Managing OSA and IH

Pugsy · Post by **Pugsy** » Sat Jan 23, 2021 8:24 am

I would suggest starting a new topic/thread for the machine you want to sell. That way more people will see it.

As for your feeling like you wake up feeling the heart pounding....unfortunately you don't have much to go on with the data the machine gathers.

What you might do the next time that happens is immediately turn the machine off and then back on again so you have a definite known marker where you can investigate exactly what the flow rate looks like immediately prior to the wake up to see if anything stands out.

Naps aren't a really good time to be evaluating flow rate because often we sort of drift in and out of sleep..
Your top zoomed in section...looks like arousal breathing to me
The bottom graph at the end of the sleep session...harder to tell for sure due to scale.

As for your concerns about rebreathing CO2....In 11 years and countless nasal pillow masks, I have never had that happen...and I pretty much have always used the smallest or next to smallest size pillow.

With any perceived issues with heart rate I always tell people to talk to their doctor and see if they think maybe a holter monitor might be indicated so you can for sure see a record of the heart rate. No guessing. Just because someone feels like their heart is pounding or racing or whatever doesn't mean it is doing anything or if it is then maybe the data results will help isolate a cause.
I don't like guessing or poo pooing off potential heart issues.

ReverseBall · Post by **ReverseBall** » Sat Jan 23, 2021 5:52 pm

Pugsy wrote: ↑
Sat Jan 23, 2021 8:24 am
I would suggest starting a new topic/thread for the machine you want to sell. That way more people will see it.

As for your feeling like you wake up feeling the heart pounding....unfortunately you don't have much to go on with the data the machine gathers.

What you might do the next time that happens is immediately turn the machine off and then back on again so you have a definite known marker where you can investigate exactly what the flow rate looks like immediately prior to the wake up to see if anything stands out.

Naps aren't a really good time to be evaluating flow rate because often we sort of drift in and out of sleep..
Your top zoomed in section...looks like arousal breathing to me
The bottom graph at the end of the sleep session...harder to tell for sure due to scale.

As for your concerns about rebreathing CO2....In 11 years and countless nasal pillow masks, I have never had that happen...and I pretty much have always used the smallest or next to smallest size pillow.

With any perceived issues with heart rate I always tell people to talk to their doctor and see if they think maybe a holter monitor might be indicated so you can for sure see a record of the heart rate. No guessing. Just because someone feels like their heart is pounding or racing or whatever doesn't mean it is doing anything or if it is then maybe the data results will help isolate a cause.
I don't like guessing or poo pooing off potential heart issues.

I will start a separate thread.

I'll bring the heart pounding up with my doctor. Regarding the CO2 rebreathing, I saw a well documented thread on this or some other cpap forum done by someone (who was supposedly an MD) showing both through flow data and through microscope imagery that the P10 was prone to clogging the vents (nothing to do with the nasal pillow size). It's been a bit of a fear of mine, which is a shame because it's easily the best fitting mask for me.

When you say it looks like arousal breathing, are you referring to post-arousal, irregular breathing? In those videos you linked about analyzing flow data, the guy said that a lot of the irregularities were due to being awake and that he wouldn't count them as events. Is this what you are referring to?

Pugsy · Post by **Pugsy** » Sat Jan 23, 2021 5:58 pm

I used the P10 for probably 3 or 4 years until I switched to the Bleep.
Not once did I ever have those vent holes clog up.
And yes, I know of that person on the other forum. I don't think he is a doctor but even if he was I don't put doctors up on a pedestal and think they walk on water and aren't ever wrong. I worked with too many of them over the years. They are far from perfect.

ReverseBall wrote: ↑
Sat Jan 23, 2021 5:52 pm
When you say it looks like arousal breathing, are you referring to post-arousal, irregular breathing? In those videos you linked about analyzing flow data, the guy said that a lot of the irregularities were due to being awake and that he wouldn't count them as events. Is this what you are referring to?

