, the pressure seems to have gone up but had no effect. Not sure how to proceed. Any opinions welcome!

http://imgur.com/a/Y4btc

[Pugsy]

Your pressure went up and had no effect because it wanted to go higher and couldn't because of the maximum limitation set to 18.

It's either sleeping position or REM sleep or maybe combination of both.

You need to be checking with the doctor about a bilevel machine.

[Fenelon]

Your pressure went up and had no effect because it wanted to go higher and couldn't because of the maximum limitation set to 18.

It's either sleeping position or REM sleep or maybe combination of both.

You need to be checking with the doctor about a bilevel machine.

Thank you Pugsy. Would a bi-level machine help if it's caused/worsened by position or REM? I don't think I can sleep with a collar nor with some kind of wall ( a triple problem of comfort, logistics, relationship), not long-term anyway. I'll speak to the doctor and get a copy of my lab results when I'm there on Thursday. I do recall the doctor saying in the lab one morning that it was my deep sleep that was affected but I had yet to do any research and so no further questions were asked at the time.

I have rescheduled meetings to have the morning off tomorrow, so I'll take the risk of bumping the pressure up to 20 and see if I can sleep tonight. I'll also put my mind towards an alternative to a neck collar, as the first cluster from last night that lasted about an hour scares me a little. When I previously tried a neck collar I found it physically uncomfortable and I'm not sure I'd be able to fall asleep at all (I actually wore one for three months after breaking my neck when I was younger so there's a psychological element there too probably), but perhaps I can come up with a solution.

Thanks again for your input!