CPAPtalk.com

xoxoxoxoxoxo

Thank you SO much.

Drowsy Dancer wrote:

mollete wrote:

mollete wrote:Or if one has OSA with concomitant nasal obstruction being treated with xPAP, wear one under the mask?

That being said, one might postulate that this proposed benefit would not be realized when employing a pillows-type interface.

Not sure why it wouldn't help with pillow interface. Explain, please?

I envision that pillows would inflate compliant areas, where a nasal mask, applying equal pressure intra- and extra-nasally, would not.

jencat824 wrote:...getting the data electronically & viewing on Alice is a very good idea. I'm assuming Molette will hook you up with a copy of Alice...

The raw data is composed of about 900 screens of 12-16 channels of squiggles which need to be processed electronically and reviewed manually. Alice is proprietary (although Torrents being what they are, one could probably find it somewhere). In the interests of time (it would take PT about 2 hours to learn to be an entry level scorer with a good instructor, and 60-90 minutes to score/review the data depending on the complexity of the case)(and I'm leaning on 90 minutes because I think there's going to be considerable sleep fragmentation) I will process the data and create/affirm their report.

mollete wrote:..affirm their report.

Because their scoring could very well be absolutely fine.

However, "IMHO", I believe there's WAY too much attention on "The Number" (AHI), and not enough on Sleep Architecture (which, until proven otherwise, I believe will have the appearance of a Train Wreck).

I also think knowing and understanding what's going on here will go an awfully long way in achieving goal (which, ultimately, is getting consistently good quality sleep).

should I be trying a full face mask? For my sleep study and titration I was using a nasal mask and not pillows.

pandatx wrote:should I be trying a full face mask?

What I really think you need to do is:

Stop.

Sit down.

Take 6 moderate, slow breaths (not deep, you'll hyperventilate and pass out).

Say "I am fine" once (and only once because you ARE fine).

Your brain is scrambled because (at least in my mind anyway) your sleep is AFU.

We will fix above.

I love you. You are 100% right.

mollete wrote:

jencat824 wrote:...getting the data electronically & viewing on Alice is a very good idea. I'm assuming Molette will hook you up with a copy of Alice...

The raw data is composed of about 900 screens of 12-16 channels of squiggles which need to be processed electronically and reviewed manually. Alice is proprietary (although Torrents being what they are, one could probably find it somewhere). In the interests of time (it would take PT about 2 hours to learn to be an entry level scorer with a good instructor, and 60-90 minutes to score/review the data depending on the complexity of the case)(and I'm leaning on 90 minutes because I think there's going to be considerable sleep fragmentation) I will process the data and create/affirm their report.

WOW - I didn't know the raw data was that extensive & takes that much time to learn how to read. I take back what I said. Will the written copy be a summation from a Dr who read it? If its like a summary of an MRI or xray, that would be helpful, if its just copy of what you described above, probably useless. Thanks for the education, now I know what the 'raw data' looks like. You are a really great person to do this for panda.
Jen

I have back and forth between the Swift FX nasal pillows and Fisher Paykel Eson nasal mask. The Eson mask has won the battle. I am now sleeping on an average of 7 hours a night with only maybe one potty break. Man am I dreaming in REM. Wild dreams too! Kind of neat. This mask is comfortable and the cushion around the nose is very nice. I move a lot from side to side but always end up on my back but am I cutting the Z's. Also, this mask is very quiet. My wife said between the ResMed S9 and this mask she can hardly hear anything. I'm on my 3rd week and finally everything is coming together. I wish you the very best!! It really will come together for you! Take care!!

Thank you Ringo. So glad to know that everything is coming together for you. That's such a nice feeling, isn't it? Enjoy your sleep!

pandatx wrote:should I be trying a full face mask?

At this point, I don't think so. While you have a ton of flow limited breaths, there are some areas that have a rounded, normal appearance:



and there does not appear to be any areas (after a cursory look anyway) where nasal flow gets so occluded as to require oral interface.

