Four months in, needing help interpreting data

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
xcountrygal
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Re: Four months in, needing help interpreting data

Post by xcountrygal » Sun Apr 15, 2018 9:49 am

Thanks Pugsy! I was coming to that conclusion myself. I wasn't sure whether having such an active flow limitation graph was perhaps resulting in low O2 levels. Do you think it would benefit me to get O2 readings for a night or two? (I would have to get an oxometer and figure out how to use it :? - not happening today as we are snowbound in Wisconsin!)
On the otherhand, I am not sure I really want to know if there is no way to fix that. With the latest sleep studies even when my AHI was 47 (without mouthguard), my oxygen levels didn't really dip below 90 much at all.

I guess I am hoping that a ffm with the new MAD might be the best combo - dreamwear ffm coming soon!

Thanks for all of your time and help!

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Pugsy
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Re: Four months in, needing help interpreting data

Post by Pugsy » Sun Apr 15, 2018 10:01 am

Yeah I heard you had a big mess in the weather...
I am in SW Missouri...Friday night we had tornados and bad thunder boomers...and today it snowed. Go figure.
Didn't stick but snow of any sort here in mid April is really unusual.

You know if you didn't have significant oxygen level drops with untreated AHI of 47...it's really unlikely that with treated OSA that it would be worse now on the machine.
And remember whatever those FLs are doing now and/or why/what is causing them....they were also present at the time of the recent study without cpap at all.

I don't know that you really need to go buying one of those overnight pulse oximeters. If your O2s didn't get bad without cpap...I just don't see it worsening with cpap.
But....for peace of mind...ask your doctor to order an overnight pulse ox test and the DME can do it...and insurance should pay for it if the DME even charges for me which often they don't even charge. That's what I did...I asked my DME to ask my doctor for the test just for my own peace of mind and they did all the reading and stuff and I didn't have to mess with it.
The reason I wanted the peace of mind...pre cpap my O2 levels went to 73%...I just wanted to make sure.
But any reason you might want peace of mind is a good enough reason to do it.
I can't see your DME or doctor having a problem ordering it.

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xcountrygal
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Re: Four months in, needing help interpreting data

Post by xcountrygal » Sun Apr 15, 2018 10:26 am

Hi Pugsy:
Good idea! My DME has been most unhelpful :cry: . However, I think I can get the Dr. Office to order it for me. I have had to sic the Dr. Office on the DME several times already - DME can't seem to look beyond the AHI number which has been low from day one even tho I felt like a truck had run over me for at least the first month and was having major problems with mask fits. Still climbing out of that hole.
Off to shovel :D :D

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zonker
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Re: Four months in, needing help interpreting data

Post by zonker » Sun Apr 15, 2018 11:42 am

xcountrygal wrote:
Sat Apr 14, 2018 6:01 pm
Zonker: I have tried the headband trick, but will have to try it again - just don't want to change too many variables at once until I can figure out what might work or not.
absolutely! it's always best to make changes one at a time.

good luck!
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yrnkrn
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Re: Four months in, needing help interpreting data

Post by yrnkrn » Fri May 11, 2018 1:44 pm

In a similar situation of low AHI with insistent flow limitations, I found out that using pressure support (with BiLevel) or EPR=3 (with AirSense 10) was more effective than raising pressure.
Some examples with constant pressure

CPAP=13cm 95% FL=0.2
CPAP=13/10cm (EPR=3) 95% FL=0.1
BIPAP=13/9cm (PS=4) 95% FL=0.03

Research https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5015642/ suggests having prolonged flow limitations, even without satuarion dips, is not good for you.

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xcountrygal
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Re: Four months in, needing help interpreting data

Post by xcountrygal » Fri Sep 21, 2018 1:21 pm

Hi All:
I wanted to post an update on my progress and seek additional advice. First thank you to all who have posted suggestions and to others who have helped as I have read the range of posts on the forum.

Changes I have made and result:
1. switched to P10 nasal pillows with my own adaptation. Apparently the angle of my nares is different than the majority and I was losing the seal during the night as the weight of the hose pulled in my sleep or ?? - Anyway, I now use 1/2 of a silicone ear plug shaped into an oval and placed between the two pillows and just below to hold the mask in the best position. This has worked great - I need to reshape the silicone piece every now and then as the heat of my skin tends to flatten it. When I want to remove it to clean, it comes right off - but will stick until manually removed. See attached picture.
p10.jpg
p10.jpg (180.83 KiB) Viewed 4536 times
.

2. I have turned EPR on to 2 (thanks yrnkrn). I tried 1, 2 and 3 with 2 feeling most comfortable. This has somewhat tamed my flow limitation graph (tho it is still not pretty), and has changed the trace shape of my individual breaths so that they are a bit more rounded and not quite as sawtooth. Also, I am feeling much more rested most nights.

3. I use a double layer of micropore tape along with Zonker's headband idea over top. This has really improved my leak line and I am no longer getting large leak warnings.

4. I requested oximetry testing per Pugsy's suggestion - it took forever to get this scheduled as the DME had persistent problems with the computer software to read it. However, it is finally done and that leads to my questions.

I have a Dr. appointment for this coming Friday to go over the results of the O2 testing. This appointment was originally scheduled for yesterday with the nurse practitioner, but I got a call the day before from the office telling me that they had rescheduled this with the actual sleep Dr.. I am apparently beling "squeezed in". I have never met this man as my only two appointments with this sleep dept. office have been with a PA and the NP - the usual wait for an appointment for the sleep Dr. is 4 - 5 months. So...I am a bit alarmed! I want to have my ducks in order when I go and while I know that I want to address the O2 testing results and flow limitations, I was hoping that others could look at my sleepyhead chart of that night and give suggestions.
Screenshot (36).png
Screenshot (36).png (137.08 KiB) Viewed 4536 times
You will see that ugly cluster of hypopneas (the whole reason I requested the testing). I don't always have that many - but I do usually have clusters which I assume are when I am in REM sleep. Am I looking at bipap? - Do I need to revisit EPR 3? Raise pressure?

As a side note, this is a higher AHI than I have had for a bit - I am usually running in the range of .8 to 1.3 or so. I was having trouble sleeping with that wrist thing for the testing. Also up 2 X with my legs - have been taking magnesium with fairly good success - but was having more difficulty that night - usually I am only up 1 X often about 4 -5 hours into the night.

Thanks so much!! xcountry gal


Any help appreciated.

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Jas_williams
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Re: Four months in, needing help interpreting data

Post by Jas_williams » Fri Sep 21, 2018 1:45 pm

I would say that a soft cervical collar may help stop your chin tucking as those clusters could be positional. A soft cervical collar or similar may reduce your overall pressure needs

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xcountrygal
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Re: Four months in, needing help interpreting data

Post by xcountrygal » Fri Sep 21, 2018 5:43 pm

Thanks for the suggestion, jas-williams. I did purchase a foam cervical collar when I first started apap therapy. It was just one from Walgreens - one size fits most - but not me. I have a very skinny neck and the collar overlapped a lot making it very uncomfortable. It was also very hot! I haven't wanted to revisit that but may be forced to reconsider.
Any suggestions for my Dr. visit questions?

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