First time therapy, settings and progress

[BoxcarPete]

Clusters aside, your night looks a little better overall. You mentioned using nasal steroid spray for congestion, have you considered an evaluation by an ENT for "hard" nasal obstructions? In my opinion, your choice right now is to look into nasal surgery (if clinically indicated) to open things up and get your nose working well enough to properly use a nasal mask, or move towards bilevel where the machine can help you push the air through despite the lingering resistance. Try a couple more FFM if you have them ordered, but good nasal breathing is the ideal solution and I believe an evaluation should be at least considered.

[Schernenk]

Clusters aside, your night looks a little better overall. You mentioned using nasal steroid spray for congestion, have you considered an evaluation by an ENT for "hard" nasal obstructions? In my opinion, your choice right now is to look into nasal surgery (if clinically indicated) to open things up and get your nose working well enough to properly use a nasal mask, or move towards bilevel where the machine can help you push the air through despite the lingering resistance. Try a couple more FFM if you have them ordered, but good nasal breathing is the ideal solution and I believe an evaluation should be at least considered.

I have been taking Nasonex (Mometasone), a steroid, for ages but I don't think it is as effective as I thought.  It's like anything, a person can really get used to something and think it's normal, I thought I was pretty good until now.  I think on my best day I'm probably 20-30% constricted compared to the average person.  That's not a clinical diagnosis mind you, just based on taking a shot of Dristan the other day as and experiment since I never use that stuff, the difference as like night and day.  Then I started comparing to people around me and I'm saying "whoa, my idea of a clear nose isn't even close".

I spoke with my GP earlier this week and got a referral to an ENT, that's the process up here.  The closest one is 4.5 hours away and I'm likely looking at months just to get in to see him, so I'm left with a full face for now, or I guess trying a bi level if you think it is worth it.  I am fully into surgery if he deems it necessary, if I can naturally feel like I did after the shot of Dristan I would have surgery tomorrow.  The question is the wait time, could be months for a consult, then many months more for a procedure.

I can try some more FFM, but the Evora seemed decent last night, though under my nose is a bit red....the DreamWear I didn't like.  I am sure I need a few nights with the Evora to get a good read, but could tell right away the DreamWear mask wasn't for me. 

I really feel as though the first few weeks with the nose pillow my O2 levels at night were low due to the restriction in my nose, probably why I had so many mouth leaks too.

[UnicornRider]

Do not ever think you're a PITA, we are a loose group of individuals trying to give back, meanwhile we have daily activities of living to attend to so we get back when we can.

You have been into this for ~ a month now. You are coming along. That Wiki article on positional apnea is a good lead I would have recommended had I gotten back before Expat31 came through with his recommendation.

 So I am going to assign some homework. I have not explained why you need to leave out the calendar when you post screenshots of OSCAR. It provides no additional information and pushes needed information down out of the view of the screenshot.

The Guide always a good starting point and good for referring back to:     

• OSCAR - The Guide
    
  

How to organize your chart, it helps us help you.
    

• OSCAR Chart Organization
  

CPAP Friend, is a forum member here and a fellow Canadian of yours, he has put together several very good  YT videos. To help you navigate OSCAR I recommend the following:

    https://www.youtube.com/watch?v=32JwMc6dphQ&t=2s

    https://www.youtube.com/watch?v=ujaoKvBnP00


And just to let you know that you are not alone, and perhaps to give you an idea of the path ahead of you, here is a recent post of CPAP Friend that will explain the journey he has been through.

    https://www.youtube.com/watch?v=L_WqxuYrXnA

Do not get discouraged, we will guide you to the best you can do, with the machine you were provided, and guide you to the best machine for your current needs. Over time your needs will most likely change, mine sure did and I expect it to change in the future.

This may seem like a lot to learn, but it will come with time and repetition. I had to review a lot when I first started. I still review to freshen my memory and understanding.

[Schernenk]

Thank Unicorn!  Yeah, I realize this isn't everyone's day job, I guess that's why I worry about being a PITA sometimes but thank you nonetheless.  

On the date thing, you did tell me and I have had it off normally (previous screenshots) but it got turned back on yesterday somehow, thanks for the reminder though, I shut it off and did a small amount of re ordering on the Oscar chart.

I will review all of those videos, and get my homework done this weekend.

Now to everyone who suggested positional apnea...I did a small test last night.  I remembered I had a "shaped" pillow I got from a chiro, it is dipped with support for the neck.  I don't have a cervical collar so I thought it was worth a shot, I think it had a positive affect!  Now I had a few beers last night with a friend but if anything I suspect that would have worsened things, I think the chart below speaks for itself, the cluster at the end is pretty much me waking up.

Have a great weekend everyone!

