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RubySnooze wrote:Guess I'll continue tape and pressure experiments. Any requests?

My thoughts back when I was coming up with bilevel pressures and had to do some trial and error...
Once I found a setting that gave me good results at least once then I decided to keep using that setting because I knew it would/could work because it did.

A new record AHI last night...it did it at least the one time and I would be for trying to see if I could get it to happen again. That's what I did when I was trying my bilevel experimental settings and at first I would have some good nights, some bad nights and some really good nights. Over time the really good nights became more frequent.

Given your history...I don't know that the crappy sleep is necessarily related to cpap therapy itself.
I would try to repeat what was done last night. It did set a new record.
The leak rate is much improved too. Initially it looks like a lot of leak line movement but it really wasn't nearly as much as past nights because of the scale involved with this one. The closer in the scale the more mole hills look like mountains.

RubySnooze wrote:Met with Doc 2 this morning. For about 12 minutes.

He agreed that APAP is not working for me, but wants his own tests before he starts to consider what is going on. He's scheduling me for a chest xray, a breathing study, and a three-night in-home sleep study. I'll see him again the middle of September.

He didn't really want to hear what I thought about anything, but I left him a stack of printed materials, all nicely organized, in case he gets bored some night and can't help taking a peek.

So another six weeks of treading water.

Guess I'll continue tape and pressure experiments. Any requests?

Wow, I'm shock at that "For about 12 minutes" considering your history... But not so much about the "He didn't really want to hear what I thought about anything"! First time I heard about a 3 nights in-home sleep study, I wounder what reason he gave you for those 3 nights and and I guess it won't be cheap? Sorry you have to wait an other six weeks... and probably a little more if you go thru a titration night. I find it odd that he didn't work/check at least your leak problem?? Did he even load and check your SD Card data on his computer?

As for pressure experiments... One thing for sure I would stick to fixed presure. You can try to stay at 8.5/8.5 for a few days if you feel good on it and see if you can reproduce the last night AHI or at least stay below an AHI of 5. If not, we will still be able to go back to the pressure experiment where we left off!

Aug 1
Pressure 8.5 / 8.5
Swift FX
3M Micropore tape + painters tape

OSAHell wrote:Wow, I'm shock at that "For about 12 minutes" considering your history... But not so much about the "He didn't really want to hear what I thought about anything"! First time I heard about a 3 nights in-home sleep study, I wounder what reason he gave you for those 3 nights and and I guess it won't be cheap? Sorry you have to wait an other six weeks... and probably a little more if you go thru a titration night. I find it odd that he didn't work/check at least your leak problem?? Did he even load and check your SD Card data on his computer?

All he knows at this point is that APAP hasn't been working. That's all he wanted to know. The subject of leaks never came up.

I gave my SD card to the girl at the reception desk (she didn't ask for it, but she did take it from me) and I assume it was downloaded. But I'd be super surprised if the doc had looked at it before we left.

The only rationale I heard for the three-night study was that "everything we do is based on data." Apparently, it has to be data he collects himself. I don't have any specifics about the three-night yet; someone from doc's office will call to get it all set up. I'm going to call my insurance company and make sure it will be covered. This is actually a bit of a relief for me 'cuz I would have so much trouble sleeping in a lab. Three at-home nights should be a much better representation of my real sleep than one lab night.

Am also happy to have breathing checked. I've had a lot of congestion and coughing lately.

This guy definitely has his system and it is completely inflexible. If I can deal with the rigidity and he can figure out what's going on, I guess it'll be worth it. But meanwhile, it's certainly annoying

OSAHell wrote:As for pressure experiments... One thing for sure I would stick to fixed presure. You can try to stay at 8.5/8.5 for a few days if you feel good on it and see if you can reproduce the last night AHI or at least stay below an AHI of 5. If not, we will still be able to go back to the pressure experiment where we left off!

Certainly getting the best results so far with 8.5 / 8.5. I'll stick with that and we'll see what happens...

If you have been doing quite a bit of coughing during the night then some of those flagged events could be coughing artifacts...or irregular breathing.

One big prolonged wake up last night....approx how many little ones that you didn't turn the machine off?

