djam's therapy thread

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Jay Aitchsee
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Re: djam's therapy thread

Post by Jay Aitchsee » Mon Mar 25, 2019 6:01 am

In reference to the two charts posted immediately above:

IDK, kind of hard to tell outside of a lab whether apneas are central or obstructive. The machine relies on the phase shift of the FOT to determine whether or not the airway is open or closed. I believe, from observation, that the airway can be closed in both instances of apnea. The true test in the lab would be whether or not there was respiratory effort associated with the apnea. No respiratory effort, then central.

In the case above, there are signs of irregular breathing prior to the event starting around 05:30:48 and becoming more pronounced around 05:31:06 indicating a possible arousal preceding the event, which is typical of a central. On the other hand, there is some Flow Limitation preceding the event which might be expected with an obstructive. However, in the case of second obstructive, around 05:45, there are no Flow Limitations preceding.

Also conspicuously absent are any hypopneas during the night which might be expected if the thereapy pressure was too low and that, coupled with relatively minor FL throughout the night, in my mind, causes the OA's to be suspect.

So, what to do? If the OA's are real and bothersome, then the treatment would be to raise the pressure, either by increasing IPAP, decreasing EPR, or both. Since it appears these events occur at EPAP less than about 7, then that would seem to be a reasonable level to set as a minimum.

However, with an AHI less than 1, I question the validity of trying to suppress a couple of events unless there is an expectation of greater comfort or more restful sleep.

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Re: djam's therapy thread

Post by Pugsy » Mon Mar 25, 2019 7:13 am

Couple of nights ago I had an AHI of 1.34 I think it was. 10 events over not quite 7 1/2 hours. 1 central and 9 OAs. All but one OA were definitely arousal/post arousal SWJ related. The last OA was "iffy"....when iffy I treat it as real in my mental evaluation of things. Which means 1 real event doesn't even garner a blink of an eye. It gets a shrug of the shoulders and I move on.
I know I don't sleep so great sometimes (or a lot of the time) but I also know totally unrelated to airway issues and fully related to crappy back/pelvis issues. :lol:
I so wish that the back stuff was as easily fixed as the airway stuff...sigh.

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Re: djam's therapy thread

Post by djams » Mon Mar 25, 2019 7:20 pm

Jay Aitchsee wrote:
Mon Mar 25, 2019 6:01 am
In reference to the two charts posted immediately above:

IDK, kind of hard to tell outside of a lab whether apneas are central or obstructive. The machine relies on the phase shift of the FOT to determine whether or not the airway is open or closed. I believe, from observation, that the airway can be closed in both instances of apnea. The true test in the lab would be whether or not there was respiratory effort associated with the apnea. No respiratory effort, then central.

In the case above, there are signs of irregular breathing prior to the event starting around 05:30:48 and becoming more pronounced around 05:31:06 indicating a possible arousal preceding the event, which is typical of a central. On the other hand, there is some Flow Limitation preceding the event which might be expected with an obstructive. However, in the case of second obstructive, around 05:45, there are no Flow Limitations preceding.

Also conspicuously absent are any hypopneas during the night which might be expected if the thereapy pressure was too low and that, coupled with relatively minor FL throughout the night, in my mind, causes the OA's to be suspect.

So, what to do? If the OA's are real and bothersome, then the treatment would be to raise the pressure, either by increasing IPAP, decreasing EPR, or both. Since it appears these events occur at EPAP less than about 7, then that would seem to be a reasonable level to set as a minimum.

However, with an AHI less than 1, I question the validity of trying to suppress a couple of events unless there is an expectation of greater comfort or more restful sleep.
Thanks Jay. I was kicking around the thought of CA vs OA as well, because of the arousal. I didn't think to consider the lack of hypopneas. This is a good thought. And the 2 "OA's" that I didn't post were definitely arousal related. It was clear even to me. So all three of these are "likely but not for sure" CA's I think. But of course can't say for sure.

Now I had a very unexpected aerophagia spell last night. If that continues, turning EPR off and getting EPAP back to 7 is a no-brainer for me. :)

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Re: djam's therapy thread

Post by djams » Mon Mar 25, 2019 7:24 pm

Pugsy wrote:
Mon Mar 25, 2019 7:13 am
Couple of nights ago I had an AHI of 1.34 I think it was. 10 events over not quite 7 1/2 hours. 1 central and 9 OAs. All but one OA were definitely arousal/post arousal SWJ related. The last OA was "iffy"....when iffy I treat it as real in my mental evaluation of things. Which means 1 real event doesn't even garner a blink of an eye. It gets a shrug of the shoulders and I move on.
I know I don't sleep so great sometimes (or a lot of the time) but I also know totally unrelated to airway issues and fully related to crappy back/pelvis issues. :lol:
I so wish that the back stuff was as easily fixed as the airway stuff...sigh.
The majority of my events are arousal related these days. I go through the same mental gyrations you describe. Even the "iffy ones count". I was looking at the most recent one I posted as "iffy", but I think Jay talked me out of that. :)

I wish your back stuff would just go away. You deserve to get a good night's sleep - you help so many do just that.

