5 months later..

Ouch, I was afraid we were bumping up against the limits of where the aerophagia monster lives.

The Swift FX is a nice mask with the adjustable straps and all BUT it is noisy as all get out in terms of the venting when compared to the P10 venting. The Swift FX was my primary mask until the release of the P10. It's not horribly noisy in reality but when compared to the silent venting of the the P10 it's going to seem noisy.

Try 9.5 minimum tonight. If the aerophagia monster returns...reduce it to 9 and we will regroup and I need to get your SD card contents. I would like a night or 2 with minimum at 9.5 if at all possible.

There is a new mask put out by ResMed....not sure you have access to it yet.
This one...the N30....don't confuse it with the N30i.
https://www.resmed.com/us/en/consumer/p ... t-n30.html
You might like it and it apparently is slightly adjustable and will fit on the P10 frame (at least that is what I have been told...I haven't actually done it yet).

Your P10....how long have you been using it? I found that after about 6 or 7 months it really wouldn't ever shrink up enough for me and I had to resort to the little clips.
Do you have the little clips that can be used to help tighten it up?
https://www.cpap.com/productpage/resmed ... gear-clips
They will help tighten things up when the elastic will no longer shrink up. Rather primitive solution IMHO but it works.

I am not so worried about the AHI from last night. I will bet my last dollar that there is large number of SWJ stuff muddying up the results.

To get headgear to shrink up.....rinse in really hot water and maybe even dry it in the clothes dryer.

Is there any way in the world you could get your hands on a ResMed AirSense 10 AutoSet?

What happens if you increase Flex to say 2 or 3?
Are you using CFlex or AFlex?
Have you tried it?

Hey Pugsy good day,

Ill reduce pressure to 9.5( i still think thats too much, but ill try )
When i use 8.0 as pressure that feels te most natural ( no blown upfeeling ) thats my ramp starting setting

I dont need a noisy mask, that will wake me up. I didnt knew these clips are for tightening the strap! HAha but i do have them yes. Wil try em.
I have the p10 i think for like 3 months now, but havent slept 3 months with them. So in theory they should be okay, or the kushens are to big ( i use medium )
But i think theyre fine.

I think you are right about the SWJ, cause im awake often and toss and turn alot, they will all be flagged as events probably...

I already spent 500+ euros on masks, since im not totaly sure the n30 will be better, ill stay with my current p10 and dreamwear. The dreamwear can be used with pillows aswell

I dont think i can get a airsense 10 autoset, why do you ask?

I have played with the flex settings. ATM i use Cflex with flex setting 1 (lowest) This is most comfortale for me.
Increasing flex to 2 or 3 feels to unnatural. I then breath out super easy, kinda strange.

bye!

huydts wrote: ↑

Thu Nov 28, 2019 9:51 am

I dont think i can get a airsense 10 autoset, why do you ask?

Just wishing. It has some features on how it does its job that I think would be better for your situation. Exhale relief is better and the auto adjusting algorithm would be better in your situation IMHO. I have used both brands APAPs...I can get by with less pressures overall with the ResMed...and in your situation you need less pressure to avoid the aerophagia.

Flex is exhale relief and it does affect the timing which can make it feel a bit "off" in terms of being natural.
But exhale relief is the first thing we suggest to try when people have aerophagia issues because the pressure drops during exhale and this often results in less stress/pressure on the LES (lower esophageal sphincter) which is weak and letting the air enter the stomach from the esophagus.

I know 8 cm minimum feels better but I don't think it is going to do any sort of decent job holding the airway open and it has to be held open to keep it from collapsing. You will end up with sub optimal results. While the sub par therapy might be better than nothing....I try to avoid "better than nothing" if at all possible. I figure if we are going to go to all this trouble I want to do the best I can and not "better than nothing".

Let's add A Flex (not C Flex) to the mix tonight with the 9.5 minimum. A Flex stands the greatest chance of feeling more natural and I want you to use as high of A Flex setting as you are comfortable with. At least 2 hopefully.
This lets the exhale pressure drop just a little and it might help with the aerophagia.
wiki/index.php/Aerophagia
See above link for potential options and discussion.
You may end up needing a bilevel machine with more exhale relief to be able to avoid the aerophagia monster but lets try what you have available right now which is Flex which does create a limited bilevel situation.