Pugsy wrote:If you have been doing quite a bit of coughing during the night then some of those flagged events could be coughing artifacts...or irregular breathing.

I've been coughing a lot just before I go to bed. Actually took cough syrup the last couple of nights, which helped. I can't do any coughing while I'm all taped up, so if I just HAVE to do it during the night, I stop the machine, remove the tape and hack away. Did that at @ 2:20 and 6:00 a.m.

Pugsy wrote:One big prolonged wake up last night....approx how many little ones that you didn't turn the machine off?

I do fine from when I go to sleep until that first wake-up every night. Probably my lovely sleep-cocktail hard at work. After the first wake-up, I go back to sleep but sleep feels more shallow. By early morning, a lot of little things are bugging me (urge to cough, tape, noise or movement in the house). I usually give up, even though I want to sleep longer.

Aug 2
Pressure 8.5 / 8/5
Swift FX
3M Micropore + painters tape

Pugsy, what would be the upper limit of what I can consider well-controlled leak numbers? [Thanks!]

Well....I am personally good with anything as long as the machine isn't flagging a large leak and the leaks don't wake me up.

Large leak territory will vary but with your pressure now, it probably is up around 75 L/min (total leak).
The worst you had last night was 44 L/min (total leak) which is WELL below large leak territory. I would be doing a happy dance if that were me.

The leak line looks like it is moving a lot but it really isn't moving as much as one might think...it looks worse than it is because of the scale. If you had experienced say a max of 80 for couple of minutes the scale would be different and the leak line itself would appear more stable.

Considering what your leaks have been in the past...if you can repeat last night on a consistent basis then I wouldn't be worrying about leaks anymore.

Aug 3
Pressure 8.5 / 8.5
Swift FX with two tapes
That last segment I re-used the tape after removing it to have some water.

Total use time: 8 hrs 36 mins. One 2 min break at 5:50. Different sleep meds.

Do you have a copy of your sleep studies? Just wondering if there was a mention as to if your OSA was worse when supine or during REM stage sleep.

Pugsy wrote:Do you have a copy of your sleep studies? Just wondering if there was a mention as to if your OSA was worse when supine or during REM stage sleep.

From Oct 1, 2014 sleep study:

During baseline study
Supine: 32 events Index 25.8
Non-Supine: 12 events Index 8.8

During titration
Supine: 24 events Index 12.9
Non-supine: zero events Index 0

I was on my back only, no side sleeping, during the titration.

I had no Stage 3 or REM sleep during the entire study.

Here at home, I'm sleeping almost entirely on my right side. Now that I have nasal pillows and I can get there without dislodging a mask.

Okay. I was just wondering because it seems like on the nights where your OAs are a little higher it's also later in the sleep cycle or in the wee hours of the morning both of which might point to getting more REM sleep. In other words the longer your sleep cycle then the greater chance for more REM where it is common to see more airway collapse.

Just watch your reports to see if you see this pattern especially when you get longer sleep sessions.
Might explain those little clusters of OAs that you see. I notice it because my OSA is about 5 times worse in REM sleep and supine sleeping never mattered much for me.

Since you never got to REM sleep then we don't know what your OSA would have been in REM sleep. I wouldn't be surprised if it was worse.

Crap crap crap! I think I've got allergic contact dermatitis from the 3M Micropore tape. You know...the tape that actually sticks to my face all night?

Sheesh...what do I do now?

RubySnooze wrote:Crap crap crap! I think I've got allergic contact dermatitis from the 3M Micropore tape. You know...the tape that actually sticks to my face all night?

Sheesh...what do I do now?

Back to the hoodies and FFM?

Does your AHI still in the low range in the last couple of days? I must admit I miss my daily entertainement from your daily graph!

Man, if it weren't for bad luck you wouldn't have any luck at all.

If it really is the tape...can't be having that happen. Try different tape again? Maybe try more of the painters tape since it doesn't seem to cause a problem?
I have read of people using a thin coat of milk of magnesia (let it dry good) to act like a barrier when dermatitis is involved but I don't know how that would affect your already fragile tape seal.