The Daily Blowdown

[TalonNYC]

Cool, WhoDat, it can make the whole thing a little easier to deal with, at least for me it does.

[TalonNYC]

4/9/2011

AHI 4.9
Leak 4.2

First night using the silicone nose-pad gizmo on the bridge of my nose, and it's made two major differences. 1: Lowest leak rate ever. 2: extremely comfortable. Just ordered a backup one =)

What I learned: AHI is still hovering close to 5, so I'm going to go up to 14cm/H2O tonight and see if I can get it down below 2 on a regular basis, as opposed to on the good nights only.

Question: Could the sleep techs have been 2 full cm/H2O off on my titration, or should I instead go up in increments of 0.1 cm/H2O from here on out? Or both?

Thanks!

[Pugsy]

Question: Could the sleep techs have been 2 full cm/H2O off on my titration, or should I instead go up in increments of 0.1 cm/H2O from here on out? Or both?

Sleep techs may have caught you on a "good" night too. If split study, even less chance to catch a "normal" night.
We don't always have the same sleep each night. Some nights my APAP doesn't do a thing and sometimes it works its little butt off going all over the place.

I forget, are you using EPR? That might make some difference if you are.

You are close to your goal that you have set. How much to increase? If using EPR maybe 1.0 cm increase. If not using any EPR maybe 0.5 cm increase. You could do the 0.1 thing but to be honest, your nights are going to vary anyway and you would have to leave it at 0.1 for quite a while to see any perceived trend. I get the sense that you don't have the patience for that. I wouldn't. Your choice. Just remember that nights will vary even without pressure changes. I can have a less than 1 AHI tonight and tomorrow night it will be 2.5 AHI and nothing has changed except my sleep pattern.

[TalonNYC]

Hi Pugsy!

I turned EPR off a week back since I don't mind the pressure on exhale. If I can keep it below 3 for a week, then I'll be happy to regain patience and wait to see what happens past that, so I think I'll do a 0.5 increase for a few days and see if it has the desired effect.

I know that it will take time to get below 2 on a regular basis, even if the therapy is working perfectly, so I want to set reasonable goals for short-term and long-term. Short term is below 3 every night. Long term is to head for zero, but safely and sanely.

Thanks for all the advice, hopefully I read it right and this course of action is what you were aiming toward =)

[Pugsy]

Yeah, I would just do 0.5 increase because you are so close to your goal and you will have to be patient and give it some time because our sleep patterns do vary each night. At this point 0.5 might be just the nudge. While not hugely different, I see no sense in using any more pressure at all than is absolutely needed. Especially at your pressures. Now if you were using 6, yeah bump it up. You would have lots of wiggle room.

I have never got a 0.0 night unless it was a nap of less than 2 hours. If I get any REM I am going to have some events. I have come to accept that fact and a perfect zero is not one of my goals. Though I did have my best ever AHI couple of weeks ago 0.2 AHI. For me that is a superb number. Mostly I am between 1 and 2 now. I really don't dwell on the numbers much but I do remember when I did, so I do understand. It is a validation of sorts for all this hard work.

Now if in 3 months you consistently have 0.8 or 1.0 and you ask me if you can increase the pressure still trying to chase that perfect zero..... I will reach through the computer and slap your head..either that or get my voodoo doll out and put your name on it. Even people without OSA diagnosis will have episodes that the machine might score as events.

Goals are fine...just make sure they are realistic and don't forget the number one goal.
Feeling better...

[TalonNYC]

I promise, my long-term goal is "under 2" and that's it. I will also accept bad nights where I will go higher, because that's just life.

Considering that the actual event runs are around 11-20 for a few minutes, an overall AHI of 2 or lower means lots of hours of zero, which is very cool!

[Pugsy]

I promise, my long-term goal is "under 2" and that's it.

That's good. Watch me eat my words when he hits a perfect zero.

The reason I mention this so much is that I happened to be reading on another forum way back when I had maybe 6 months under my belt using the machine and a newbie posted being using the machine 3 nights.. AHI 0.8 or something there abouts. Reported feeling great. Wanted to get zero AHI so increased the pressure. Got bad aerophagia and was miserable and no change in AHI. DUH.... Spent nearly a week like that before going back to original pressure and of course felt much better. I am thinking, what a dufus... not nice but that is what I thought.

[TalonNYC]

I start swallowing air and all bets are off. I belch enough =)

[TalonNYC]

4/9/2011

AHI 2.2 (Partial night)
No leak info

Kind of rough night, kept turning to my left side, which makes the mask leak. I've been doing that less and less, but last night was so bad I actually switched to the nasal mask LOL. While doing so, I noticed the AHI was 2.2, so not bad. However, at some point I reset the machine, and set the counter back to zero, so not sure how the rest of the night went. For those keeping track, I switched back to the FFM and fell back to sleep within about an hour, and got another 4 hours (about 8 hours total).

What I learned: even with the hose holder gizmo, turning to my left (away from the machine) without lifting my head at all causes the mask to leak. Slowly, my body is figuring this out and not turning that way, but sometimes it still happens.

[TalonNYC]

4/10/2011

AHI 2.4
Leak - off the charts

OK, so much for the FFM. I'm keeping it for when I have a cold, but back to the nasal mask it is for me. The leak rates are horrific most of the night, according to the charts. for at least 4 out of the 7 hours I'm out (sometimes , leak rates go way over the redline - a lot. This week I'll try the nasal mask and check the leak rates against the past 2 weeks on the FFM.

What I learned: I can sleep through some pretty major leaks!

[WhoDatSleeping]

Mike, like you, I will be sticking with the nasal mask for now. I have the Quatro FFM for times when the nose is congested.

Have you had any luck with pillows? I have been thinking about giving them a shot the next time I get a new mask.

[TalonNYC]

well, as per my other post, I just took the goatee off so the FFM will work better =)

I haven't used nasal pillows alone, since I have the mouth breathing issues. I have tried the hybrid - and might just try it again now that I don't have the goatee.

[TalonNYC]

4/11/2011

AHI 3.7
Leak: 0.0 (!!!!!!)

No leaks last night! Well, OK, the 95th percentile was 0.0 and there were probably a few leaks now and then, but this is good enough results for me =)

What I learned: Looks like I will be goatee-free for quite some time to come. At least until I don't wake up with my mouth hanging open anymore.

[TalonNYC]

4/12/2011

AHI 3.8
Leak 4

Leak rates are still lower than in the whole month of treatment so far, so that's going well. AHI is also maintaining below 4, also great.

What I learned: I'm going to go back to 13.0 cm/H2O. 13.6 is very tolerable, but has no visible impact on AHI over time, so might as well stick with the lower pressure.

[TalonNYC]

4/13/2011

AHI 5.8
Leak 2.5

Great night's sleep, only woke up once during the night. Uber-sleepy in the AM though.

What I learned: Hmm, maybe 13.6 *is* a better pressure level than 13 even. I was below 5 every time at 13.6. Could have just been a bad night, though.