Chart Envy

[Gideon]

FYI, I added that blurb to the Wiki here
CPAP choice to treat OSA, CA, obstructive or pulmonary restriction

[Sleeprider]

Fred, good addition.  I think I will do a Wiki on titration protocols that start with CPAP, and move through the various forms of bilevel as a choice matrix.  We can probably cross-reference and make this even better and more understandable.  We almost always start with CPAP for obstructive apnea.  For severe persistent flow limitation and hypopnea, or higher pressure requirements, move to bilevel (Aircurve 10 Vauto); for hypoventilation, pulmonary restrictive disease and COPD Bilevel ST (spontaneous/timed); and for central or complex apnea, ASV.  I think I can cover that as well as the specific protocols that we seem to reference pretty often in posts here.

Sorry about the hijack, we now return you to your regularly scheduled Chart Envy thread.

[Technopauper]

So................wonder whats happened here then ?

Trundling along nicely with circa 5 AHI over the last few weeks then flew home on Monday and things all went to crap !

First night I had a horrible whistling noise and had to abort treatment as bothering wife, next night I was bloated and couldn't cope and last night hideous numbers but felt I slept through - this was only a 2hr time difference change so don't really understand whats changed and would appreciate views - charts attached.

No other changes, collar, mask, machine all the same.
I really thought I was getting somewhere / stable around 5 with little or no centrals..............just don't understand 

Rob

[Technopauper]

So..................no responses so I did what I thought I should - changed over the the Resmed 10 'for her' I recently picked up for a song and bumped the pressure up a little like Sleeprider suggested and am 'blown away' by the difference - Dreamstation to Resmed there is no comparison to the experience even on fixed pressure.

17.4 feels like 12, no blowing sensation at all, it feels just like natural breath making for far more comfortable so really don't need a BiPAP for comfort. I came to London 3 nights ago so pretty bad jet lag but sleep is just so much better with a Resmed machine. I also changed the elbow on my airlift F20 FFM to a whisper elbow and I honestly can't hear the machine or exhale at all - the AC in my hotel room is honestly more noisy that any part of my rig !

Early days but starting results look amazing too having dumped the dream station - have others experienced the same on change of machine ?

Rob

[Technopauper]

Hit post when I meant to post charts......as below


Rob

[Sleeprider]

Sweet! once things settle out, try adding in some EPR. Just a quick note, look how expiration time exceeds inspiratory time, as it should.

[Technopauper]

Thanks Sleeprider

Captain Slog continues - hoping this is proving useful for others to read as well as me just capturing learning as I go ?

Still on UK timezone and things settling out around AHI of 3 - will add some EPR once safely back on Mountain time next week.

Timezones seem easier to deal with on CPAP which is good, the Resmed machine is amazingly quiet and the whisper elbow on the F20 makes it near silent.

Wondering if I should be concerned about the increase in max respiratory rate since swapping machines ? The 95% rate has shot up but the median has stayed pretty constant but appreciate thoughts.......

Seem to have knocked out the Hypoapneas with the little higher pressure - are the remaining ones being largely central a concern ?

Charts looking good and great to see a weekly average below 5 - never thought I'd see that !

Rob

[Sleeprider]

Fixed pressure is certainly working best for you. Considering the extent of complex apnea you came from with variable pressure, I need to recant any suggestion for EPR. It would likely bring back more CA events in your case. Pretty impressive results using CPAP pressure for a problem that looked more complex.

[Technopauper]

All - a good session with sleep doc today, summary as below of the discussion

- Confident I'm 'treated' at over 17 - he's happy with where I am
- Didn't want me to mess with BiPAP as changing settings and 'tinkering' with those can have other health effects
- Would diagnose need for comfort only but didn't think I needed it
- Could try a little lower pressure but that would likely bring back there hypo apneas
- trade off just now seems to be centrals for hypo - he's convinced the small amount of centrals will disappear with time, every time I mess with pressures it just resets this in his book
- discussed 'fat head' I feel first thing every morning and suggested I try some nasal decongestants - thoughts on these ?? Anyone else have this ?

I'm one day back from UK timezone and managed an AHI first night of 5 which is nothing short of incredible, these used to be 'over 50' nights and I actually feel fine today and didn't have a daytime nap so thats progress

So...... the main problem I have now is a luxury one to deal with really, the current rig with whisper elbow is so dammned quiet that any movement caused mask leaks make lots of noise (relatively) - wondering if I should go loud again just to increase the ambient noise and avoid waking up my wife - reason to try lowering pressure was to reduce the impact of leaks ?

Feel free to jump in anyone, feel a bit like I'm talking to myself sometimes - that is just part of my intent of this thread - capture thoughts, concerns and learnings but really would appreciate other experiences of similar issues

My last week average is 2.56 btw 

For those further back / just starting........look what is possible with some perseverance, really beginning to feel great !

Rob

[snorybob]

Hi Rob!  
You might think you're sometimes talking to yourself but let me tell you that with 2300 views some people out there have learned things good for there own therapy, I know I did. 

I've followed you on your journey & it wasn't always easy. So congrats for your results, you've come a long way. For the noise, try to snore tonight & see what happens. I'll leave it at that.      


                                                                     snorybob.