Alright.

Will try that setting tonight.
A flex on 2 or 3 with 9.5 to 12.

Sounds scary... Needing a bilevel machine... Cost wise.
Hope my dreamstation will do the job!

I'm off to bed! Byebye will be back tomorrow with a report

goodmorning,

Tonight i slept pretty good. No leaks or waking up from the leaking noise of the p10 ( since i rinsed it in water )
I made a mistake with the settings. I went to sleep with FLEX OFF.

The monster didnt show up tonight, not at all so thats a good thing.

You can see i took a nap yesterday afternoon.

For next night, with high flex setting you mean, the setting 3 which gives most exhale relief right?

Il try that tonight. this morning when i woke up around 6:45 i did change the settings tough to A flex and flex 3...

THis are my results..

What to do with next night? I suggest staying with a flex / flex 3 and maybe try again the min pressure of 10? or what do you think?

byebye

Ah man, you don't make a girl's job easy do you?

https://www.dropbox.com/request/2d02LyIIgW58f4eYS7h2

compress/zip your entire SD card in one step so that I get all the contents in order and one folder and up load it to the above link.

I guess I need to try to figure out exactly what we are fighting.
Turkey day is over and I am not a Black Friday shopper....I have the time to look through your results and last night is as good as any since we know you slept decently.

How about trying minimum of 10 with AFlex engaged and max of 12.5 before you send it to me though. I already am 99.9999 % sure you need more pressure.

Pugsy wrote: ↑

Fri Nov 29, 2019 8:42 am

Ah man, you don't make a girl's job easy do you?

https://www.dropbox.com/request/2d02LyIIgW58f4eYS7h2

compress/zip your entire SD card in one step so that I get all the contents in order and one folder and up load it to the above link.

I guess I need to try to figure out exactly what we are fighting.
Turkey day is over and I am not a Black Friday shopper....I have the time to look through your results and last night is as good as any since we know you slept decently.

How about trying minimum of 10 with AFlex engaged and max of 12.5 before you send it to me though. I already am 99.9999 % sure you need more pressure.

Hehe i really wish i could make it easy!

But then again i rly apreciate the time you are investing to help.
Today was real bad.. so litle energy during the day, had to take a nap again, and even that didnt result into more energy.

ill try 10 -12.5 with aflex

Ill upload the SD card data anyway.. just in case

Thanks Pugsy.

Byebye

I have your data in my OSCAR and I need more time to put things under the microscope more but I did just now take a quick look at just the OA flagged events...31 of them and only 4 were probably real asleep events.
One of the real asleep events did maybe cause an arousal with another couple of OA flagged events coming from just that one real arousal.

I need more time to dig deeper but your over all sleep quality sucks and you are having a lot of arousals happening when there is nothing going on in terms of your flow rate prior to the irregular breathing.

In other words....crappy sleep for sure but not necessarily related to restrictions in the airway itself. While there are definitely a few real asleep breathing restrictions happening....not nearly as many as it looks like on the big picture of the detailed data.
Even the times where the pressure does max out looks mainly like false positives driving the pressure.

At this point I am not so sure that more pressure is the answer but instead maybe sit back and take a hard look at sleep quality in general.

Let's proceed with the AFlex experiment though if you can. Use whatever minimum you are comfortable with at this point.
Right now I want to try to figure out how to reduce your crappy sleep quality. Your flow rate is chocked full of irregular breathing all during the night.
You would feel like crap even with OSA being in the mix.

Pugsy wrote: ↑

Fri Nov 29, 2019 12:52 pm

I have your data in my OSCAR and I need more time to put things under the microscope more but I did just now take a quick look at just the OA flagged events...31 of them and only 4 were probably real asleep events.
One of the real asleep events did maybe cause an arousal with another couple of OA flagged events coming from just that one real arousal.

I need more time to dig deeper but your over all sleep quality sucks and you are having a lot of arousals happening when there is nothing going on in terms of your flow rate prior to the irregular breathing.

In other words....crappy sleep for sure but not necessarily related to restrictions in the airway itself. While there are definitely a few real asleep breathing restrictions happening....not nearly as many as it looks like on the big picture of the detailed data.
Even the times where the pressure does max out looks mainly like false positives driving the pressure.

