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Uff Da wrote: ↑

Wed Jun 13, 2018 11:51 am

The only other line it seems to correspond with is the exp. time. But I don't know what that means, what exactly happened. And an increase in pressure occurred over the next few minutes. Is that related?

I agree with Jas... just a glitch in the data, it happens... just something to ignore.

I would also vote for data glitch. Corrupted data point or file maybe.
I also would just ignore it. No way to prevent or fix that type of thing.

Thanks, Jas, PR and Pugsy. One less thing to try to sort out.

UPDATE. My last day of using the F10 full face mask was Wednesday night and after all the struggles I've had with it, I finally hit an AHI of 1.74. The better result those last three nights I attribute to using a pillow under my knees. While the primary purpose of that was to relieve back pain, a side effect was that it prevented me from rolling to my side, which caused leaks and problems with the mask. Unfortunately, I can't tolerate lying on my back all night and usually no more than an hour or 1.5 hours at a time. Thus, I could never be able to use that mask and expect to get good uninterrupted sleep. It will be a good backup for times that I'm too congested to wear a nasal mask, though.

Thursday I went to my DME. She told me that my original sleep study showed an uncorrected AHI of 88. So now I don't feel quite so bad about those terrible numbers I've been getting in the 20s and 30s. While far from the desired result, as least it is a marked improvement.

I'm now trying a Phillips Respironics Wisp nasal mask, along with wearing a 3-inch cervical collar. My first night was horrible, getting no sleep at all with four hours of use. I discovered that using the "check mask fit" doesn't work for me with this mask, as when the pressure starts going up, the air just explodes out of my mouth. Last night I started directly with my minimum pressure of 8, and that worked much better. I seemed to be able to handle higher pressures when they approached more gradually as needed during the night. I re-set my minimum/maximum pressure to those my doctor prescribed, 8 and 18. In the first three nights the highest my pressure has actually gone is to 16.

One thing I found drastically different between the two masks. The Airfit 10 FFM caused so much noise with even smaller leaks that I was often at wits end and had to pull the mask off. With this mask, in contrast, I'm having trouble finding where the leaks are because they aren't that noisy to be disturbing. In fact, I have great difficulty hearing leaks since the venting is noisier. It will take some adjusting, but I'm hopeful that I might have more success with this mask.

Here are last night's results. Still too much leakage, but at least I'm getting a better AHI and have less trouble alternating between back sleeping and side sleeping. I got some sleep in the earliest session and the sessions after midnight, but no sleep between 10:30 and midnight.

To better to be able to evaluate the leak scale you can change it from the static 120 L/min so that the top of leak graph reflects the max leak that night. Will help you see how far you went over the red line.

In SleepyHead take your mouse cursor and hover it on the leak graph lower left corner where the vertical and horizontal lines meet at 0.
So in that corner and on 0...click the mouse once and see if the numbers change to reflect something other than 120.
If it does...leave it alone and the leak graph will now sort of auto adjust the top number depending on what the max happened to be.
It will change the scale you you can better see the leak detail between say 40 and 60 L/min.

Your AHI for the night is probably not too far off even if the machine missed a few events. Normally we start seeing UAs before the machine starts having trouble recording and you only have one of those. I would expect to see more UAs first before I started thinking the machine totally missed a bunch of events. It might have missed a few but I don't think it missed a truckload of them.

Keep working on it. You will eventually get there. Like you said...it's already much improved over what it would be without cpap.

Pugsy - I couldn't get the leak graph to change from the 120 L/min maximum. Maybe I'm not doing something right.
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I had my follow-up appointment with the sleep doctor today. In one sense she gave me a "carry on" approach, yet she also seemed quite emphatic that if I don't feel a lot better in a month, she wants to have me evaluated for bipap therapy. I guess I should have asked more questions, but I fear that at the time I kind of dismissed it as not being necessary. But now I'm wondering what she saw that made her think I might need that. I only had one central apnea out of 145 respiratory events in the sleep study. I did have 17 central apneas out of 36 respiratory events in the treatment section of the study. I do see in the "overall impression" section the statement "Mild treatment emergent central events," along with "Severe obstructive sleep apnea improved on CPAP." I guess that may be the basis for her thinking. But I haven't been having many central apnea events on CPAP at home. I wish she would have been more specific than just saying I should be "feeling a lot better." With my other medical problems, there are so many other things that can impact sleep, that I don't want to blame how I'm feeling on apnea necessarily.