Yep...arousal breathing or awake breathing...pretty much the same irregular breathing as opposed to the nice rhythmic balance breathing of asleep breathing.
Anything that gets flagged and you aren't asleep....doesn't count. You muse be asleep for it to matter.

zonker · Post by **zonker** » Sat Jan 23, 2021 7:31 pm

Pugsy wrote: ↑
Sat Jan 23, 2021 5:58 pm
I used the P10 for probably 3 or 4 years until I switched to the Bleep.
Not once did I ever have those vent holes clog up.

different strokes for different folks. after three years, mine "clogged" but was still usable. when i finally got a rechargeable water pik, i took it to the shower with the p10. crap all gone.

(many thanks to chunkyfrog for that tip!)

ReverseBall · Post by **ReverseBall** » Sat Jan 23, 2021 10:12 pm

zonker wrote: ↑
Sat Jan 23, 2021 7:31 pm

different strokes for different folks. after three years, mine "clogged" but was still usable. when i finally got a rechargeable water pik, i took it to the shower with the p10. crap all gone.

(many thanks to chunkyfrog for that tip!)

Oh, water pik as in a water flosser? I actually have one lying around that I haven't been using - maybe this could be a good use of it. Do you just fill it up with distilled water, spray it down, then let dry? Does it noticeably vent better afterwards?

Pugsy wrote: ↑
Sat Jan 23, 2021 5:58 pm
Yep...arousal breathing or awake breathing...pretty much the same irregular breathing as opposed to the nice rhythmic balance breathing of asleep breathing.
Anything that gets flagged and you aren't asleep....doesn't count. You muse be asleep for it to matter.

I'd like to clarify - is it an issue that the arousals are happening in the first place? Is there a breathing/cpap related solution to getting these arousals down, or are these arousals understood to be caused by something else?

Pugsy · Post by **Pugsy** » Sat Jan 23, 2021 10:59 pm

You don't have to use distilled water in the water pic unless you just want to.

ReverseBall wrote: ↑
Sat Jan 23, 2021 10:12 pm
I'd like to clarify - is it an issue that the arousals are happening in the first place? Is there a breathing/cpap related solution to getting these arousals down, or are these arousals understood to be caused by something else?

There are 2 kinds of arousals.
1...Respiratory event or airway related arousals....cpap can help with those.
2...Spontaneous arousals...means we don't know the cause and the list of culprits is miles long...cpap won't help those no matter how much we might want it to.

Good quality sleep means we strive to keep any arousal (no matter the cause) to a minimum if at all possible.

Wake up 20 times a night from a spontaneous arousal and you post likely won't get the needed amount of sleep in each sleep stage and the end result is we feel like crap even if the AHI is 0.0.
There's more to getting good quality sleep than just AHI....with or without the OSA diagnosis complicating things.

So the issue is that the arousals are happening in the first place...no matter what the cause because a lot of them means crappy sleep quality.

Now it is normal to have a few arousals/awakenings like after REM sleep cycle is completed. Normally we don't remember it though because we aren't awake long enough to form a memory of being awake.

zonker · Post by **zonker** » Sat Jan 23, 2021 11:10 pm

ReverseBall wrote: ↑
Sat Jan 23, 2021 10:12 pm

zonker wrote: ↑
Sat Jan 23, 2021 7:31 pm

different strokes for different folks. after three years, mine "clogged" but was still usable. when i finally got a rechargeable water pik, i took it to the shower with the p10. crap all gone.

(many thanks to chunkyfrog for that tip!)
Oh, water pik as in a water flosser? I actually have one lying around that I haven't been using - maybe this could be a good use of it. Do you just fill it up with distilled water, spray it down, then let dry? Does it noticeably vent better afterwards?

yup. just used tap water. the key is to use it in the shower stall because it's quite messy.

ReverseBall · Post by **ReverseBall** » Sun Feb 07, 2021 11:27 am

I've been experimenting and here's a sum-up of previous weeks.

zonker wrote: ↑
Sat Jan 23, 2021 11:10 pm
yup. just used tap water. the key is to use it in the shower stall because it's quite messy.

I ended up using distilled water in the shower. Can't tell if it had results though. Can you visibly tell that you removed stuff from the P10's vents? Or can you otherwise feel it during use?