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Re: djam's therapy thread

Post by djams » Fri Mar 29, 2019 2:21 pm

zonker wrote:
Sun Mar 24, 2019 11:41 am
djams wrote:
Sun Mar 24, 2019 7:08 am
I really appreciate all of the replies! Thanks.

In my last post, I didn't even state WHY I'm messing around with near perfection. I'm hoping to get to the point where I can sleep without taping my mouth. Pretty big omission.

well, i'm going to follow this more keenly, then. i, too, tried sleeping without anything over my mouth. i was just wondering if my mouth had been properly trained to the point where i wouldn't need anything.

alas, for me, it wasn't to be. for one thing, i discovered that the scunci rig across my mouth helped press the p10 a bit more against my nostrils thus cutting down leaks.

for another thing, i found that my bottom lip would still slide down and cause me to wake up. so, will continue with it for the present.

hope you have good luck in trying to get rid of the taping.
Looks like you're keenly following the wrong thread zonker. :lol: :lol: :lol:

I think I'm destined to be a mouth-taper forever.

Here's my SleepyHead from Monday this week. Had a lot on my mind, and was awake for that entire initial hour and a half. Dozed off briefly a few times. Finally got out of bed and went to read on the couch. Fell asleep on the couch at some point. I'd left my dreamports stuck to my nose, so when I went back to bed I just plugged in - forgot all about needing to re-tape my mouth. Realized this almost immediately, but thought "hell with it, let's see how it goes".

Well, you can see how it went. "Not well" is an understatement. The morning wake-up was like the bad old pre-PAP days. Groggily hitting the snooze button over and over and over.

I read the advice to "train your tongue" to be in the proper position. While I'm awake, I've always breathed through my nose, and whenever I think to check, my tongue is in the proper spot - seemingly all the time. Also can do all the tricks; While running the machine I can open my mouth wide, stick my tongue out and waggle it around. No mouth leak. I can talk clearly. No mouth leak. While using the machine, laying on my back I can drop my mouth open, let my tongue relax and it seems to naturally drop into a position that blocks the air from coming out of my mouth.

But alas - none of this matters while I'm sleeping.

Certainly don't want to run you off zonker, but you better find another thread to follow if you want to learn how to use a nasal mask bareback. :lol:

By the way, boy was I beat all day Tuesday. Tuesday night I went to bed early and got a solid 8.5 uninterrupted sleep. That didn't even bring me all the way back. Felt tired Wednesday after work. Took another good night to get me back to normal. Don't think this experiment is worth it. :)
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Re: djam's therapy thread

Post by zonker » Fri Mar 29, 2019 5:18 pm

djams wrote:
Fri Mar 29, 2019 2:21 pm

Looks like you're keenly following the wrong thread zonker. :lol: :lol: :lol:

I think I'm destined to be a mouth-taper forever.

Here's my SleepyHead from Monday this week. Had a lot on my mind, and was awake for that entire initial hour and a half. Dozed off briefly a few times. Finally got out of bed and went to read on the couch. Fell asleep on the couch at some point. I'd left my dreamports stuck to my nose, so when I went back to bed I just plugged in - forgot all about needing to re-tape my mouth. Realized this almost immediately, but thought "hell with it, let's see how it goes".
no, no...i was being precognisant! :lol: :lol: :lol:
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Re: djam's therapy thread

Post by babydinosnoreless » Fri Mar 29, 2019 6:20 pm

djams wrote:
Mon Mar 25, 2019 7:24 pm
Pugsy wrote:
Mon Mar 25, 2019 7:13 am
Couple of nights ago I had an AHI of 1.34 I think it was. 10 events over not quite 7 1/2 hours. 1 central and 9 OAs. All but one OA were definitely arousal/post arousal SWJ related. The last OA was "iffy"....when iffy I treat it as real in my mental evaluation of things. Which means 1 real event doesn't even garner a blink of an eye. It gets a shrug of the shoulders and I move on.
I know I don't sleep so great sometimes (or a lot of the time) but I also know totally unrelated to airway issues and fully related to crappy back/pelvis issues. :lol:
I so wish that the back stuff was as easily fixed as the airway stuff...sigh.
The majority of my events are arousal related these days. I go through the same mental gyrations you describe. Even the "iffy ones count". I was looking at the most recent one I posted as "iffy", but I think Jay talked me out of that. :)

I wish your back stuff would just go away. You deserve to get a good night's sleep - you help so many do just that.
I will take the aliens tonight if it will help pugsy. I've already been visited by the insominia monster and the leak monster this week. What they hey, someone should get some sleep and she has to put up with all of our sleep deprived ranting.