And indeed, last night's download looked a little better in re: the flow limitation (although still generally classified as C.U.).

Sleep fragmentation can be assumed wherever there is a spike in Minute Ventilation. And there are quite a few of those as well, so the fragmentation on most nights is probably severe (although again, last night looked a little better).

Flow limitation should generally be addressed, but arguably, if they don't cause issues, they may be allowed to exist ("permissive flow limitation").

However, flow limitations that cause sleep disturbances ("RERAs") need to be addressed. Those 3 distorted breaths probably represent an arousal:



Whether the breaths are flow-limited or normal rounded, the breathing pattern needs to be regular in rate and amplitude. Waveforms that look like a spiderweb whose resident just had a seizure are certainly not quality sleep (if they are, in fact, sleep at all) and should be classified as SWJ.

In reviewing treatment course thus far, apparently it was decided to address FL with a modest pressure increase. In a patient where compliance (although "acceptance" might be a better term) is a significant obstacle, comfort modes, such as BiPAP, might be a choice made earlier rather than later. Interestingly, the present setting selection (aggressive EPR) essentially provides this modality:

Keeping in mind that waveform analysis from xPAP devices cannot tell if you're asleep or not (although sometimes one can make semi-calculated assumptions based on tidal volume, minute ventilation and respiratory rate), a review of the D/L from 4.10 shows a majority of the night in FL:



If you went along all night and slept without interruption, one might consider just letting them sit there, but since your sleep is highly fragmented, one needs to consider attacking them. To do so, one must see if they are pressure-responsive or not. And if they are not, then the decision may be made to go a FFM (making another assumption that you are going to breathe through your mouth during that time).

However, what leads me to believe that they may be pressure-responsive is that once again, some fairly normal waveforms are seen again, and these come at the end of the session:



Lacking the additional channels that would be seen in NPSG, one can only guess why this happened. Perhaps you were not asleep (see previous link on nasal narrowing that occurs during sleep), you had a position change from supine to lateral, sleep stage change, removal of foreign (ecch!) material, position change from lateral to opposite lateral to correct deviated septal influence, etc.

While your AHI looks good, the thought of RDI (which would reflect RERAs)(and consider UARS) must be strongly considered here. An analysis of the NPSG and CPAP titration will be focused on this (and this is the area of bafflement. I'm seeing a ton of FLs, didn't they see them and address them? If not, why not?) as well as overall sleep fragmentation.

It re: sleep fragmentation, cause and effect should be reviewed. If Graves is generally causing all the sleep fragmentation and insomnia, then successful treatment should add some sleep stability.

Bunches of Little Lumps (BLLs)(aka Ballistocardiographic Artifact) on the 7th:

Mollette, first of all, I don't even know where or how to begin to thank you. The fact that you have taken so much time to help me...I honestly don't even know how to express how that makes me feel. Hopefully I will get the rest of the data from the sleep center on Monday. I tried to upload my dictacted study and titration results to Photobucket to share with you (they are PDF format) but got a message of invalid file type so not sure how to get that info to you. I have one idea I'll try today, which would be uploading to my website server and having you download from there.

What kills me is that they originally sent me home with the S9 Escape and told me I didn't need the Autoset because Dr Moore doesn't look at anything besides the AHI number when you come in for follow up. If he went by that, my numbers are totally acceptable even though I'm having shit sleep and am exhausted.

I am really curious to see how treating the Graves Disease effects the fragmented sleep. Also am reading a book recommended by StudentUnderPressure. Who knows how long it would have taken to get the Graves diagnosed if not for the sleep study b/c they noted the constant tachycardia. I was just used to living every day feeling like crap.

I will try to make sense out of all of your interpreting when I can have my husband look at it with me. Technical stuff = extremely difficult for me to make sense out of. Working with children= good. Taking photographs = good. Anything "mathy"= dismal.

Thank you thank you thank you so very much!