At this point I am not so sure that more pressure is the answer but instead maybe sit back and take a hard look at sleep quality in general.

Let's proceed with the AFlex experiment though if you can. Use whatever minimum you are comfortable with at this point.
Right now I want to try to figure out how to reduce your crappy sleep quality. Your flow rate is chocked full of irregular breathing all during the night.
You would feel like crap even with OSA being in the mix.

Oh Wow, thats demotivating for sure!... right?

Is an arousal the same as ''RERA''?

I know my sleep quality sucks, i'm always wandering ''will i sleep tonight?'' ''Will i be refreshed tomorrow?'' I wake up from every sound or feeling, my wife pulling the sheets for example. Or i wake up from aire gushing sounds.

Last night was despite only 4 AHI terrible. I was dreaming i made a baling sound in front of family and i just couldnt stop. They were annoyed by that. And i felt embarresed.
Then i woke up and noticed it were my lips doing BRRRRR cause of the cpap blowing out of my mouth. I got sick of it and changed the mask after that ( 6:15 am ) to the wisp.

Ofcourse my nse got glogged right after that -_- Then i decided to give the FF a try... It was a slight relief to breath trough my mouth knowing there wont be any air gushing from it anymore.. But i couldnt get real deep sleep anymore.

So here we are.. really tired and i have to go to some crappy Party at my wife her work in about 30 minutes .... :/:/

24th of december i have an appointment with the 'what we call here a '' throat nose ear'' doctor.. Just to make sure there are no extra fysical probems

Arousals or awakenings from a sleep stage. We may or may not remember them.
2 kinds of arousals. Spontaneous which means no known cause per se and RERA or respiratory event related arousal.
Respiratory event related arousals are those that come from some sort of airway air flow restriction or reduction.
I cannot tell for sure about sleep stage when looking at the flow rate pattern. I can make educated guesses but I have zero way to know if you are really asleep or not.

The machine can't tell either and when it flags a RERA it is saying your breathing looks like the breathing of someone who has some sort of respiratory related arousal that can be seen if in a sleep lab with all the EEG wires hooked up to determine sleep status. It's making an educated guess too.

The majority of the changes in your flow rate pattern, which tells me you aren't asleep, appear to be more spontaneous than related to airway restrictions. You have a few airway air flow reductions which might point to being related to the airway but the bulk of all the changes in your flow rate pattern don't seem to have any sort of air flow reduction prior to the arousal/awakening.

I need you to do a little bitty experiment for me. Take your fingers and press them gently along the sides of your nose up by where eyeglasses would rest. This is the area of the nose where the turbinates are. Press gently with about as much pressure as the Wisp puts on that area. Hold it for about 5 minutes...does your nose become congested? If it does....remove the fingers and release the pressure...how long before the congestion goes away?

Some examples of arousals.

I circled the arousal in red on this example. Prior to the red circle see how the flow rate is nice and smooth and even and rhythmic?
After the circle the flow rate/breathing is sort of all over the place? You woke up...that's the area circled and the stuff flagged after that arousal isn't real asleep flagged events. It's SWJ sleep/wake/junk false positives.
See that big spike of air prior to the first hyponea? That's an indication of of a big gulp of air and that doesn't happen when asleep. Note the regular flow rate pattern prior to the big gulp. Everything flagged after that first hyponea is most likely SWJ. We call them post arousal events. Related more to the arousal itself than the airway collapsing.
The bulk of your flagged events look like the image above.

I am having a hard time finding a real asleep flagged event that is classic on your reports but I will continue looking.
What I am looking for is nice asleep breathing and flagged events right in the middle of it. Like this one below which is one of mine since I can't easily find one from your data.

hey Pug,

I tried the thingie with the fingers on my nose XD My wife asked if i was okay ;0.
It seems one side of the nose gets congested ( most of the time its the right side ) But im not very sure if its from te pressure. 1 side was alrdy a litle bit congested.
Ill try it again as soon as my nose reopens.

Today i tried to take a nap... i layd on bed for 50 minutes ( couldnt fall asleep ) But when i checked the data it said vibrated snoring 4 times, 4 times RERA , and 1 hypopnea (44seconds)
Well im 100% sure i didnt sleep, and i didnt snore. What did was scrape my troat few times to get rid of the slime... ( sorry for details ) Thats what i do at night aswell few times, at least before i fall asleep.

