First Week CPAP results - help with results

[Pugsy]

The periodic breathing isn't really thing to be alarmed about unless you have a whole bunch of it chocked full of events especially central apneas. Periodic breathing is nothing more than a waxing and waning of the air flow that lasts at least 2 minutes. It gets flagged so that people can rule out a very special kind of periodic breathing called CSR or Cheyne Stokes Respiration. CSR is a form of periodic breathing but it isn't the only form of periodic breathing.

So zoom in on the green breathing time frames.
If it looks more like this...ignore it.


If it looks like this and there is a lot of it...yours isn't a lot by any means...then we look a little closer.


Keep these settings for 2 or 3 more nights and then try minimum of 10 for about a week and lets compare the results.

[jwalsh126]

Sounds good, thank you for your informative posts. That sounds like a good plan to me. I will update in a week, unless there are oddly negative results.

[jwalsh126]

Back with an observation - last night was the second night that pressure ramped up, a large leak occurred, and I woke up swallowing air with a bloated stomach. You can see at 4:30 I got up and went to the bathroom. After 4:30 the rest of the night was very smooth without leaks or anything. I've read on these forums that the dreamstation sometimes malfunctions and ramps up pressure super high. Is this a sign for me to reduce the maximum pressure setting? I've never needed it as high as 16. Whenever it has reached 16+ in the past, I woke up with chipmunk cheeks swallowing air.

Note - I'm thinking of trying a soft cervical collar to address the dry mouth/lips to prevent my chin from tucking and mouth from opening.

[Pugsy]

The machine increases the pressure because of either apnea events or the early warning signals of the apnea events.

Either supine sleeping or REM stage sleep...those are pretty much your culprits. Machine malfunction just for pressure increases...I have never heard of it happening. There's always been a reason for it. Now we might not easily see the reason but the reason is there nonetheless.

[jwalsh126]

Perhaps it is all the vibratory snored being detected? Regardless, I think with my supine sleep position, it would be ideal to rest the head/spine in an optimal position that prevents chin tucking. I guess people try either collars, chin straps, or certain pillows. I can start with a cervical collar to see if it makes any difference (either in feeling or qualitatively in AHI, etc...) I've browsed the forums and any soft cervical collar seems to be fine. Do you have any thoughts on this line of thinking?

[Pugsy]

If I were in your shoes and faced with your issues. I would try a cervical collar. It's a relatively cheap and easy experiment to do.

Snores are part of what the auto adjusting algorithm will increase the pressure in an effort to kill them because they are early warning signs the airway is trying to collapse.

[Miss Emerita]

If you'd like to learn more about VS and VS2, there's an excellent discussion here:

viewtopic/t155478/The-meaning-of-VS-and ... -long.html

(Sleepyhead is the ancestor of Oscar, and JediMark is the person who led the development of Sleepyhead.)

Some people recommend turning off VS2 flags, especially because it is hard to know what aspect of the data creates them. And it reduces visual clutter!

[jwalsh126]

Thank you for all the replies. I am buying a soft cervical collar from amazon to try out. Also, i'm thinking of reducing the max pressure now that I have been having these instances of super high pressure spikes. From the data it does not appear I need the pressure that high to breathe. The machine is clearly marking something to cause it to increase (as Pugsy mentioned), but it isn't clear what. For now, I am thinking of reducing my max pressure to 16 or even lower like 14/15.

[zonker]

For now, I am thinking of reducing my max pressure to 16 or even lower like 14/15.

reducing your max pressure will most likely not do anything. look at the oscar graphs you've posted. your machine is set to a maximum of twenty. but the pressure graph shows that it's not going that high. and it won't until it needs to.

