Chin Tucking as cause of apnea

[ejbpesca]

I got a PM that I should limit using quotes from replies.  The quotes make the replies clearer so I do not understand how they make a followed thread confusing.  Whole quotes of a reply may be what is being asked to "limit."  Not sure.

If it is determined I can do better with BPAP, I will buy one.  I looked them up and yes, currently a RESMED is over $1K while the AirSense 10 is down to $399.  My first machine was $1500 and very simple compared to current devices. One year into therapy I read about flex machines, told my doctor I needed one and he wrote a prescription (with reluctance) for a new CPAP machine.  The prescription was accepted so I got a new machine which was recalled after I used it for 5 years and had gotten my 3rd CPAP, an AirSense 10.  I now have a second AirSense 10.  I possibly could make a case for a BPAP to see if United Health Ins. (Medicare) will pay for it, but I don't mind buying one on my own if that's what I need and no prescription is needed.  I take it they are very proud of the BPAP firmware but one would think they would bring down the price to get a bigger sales volume. 

I am successfully getting an O2 report from O2 ring to Mac. The frustration is finding the report file in binary form on the Mac. The instructions on WikiApnea are incomplete.  The last part of the instructions is has an area for YOUR NAME and SERIAL NUMBER.  The Mac O2 version of Insight Pro has errors in Options.  It will not accept so I can't put my name on a file, and I don't know what SERIAL Number the instructions are referring to.  If I just copy paste either line of code to the prescribed location, I get an error beep.

Last nights OSCAR:  (no collar, successful taping, O2 ring not worn due to forgetting it) 

The OSCAR below's RERA count is high. It is an amount I've never seen till this report.  I may have stray RERAs here in there on reports but nothing like this.  To the left and right of the RERA storm, my FLOW RATE waves are not nice round domes on top but they might be acceptable.  The wave forms during the cluster of RERA events are in the second image.  They look like I was barely breathing.  Devil horned buttes are what they resemble and look scary shallow then go to a deep breath as the RERA is registered. Your opinion on these RERAs (36 events) would be appreciated, please.

   

   

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[Jay51]

   

   

It is kind of strange that you do well for a long stretch, then hit a quagmire like this.  IMO the odds seem to point to positional events as the cause.  Others may want to post if they see anything else.

[UnicornRider]

Where you have a sudden increase of Flow Limits, Leak Rate and a series of clustered events; I would have to suggest that is a positional typical Chin Tuck.

A properly fitted collar would have prevented or minimized this. 20(cmh2O) did not blow through this, I have some doubts that 25 (cmH2O) from an AirCurve 10 VAuto would clear this. Your O2 recording would have been interesting to see.

Which collar are you using? Does it have any bulk behind the neck?

Hang in there, we will walk you through this. 

Did you purchase a ResMed because of the recall? Have you heard of the rebate program Philips came out with for the people who rented or purchased from their own pocket a replacement machine?

[Sleeprider]

In your last chart, the events start with a cluster of obstructive apnea, and the close-up confirms significant obstruction resulting in flow limitation through the entire period from 02:10 to 04:00,even at the full 20 cm pressure of your CPAP. If you study the breathing in that time-frame, you will see this pattern repeated over and over for that long 2-hour span. Severe flow limited breathing broken by arousal and recovery breaths. Of course this is textbook RERA (respiratory effort related arousal), and it is the result of positional apnea. While a bilevel machine can increase the maximum pressure by 5 cm and provide more pressure support, the solution to this is to resolve the positional apnea (chin-tucking). In the sequence below, you arouse for a recovery breath, but do not shift position to break the obstruction. If you can learn the sleep position or mechanism of this by using a night camera or other means, you could probably resolve it. The effort of sucking in a breath through the obstruction, with inhale lasting over 3-seconds and a shore exhale between efforts is why RERA occurs. It looks absolutely painful, and pressure alone will not resolve it. Note that during most of the night, this condition is completely or mostly absent.

[ejbpesca]

Which collar are you using? Does it have any bulk behind the neck?

I have a Corflex Small collar.  It tapers at the back of the neck a bit.  It will keep my chin up if I tighten it to the degree I feel I'm choking, I will give it another go to try to get it to function without a choking sensation.

I tried one other sleek nicely covered mask, but it was too irritating due to a sharp top edge.