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Re: djam's therapy thread

Post by katestyles » Fri Mar 29, 2019 6:34 pm

babydinosnoreless wrote:
Fri Mar 29, 2019 6:20 pm
djams wrote:
Mon Mar 25, 2019 7:24 pm
Pugsy wrote:
Mon Mar 25, 2019 7:13 am
Couple of nights ago I had an AHI of 1.34 I think it was. 10 events over not quite 7 1/2 hours. 1 central and 9 OAs. All but one OA were definitely arousal/post arousal SWJ related. The last OA was "iffy"....when iffy I treat it as real in my mental evaluation of things. Which means 1 real event doesn't even garner a blink of an eye. It gets a shrug of the shoulders and I move on.
I know I don't sleep so great sometimes (or a lot of the time) but I also know totally unrelated to airway issues and fully related to crappy back/pelvis issues. :lol:
I so wish that the back stuff was as easily fixed as the airway stuff...sigh.
The majority of my events are arousal related these days. I go through the same mental gyrations you describe. Even the "iffy ones count". I was looking at the most recent one I posted as "iffy", but I think Jay talked me out of that. :)

I wish your back stuff would just go away. You deserve to get a good night's sleep - you help so many do just that.
I will take the aliens tonight if it will help pugsy. I've already been visited by the insominia monster and the leak monster this week. What they hey, someone should get some sleep and she has to put up with all of our sleep deprived ranting.
Seconded.

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Re: djam's therapy thread

Post by djams » Fri Mar 29, 2019 7:26 pm

zonker wrote:
Fri Mar 29, 2019 5:18 pm
djams wrote:
Fri Mar 29, 2019 2:21 pm

Looks like you're keenly following the wrong thread zonker. :lol: :lol: :lol:

I think I'm destined to be a mouth-taper forever.

Here's my SleepyHead from Monday this week. Had a lot on my mind, and was awake for that entire initial hour and a half. Dozed off briefly a few times. Finally got out of bed and went to read on the couch. Fell asleep on the couch at some point. I'd left my dreamports stuck to my nose, so when I went back to bed I just plugged in - forgot all about needing to re-tape my mouth. Realized this almost immediately, but thought "hell with it, let's see how it goes".
no, no...i was being precognisant! :lol: :lol: :lol:
:lol: Just waiting for the show to start! Well I hope you enjoyed Act 1. :lol: :lol:

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Re: djam's therapy thread

Post by djams » Fri Mar 29, 2019 7:30 pm

katestyles wrote:
Fri Mar 29, 2019 6:34 pm
babydinosnoreless wrote:
Fri Mar 29, 2019 6:20 pm
djams wrote:
Mon Mar 25, 2019 7:24 pm
Pugsy wrote:
Mon Mar 25, 2019 7:13 am
Couple of nights ago I had an AHI of 1.34 I think it was. 10 events over not quite 7 1/2 hours. 1 central and 9 OAs. All but one OA were definitely arousal/post arousal SWJ related. The last OA was "iffy"....when iffy I treat it as real in my mental evaluation of things. Which means 1 real event doesn't even garner a blink of an eye. It gets a shrug of the shoulders and I move on.
I know I don't sleep so great sometimes (or a lot of the time) but I also know totally unrelated to airway issues and fully related to crappy back/pelvis issues. :lol:
I so wish that the back stuff was as easily fixed as the airway stuff...sigh.
The majority of my events are arousal related these days. I go through the same mental gyrations you describe. Even the "iffy ones count". I was looking at the most recent one I posted as "iffy", but I think Jay talked me out of that. :)

I wish your back stuff would just go away. You deserve to get a good night's sleep - you help so many do just that.
I will take the aliens tonight if it will help pugsy. I've already been visited by the insominia monster and the leak monster this week. What they hey, someone should get some sleep and she has to put up with all of our sleep deprived ranting.
Seconded.
Thirdeded! Motion approved!

babyd will distract the aliens and Pugsy will sleep the sleep of the innocent. :D

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Re: djam's therapy thread

Post by djams » Wed Apr 03, 2019 7:18 pm

Let me just start this post by emphasizing: I am fully aware that I am talking about my *treated* AHI in the post.

I've been wondering a lot lately about my treatment, and if it's necessary. Switching from FFM to nasal masks has allowed me to reduce my min pressure from 12cm to 9cm, at the same time reducing my AHI. Then along comes the Bleep DreamPort, which allowed me to reduce my pressure from 9cm to 7cm. Again, reducing my AHI (ever so slightly). The DreamPort got me focused on mouth leaks, and I've got that figured out now. My "asleep AHI" is zero nearly every night.