[jwalsh126]

I agree, I have not touched the max pressure. Unfortunately I have had bad mask fit the last several nights, so last night I switched out the cushion, and still had a mask fit of 55%. I woke up several times throughout the night so it was horrible. This morning I tried the "test mask fit" feature on the machine itself after adjusting the straps and got a check mark. I'm hoping tonight will be better. I didn't have these mask fit issues when I first started using CPAP 3 weeks ago, but this is very frustrating. I haven't gotten a proper reading of AHI with the pressure at 10 due to the max leak.

[zonker]

I agree, I have not touched the max pressure. Unfortunately I have had bad mask fit the last several nights, so last night I switched out the cushion, and still had a mask fit of 55%. I woke up several times throughout the night so it was horrible. This morning I tried the "test mask fit" feature on the machine itself after adjusting the straps and got a check mark. I'm hoping tonight will be better. I didn't have these mask fit issues when I first started using CPAP 3 weeks ago, but this is very frustrating. I haven't gotten a proper reading of AHI with the pressure at 10 due to the max leak.

have you tried looking for mask fitting videos on youtube?

[jwalsh126]

Yes, I don't think it's anything to worry about. It must have been a bunch of tossing and turning due to the bad weather the last few nights (I have allergies). I had mask fit above 95% for the first 2.5 weeks of therapy, but I think the cushion started to weaken. Yesterday was the first night trying the replacement cushion, so i'm going to mess around with re-adjusting the straps and I have found with this mask that I generally need to go tighter than expected for the mask to fit well without leaks.

1 positive takeaway (maybe) - the AHI went down AGAIN with the pressure added to 10. Sadly the mask did not fit. I have a feeling the mask needs to be tighter with this higher pressure I am using, as there is a greater chance of dislodging the seal when I shift my head at a higher pressure.

[jwalsh126]

Update on first night of cervical collar - Weird results.

I woke up around 3:00 after 2 hours of sleep. Then there was a short period of 2.5 hours of what seems to be amazing sleep according to the chart between 3:20ish and 5:30? Pressure ramped up for some reason and I started swallowing air again (waking me up yet again, this time feeling nauseous). This has happened about 1x per week where the pressure ramps to above 16 and I swallow air and wake up. I will try the cervical collar again for several days. Is anyone able to distill any positives/negatives from this data? I'm really not sure what to attribute to the collar or not.

Side note: My ffm cushion has been used for 1 month and it seems to be getting looser on bottom. I will continue using it until the mask fit lowers.

[DreamDiver]

Update on first night of cervical collar - Weird results.

I woke up around 3:00 after 2 hours of sleep. Then there was a short period of 2.5 hours of what seems to be amazing sleep according to the chart between 3:20ish and 5:30? Pressure ramped up for some reason and I started swallowing air again (waking me up yet again, this time feeling nauseous). This has happened about 1x per week where the pressure ramps to above 16 and I swallow air and wake up. I will try the cervical collar again for several days. Is anyone able to distill any positives/negatives from this data? I'm really not sure what to attribute to the collar or not.

Side note: My ffm cushion has been used for 1 month and it seems to be getting looser on bottom. I will continue using it until the mask fit lowers.

If aerophagia is a problem, you probably could lower your max pressure to deter that from happening. I hate that straps get over-stretched. Sometimes you end up having to buy new straps.

[jwalsh126]

Based on my data it appears the aerophagia occurs every time the pressure spikes to 16 or above. I'm going to try setting pressure at a range of 10-14 for now to see if it prevents the issue, but i'm thinking the range could potentially be lower. I'm starting to have long stretches where the pressure is constant at 10-11 and I am having few apneas, however it seems vibratory snores and flow limitations are triggering the pressure spike which results in me swallowing air and waking up extremely bloated. My hunch is that this pressure spike is actually not necessary, or that it is excessive in the least. I will try capping my max pressure slowly and monitor for any negative effects. As others have posted, if I really do need that pressure for the 30 minutes to be that high, I will have to figure out a way to not swallow air to allow for it. However, my hunch is that I do not. I will need more sample size.

Settings: Min pressure 10; max 14; Flex 1