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Good morning.


NOTE: TRIED TO ATTACH ONE IMAGE AND GOT MESSAGE THAT ATTACHMENT QUOTA IS FULL

I am a newbie here, searching for relief, again.

My journey to this point has spanned many years, some apnea related surgery and many different machines. I am finally back on the ResMed AirCurve 10 ST-A. (Three years ago I had to turn in this machine for various reasons, and I only had it a short time). However, although I don't fit the "classic" ST-A patient needs for this machine, it is the only one that provided some improvement in my NUMBERS. Though, as before I am not getting the relief I should be having for decent sleep. (I preface all this with the fact that I have someone who is currently trying to help me, but the individual has limited experience with ST-A therapy. So, at the risk of stepping on any toes, I have joined this board). I am very groggy in the morning after first getting up, after a while I feel ok, until the afternoon - if I am at work and it is busy, I don't notice too much of a problem. If it is slow, I get tired, and if I am off work and at home I get so tired I usually need a nap.

The present issue is likely to do with adjusting settings appropriately based on my current breathing patterns. I have four screenshots I am prepared to share if you all would like to see them. I am posting the main overview of last night in this post and will be happy to share the more detailed three if they are requested. I have tried to learn about the shapes of the FLOW RATEs but it is difficult for me to understand about them and their nuances.

SOME ADDITIONAL INFORMATION:

1) In order to keep air from leaking I have to make my mask tight and this is uncomfortable to say the least. I have tried many masks though over the years and this one is by far the best. I cannot use a nasal mask, as I am a mouth breather.

2) Without therapy, I will consciously awake three to four times a night. With this therapy, I believe I only consciously awake 1- 2 times per night.

3) All my previous sleep studies state I sleep on my back. At home, I try to sleep on my side, but from time to time I do turn onto my back.

4) My doctor prescribed Clonazepam to help me sleep prior to getting my machine. I only took it a couple of times and it did not work. I hesitate to try them again on my therapy because I want to see if the therapy alone will work for me.

5) Unfortunately, I normally have to go to bed for the night pretty late and my body naturally wants to get up for the day quite early. I have been getting four to five hours of "sleep".

Here is the overview of last night:

Notgivingupagain wrote: ↑

Mon Mar 27, 2023 6:47 am

NOTE: TRIED TO ATTACH ONE IMAGE AND GOT MESSAGE THAT ATTACHMENT QUOTA IS FULL

Please read the sticky at the top of the index page.

Notgivingupagain wrote: ↑

Mon Mar 27, 2023 6:47 am

Without therapy, I will consciously awake three to four times a night.

This is normal, even for a healthy sleeper.

Notgivingupagain wrote: ↑

Mon Mar 27, 2023 6:47 am

With this therapy, I believe I only consciously awake 1- 2 times per night.

This is wonderful.

Notgivingupagain wrote: ↑

Mon Mar 27, 2023 6:47 am

In order to keep air from leaking I have to make my mask tight

This is wrong. Find your mask on youtube and watch some videos about fitting and adjusting. Masks should not be tightly adjusted. Where are the leaks occurring?

Let's see those charts. Please follow the directions for formatting. See links in my signature.

Hello ChicagoGranny, nice to meet you.

I did see the warning about the image situation before posting, I just thought it might have been handled. Sorry. I will try to use the imgur method in a while.

No one has ever said anything to me, ever, about it being normal to wake up 3-4 times a night. I'm not talking about waking up for a few moments and then going back to sleep. When not on therapy, I'm talking about waking up and doing stuff until I feel I should try going back to sleep. I have been dealing with this since the early 2000s. I did forget to mention I also have a parasomnia that causes me to sit up crossed legged with my head lolling down to my chest or shoulders. Doesn't happen every night as farr as I know, but my husband told me about it and I stated video taping it, soooo weird. It can happen on therapy or not.

As for mask air leakage, I thought I haave tried everything but will view your suggestion about viewing youtube. The leaks are normally from around the portion by the mouth and sometimes by the nose area.