[Schernenk]

Hey Team;

I have been off the wagon for the last week or so and wanted to touch base.  About two weeks ago I did a bit of research on my own and communicated a bit with CPAPFRIEND, his videos and others have been quite informative.  Coming out of that and after speaking with CPAPFRIEND I thought I would look for a used BiPap machine to try, without having to invest much, and I was lucky enough to find a good used one close by for $600.

Long story short, I used it for several days, and while I felt like I slept through and it was quite comfortable, the sleeps were not restful.  I took the last 6-7 days off of any PAP therapy for various reasons, but am keen to get back at it and start playing with the settings a bit.  Now I know BiPap isn't everyone's specialty but I was hoping you could have a peek at the attached Oscars.  The AHI and leak rate not withstanding (I continue to play with pillows and have purchases a soft cervical collar), can anyone comment on the shape of my flow rate?  My understanding is that the goal should be a nice fairly rounded curve, but on the BiPap, for the little I have used it, I have fairly sharp peaks.  I believe this may be contributing to micro arousals an lack of REM sleep.  I am going to try some expiratory and inspiratory pressure settings over the next few days.

The Oscar 4 attachment shows a zoomed view of the curve.  It will only let me post 3 attachments so I will post the fourth separately.

[Schernenk]

Here is the fourth OSCAR to complete the images.

[Sleeprider]

The Aircurve 10 ST is kind of a different animal than the VPAP S or Vauto. It does not have the EasyBreathe algorithm for IPAP/EPAP pressure transition and uses a square-wave pressure transition we can affect with rise time, but certainly not the equal. In S-mode it provides fixed pressure bilevel therapy, and in ST mode you can select a backup respiration rate to stimulate breaths if you have centrals. Based on these results, you need a higher EPAP pressure to resolve the UA (obstructive) events and more pressure support for the hypopnea. I think we should consider using the ST mode with a backup rate of 13 bpm just in case there are centrals. My honest assessment is your CPAP with EPR gave much better results than this, and I'm waiting to hear you thought it was more comfortable as well. I think this particular flavor of bilevel is a mistake. I mean you are throwing this out for the ST? I hesitate to even make suggestions unless you can upgrade to the Vauto.

[Schernenk]

Yeah, I dunno, I'm a bit lost at the moment.  I was starting to show good OSCARS on the AirSense APAP but definitely not feeling good or rested in the morning.  It was suggested that I watch some of CPAPFRIENDS YouTube videos and I did.  I found them very informative to the point where I thought what the heck, I'll pay $70 and do a Zoom call with the guy.  It was a good conversation and he reviewed my OSCARS in depth and figured there were lots of microarousals going on and that they could very well be the reason I wasn't feeling rested on APAP.  

He figured maybe I could find a used BiPap and see if that helped before going whole hog and buying new.  Also I started following another fellow on YouTube "ThatLankyLefty27" who also seems to be a big proponent of BiPap.  When I found a used BiPap close to me i got excited and this ST BiPap was advertised as an ST Vauto, when I got it I realized it was just an ST, I was a little disappointed but figured it would suffice...I guess not.  

Anyway, here I am, the BiPap is obviously not working as I'd hoped, not yet anyway, and the ST feature set has some holes in it, I kind of new it wasn't as good as a VAuto but didn't think it was that bad either.  I was feeling so exhausted there after a few days of BiPap therapy that I stopped therapy so I could keep it together for my daughters soccer trip last weekend.  I can try the settings you suggest or just go back to the AirSense and see if things improve.  At the end of the day I am a bit frustrated and willing to go all out and get the VAuto BiPap if things don't progress.

I also have what I believe to be chronic Sinutis that has gone un diagnosed for years, who knows how long before I see an ENT though, I'd like to think that isn't the source of all my troubles.

[Schernenk]

I went back to the AirSense 10 last night and tried to narrow my pressure window, down to 10 over 9 and at this point I have turned off Ramp.  I think from the surface the chart looks really good but I am just not getting that restful sleep, not yet at least.  

My understanding is i want the flow rate to have a nice bell curve on top, at least as much as possible and it was pointed out to me that many of mine have a flatness to the top of them and those little bumps over the top of the curve could be snores or something else.  Also my flow rate tends to be a a bit spikey, with lots of little events that aren't obstructions but microarousal's of some kind.  You'll see on the surface the numbers look good, I just don't feel good yet.  This is why Bilevel was suggested to me by CPAPFRIEND, the EPR did have a significant improvement for me when I turned it on way back and he thought it could help round out those peaks on the flow rate and maybe elminate what we though could be a bunch of little arousals.  

I attached last night's OSCAR data and a zoom of some of the flow rate in another reply.

[Schernenk]

Zoomed flow rate