Bipap Titration advice needed.

[amafra]

Hey buddies,
Just update, I keep trying to sleep with cpap, tested all modes possible. I feel way better with 40-50 AHI the next day than using CPAP. Could not stay awake during the day for so long.
My cervical pillow did not arrive yet to know the resul
ts. It is hard to get more than 2 hours. These masks need to be so tight that mirage I feel the plastic touching the skin. F20 I tested medium and large. Not sure why I bought it. Just leaks.
I can't understand why centrals apear all modes except for ASV, I do not have central apnea according to my polysomnography.

Thanks



Seems that major OA, CA happens on lower pressures.

[Sleeprider]

If you can't control leaks with a comfortable fit and not cranking down the mask straps, the mask does not fit.

[amafra]

I thought it was like that and I needed to get used to it.
I'm going to check Fisher and Paykel Vitera recommended by SarcasticDave, the bad thing is these most well known masks cost 75% to 130% of minimum salary just for comparison and no test can be done.
Thank you Sleeprider.

[Rubicon]

IMO there is no evidence that you have positional apnea (although you MAY have positional apnea).

The evidence is that you have largely REM-related apnea.

Interpreting the graphs is difficult because of artifact, leaks, insomnia, wingin' the dials all over the place, looking down from 40,000 feet (aka SkyLab view) and discontinuing therapy after short periods.

Can you upload the card contents to Dropbox?

What are you doing to improve sleep hygiene? I didn't expect you to stop espresso (hey, I would never either. I love Sant 'Eustachio Moka in a Bialetta) but at least stop drinking it after like 10 AM.

At home, do you sleep on you side or your back?

[amafra]

IMO there is no evidence that you have positional apnea (although you MAY have positional apnea).

The evidence is that you have largely REM-related apnea.

Interpreting the graphs is difficult because of artifact, leaks, insomnia, wingin' the dials all over the place, looking down from 40,000 feet (aka SkyLab view) and discontinuing therapy after short periods.

Can you upload the card contents to Dropbox?

What are you doing to improve sleep hygiene?  I didn't expect you to stop espresso (hey, I would never either.  I love Sant 'Eustachio Moka in a Bialetta) but at least stop drinking it after like 10 AM.

At home, do you sleep on you side or your back?

I have been improving sleep hygiene not attempting to put the mask back on. Usually start on my back and move to side afterwards.
The days that I do, I can't stant awake. It has been a nightmare, I can't find a way to get used to it and have one night long sleep. 
I usually sleep 40-50 minutes, when I recall to take the mask, usually because it is so tight and uncomfortable or because the leak blowing on my face is very strong.
Yesterday I shaved the beard that was not long, no help at all, I woke up with a bit of a leak that I almost kicked the device in the floor, I thawed mask in the air so P*ssed off.
I did not give up on this for a few reasons, first I would like to sleep and wake up rested, second avoid all health issues associated with untreated apnea, third is allow my girlfriend to sleep beside me. The last reason was the reason I went to the polysomnography test. Before Cpap I had performance impacted because of sleepiness, overload of coffee, but now I'm basically worthless.  My father that uses cpap ( after crashing his car while driving sleepy) sleeps the whole night saying he woke up rested. In the USA I used to have people waking me up when I slept on the drive while waiting at a stoplight, but I never slept while driving, only when I was stopped waiting for lights to go green. 

Not sure what to do anymore, really I don't. 
I'm adding the OSCAR data zipped file, I have many profiles and the main one is mafra. 
Usually when I wake up I change settings and OSCAR gets confused if many different treatment modes are used during the same night. I have more  extra profiles, I deleted some after review. Kept most relevant.
I erase the SD card every time I read data from it, so it will not confuse OSCAR importing Vauto and S or Autoset in the same profile. I can share OSCAR data.
Here is: https://drive.google.com/file/d/1Y0NvG4s...sp=sharing


Thank you for help and for following up

[amafra]

What are you doing to improve sleep hygiene?  I didn't expect you to stop espresso (hey, I would never either.  I love Sant 'Eustachio Moka in a Bialetta) but at least stop drinking it after like 10 AM.

I love Bialetta coffee maker. I used to avoid it after 12, but it is probably not ideal.

I used to go to the whole foods coffee section, get different beans. grind it and use it on these machines. I missed Sant 'Eustachio Moka, I will try to get my hands on that one, on my next US visit, possibly July or someone coming to Brazil.

[Rubicon]

Yeah, that's a pretty busy folder.

Anyway, to underscore your battle:

[Rubicon]

Some points:

It is generally accepted that some xPAP is better than none.  Kinda hard to believe with some of those nights, but let's let that sit.

Your tolerance of therapy does not seem to be improving.

ASV doesn't know if you're awake or asleep.

The ASV algorithm is VERY aggressive.

A (or maybe THE) goal should be to get you to sleep through the night without interruption.

[Rubicon]

Let's consider a plan:





A frequent pattern consists of things going fine; an arousal occurs; a respiratory event happens that should probably be left alone but the ASV doesn't know any better and starts beating it over the head with a club; increased pressures occur followed by leaks and ultimately ends with cessation of therapy.

I would submit that a potentially successful strategy would be turning off ASV and going to a fixed pressure that effectively treats events and provides continuous sleep (there's probably going to be a trade off involved). That seems to be in the neighborhood of 11/8 give or take (it would be dependent of sleep stage and body position so IDK if there's a truly "best" setting).

If you can get to 8 hours of relatively event-free sleep, it seems to me that's going to be a heckuva lot better that leaving 3-5 hours of non-therapy per night.

Then (or along the way) you can add in some ASV as necessary.

[amafra]

Thank you very much for taking your time and checking on my OSCAR data.
I think you are correct, pressure fluctuations on ASVauto do wake me up. It always goes to max allowed. I'm usually avoiding fixed pressures because all the time I did it, OSCAR reported central apneas and usually it scores higher AHI than ASVauto.
I feel better when I do not attempt to put the mask back, so probably I do some rest for the 50-90 minutes with mask than keep sleeping without even with apneas. Multiple attempts at night make me feel exhausted next day. Today I feel rested above average for sure, maybe because I had 1.4 hrs on cpap. 

Last night I used Vauto pressure close to what you recommended. 

I will give it a try on 11/8 on Vauto and see what happens.


Best regards