Chin Tucking as cause of apnea

[PamVT41]

Yes.  I have always slept on my side for all sleeps until recently.  I had rotator cuff issues and surgery and have had to sleep on my back.  My AHI went up up and away and flippeed into central apnea and cheyne stokes breathing.  I recently realized I tuck my chin and bought a few cervical collars.  So I tried a few and found one I can tolerate.  The doctor switched me to an ASV machine and with the collar  and a bed wedge i am more comfortable and sleep better with a lower AHI.

[Jay51]

Sorry for just now getting back to posting.  Congratulations to you for putting the effort into your therapy and experimenting to better it.  Hopefully your 8.4 median respiratory rate was just a one-off thing then.  It still seems strange though to me since it was so significantly lower than your usual median.  

In regards to the median inspiration time and median expiration time:  I have seen a few 3 second inspiration median times on OSCAR charts here.  It usually means resistance somewhere along the airway is slowing inhaling down, and hence it takes a bit longer to complete every inhale (and takes more effort on your part also).  Most people's inhale median that I have seen is either in the 2's or even 1's (seconds).  For example, a 1.5 or something like that usually signifies a quick and probably very clean inhale with no to practically no resistance.  

The exhale median is again very suspicious to me.  I have never seen an OSCAR chart posted here with a 4 second median exhale.  A few 3 second charts, but never one 4 whole seconds.  Sometimes this can be miscounted.  

Do you mind posting a 3 minute close up zoom of any time during Post #34's OSCAR when you are sure that you were asleep?  That could possibly help determine if your exhale median and inhale median are correct or not.  Just pick any point where you know you were alseep and click and drag the cursor for a 3 minute close up chart and try to uplaod it here.  Hopefully it was nothing.

[UnicornRider]

I was being pestered by some Santa believers who were concerned that Santa might be delayed and/or lost. Therefore I made a few errors.

"I need you to zoom in and take a screenshot of ~15:54 to ~15:56."should have been ~14:54 to ~14:56

"Before you take the screenshot, I would like you to rescale the y-axis to +60 to -60 for the flow limits graph".  Should have been Flow Rate Graph,

I wanted an area where your Flow Rate appeared relatively smooth, yet the Flow Limits graph showed some activity. By zooming in on Flow Rate we can see the waveshapes to determine what and how much restrictions you are experiencing.

Now that you have your. O2 Ring up and operational, are you able to import your O2 information into OSCAR? Do you need help getting that set up?

Back to your OSCAR Report with an AHI of 0.00, I have had those but my O2 drops told me I had more fine tuning to work on or I had to build the documentation with OSCAR and Oximeter to convince my Doctor I needed a different machine, with built in Oximeter.

If you are going to get Medicare to foot the bill for a change of machine and/or an Oximeter you need to document the need. Then you have to use documents to have the Doctor prescribe the needed equipment. It does not have to be your Sleep Doctor. Your primary can prescribe it for you.

For more about low AHI, yet poor sleep outcome due to UARS, "Our method enables quantification of flow limitation frequency, a key aspect of obstructive sleep-disordered breathing that is independent of the AHI and often unavailable. Flow limitation frequency varies widely between individuals, is prevalent during arousals and stable breathing, and reveals elevated ventilatory drive."

Look at the Flow Rate waveshapes they have at the end of the article.

        https://pubmed.ncbi.nlm.nih.gov/34240221/  

 I too noticed your breathing inspiratory vs expiratory, breath rate as well as tidal volume. So now is the time to ask if you could list age, height, weight, known health issues,
any medications that may interfere with respiration. 

Post some new OSCAR Reports, I am curious how the new press min 13.6 (cmH2O), is doing for you.


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[ejbpesca]

Do you mind posting a 3 minute close up zoom of any time during Post #34's OSCAR when you are sure that you were asleep?  That could possibly help determine if your exhale median and inhale median are correct or not.  Just pick any point where you know you were alseep and click and drag the cursor for a 3 minute close up chart and try to uplaod it here.  Hopefully it was nothing.

Here's a closeup of wave forms for a bit over 3 minutes from the OSCAR image on post #34.  I expanded the xy axis which I hope is what is needed.  If not please tell me and I'll reply with the default axis setting.

   

[Jay51]

Thank you for posting that James.  Just by counting the little bars between the time segments your exhales do not last 4 seconds.  They are shorter than that.  Not super important though, since your exhale time in this segment looks ok to me.  

UnicornRider makes some good points and has some great examples of flow limitations.  Try to post the example she wants and it may reveal something important.  

The top of the respiratory wave is important.  Basically, a rounded top is normal.  Flat tops and jagged tops, etc. mean abnormalities of flow.

[ejbpesca]

"I need you to zoom in and take a screenshot of ~15:54 to ~15:56."should have been ~14:54 to ~14:56

"Before you take the screenshot, I would like you to rescale the y-axis to +60 to -60 for the flow limits graph".  Should have been Flow Rate Graph,

EJBPESCA

Age: 72
Height: 5' 6"
Weight: 180 lbs. (recent gain of 10 lbs)
Medical conditions:
1. Chronic pain due to numerous spinal issues from injuries.  
2. Allergic to many airborne particulates (mold, pollen, dusts,).
3. Hypterention.
4. Acid Reflux.
5.Severe Sleep Apnea. 
6. Mild Narcolepsy. 

