learning to understand

[Josephina]

Hi,

I am a new cpap user (resmed airsense 11), since nearly 2 months. I have moderate sleep apnea which is a lot worse on the back than on the side. My current nose mask (Fisher and Paykel eson 2) is leaking a lot, so me as well as my partner are sleeping with earplugs since a good week, my sleep was getting really bad and I think the noise from the leaks caused micro-awakenings. I am a side/belly sleeper.
I would like to have your experience with other types of masks and to have your reading of my last nights stats. What do you think of special cpap pillows?

I used a mandibular advancement device for more than 3 years, with very little follow up from a technical point of view, and felt getting more and more tired again. Last sleep test was showing AHI of over 40 when lying on my back. I was not aware of being tired before my first sleep test which I took 4 years ago. I am a 50 yo non-smoker, female, normal BMI, the sleep test was done because I had night-time shifts as a midwife.

Thanks a lot for helping me discovering how to read and interpret my own data!

[attachment=72558][attachment=72559]

[G. Szabo]

Please activate the Details folder on the left-hand side and repost your Oscar, ensuring that all the instrument settings and statistics are visible. Also, turn the calendar off.

[Josephina]

Hi,

so here the same images but with the details.
I also post the data from last night's sleep. I changed the tension of the headbands to get the mask being better sealed. I do not have the impression it works a lot, does it?


Agenda is already at its lowest image, I do not see how to further reduce it.

Thank you!

           

[Josephina]

In fact getting the mask tighter seal was what the technician said. When looking in detail to the flow rate this is what I get.
Are those the sinusoidal normal waves or do I rather see plateau waves telling me there is a collapse of a noncompliant upper airway?


Thanks a lot!

       

[G. Szabo]

Your flow limitations and distorted inhalation peaks can be improved by setting your minimum pressure to 9 cm and using EPR =3 full time. I suggest you turn the ramp off if you have been using it.

[Josephina]

Hi!

Thanks for the advice. I read on the board one should change one parameter after the other, so I choose to swithc on EPR and put it on 3 without changing other parameters. It gave me the following stats : nearly no leakage AND my partner kept sleeping through the night without being hindered by the noise

   

I had few events followed by some irregular breathing which I understand is recovery breathing. I see some occurrences of similar breathing without OA just before, are those artefacts? Or undocumented OA'S (if that were possible?)?
   

I noticed the appearance of a cyclic augmentation then diminution of the flow rate as you can see here
   
What does this relate to? Is this the periodic breathing? It occured as such for 35 minutes and came back in a less characteristic form at least twice that night. On the forum it is marked it can occur now and then, without mentioning what "now and then" really means... Any idea?

Thanks!

[G. Szabo]

Based on your latest chart, I suggest you set your minimum pressure to 8 cm. This can mitigate the OAs and resolve the "cyclic" betting pattern.
Also, turn the ramp off.  
A breathing disturbance is not counted and recorded as an event if it is short. A person changes sleeping position 11 times during the night, and each of these comes along with some breathing disturbance. It would be best if you did not worry about them. Your last chart is not a periodic breathing.  
Do you have a congested nose during the night?

[Josephina]

Hello!


Thanks for your answers , and yes, I have nose congestion since I was a kid, recently found back an X ray telling I had hypertrophia in the sinuse. This has not largely been explored though, I have an appointment for it at the end of January. I finally do not have to switch sides any more since I have the CPAP, this makes falling asleep a lot more confortable to me  

Here are last night's stats and some details. Do I get the EPR to a higher level when putting the minimum pressure higher? 
   

And do I understand well that CA's are central apneas?

In this detail, there is less flow rate and there is also a considerable leak. Can the leak cause an arteficially lower flow rate?
   
 In this last detail, I see the flow rate being diminished after - maybe- a movement or so... Do you have an idea of how the algorithm defines it being just some normal event of hypo- or apnea?
   

Thanks again a lot!

And I get convinced that having an oxymeter might help seeing the clinical impact of these respiratory rates! I'm telling young parents not to buy one for their babies and will get one for myself (I agree, the objectives are different, SIDS or trying to understand what my upper airways and brain are doing to my organism while sleeping)... Caffein helps preterm babies breath, I guess it will only work on myself by preventing me to sleep and hence controlling my breathing

[G. Szabo]

In the APAP regime, the instrument sets the inhalation pressure (within the min. max limits) based on the flow rates/ flow limits and disturbances. 
At EPR= 3, the instrument provides a 3 cm lower exhalation pressure than inhalation. However,  the instrument hardware cannot deliver lower than 4 cm pressure; hence,  the minimum pressure at which the entire 3 cm pressure drop can be enjoyed is 7 cm. Therefore, setting the minimum pressure to 7 cm or higher is advisable. Incidentally, most adults need a minimum of 7 cm; the lower minimum is for kids. 

"And do I understand well that CA's are central apneas?" Correct

"In this detail, there is less flow rate and there is also a considerable leak. Can the leak cause an arteficially lower flow rate?" Your leak rate approaches the tolerable limit where the instrument cannot compensate for it. Hence, reducing the leaks to achieve the correct treatment would be best.

"In this last detail, I see the flow rate being diminished after - maybe- a movement or so... Do you have an idea of how the algorithm defines it being just some normal event of hypo- or apnea?" the length of the "diminished " The period of the low flow rate you focused is not long enough to be counted as OA or H. See the wiki for definitions of precise time lengths.

You can use different sprays to combat nasal congestion, and nasal strips can also be helpful. 

I use the 
TURBINE Nasal Dilator from RHINOMED to use instead of Nasal Strips
and 
 HylaMist nasal spray against nasal congestion

    

[Josephina]

thanks for those quick replies! Bedtime here in Europe now!