So, This means my real AHI might be lower?
I still dont understand why a ( semi) arousal causes an Apnea ) or at least gets flagged as an apnea.

I have found the same chart as you mention about arousel SWJ flags.. But my breathing is amost never so nice and rythmic...

Big gulps of air dont occure in sleep? Aha that helps me to interpret the charts .. good to know.

I was looking for that aswell.. But my flow rate always looks totally fucked up... Very strange.

Could it be possible i just need a LOW pressure ( as my doctor said 7,5 or 8,5 ) and then fixed pressure?? This will possibly helps me sleep more comfy.
But im affraid it will rise the AHI. But since the AHI's are probably SWJ's... they will reduce overtime when i get used to sleeping with 1 and the same mask?

OR my other theory could be try to get used to a FF mask, then my mouth openings wont disturb me in my sleep again? ( but this is not my favorite choice since a FF is very unlikely to get comfy )

I dont know if you can do something with the data from my sleepstudy? but ill add it in..

Oh Wait...my very first study i only had 18 AHI, but this was just a take home test / screening rapport.. And therefore not so reliable and just an indication for further investigation. ( kinda strange i think but okay )

Second graph is my at home sleep study.. I do know that i almost didnt sleep that night cause of all the wiring etc. Sleepcentre said they had enough data to conclude i had severe apnea.

Its in Dutch langiage but i wrote some notes on it for you to translate.

AND HEY! If you think OMG this is way to much work, or you arent competent, or dont feel good or whatever. You dont have to do this for me alridght? Dont feel forced please.

I send the original polygraphy in your Dropbox

By Pugsy, and thanks alot!

hope to hear from you, especially about my own suggestions

huydts wrote: ↑

Sat Nov 30, 2019 11:43 am

So, This means my real AHI might be lower?

Yes, definitely.

huydts wrote: ↑

Sat Nov 30, 2019 11:43 am

Could it be possible i just need a LOW pressure ( as my doctor said 7,5 or 8,5 ) and then fixed pressure?? This will possibly helps me sleep more comfy.
But im affraid it will rise the AHI. But since the AHI's are probably SWJ's... they will reduce overtime when i get used to sleeping with 1 and the same mask?

I don't know about the 7.5 yet...I need to go way back in your detailed reports and check it out. Will do that later.
But maybe you don't need as much pressure as we thought or as much as the machine wants to sometimes give you.
Here's the deal with the machine....it only measures air flow and responds to what it thinks is something going on blocking the air flow and it can/will sometimes get it wrong because of the awake/arousal breathing irregularities that it senses.
Asleep breathing is very boring and rhythmic but awake/arousal breathing is very irregular when compared to asleep breathing.
The irregularities get misinterpreted as something going on while asleep (because the machine has no idea if you are asleep or not) and that's why you get false positive flagging and responses to those false positive SWJ events.

You need to quit worrying about the AHI for now and let's start worrying about trying to fix your sleep quality issues.
Your AHI is high because of the poor sleep and not the cause of the poor sleep. I know that isn't what you wanted to hear.
Trust me....it isn't what I wanted to see either because it's a lot easier to fix OSA issues than it is poor sleep in general issues that aren't related to OSA.
The machine can only fix bad sleep when the bad sleep is related to OSA....it can't fix bad sleep caused by anything other than OSA and you have bad sleep from probably 2 things...the OSA which the machine is dealing with but the remaining thing we don't know what it is but it is really f...ing up your sleep quality.

Have you ever tried some sort of over the counter sleep aid?

I need to do some more digging around in your detailed data...got a few irons in the fire here at home right now so it will have to be later. We had some bad storms and now it is really nice outside but it won't hold and I got a lot of downed tree limbs that need to be cleaned up.

I see no need right now to be using the higher minimum and instead I would like to see you back up and try something more comfortable in an effort to maybe improve on your sleep quality or reducing those arousals from whatever might be causing them.
Minimum 8.5 or 9.0 and leave the max at 12 I guess for now.

I will go look at your sleep study results later.

Ty pugsy,

Will do that

(You mean sleeping pills? With sleeping aid?)

Good luck at your house!! That's goes first ofcourse.

Bye