My sleep study (last November) indicated the following:
AHI of 39/hr - all hypopneas
O2 saturation of 96% with a nadir of 92%
Suggested titration of 7.0
Since then I've had ACDF surgery to fuse 4 levels in the cervical spine. Whereas I was largely non-compliant with CPAP prior to the surgery, immediately post-surgery it was obvious I required CPAP and have been 100% compliant since (no real choice in the matter). I believe the surgery has resulted in some constriction of the airway, which is why I now need the CPAP.
The settings on the IntelliPAP are:
Auto w/low limit of 6.0 (recently increased from 4.0) and high limit of 10.0
Delay is set to 4.0 for 10 minutes
ERnd is set to 3
IRnd is set to 3
I've used several masks, and will address those later in this post. Current mask is the Mirage Quattro full-face mask.
For now, I am not using the heated humidifier and do not seem to miss it.
The first report shows the upper and lower settings, and the average pressure for each of the last 7 days --
The next report shows the daily AHI (2.09/hr) and leak (20.73L/min) --
Focusing in on the nightly report for 9/28, the following:
Pressure profile --
Events --
Now for the data that I find curious.
The SpO2 report for the same night looks like this --
And the graph looks like this --
I have been struggling to get a reliable connection using the CMS-50F oximeter - and Kevin from pulseoxstore.com has been TERRIFIC in working with me. If these oximeter results are accurate, there seems to be a number of times when O2 saturation is dropping below the 88% threshold - and sometimes into the 70's - which cannot be a good thing.
The leak rate seems to be consistent with the graphs provided by the mask manufacturers for vent flow rate, and I do not seem to be battling leaks with the Mirage Quattro like I was with the ComfortFull mask.
In terms of masks, I have tried the following:
Respironics ComfortGel nasal mask. The only way I could comfortably use this mask was with application of paper tape to the skin areas it came into contact with, or I would have lots of problems with sores and skin irritation. The problem with the tape is that it does not allow for a good seal, hence, there were a few problems each night with leaks.
Respironics ComfortGEL full face mask. This was the only mask that I did not notice ANY leaks with - but that is probably because I had it cinched too tight and it bruised the bridge of my nose - something I am still suffering from nearly a week later.
Respironics ComfortFULL full face mask. I am pretty sure this was the mask they used at the hospital when I was recovering from the ACDF surgery. I had NOT taken my CPAP machine (since I was not using it), but like I wrote earlier, there was just no way for me to get air after the surgery and I asked them to bring the CPAP. The ComfortFULL mask works pretty well for me. I *do* have leaks each night that wake me up briefly, but in comparison to the ComfortGEL nasal and full-face masks, the ComfortFULL was MUCH better.
ResMed UltraMirage full-face mask. I have not tried to sleep with this mask. When I tried it for fit and function, it is FAR noisier than any of the other masks - the most noise occurring when I exhale. I suspect the mask is defective in some way, and will be looking into the further as I have time.
ResMed Mirage Quattro full-face mask. At this point, the Mirage Quattro is my preferred mask by a mile. I do have some small leaks occasionally, but not nightly. It also makes a very subtle whistling noise on exhale that both my wife and I can detect, but to not find distracting enough to disturb either of our sleep.
I would like to try the ResMed Activa nasal mask - and the FlexiFit HC431 full-face mask.
The other thing that has come up since becoming fully compliant with CPAP is that I am definitely grinding my teeth more (bruxism). In speaking with the dentist and then an orthodontist, both tell me they have CPAP patients making a similar complaint. In the case of the dentist, he may be motivated by wanting me to try a dental appliance for apnea - but one thing that has me thinking is - to help with the pain of the teeth grinding, he made a quick upper appliance - something like the 'boil-and-bite' plastic mouthguards used for football and other contact sports. This one fits tightly on the upper teeth. In the office, he warmed the plastic and had me bite the device to align both bottom and top teeth. This was done while standing, and it resulted in my bottom teeth impressions being left in the plastic appliance that covered all my upper teeth. If I put the appliance on my upper teeth right now, I can easily and comfortably bite the appliance and it feels fine. At night while laying in bed, however, my jaw definitely moves out of position and the bottom teeth no longer fit into the impressions made in the appliance. Since the dental appliances for apnea claim to work by forcing the lower jaw 'forward' so that the airway is not constricted, this seems (at this point, anyway) to have some possible merit. I'll look into this more in the future as well.
OK - so that's my story so far.
Any and all comments are welcome.
Thanks in advance.