I've been slowly upping the PS to 4.6. I think it is overall slightly better sleep than before, but still struggling with tiredness/exhaustion. Any thoughts on this current data? Are the number of CA apneas enough to be a problem?

zonker · Post by **zonker** » Sun Feb 07, 2021 11:50 am

ReverseBall wrote: ↑
Sun Feb 07, 2021 11:27 am
I've been experimenting and here's a sum-up of previous weeks.

zonker wrote: ↑
Sat Jan 23, 2021 11:10 pm
yup. just used tap water. the key is to use it in the shower stall because it's quite messy.
I ended up using distilled water in the shower. Can't tell if it had results though. Can you visibly tell that you removed stuff from the P10's vents? Or can you otherwise feel it during use?

worked for me. and yup, could see the removal of the black build up. worked better afterwards.

Julie · Post by **Julie** » Sun Feb 07, 2021 12:08 pm

Why are you being SO careful raising the pressure when it's So low to begin with? You're not going to have centrals there... maybe over 10, but not at eg 6.

Miss Emerita · Post by **Miss Emerita** » Sun Feb 07, 2021 12:28 pm

I think I see why you're being careful -- raising pressure support rather than minimum pressure, you want to be sure you're not provoking CAs, right? And everyone's "apneic threshold" is different.

CAs are notoriously variable; your CA index can be 0 one night and 2 the next. My own rule of thumb is that an AHI between 1 and 2 is good and under 1 is excellent.

But honestly, for you the big question is how you're feeling during the day. If you're feeling a little better with PS of 4.6, then I'd say keep it there for a couple of weeks and then go up to 4.8, see how it goes, etc. For me, that process took me to 4.8; above that I get a lot of CAs and way too much air in my GI tract.

There are so many things on the cusp for you -- weight, thyroid, vit. D, testosterone -- seeing where you can get yourself off the cusp may be a good long-term strategy. You're doing great on weight; you must have a lot of determination and self-discipline!

Pugsy · Post by **Pugsy** » Sun Feb 07, 2021 12:55 pm

Julie wrote: ↑
Sun Feb 07, 2021 12:08 pm
Why are you being SO careful raising the pressure when it's So low to begin with? You're not going to have centrals there... maybe over 10, but not at eg 6.

Look at what the OP is using....he's talking about slowly increasing the PS to 4.6....not the overall pressure.
He's using a bilevel machine...EPAP is 4.6 and with PS of 4.6 that makes his IPAP 9.2 and the max IPAP is 17 which it doesn't seem to go near.

And actually increasing PS to 6 might cause centrals to worsen. I don't ever advise PS over 5 without a heads up about PS maybe being a factor in triggering centrals.

I have a friend who gets about 15 centrals per hour with PS of 4 and essentially none at PS of 3 and she uses EPAP in the mid teens.
PS itself can trigger centrals.

joeljjk11 · Post by **joeljjk11** » Sun Feb 07, 2021 2:07 pm

Not sure if anyone mentioned this but you need to clean the vents of the P10 with a toothbrush every day. Just scrub them with a wet toothbrush for about ten seconds on each side and rinse them, then let it dry. The vents get clogged after a while and it makes exhaling difficult. Took me a while to discover this. I have had no issues since I started cleaning them.

Julie · Post by **Julie** » Sun Feb 07, 2021 2:18 pm

O, didnt get the bipap part!

Pugsy · Post by **Pugsy** » Sun Feb 07, 2021 2:30 pm

joeljjk11 wrote: ↑
Sun Feb 07, 2021 2:07 pm
Not sure if anyone mentioned this but you need to clean the vents of the P10 with a toothbrush every day. Just scrub them with a wet toothbrush for about ten seconds on each side and rinse them, then let it dry. The vents get clogged after a while and it makes exhaling difficult. Took me a while to discover this. I have had no issues since I started cleaning them.

When I used the P10 I didn't clean the vent holes every day....or even every week...sometimes not even once a month.
In all the years I used the P10 I never had the vent holes get clogged.
Just saying....not everyone has this problem with the vent holes.

Managing OSA and IH

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