Also, in reading the sleep study summary, I see "Sinus rhythm with PACs" in both parts of the study. And there's a technician's note elsewhere "possible ectopy." Would that have any relationship to recommending bipap? Or is it totally unrelated?

Uff Da wrote: ↑

Mon Jun 18, 2018 7:56 pm

Pugsy - I couldn't get the leak graph to change from the 120 L/min maximum. Maybe I'm not doing something right.

Right click on the vertical scale on the left of the chart. x axis, then pick override, put in some other numbers.

Uff Da wrote: ↑

Mon Jun 18, 2018 7:56 pm

Pugsy - I couldn't get the leak graph to change from the 120 L/min maximum. Maybe I'm not doing something right.

Right click on the chart title "Leak Rate", select Y-axis, and set scaling to Auto-Fit.

Thanks, PR and BD. Got it. That leak rate graph is easier to read this way.

Sunday night I had a good night (in comparison to most) and thought I was adjusting to the new mask okay. I had less trouble than usual falling asleep. My AHI for the night was 1.74, a new low, though I had far too many leaks.

But last night was different and I was ready to conclude that this mask won't work at all. I kept feeling the urge to let air explode from my mouth in the first few hours. And worse yet, the first two hours or so I couldn't get to sleep because I was snoring far too much! I kid you not, I was ready to pound on the wall or poke myself in the ribs and tell me to "cut that out!" It was just one snore after another! I suppose I was going back and forth between light sleep and wake, but as far as I was concerned I didn't sleep at all those first two hours. And my Sleepyhead shows the unusual amount of snores I had in the early part of the night. Then the rest of the night went fine, so I'm still debating about whether I can make this mask work.

UPDATE AND NEW PROBLEM.

The first mask I had, AirFit F10 FFM had excessive leaks and gave me high AHI even with a cervical collar unless I slept in one position on my back with a pillow under my knees and basically didn't move all night. Without those measures leaks would often be 20, 30 and up to 69% of time over redline. Trying to get sleep without being able to move just didn't work. I got somewhat better results with one of the chin straps, but had to have it so tight it distorted my face and didn't seem an acceptable way to go.

My second mask, the Respironics Wisp nasal mask, only gave me a good AHI and reasonable leakage if I used it with a chin strap so tight it distorted my face and the mask so tight it left red imprints on my face.

I'm now trying my third mask, a Quattro FX FFM. After an hour or two using it Friday night, the aerophagia problems were so bad I had to tear off the mask and reduce my maximum pressure to 14. (Prescription is for 8 minimum and 18 maximum. I still get problems with swallowing air at that level, but not so severe that it causes as much pain and inability to sleep. The problem is that with this mask, I obviously need the pressure to be higher than 14. You can see that last night, the machine was bumping up against that maximum most of the night.

Is there anything I can do that might allow me to have a higher pressure without such aerophagia problems? Raising the head of the bed won't work, as the bed is on a wooden base with drawers. Are there differences between masks that make a difference in what pressure one needs? Anything consistent enough that it isn't just a matter of trying different ones until one finds one that works?

Although the first two nights lead me to think I might have found a mask that won't leak as much as the others, my OSAs were the worst I've had since starting using Sleepyhead nearly two months ago. During one stretch of my last sleep session last night it looks like I had 39 OSAs within about 45 minutes, with one as long as 55 seconds. I have a long way to go in getting this sleep problem under control!

Prime candidate for the ResMed AirCurve 10 VAuto.
You are going to need the higher pressures to get the OAs under control but those higher pressures are going to make the aerophagia monster come for a visit and plan for long and annoying stay.
You can try adding in EPR and see if it helps with keeping the aerophagia monster away or not...setting of 3.

I don't understand much about EPR. If I use a setting of 3, will that theoretically allow me to use a higher pressure setting without so much additional aerophagia as I was getting with the higher setting otherwise? I've never tried using EPR previously. Don't really understand what it is supposed to accomplish.

