[split] GoodSleepHunting Therapy Thrapy Thread

[GoodSleepHunting]

   
Hey sleeprider!,
I have few questions for you, I recently took CPAP therapy in my own hands, and I've been experimenting, some days look good like the last night one(AHI 0.44) but I feel dizzy, lack of breath during the therapy and after, foggy mind etc. I listened to some stuff from William H Noah and I tried to not decrease my EPAP. -
I turned off the system one resistance off or to X-0 it was X1 before, I use nasal pillow mask small cushion, and I felt pressure relief on IPAP, I set it up on 8 fixed and I got good results but feel horrible (pic in attachemnt) - I have a suspicion I was rebreathing. I'm 6′4", 90 kg btw - also can i know from looking at Oscar data if i'm not breathing out sufficiently/fully because of the pressure?

Also do all CPAP machines already have built in some increase in IPAP pressure while we are breathing in, because even when I turn off cflex and systemOne resistance it feels like i'ts amping up while i'm breathing, is that common? It doesn't seem like it's a true CPAP in a way.

it seems to me press 8.0 fixed with X1 would be something like press 10.0 with cflex 2 with x-0, as I don't see difference between how cflex operates and x1,x2,x3 resistance does etc..
I have gotten good results with low pressures on paper, but i never felt good in the morning, when i remove my mask i just want to sleep more without it, and if I do that i mess up my day even more.
my last question is about the flow rate graph, sometimes it looks really fat and sometimes it doesn't (thinner), should I be chasing the fat one, as it seems to me it would signify they are deeper breaths if i'm not wrong?

Thank you for your help! i see you help a lot of people and it seems you guys care more then the doctors out there.

[Sleeprider]

I split your thread from the post by DragonOrcher so you can have a therapy thread focused on your needs, and to avoid confusing advise in a combined thread here https://www.apneaboard.com/forums/Thread...nfirmation

You appear to be using a Philips System One 60-Series Auto CPAP set to fixed pressure of 8.0 with no use of CFlex or AFlex. Your chart needs to be modified to minimize the monthly calendar to show more information in the left pane. The chart above shows good therapy, with few events and well-controlled leak rate. At the current resolution, I can't see enough breath detail to suggest why you are experiencing the symptoms you describe. The Resistance setting does not have much influence on therapy pressure, especially with fixed pressure. Rebreathing would only occur if there is a malfunction in the mask exhaust vent. Some older Resmed P10 masks have been observed not to vent properly when wet. If you have an old mask, or the vent seems obstructed, you might want to update it.

A brief section variable breathing is present at the end, which is a form of respiratory instability often related to changing CO2 levels which affect respiratory drive. https://www.apneaboard.com/wiki/index.ph...tory_Drive Specifically, with CPAP therapy some people experience increased ventilation which reduces CO2 in their blood stream. This can suppress respiration resulting in smaller breaths which increase the CO2 to normal or above normal levels. This increase in CO2 stimulates respiration resulting in larger breaths. This becomes a feedback loop that continues to create oscillations that often self-resolve. This was more apparent in an older image you posted.

[GoodSleepHunting]

           
Thanks for doing it. - sorry i was sending your private messages thinking it was the thread.

I have been experimenting with all possible combinations, utilizing chinstraps, collars, bruxism mouth guards, pillows, pressures, Cflex, and so on. Yesterday, I woke up after 4 hours, feeling actually ready to wake up, not feeling drowsy, and not removing the mask in hopes I will get some rest without it, then dreaming heavily for a few hours, and waking up again tired. The thing is, usually, I sleep for 7-8 hours and still feel this tired, but it seems 4 hours was enough last night.

The big change was the mask; I exchanged the P10 clone (BMC version - small cushion) for the Brevida Large cushion pillow mask and set the pressure to 7 fixed with x1 humidity on 4. I taped my mouth and didn't use the double chinstrap or the collar. I immediately felt how exhalation was much easier with this mask and on this pressure. I even removed the diffuser filter, which made exhalation even easier (at least I think it did), and maybe that made the difference.

