sleep study attached, looking for advice

[jgrizz80]

So i have left the machine alone now for 3 nights straight at 15cm and here are the results.  Apparently i can't get the mask to seal to save my life.  How inaccurate do you think the data is with all of these leaks, and where do i head next with this?

[Hope this helps] At pressures over 20cm I struggled with both the F-20 AirTouch and AirSeal and wanted one of them to work so I could wear my reading glasses.  The AirSeal (silicone) would never work for me.  The AirTouch (foam seal) will work but in 7-10 days it will make my nose bridge raw.  May be a reaction to the foam.  Tried several other ff masks from the 'try and return' online sources which also would not seal for me. 
I have found that the old- original QuattroAir to be the best for me.  It has minimal leakage and allows for cranking back the strap tension so it has less force against the nose bridge area.

The QA has a forehead pad that, unlike the F-20, is a stand-off helping to keep the top of the seal (where the nose bridge is) from crushing down on the top of my nose lessening morning pressure soreness and helping to maintain the seal during sleep.  The F-20 is designed with the top straps mounting onto drop-links that require more pressure to seal it as they anchor lower on the mask frame, where the QA is high and above the frame.

I believe this is probably not so much a problem with those who run at lower pressures, but at higher pressures I believe it is an issue.  Remember what works for one does not work for others..

Thanks for the advice.  I am actually going to try either the quattro air or the mirage quattro next and see if i can get a better seal with one of them.  i always have to crank the straps so tight to keep a seal and even at that i don't get that great of one at higher pressures.  

An update to my thread though...

I played around with trigger settings again last night because i had about an hour an a half before i had to get up.  

This is 2 nights ago of Epap 13.0 max Ipap 25.0 with 5.0 Pressure Support trigger Very high, cycle Very High

[attachment=7686]


This is last night, the first 4 hours were those same settings, and then the last 2 hours were on Trigger Low and Cycle Low.  Its amazing the difference between the 2 sessions.  

Whole Night

[attachment=7687]

Very High Trigger and Cycle

[attachment=7688]

Low Trigger and Cycle

[attachment=7689]

I feel like i never have consistency to a nights sleep, like, i'll get a good night or two in on one setting, and then the next night be up every 3 hours.  I see other people flow rates in their charts and they always look a lot smoother and consistent and i feel like maybe thats why i never feel rested....

[jgrizz80]

Sleeprider, 

Here are my latest graphs from last night with what seems to be a pretty good setting, but i'm curious your thoughts on how my flow rates seem to constantly vary so much throughout the night.  Can this cause sleep disruption, because i am still never feeling that well rested when i wake up.

[attachment=7759]  [attachment=7760]



My wife used my machine for a night so i could see what hers looked like, and it is so much more consistent and smooth throughout the night with very little variation.  

[attachment=7761]

[Sleeprider]

This looks normal and in fact mine looks nearly identical at similar zoom levels.

When you swapped the machines, it looks like you set it in CPAP mode at 11/8, but the graph only shows the EPAP at 8.0 fixed (y-atixis does not include 11.0). I see a significant drop in tidal volume and increased resp rate. I'm a little puzzled by this last chart and why you would swap machines to compare, but use drastically different settings.

[jgrizz80]

This looks normal and in fact mine looks nearly identical at similar zoom levels.

When you swapped the machines, it looks like you set it in CPAP mode at 11/8, but the graph only shows the EPAP at 8.0 fixed (y-atixis does not include 11.0).  I see a significant drop in tidal volume and increased resp rate.  I'm a little puzzled by this last chart and why you would swap machines to compare, but use drastically different settings.

Maybe i was confusing how i worded it. That last chart is my wife using my machine with her prescribed settings, which seem to work wonderfully for her.  She was given a brick by our DME as well so i gave her my machine for the night out of curiousity to see how it looked.  She's been on a fixed level of 11cm  with epr at 3 since she got her machine and never has a night about 1.  I have chart envy....

[Sleeprider]

Okay, I was confused. Your charts look fine and pressure rose due to flow limitation. There were a few fluctuations in flow rate through that period, but I can find many examples of my own flow chart that look almost identical. Your wife has amazing consistency, and the CPAP approach is working great for her. If we compete with that, we will be left with a bad case of chart envy. FWIW, there are many things our wives do better than us. Competition is futile.

[jgrizz80]

Okay, I was confused.  Your charts look fine and pressure rose due to flow limitation. There were a few fluctuations in flow rate through that period, but I can find many examples of my own flow chart that look almost identical.  Your wife has amazing consistency, and the CPAP approach is working great for her.  If we compete with that, we will be left with a bad case of chart envy.  FWIW, there are many things our wives do better than us. Competition is futile.

Yes, she is a pretty amazing woman and i'm very lucky to have her.  Looking at those charts above from me, would you recommend any changes? 

Back 2 weeks ago, i had a night like this, with same pressure support levels, but epap of 9.0 - 18.0 and had this.... 

[attachment=7765]  [attachment=7764]

I don't think i'll ever have as consistent of results as my wife, but I feel like my results are consistently inconsistent, and those only thing keeping centrals away are the very high trigger settings...