Then came last night. I did the strangest newbie thing. Woke up after 3 hours for a bathroom run. When I came back to bed, I didn't hook back up to the machine. I remember what I was thinking at the time. I'd caught a chill in the bathroom, and was really looking forward to snuggling down under the warm blankets. Evidently, this took priority over everything else. I slept from midnight to 5am wearing my DreamPort, but unhooked from the machine.

I kind of panicked when I woke up and realized what I'd done. I pieced it together fairly quickly. But I thought oh boy, gonna be a loooong day for you. Then as I'm doing my morning stuff, I realized that I wasn't feeling bad at all. Very normal, in fact.

Then I thought of my SleepTracker report. I've spent a *lot* of time comparing the arousal markers to my SH flow rate chart to my events in the SH flow rate chart. Both asleep and awake breathing events match up very reliably. I found 1 arousal marker between during the 5 hours I was asleep after the bathroom break.

So now I'm wondering more than ever - do I really need my CPAP? I believe that I've experienced 2 really significant events in my therapy this year. 1) got rid of the FFM lower mask straps 2) got the dreamport and learned how to tape my mouth effectively. I am thinking that I *might* be able to keep the mouth tape and stop using the CPAP.

A local DME sells a 2 night home sleep study for $296. I am seriously considering doing this just to see where I stand. But I have questions.

1) Are they complete enough to make the final determination on this? Would I really need a full PSG to find out?
2) My OSA therapy is all about FL's - are they accurately monitored in home studies?
3) (and most importantly) Would you be having these same thoughts if you were in my shoes? I really wanna know if I'm just way out in left field here.

Here is the supporting evidence from last night.
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Re: djam's therapy thread

Post by zonker » Wed Apr 03, 2019 7:33 pm

djams wrote:
Wed Apr 03, 2019 7:18 pm
Let me just start this post by emphasizing: I am fully aware that I am talking about my *treated* AHI in the post.
yeah,yeah,yeah....i get that. but let me try to turn this around. i'll see if it makes sense.

newbies (and NOT so newbies) will come in and say something like"omg, i've been doing so well in my therapy. but then, last night, my ahi shot up to an unheard of 3.87!!! what am i doing wrong?"

then cooler and calmer heads will say something like " one night's data of sleep isn't really data at all. let it go for a few nights and see how it goes.".

so, how about you repeat the experiment? try going without it for a few nights and see what happens?

it will at least give you more to go on.
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Re: djam's therapy thread

Post by Pugsy » Wed Apr 03, 2019 7:33 pm

djams wrote:
Wed Apr 03, 2019 7:18 pm
2) My OSA therapy is all about FL's - are they accurately monitored in home studies?
Depends on how comprehensive the home study might be...if they do any flow limitation data gathering at all. I don't know if flow limitations are part of what the most comprehensive Type II home study includes in the data it gathers. I don't think so though.

Go here and read about the various levels of home studies...the more it costs...the more comprehensive the home study is.
http://freecpapadvice.com/home-sleep-tests
djams wrote:
Wed Apr 03, 2019 7:18 pm
A local DME sells a 2 night home sleep study for $296. I am seriously considering doing this just to see where I stand
Be sure and ask just what type of study you get for $296....

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Re: djam's therapy thread

Post by babydinosnoreless » Wed Apr 03, 2019 7:39 pm

As pugsy and others have always said you can not make decisions based on one nights worth of data. :D also did you feel better right away when you started cpap? Because I don't imagine you would feel poorly with only one partial night without.

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Re: djam's therapy thread

Post by djams » Wed Apr 03, 2019 7:44 pm

zonker wrote:
Wed Apr 03, 2019 7:33 pm
djams wrote:
Wed Apr 03, 2019 7:18 pm
Let me just start this post by emphasizing: I am fully aware that I am talking about my *treated* AHI in the post.
yeah,yeah,yeah....i get that. but let me try to turn this around. i'll see if it makes sense.

newbies (and NOT so newbies) will come in and say something like"omg, i've been doing so well in my therapy. but then, last night, my ahi shot up to an unheard of 3.87!!! what am i doing wrong?"

then cooler and calmer heads will say something like " one night's data of sleep isn't really data at all. let it go for a few nights and see how it goes.".

so, how about you repeat the experiment? try going without it for a few nights and see what happens?

it will at least give you more to go on.
Nah, not interested in doing that at all. This accident was just that. Not really interested in punishing myself and getting no meaningful data out of it.

I'll do it (punish myself) if I get data that I can make a decision with. With the help I get here, of course. :)

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