I forgot the O2 ring last night so no O2 data to correlate with the most recent OSCAR report.

Viatom/Wellue/Lookee has yet to give me instructions to insert Insight Pro Data to OSCAR.
I fail also to do it via Wiki instructions.  I think non-synced to OSCAR chunks of the report can help though to see what these clusters are doing to O2.

I guess ResMed has figured out how to detect a RERA event from breathing as opposed to needing a brain wave activity level.

It may be worth noting that many days I will be injured from the day's or day before's activity.  I am easily injured by domestic duties like grocery shopping, washing clothes, and cleaning.  The pain from this causes very restless sleep that results in many Large Leaks and may be one reason for clusters of other events.

The reason I stopped using the recalled Phillips machine was due to its being expired, not the recall.  The next machine issued was an AirSense 10.  It too expired after 5 years. AirSense 11 was the next.  I could not tolerate its chemical gas odors so I swapped it for an AirSense 10, my current device.  DME told me others also were going back to the 10 from the 11 AirSense.

I got a letter about the $100 payout on my returned Phillips machine.  I did not pay for the machine so no $ claim was made.  I had been shipped a new Phillips device that I do not use but may serve as a backup.




Thank you.

[k888]

Hi ejbpesca, 
Based on my experience (possibly not useful for you) it sure looks like:
1) you have gotten into a position where the collar does not work,
2) your chin has dropped inside the collar, or
3) the collar is failing.  I put a lot of pressure on my collar, and a corflex only works for a while.  If that is the case, numbers will worsen until a new collar is used (or rotate collar).
k888

[Crimson Nape]

". . . Viatom/Wellue/Lookee has yet to give me instructions to insert Insight Pro Data to OSCAR."

I must ask, would you expect Ford to offer support on a Caterpillar? If not, why do you expect an oximeter manufacturer to support software they have no connection to?

- Red

[UnicornRider]

You should not have to tighten your collar to the point that it is choking you, for it to keep your chin up, i suggest you try a different collar or size of collar

The collar I use, Velpeau, actually supports  the corners of my jaw under my ears more so than my chin. But it keeps my jaw forward and mouth closed, I do have a square jaw so that may be different for you. But they do have different sizes and you can return it for a different size if the one you measured for does not fit.

    https://a.co/d/g97soCp  
      
     On your O2 Insight Pro, Left hand side should be a list of the session downloads of your ring, at the very top of that column should be something like :  Wellue O2 Ring-0123456789 (may have to drag the right border to see all of the info)

Where 0123456789 is the serial number of your ring. (should match the ser. no. on the back of your ring) Information after the ser. no. in brackets [123] should indicate the number of files underneath (I think)

    The session files comprising the column underneath should be in a date-time format:  YYYYMMDDHHMMSS  

     Last night my file was 20231229205434

   So on your Mac, I believe "Finder" is your file search.
   Go back and review the OSCAR Wiki info for MAC OS - OSCAR - Oximeter interface

   When I do a cold start up on my lap top, when importing my Checkme O2 Max data in Oscar Daily page, after I select DATA>Import Viatom/Wellue Data Inside the pop up window I have to recreate my entire click path to the "Date-Time" session file list, then I have to scroll down to locate the session file i want to import.

  I had trouble for the longest time figuring this out for my PC Windows setup. ( my file structure is not the same as OSCAR Wiki) So don't feel like you're the only one. Once I found my problem... I was  


   I hope this helps. 

    Meanwhile I still use the O2 Insight daily "Sleep Report" to do an initial evaluation of a nights sleep session, I will enter edits, usually AHI and any unusual disturbances, then I go to OSCAR with SD card still inserted and import Oximeter data.

[ejbpesca]

Crimson Nape Wrote:

I must ask, would you expect Ford to offer support on a Caterpillar? If not, why do you expect an oximeter manufacturer to support software they have no connection to?

The CONTACT US item at the top of an O2 Insight Pro (Mac) report is gives support@lookee.com so evidently the Oximeter manufacturer and the software of O2 Insight Pro are connected. (Lookee is the brand of O2 Ring and O2 Insight Pro is the software that downloads reports from the ring.)

[Crimson Nape]

I was referring to O2 Insight Pro data into OSCAR, as in your statement, ". . . Viatom/Wellue/Lookee has yet to give me instructions to insert Insight Pro Data to OSCAR."

- Red