Again, anxious to post links to my images, will do so before noon.

Thank you for your interest.

Notgivingupagain wrote: ↑

Mon Mar 27, 2023 7:59 am

did see the warning about the image situation before posting, I just thought it might have been handled. Sorry. I will try to use the imgur method in a while.

When the problem gets handled then the warning sticky will be removed. If people still see the sticky....there's still a problem.
I lost count of the number of times I have "reported" the problem..
I get crickets for a response.
I suggested a time limit on how long an image would be stored on the forum server and just have the stored images automatically go away....like a year maybe.....crickets.

I don't know what the big deal is about ignoring the warning and just hosting the report image elsewhere on the web.
Geez folks....for over 10 years we couldn't do attachments here anyway.

Or here's another solution....the lazy asses that came here and posted a gazillion images and then left the forum and their gazillion images being stored were just forgotten about because the people just don't care about others...how about they clean out their personal storage files and free up space for others???

It is what it is folks. There is a solution and yes it is a bit of extra work but the option is there to host images elsewhere on the internet.

Pugsy,

No issues here, happy to do the off site hosting.

Thanks.

Notgivingupagain wrote: ↑

Mon Mar 27, 2023 6:47 am

Good morning.


NOTE: TRIED TO ATTACH ONE IMAGE AND GOT MESSAGE THAT ATTACHMENT QUOTA IS FULL

I am a newbie here, searching for relief, again.

Post the image at a site like imgur.com and then link to the image in your post. Even better, put the link to the image inside the image tab that you get if you click on the icon that looks like a sun over the mountains.

My journey to this point has spanned many years, some apnea related surgery and many different machines. I am finally back on the ResMed AirCurve 10 ST-A. (Three years ago I had to turn in this machine for various reasons, and I only had it a short time). However, although I don't fit the "classic" ST-A patient needs for this machine, it is the only one that provided some improvement in my NUMBERS.

What are the numbers? Meaning: What was your diagnosis? What was your diagnostic AHI? And what was the breakdown of events? And what are your machine treated numbers like? Again, what is the typical AHI and what is the break down of events on a typical night when you use the AirCurve 10 ST-A?

Also, what are your settings on the ST-A? What mode of operation? Pressure settings, including PS? If the mode you are using allows the machine to "trigger" inhalations, what's the back up respiratory rate?

Though, as before I am not getting the relief I should be having for decent sleep. (I preface all this with the fact that I have someone who is currently trying to help me, but the individual has limited experience with ST-A therapy. So, at the risk of stepping on any toes, I have joined this board).

This forum exists because far, far too many of us have to deal with clueless DMEs and doctors, nurses, PAs, and respiratory therapists who claim to understand how our machines work to treat our condition, but who have little or no real experience with the machine we use.

I am very groggy in the morning after first getting up, after a while I feel ok, until the afternoon - if I am at work and it is busy, I don't notice too much of a problem. If it is slow, I get tired, and if I am off work and at home I get so tired I usually need a nap.

Let's start with the most basic question: How much actual sleep do you get each night?

The present issue is likely to do with adjusting settings appropriately based on my current breathing patterns. I have four screenshots I am prepared to share if you all would like to see them.

Screenshots would be most helpful. Post them at imgur, and link to the image files in your post over here. If you need more information about how to do this, let me know.

I am posting the main overview of last night in this post and will be happy to share the more detailed three if they are requested. I have tried to learn about the shapes of the FLOW RATEs but it is difficult for me to understand about them and their nuances.

The nuances are difficult. But the basic idea is pretty easy: Round shaped, regular inhalations are usually indicative of quality sleep breathing.

If you really want to go digging into the various kinds of shapes that may (or may not) indicate something is wrong with the breathing, then you can start with this figure:


It's from the paper Frequency of flow limitation using airflow shape available at the National Library of Medicine's website. (This is an official US government web site, so the info is reliable.)

