Feeling like I cannot breathe

[Jay51]

Thank you for posting those charts Victoria.  

Here is a quote from your post on 10-1, "I forgot to wear my neck collar last night.  The night before my CA was 1.30 and my OA was 0.43, and my hypopnea was 0.14"   My suggestion would be to try to replicate this exact set up.  These are the best results I have seen from any of your posts ever.  

In regards to the OSCAR charts you just posted, are you able to lower the PS to less than 4?  I would suggest trying lowering it to 3.8   Then possibly down to 3.6, etc.  Even 3.4 and 3.2 if necessary also.   Lowering the PS should help lower CA's IMO.  

I am glad that you found the new portable oxygen concentrator.  

[vgrando]

I think that the big difference was that I was wearing the F&P Evera FFM. When I was at the conference for the first week in October in Washington DC. I used my AirSence mini because I could put it into my backpack, and it was not heavy. I used the ResMed N20 because it allows adding this little disk to the mask to improve humidity. I loved it because I could breathe so much better with it covering only my nose. The nasal mask allows the air to flow directly up my nostrils. With a FFM, the airflows towards the mouth. Thus, I feel like I cannot breathe well. I think that the more I can lower the pressure, the less leaking I will have. I have not been sleeping well at night. The clusters of CA occur when I am awake. In fact, when I turn off my 02 before I take off my mask my 02 ring starts to vibrate immediately at a low of 87%. What do the PS numbers mean? Most of the time with the BiPap my medium tidal column is between 300 to 340.

[Jay51]

Thank you for explaining all of that.  I am glad that you like the N20 mask.  Hopefully you don't have any major leak problems with it.  PS is pressure support.  It is the pressure added to your current EPAP setting.  Say your EPAP is at 9.  With your PS of 4, that would mean that when you are not breathing, the pressure will stay at 9.  When you start to inhale, the PS kicks in and increases your pressure to 13 (9 epap + 4 PS) = 13 (IPAP).  This extra pressure when you are inhaling can make it easier to breathe.  The only drawback to using a higher PS is that it can cause some central apneas by causing you to flush more co2 out of your system (that causes your drive to breathe to get weaker with less co2 now in your system).  

I am glad you stated that all the CA's are when you are awake.  You don't have to reduce the PS then.  You could possibly even try increasing the PS if it does not cause anymore central apneas while you are asleep.  Increasing the PS may give a little boost to your inhale also and increase your tidal volume slightly (the added pressure support).  

And then of course as you start to exhale, the PS stops and you drop back down to your epap pressure to make it easier to exhale.  Higher pressure goes in the direction of lower pressure if it can.  In a tube filled with air, if pressure is higher in one end than the other end, the air will move from the higher pressure towards the lower pressure because there is less resistance.

[Jay51]

The trigger setting is set to high right now I think.  If you start getting more central apneas during sleep (not when you are awake), then setting the trigger to very high will help stop central apneas even more by triggering more breaths.

[vgrando]

Finally, got to see the ENT. She said that I had collapsed nasal valves and a deviated septum. I could have surgery but she does not want to do it. Long surgery and painful recovery. She wants me to use the nasal cap that I am using and not to use a nasal dilator.

[Jay51]

Thank you for posting that Victoria.  I hope that works out for you.  How has your therapy been going with the VAUTO?

[vgrando]

[attachment=56646][attachment=56647][attachment=56648]

Hi, 

OK, but I do not know how to judge. 

I am trying to sleep comfortably because I still wake up often. So no more mouth tape or no neck brace.

I am on 02, so no desaturations. I have more leaks with the nasal mask, but most of the time, leaks are in the mid-teens.

My apnea score is low, between 2 and 3. Very few OA, mostly CA.

I am attaching last night's chart for you to assess.

[Jay51]

Not too bad charts IMO.  I remember where you started from:  lots of CA's and a few OA's.  One change would be to raise your max EPAP to 15 (or even possibly 16).  You are bumping up against 14 pressure; so a little higher might help.  

Also, with the CA's, lowering PS to 4 might decrease some of them, but it is a balancing act.  You have some significant flow limitations, and the higher PS should help these.  I am not sure that the PS can go up to 6 on the VAUTO, but maybe trying 6 if you can might reduce flow limitations even further; but you would likely see more CA's.  

Comfort and how you feel in the morning are also big.   Maybe try these 2 (or 3) changes if you want to.  If anyone sees anything else that would help here feel free to post.  

The supplemental O2 should keep you oximetry pretty good during sleep.

[Jay51]

Did you set the trigger to "very high"?  That might help reduce your CA's even more (by triggering more breaths).

[vgrando]

Will do