Medications:  

1. Hydrocodone 7.5 mg is taken usually in waking hours 1 x per day.  It provides ≈ 4 hours of pain reduction allowing me to move.  I spend most of my time in a lift up bed.  Sleep is most always outside the 4-5 hours the medication is effective.

2. Losartan 100 Mg 1 x day, Amlodipine Besylate 5 Mg  both for high blood pressure

3. Pregabalin 50 Mg 1 dose early in day, 100 Mg taken before sleep.  This is an anti-seizure med I take for nerve pain and reduction of tingling due to my extensive nerve damage from injuries and cervical spine surgery.

The FlowRate image below had its X Y axis expanded.  I hope that is what you wanted as opposed to the default setting on OSCAR.

   

The next image is last night's OSCAR report.  I was taped and collared (no leash).

   

I cannot recall how to get my O2 App report, generated by last night's O2 ring data, into OSCAR.  I will attempt it after this writing.  There is a sort of trick to it.

FlowRate wave forms from article have been seen and understood.  Smoother good, choopy jagged bad.

Min. Pressure is up to 13.6.  Maybe this increases large leaks.  I tolerate it well so far.

I have had two more days of feeling better upon waking.  I am more alert, get up, and do chores or a project for a few hours.  That is much better than lying in bed all day/night, not awake, not asleep due to lack of true sleep and oxygen deprivation during that poor quality sleep.  

THANK YOU for helping me.  My doctor and DME give NO advice and have never looked at any of my Sleep Study or OSCAR data.

[Gideon]

Could you try a different, "higher" collar? You are still having positional events.

0.24 95% FL stat is too high.

[UnicornRider]

 Hydrocodone, is a respiratory depressant that very well could explain your low breath rate and Inspiratory/expiratory times, you have experienced on occasion.

      https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5443744/

Pregabalin, should assist your sleep:

     https://www.sciencedirect.com/science/ar...3815313742

You can post a screen shot of your daily "O2 Insight Pro" , if you have it set up on your MAC.

You could look in to Flonase, "Fluticasone Propionate" nasal spray, your doctor should write a prescription based on allergy history, about an hour before bed time, to ensure the sinuses are clear. I sometimes use a Saline nasal spray about 30 to 45 minutes before the Flonase to ensure my sinuses are clean.

Your Flow Limits as reported in the Statistics area of the left hand side bar, 95%= 0.24 & 99.5%= 0.57, are still a little high. But I would like to see you get a couple more nights of sleep at 13.6 (cmH2O) to ensure your body is adapting to the increased pressure well and you that have mask leaks under control.

If for any reason you feel tired during the day, do take a nap with your mask, tape and collar on, it is vital that you get restorative sleep when those conditions happen. After we get the timing and tuning of your therapy down and teach you how to read your Flow Rate graph waveforms, O2 Insight Pro Daily Report, to check for all of the variables that have an outside influence on UARS, only then will we send in the Dominatrix to snap that leash on to your collar.

Sleep Well and report back often.


..

[ejbpesca]

 Hydrocodone, is a respiratory depressant that very well could explain your low breath rate and Inspiratory/expiratory times, you have experienced on occasion.

      https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5443744/

Pregabalin, should assist your sleep:

     https://www.sciencedirect.com/science/ar...3815313742

You can post a screen shot of your daily "O2 Insight Pro" , if you have it set up on your MAC.

You could look in to Flonase, "Fluticasone Propionate" nasal spray, your doctor should write a prescription based on allergy history, about an hour before bed time, to ensure the sinuses are clear. I sometimes use a Saline nasal spray about 30 to 45 minutes before the Flonase to ensure my sinuses are clean.

Your Flow Limits as reported in the Statistics area of the left hand side bar, 95%= 0.24 & 99.5%= 0.57, are still a little high. But I would like to see you get a couple more nights of sleep at 13.6 (cmH2O) to ensure your body is adapting to the increased pressure well and you that have mask leaks under control.

10/4 on Hydrocodone.  I attempt to refrain from being under its effect beyond waking hours.  I am not sure if its repiratory effects are residual past the loss of its pain relieving effects which is 4 to 5 hours.

O2 Insight Pro Screen shot attached.  I have failed to insert an O2 report to OSCAR.  The proper file format does not appear in menus when I click OSCAR > Daily Report > Data > Viatom Wellue.  Past there nothing is clickable and the O2 Insight Pro screen offers no top bar options as does other applications. ??

I have been using Flonase for over 20 years as well as Azelastine.  The Azelastine does some trick to ream out nasal passages.  Not a pleasant action as to how they are cleared but it works and insurance covers the incredibly high cost.

Last night was a triple event sleep knockdown.  1/3 hours collar/tape 1/3 No collar/tape 1/3 no CPAP.  I am trying to adapt to tape and collar but they as well as my tight mask can be so irritating I will wake on occasion and take them off.  

Thank you for your advice.

   



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[ejbpesca]

Could you try a different, "higher" collar?  You are still having positional events.

0.24 95% FL stat is too high.

I had a higher collar I found too irritating to use.  I will try to spin my current collar around a bit which will increase the under chin height by 1/2".  I think I may have the collar too loose to prevent chin tucks.  If I tighten it though it becomes quite irritating with a choking sensation.  Maybe I can dial in a compromise between too tight and functional.  

Thank you.