Possible Complex sleep apnea?

[Pugsy]

There are ways to reduce mouth leaks.

I opted to tape my mouth until I developed the habit of keeping the mouth shut.

You aren't flagging any large leaks despite what the statistics say. Look over on the Events graph...see the LL line? That's large leak. No LL flags seen
The statistics portion is doing calculations based on a ResMed leak number and it's not correct for a Respironics machine.
Go to Preferences/CPAP tab and change the 24 to something more suitable for your mask at your pressures....We aren't ever given a static number for large leak because it varies with mask and pressure but something around 75 L/min would be more in line for you.
So either change the threshold or just don't use that statistic.

Are mouth leaks waking you up? If they aren't...don't worry about them. You aren't having any leaks big enough to cause a problem with therapy effectiveness.

[Krpepe]

I don't think it is an issue so much for therapy but they do sometimes wake me up.

[Krpepe]

Does the response to the pressure increase look good to you, or do you think it needs to increase?

[Pugsy]

The flagged stuff around 5:00 and after is probably SWJ stuff...not real so I am not too concerned about that at this point other than you were awake and we don't like being woke up.

I would like a couple more nights with the new minimum pressure and hopefully you can sleep a little sounder without the half awake stuff messing with things.
Makes for evaluating pressure needs a little easier when we don't have SWJ increases screwing with the data.

I am thinking probably need a little more minimum...like maybe 1 cm more but it's not urgent.

[Krpepe]

Thank you Pugsy!

Just got off of the phone with my sleep doctor. She was very grateful for the help that I received from you so I could continue my treatment. She was at a conference on Friday and just first received the note that I called. I asked if there was a way I could get in touch with her if I needed help like I did on Friday. She gave me her email address and said to put only call me in it because of hippa laws. But at least I have a way to contact her. She also reiterated that this is the exact reason that she does not like giving patients an apap instead of a titration study. She said she at least now has a leg to stand on for getting me a study and at this point will wait and see for a week or two to see how everything looks. Just thought I would give you the update and let you know the doctor was grateful for your assistance as am I!!!!

[zonker]

Good Morning Pugsy!
From about 5, half awake.
Is there a way to stop the mouth leaks or is that just part of getting used to it?

this, with some modifications, has helped me tremendously-

viewtopic/p1089718/viewtopic.php?f=1&t= ... s#p1086296

good luck!

[Krpepe]

Zonker,
Thank you, I will definitely give that a try tonight. Exactly what I was looking for. Thank you again!!

Kevin

[zonker]

Zonker,
Thank you, I will definitely give that a try tonight. Exactly what I was looking for. Thank you again!!

Kevin

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please let me know if it works for you or not. i may have some suggestions for fiddling with it. also, i kind of like to know in general if it works for others. some have reported back as a no go.

i want to mention that i use a firm foam cervical collar in conjunction with jay's rig.

[Krpepe]

Definitely will let you know. My son has swimming tonight so going to stop and hopefully pick some up after his swim class.

[Pugsy]

I am glad the doctor was okay with you getting some armchair help over the weekend.
She's doing what I expected now....adopting the wait and see attitude and it's what I would suggest as well.
There is a lot of truth in that "give it time" thing.

The reduction in Flex thing was really the only thing I had to offer for the central situation and it still might not be enough but it at least bought you some sleep time with the machine so that the doctor has so data to work with.

As for her comment as to why she prefers in lab titrations to avoid situations like this....to be fair the majority of the people put on apap after a positive diagnostic sleep study will do just fine when put on apap to find optimal pressures.
The people who have problems with centrals like you do...actually a very small percentage of people. It's not common at all but it's fairly important when you are the one that drew that unlucky straw. This is why insurance companies are going more to just dispensing apaps instead of the formal in lab sleep study. They go by the numbers and the odds...and the odds are that most people won't have a problem like yours.
Besides...an in lab titration isn't always ideal either. I had one myself and the idiot tech and I nearly had World War III and I slept horribly and came away with an incorrect prescribed pressure because I slept horribly....but I figured it out with my apap.
Nothing is ever entirely perfect for everyone.

[Krpepe]

Something woke me last night about 1:30 and of course had to use the bathroom then. Foggy, lethargic and tired today. Feeling like before starting therapy. Not getting discouraged just passing along how I feel. Anything after about 5:15 - 5:20 I was awake.

Pugsy,
I totally understand why the insurance does this but doesn't make it any easier when as you said, you draw the unlucky straw. I also understand that the titration study is only as good as the tech that is administering it. Some people don't like to do there job or are incompetent. I just think if nothing else it probably would have spotted the centrals issue for me. Thank you again for all of your assistance and knowledge. I am truly grateful.

Zonker,
The scunci did seem to work. don't remember waking up because of leakage. thank you for the suggestion.

[zonker]

Zonker,
The scunci did seem to work. don't remember waking up because of leakage. thank you for the suggestion.

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[Pugsy]

Quick sort of update.

I got a copy of the SD card contents and I am in the process of reviewing the flow rate to see how much of the flagged stuff is asleep flagged stuff. Maybe a half a dozen of last night's total flagged events were the real deal. The bulk of it is SWJ.
I wanted to review it up close to see if I could maybe recommend an increase in the minimum pressure but I don't see it being needed.
Not with probably 80 to 90% of the flagged events being SWJ arousal/awake related stuff.

There's still a lot of crappy sleep quality but it doesn't seem to be airway related at least from what I can see on the flow rate.

Later on this evening after I get my chores done and some rest....I will look further but for right now I am in agreement with the doctor with the wait and see what happens after a week or so.

[Krpepe]

Unfortunately another night of no sleep, or at least it feels like it. Would love to know what is going on. Here are the results.

[Pugsy]

Could you safely take some sort of OTC sleep aid?

While the data from the machine is good...it can't always tell us why we have poor sleep quality. All it can do is document the poor sleep quality.
Does maybe a lone real asleep event create a snowball kind of effect??? Possibly.
One of the things that an in lab sleep study could maybe isolate better than we can given what we are given from the machine in terms of data.
There are 2 main kinds of arousals....arousals from airway events like OSA events and spontaneous arousals which mean we don't know the cause but we know they aren't airway related. CPAP/whatever pap doesn't do a thing for spontaneous arousals...it can't...as much as we wish that it could. Then there are the various levels of sleep or sleep stages that we simply can't evaluate from the data we are given.
Alpha waves and delta waves and whole multitude of data relating to sleep itself.

If it were me I would at least consider more minimum pressure as an experiment to see if maybe it helps or not. Something to try...long shot I know. The bulk of your AHI is SWJ stuff but you have a lot of just ragged breathing other times during the night. It's hard to know for sure if it's awake related or asleep related and then of course no way to know why it is ragged.