My AHI on the Oscar is 3.33, though on some other days, it was 0.10, but I would feel like crap. I know these numbers can be wrong, but it still makes me question things.
All of my days seem to have these patches where periodic breathing coupled with hypopneas is really visible and clear, and my suspicion is that it happens when I change my position and the nasal cycle. If I'm sleeping on the left side, my left nostril closes - it always does. So, I think when I go to my right side, there is a period of time where the right nostril is closing because of the pressure, and the left nostril is still closed because of the previous sleep position and is not yet fully open. This is where the variable breathing is present. The problem is it's not short; it goes on for a while, no matter if the pressure is 9, 8, or 7 or if I wear a chinstrap tightly. I don't go to 10 with nasal pillow masks on CPAP because I feel it's too much for me.
I have placed some pictures with the last night and a picture of the phenomenon I shared.

[Sleeprider]

I'm seeing obstruction in the events posted above. Increase pressure to 8.0. We may go a bit higher.

[GoodSleepHunting]

Hey Sleeprider,

I appreciate all you do in this community. I didn't get back to you for some time from this thread. I experimented with all pressures and all combinations under the sun, and I learned at least a few things that help that are not tied to the machine itself. One thing that is tied is that I breathe best when the EPAP is at 5; any higher and I struggle. Some of the best-looking charts were from me putting 6 IPAP and Cflex 1, but it's not consistent since my nose often blocks during the night, and then it makes 6 IPAP not sufficient. I can see on OSCAR from the really short breaths that I'm struggling to breathe, and the waxing and waning of my breaths are always there at some point in the night.

Now, I always had moderate apnea nothing severe, and from all of the experimentation, it seems to me that the thing I need the most is air pushing through my nose that gets clogged up during my relaxation. So basically, I need a machine that helps me get in the breath and is helping me push air through the nose and resolving RERA's, flow limitations, period breathes etc. more so then purely treating OA and titrating an EPAP pressure to keep the throat/soft palate etc. open. I'm looking into buying a new machine, but I don't want to get the wrong one. There's so much to choose from. I'm leaning towards buying the AirCurve ST.

At least I know what I don't want from my time with Philips' machine, the thing I don't want is that the new machine has EPRs that are similar to C Flex, which only works for me on level 1 with 6 to 5. Any higher IPAP, whatever level the cflex is set, will not be sufficient. C flex + truly gets to EPAP 5 if I put an IPAP of 8 and cflex+ 3, but it's annoying that I feel like I need to initiate the IPAP when I start to breathe, this is what I appreciate with the C Flex that it doesn't jump and when i'm read to inhale there is already enough support but it comes at expense of not providing me a good EPAP, and another thing that is very much annoying with C Flex + that I can't just take deep breaths spontaneously here and there because it will cut me off beforehand.

Now I realize that Resmed's EPR is a bit different and acts as Bilevel, but I'm still not sure if 8 IPAP will be enough for me. Any higher pressure, if I will need like 9 or 10, I risk not being able to breathe out completely when relaxed on 6 or 7 EPAP - which draws me towards the Resmed bilevel machines, but there are so many to choose from. I don't think I will need an auto bilevel as I'm skeptical of the machines catching when I will actually need more pressure since I will just probably have shorter breaths, RERAs, and periodic breathing rather than full-on OAs from my experience looking at OSCAR charts.

So I don't know if I need a ventilation therapy like iVAPS, which I still don't fully get what it does differently to a bilevel machine. I can get a ResMed AirCurve 10 S used (barely) for pretty cheap now, so that is tempting. Then ST another used one for 200 euros more, and then again 200 euros more for a Vauto. Price kind of matters to me at the moment. I can get a used ResMed Autoset for the same price as Aircurve S, a bit less hours on it but both deals are pretty good. But I'm wondering if I buy Resmed Autoset and EPR of 3 will not be sufficient that I will regret it.

I would appreciate your input!