So you think a bi-level might be helpful? I thought that was mostly for people having a lot of centrals. My doctor said if I continued to have problems, she might want to consider me for a bi-level. I didn't really see why, as though I apparently had quite a few centrals in my sleep study, I haven't had very many in most of my Sleepyhead reports. I hadn't seen all that many OSAs on my Sleepyhead reports, either, almost always under 3% and many times 0. However, it could just be that they were being missed, I guess, because of all the terrible leaks. We'll see in a few more days how this all works with this mask that seems to control leaks better.

There are several kinds or models of bilevels...yes, some will treat centrals but not all of them are for centrals.
Some are for people like you who need higher pressures and need a bigger difference between inhale and exhale than the cpap/apap machines can give them with the exhale relief available.

EPR of 3...3 cm reduction upon exhale from inhale...it's essentially a bilevel function but it is limited to maximum of 3 difference.
Bilevels will let you have a bigger difference and it's that difference that can really help out a person who is having problems with aerophagia at any pressure (doesn't necessarily have to be high pressures).

Try an experiment for me.

Turn EPR On...set it to full time.... set it to 3
Minimum pressure 11
Maximum pressure 16 (worry about going higher later once we see if the aerophagia monster returns and if you actually need higher. Maybe with the higher minimum it won't need to go so high.
Do it one night and report back with what happened and the detailed report.
The manual that explains EPR and how to change settings in the clinical setup menu. If you don't have it.
https://sleep.tnet.com/home/files/resme ... -guide.pdf

Sorry I am zero help with full face masks...I don't use them. I do have the Respironics DreamWear Full Face mask available as I could actually sleep with it (never could with any of the others) but so far I have never really needed a full face mask and I really don't particularly care for them.

Uff Da wrote: ↑

Sun Jul 29, 2018 5:41 pm

I don't understand much about EPR. If I use a setting of 3, will that theoretically allow me to use a higher pressure setting without so much additional aerophagia as I was getting with the higher setting otherwise? I've never tried using EPR previously. Don't really understand what it is supposed to accomplish.

I am not at a reliable level of knowledge here, but from subjective experimentation, the easier it is to exhale, the less I get that feeling of air being backed up down my throat so to speak. As if to say, "this air is too hard to breathe out, I think I'll eat some of it!"

That could be hilariously wrong though lol

Uff Da wrote: ↑

Sun Jul 29, 2018 5:41 pm

So you think a bi-level might be helpful? I thought that was mostly for people having a lot of centrals. My doctor said if I continued to have problems, she might want to consider me for a bi-level. I didn't really see why, as though I apparently had quite a few centrals in my sleep study, I haven't had very many in most of my Sleepyhead reports. I hadn't seen all that many OSAs on my Sleepyhead reports, either, almost always under 3% and many times 0. However, it could just be that they were being missed, I guess, because of all the terrible leaks. We'll see in a few more days how this all works with this mask that seems to control leaks better.

I just bought a bilevel (not received yet) strictly in search of incremental comfort at higher pressures. I have no problem with centrals. I think the machine I have now is more than adequate to treat, but I'm being greedy because I think there is room for improvement in the experience.

Adding the EPR of 3 seemed to work to eliminate the worst of the aerophagia. I used a max pressure of 17, as I thought with the EPR of 3, that would give me the equivalent of 14 on exhale, which is the max pressure that seemed tolerable before. I see from the Sleepyhead data that I only bumped up against the max of 17 briefly twice during the night. So I think I'll try a max of 18 tonight. Hopefully if I don't need that higher pressure for long, it won't be enough to wake me up.

I did also bump up the minimum pressure last night from 9 to 10, as well.

My AHI last night was 4.64 with the higher max pressure and the EPR. The previous night AHI was 13.36 with max pressure of 14. Last night total time in apnea was 13 minutes 41 seconds, whereas the previous night was 30 min 35 seconds. It will take several nights to draw definite conclusions, but I think I'm on the right track.

One negative note regarding last night's sleep. I had one OSA that lasted 102 seconds! That's the most I've seen in any of my Sleepyhead reports to date. Not good!