SOME ADDITIONAL INFORMATION:

1) In order to keep air from leaking I have to make my mask tight and this is uncomfortable to say the least. I have tried many masks though over the years and this one is by far the best. I cannot use a nasal mask, as I am a mouth breather.

Over tightening the mask can make the leaking worse as well as leading to discomfort. Most modern masks use an air cushion to seal, and if the mask is tightened too much, the air cushion cannot fully inflate, and that leads to leaks.

If you can tell us exactly which mask you are using, there will be people who can give you specific pointers on how to properly fit the mask so that it is not too tight and does not leak.

But in general, here are some tips that work for any air cushion mask:

• Fit the mask while lying down in your preferred sleep position, not while sitting up.
• Fit the mask using your full therapeutic pressure settings.
• Consider loosening the head gear straps if you discover leaks instead of just tightening them.
• If you feel a leak somewhere after making an adjustment, do this: Pull the cushion away from your face a fraction of an inch so the air cushion can full inflate. Then let go of the cushion and allow it to resettle on your face. Most of the time this will fix a small mask leak. Note: Be prepared for a blast of air blowing through the mask when you pull it away from your face.

2) Without therapy, I will consciously awake three to four times a night. With this therapy, I believe I only consciously awake 1- 2 times per night.

It is considered normal to have a brief wake at the end of each full sleep cycle. But most people who have no identifiable sleep problems do not tend to remember those brief wakes: They wake up, discover everything is fine in their sleeping environment, and then go right back to sleep. We typically remember a wake only if the wake lasts at least 5 minutes.

So the significance of these wakes lies more in your own reaction to them and whether you are doing something that prolongs them to the point where they are problematic in terms of preventing you from getting the restorative sleep you want to be getting.

3) All my previous sleep studies state I sleep on my back. At home, I try to sleep on my side, but from time to time I do turn onto my back.

If the pressure settings on an xPAP machine, including your AirCurve 10 ST-A are set correctly, then back sleeping should not be an issue. And if you are more comfortable sleeping on your back, your efforts to keep yourself sleeping on your side may be adding problems rather than helping. Some people find that sleeping on their side can aggravate shoulder or hip pain. Some people find that sleeping on their right side can aggravate any kind of acid reflux issues they might have. If you are not a natural side sleeper, it's worth asking why your particular body doesn't want to be on your side while asleep.

4) My doctor prescribed Clonazepam to help me sleep prior to getting my machine. I only took it a couple of times and it did not work. I hesitate to try them again on my therapy because I want to see if the therapy alone will work for me.

Do you have a history of insomnia? Was the Clonazepam prescribed to help with insomnia?

And when you are using your machine, do you have any problems getting to sleep at the beginning of the night? Do you have problems getting back to sleep after you wake up in the middle of the night? Do you wake up too early in the morning and find that you cannot get back to sleep?

5) Unfortunately, I normally have to go to bed for the night pretty late and my body naturally wants to get up for the day quite early. I have been getting four to five hours of "sleep".

So you are trying to fit the proverbial square peg into a round hole.

Your body wants to get up quite early---as in how early?

But you say you have to go to bed pretty late. Why? What is preventing you from going to bed earlier that you are currently going to bed?

Because here's the thing: No matter how well your AirCurve ST-A is working, if you are only getting 4-5 hours of sleep each night and your body wants 6-8 hours of sleep, you are going to feel sleep deprived because you are sleep deprived. Most of us simply cannot function long term on only 4-5 hours of sleep every night, even if we think we can or should be able to.

So here's where I would start if I were you:

1) Really examine your lifestyle. If your body says, "It's 5:00 AM and time to get up", you need to not fight that. But it does mean you need to find a way to get to bed by 10:00pm at night. Unless you've got a late shift job, that should not be an issue. If you have a late shift job, then you need to be thinking about whether it's possible to request a shift that ends earlier because that's going to be easier on your body in the long run than trying to train it to sleep several hours later than it wants to get up.

