Early Morning Train Wreck

[gregger]

[attachment=6194][attachment=6193]More on my "tale of two masks," wherein I am fighting nasal congestion issues in order to be able to use my preferred nasal cushion mask, but also trying to make the FFM work when it's required.

On Sleep Rider's advice I have increased max pressure to 14, since even on "good" nights with nasal I was holding close to max of 12 much of night. 

Starting two nights ago I have been trying a soft cervical collar, as well.

Per attached charts, two nights ago I used the FFM and got an AHI of 5.21. I can't tell if the collar is helping or not...any evidence of positional OS here?

Last night, nose was clear enough at bedtime to use the nasal mask. First segment of evening I got an AHI of 2. Then, I awoke at 5:08 with one nostril clogged and sensation of air starvation, so I got up, blew my nose, and went back to bed. Second segment I got an AHI of 10! (Overall evening AHI was as you can see 4.61).

1) For the FFM night -- any signs of other things I can do?

2) For the nasal night -- I'm happy with segment one at AHI 2, but...ideas on what caused the train wreck in second segment (AHI 10?)

Playing with lots of variables and trying to be patient. Advice appreciated as always, you folks are great.

[Apnea Infant]

First of all, well done on your mask usage.

FFM NIGHT
7 hours continuous usage is pretty damn good. There are a lot of leaks with your use of the FFM as compared to the other night with the nasal mask. This may have affected the overall AHI count. I note that you have max EPR of 3 which may have caused some of the central apneas and also that the min EPAP is 5cmH2O which may have allowed some OSAs to creep in. Reducing EPR to 2 or 1 may help with both the obstructions and centrals.

NASAL MASK NIGHT
Mask usage is still good despite that one break. I would make the same comment too for this night in that reducing EPR from 2 to 1 may see a reduction in the hypopnea and centrals.

Keep up the good work.

[gwc2795]

put the EPR at 1 and post another night. Should help with CA's might bump up H's, lets see.

[gregger]

Thanks for the feedback, I very much appreciate it. 

I will bring the EPR down a notch at a time and report back after capturing an evening with both mask types. 

Apnea Infant: I'm Not familiar with that 5 value...is that a setting?

Thank you again for your time.

[Apnea Infant]

Thanks for the feedback, I very much appreciate it. 

I will bring the EPR down a notch at a time and report back after capturing an evening with both mask types. 

Apnea Infant: I'm Not familiar with that 5 value...is that a setting?

Thank you again for your time.

Hi Gregger

If you look at your chart, you have minimum pressure of 8cmH2O and maximum pressure of 14cm H2O with EPR at 3cmH2O.

That is to say, your minimum IPAP (inspiratory positive airways pressure-when you breathe in) is 8cm H2O but your minimum EPAP (expiratory positive airways pressure-when you breathe out) is 5cmH2O with your EPR set at 3cmH2O. (8cmH2O -3cmH2O = 5cmH2O). EPAP deals with obstructions generally.

5cmH2O is quite a low pressure to deal with obstructions. So I was suggesting that you could afford to raise your minimum pressure of 8 to say 10 (then 10-3=7cmH2O) or reduce EPR to 1 say, (8-1=7cmH2O). So you end up with the same minimum pressure to deal with obstructions but have 2 methods to get there. Reducing EPR when you are ready to will also help with reducing centrals.

I hope I have explained clearly. I do recall finding it hard to get my head around this concept in my early days too.

[gregger]

[attachment=6210]Thanks A.I.   Consider me confused but at least half enlightened!

Having reduced EPR to 2cm H2O, I had a much better night with the FFM, per attached. Will see whether it's repeatable and whether I obtain a similar benefit with the nasal mask when possible.

Leak rate looks too high, right? But that's another thread. I know this FFM is very tricky leak-wise.

[Apnea Infant]

Hi Gregger

Your numbers are definitely moving in the right direction. Do you prefer to use the FFM? From what I remember, your leaks are more problematic with the FFM compared with the nasal mask.

Your usage hours are great!! Keep up with it. Perhaps when you are ready, you might consider reducing EPR down to 1 and it might help get rid of those lingering obstructions and hypopnea.

With your good hours, hopefully it will not be too long before, you no longer feel like a train wreck.

[gregger]

Hi AI,

Yes, I definitely prefer the nasal cushion over the FFM, because of the leaks and the general comfort issues. 

I need to make an appointment with my DME and see about an alternative FFM, or at least advice on getting a better fit. I have both L and M sizes in the FFM; tried the M for the first time the other night and it worked a bit better but still not "great." Will keep trying.

[Sleeprider]

Greggor, just wanted to second the reduction on EPR. Your obstructive apnea is nearly gone, and reducing EPR should take care of the CA. I think you will be surprised you're almost there.

[gregger]

Greggor, just wanted to second the reduction on EPR.  Your obstructive apnea is nearly gone, and reducing EPR should take care of the CA. I think you will  be surprised you're almost there.

Thanks Sleeprider for the encouragement.

I had a "shorter" therapy with the nasal cushion last night, and reduced (3 to 2) EPR, and achieved 0.5 AHI!

I will try taking EPR down to 1. Bigger challenge right now is addressing congestion issues so I can use nasal cushion more often, and finding right FFm for when I can't. Will let you know what the ENT says/does.