First time therapy, settings and progress

[Schernenk]

Thanks for the reply and the info BoxCar, means a lot. I just need to get a few weeks under my belt I’m sure. 

Should I boost the lower end of the pressure range?  Or just boost the ramp pressure a bit?

[BoxcarPete]

Both if you can handle it. If you wake up burping and farting you'll need to back off, but otherwise most of the time increasing pressure is no big deal once you get used to it. With min pressure, at this point small changes are good, no more than 1cm at a time and we'll see if that helps you cycle a little more air overall.

[Schernenk]

Boosted pressure last night by one on both ramp and lowest pressure setting.  It felt fine but definitely had more leaks last night, could be mouth breathing or that I slept weird and lost a seal.  The only new thing is I show a small amount of RERA, I haven't seen that before, I gather it is just another form of APNEA.  I thought last night went well until I saw the OSCAR this morning.

[BoxcarPete]

Definitely looks like mouth leaks. Are you still using tape?

Don't think that last night went poorly just yet. Your initial impressions when you woke up along with your chart tells me that you likely got more deep sleep which you needed. RERA are not a form of apnea, it is an indication of sleep disturbance caused by respiratory effort, hence the term Respiratory Effort Related Arousal. I can see from your charts that you have been having these all along (arousals that were not necessarily related to acute respiratory effort), but you have only just now met the criteria for your machine to flag them last night. You can go back to previous nights and see as many or more spikes, but most importantly you have a good solid 40-50 minutes of undisturbed deep sleep last night which we weren't seeing previously and I suspect that was a factor in why you felt you had a more restful night until you logged into OSCAR.

[Schernenk]

Great, thanks!  Yeah, I feel pretty good so far this morning, a bit of sleep inertia I think but as that wears off I feel reasonable.  No mouth taping at the moment, I had a pretty rotten night the night I tried it, I may give myself another few days to acclimate to the APAP and then try it again.  When you say you can see a sold 40-50 mins what exactly are you looking at on the OSCAR?

[BoxcarPete]

Look at the time from 23:00 to 23:40 and count how many times the flow rate spiked significantly above the average breath. Then go back and do the same for some of your older charts, looking at the first hour to hour and a half of sleep and do the same. Find the longest chunk of steady breathing on each of your charts within the first four hours of sleep, and according to what you've shared so far here I don't think you'll find any as long as the 40 minutes you got last night. Your wearable device also reported a lack of N3 deep sleep when you used it if I recall correctly.

Deep sleep is the steadiest your breathing should ever get. If it's spiking, the most likely explanation is that you are waking yourself up to a lighter stage of sleep to get air. If there's no clear indication of why this is happening it can be hard to trace back to a root cause, so we will have to make some guesses to see what works and what doesn't.

[Schernenk]

OK, that's great info, I see the flow rate, the tidal volume, resp. rate were all very even for that time.  Guess what my fit bit told me this morning?...exactly 40 mins of deep sleep from  23:07 to 23:42    That's wild...the Fitbit would basically be tracking heart rate, movement, maybe basic SP02 but that correlation is uncanny.

[BoxcarPete]

Just goes to show that a blind squirrel can find a nut every now and again, eh? Now, whether the blind squirrel is me or your wearable (or both) is another question entirely...

[Schernenk]

Love the analogy LOL

Have had the increased pressure and tolerated it well for a couple nights, I may give the bottom numbers a bump again tonight by 1. I may actually shut the ramp feature off, I don’t know that I need it, I seem to tolerate the pressure pretty well. 

Would the ultimate goal to get the min pressure fairly closer to my average over a period of time?  That will be under 10 I think. 

Again, burps are gone, tolerating the current settings well enough, maybe some mouth breathing still and I will attempt mouth taping again this week.

[Schernenk]

Last night I did mouth tape, I didn't entirely cover my mouth but did about 3/4 coverage, I figured it would be enough to at least keep my mouth shut, I also upped the pressure marginally.  I tolerated both well BUT still show some pretty good chunks with leakage.  The mouth tape didn't come off so I'm assuming they were actual leaks, though I can completely cover my mouth tonight and see.  Also a bit of weird night with a good cluster of events (most of my nights have shown under 1 AHI).  I ended up taking the mask off at about 3:15, I had a "blow out" where the tube got caught on the bed and pulled off of the mask, I was too out of it to put it back together.