2) On your days off, don't worry so much about the need for a nap. If you only got 4-5 hours of sleep the night before, the body's desire for a nap after lunch is pretty much normal. It's the body's way of trying to get the sleep it needs. Take the nap as long as taking the nap doesn't make it harder to get to sleep "on time" at a reasonable bedtime for your body.

3) Work on problem of over tightening the headgear to the point where it is uncomfortable by learning how to properly fit your mask.

Hi. Regarding the imgur site: I see that they're are two types of accounts, FREE and PAID. The FREE account says there are ads and things, the PAID ($5 per month) causes this not to happen. Is it ok to do the FREE method for posting my image links here?

Dear robysue1,

Wow! Thank you for all your input. I will try to answer all the questions so far, after I get these images posted if that is acceptable?

The image you shared showing FLOW shapes really is of interest. You will see from my charts that I don't have the round tops. Some of the shapes from this latest journey arre not as bad as they used to be back on regular CPAP or BIPAP. I had someone tell me once that they were some of the worst shapes they had ever seen.

Notgivingupagain wrote: ↑

Mon Mar 27, 2023 9:08 am

Hi. Regarding the imgur site: I see that they're are two types of accounts, FREE and PAID. The FREE account says there are ads and things, the PAID ($5 per month) causes this not to happen. Is it ok to do the FREE method for posting my image links here?

I use the FREE account. I dare say the vast majority of users here use the FREE account over at imgur.

Yes, when I log in over at imgur, I see ads. Likewise if I click on a link to an image posted with a FREE account, I'll see ads.

If the link to the image is posted using BBCode stuff inside an image tag over here? No ads appear in the cpaptalk.com post.

I have used the "free" imgur account for years. Quite frankly I really just sort of tune out the ads. It's a non issue with me and in general I hate ads.

Better yet do like RobySue and myself do....use the linked BBC code and post the image directly in the post so the image is seen straight away and most of the time there is no need to click on it to make the image a bit larger.

Here's what happens if the linked image BBC code is used. If you click on it it's a little less indistinct. No ads.

I wonder how many of the "lazy asses" were really trolls gunking up the forum.
Considering how quickly they used up all the space, I would not be a bit surprised.

This has come up before and I seem to be in the minority, but I prefer to see the image link only. It's easily opened in a tab, and you can tab back and forth. The problem with posting the image in the thread is the many bleeps who quote entire posts thus repeating the images and making the thread longer than necessary.

My two cents.

Below are images from last night.

I do not have a current sleep study result report because I had already been diagnosed three times with sleep apnea. This time the doctor was only supposed to titrate me for the ST-A. I do have a titration report that has some very interesting information in it but when I try to upload the images to Imgur as png files all the backgrounds of the paper are black and you can't read the type. I thought maybe I could upload pdf but that does not seem possible. I did a Google search and am left confused, sorry.

HERE IS TRANSCRIPT OFF FIRST PAGE:

Before optimum pressure was reached I had 170 arousals.
Arousal index was 27.4 per hour.
PLMS 67 for an index of 10.8 per hour.
AHI 20.3 per hour (REM AHI 0.0)
Total of 47 apneas, 79 partial apneas.

There were 126 respiratory events consisting of 30 obstructive, 5 mixed, 12 central. The average event duration was 20.1 seconds, and the maximum duration was 37.0 seconds.

Minimum Sp02 during titration before reaching desired pressure was 87%. Time <88% was 0.3 minutes.

Conclusion: Complex sleep apnea: Poor response to CPAP; Positive esponse to Bipap S/T.
Snoring and associated hypoxia corrected.
Leg movements and occasional PACs noted.
Total sleep time and efficacy are normal. REM and Slow Wave sleep are reduced.

FULL NIGHT

AS DECENT SHAPE I CAN FIND?

ISSUE WITH SHAPES?

NOT SURE WHAT TO MAKE OF THIS VIEW. DID HAVE AIR LEAK

Uh oh! Why are mmy. images showing so large??? Did I do something wrong? I thought these were links to imgur?