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I had many discussions here trying to improve the results with my CPAP therapy. The conclusions were some concern about positional apnea and possibly changing my machine for a Bi-Level one. I got a rigid cervical collar but did not change my machine (yet).
My research brought to my attention the possibility of a problem with my lower jaw. I got a MAD (mandibular advancement device) to try. I just got one from Amazon, not from my dentist. Since I have used it, my results have improved drastically. See the table below.
Data obtain from Oscar Statistics:
[attachment=43306]
With the CPAP, I wear a rigid cervical collar and the MAD. The collar really forbids my head tilting forward.
With all the above, I sometimes get a higher IAH peak for a short time in my sleep. See screen capture submitted.
My question is should I forget about those peaks or still try to find the cause and a remedy. I can provide more screen captures and information if it would help.
I'm impressed with the improvement from earlier threads I saw. It seems you still have some positional related flow limitation that drives your pressures higher and in this case increased events at the onset. Your pressure remains high for the remainder of the night. Looks good, and I don't know that you could do more without transitioning to an Aircurve Vauto.
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
Thank you for your input, it helps me search for perfection. I know, I know there is no such thing.
More seriously, can you tell me how the Aircurve Vauto would improve my flow limitation results.
My research tells me that in my case, to improve I should quit smoking and loose weight. I smoke a pack a day, I weight 230 lbs and measure 5' 8".
I am not certain my will would be strong enought to lose the weight and quit smoking.
Also, to get the Aircurve Vauto seems to be problematic in Canada, you need a prescription.
Dan, the Vauto allows us to implement more pressure support (PS) than the EPR which is limited to 3-cm. This gives you a mechanical assist using higher inspiratory pressure to help shorten inspiration time, which is the crux of flow limitation. We want you to get to the peak flow smoothly and quickly, then release that pressure to allow full exhale. As a smoker, you have considerable risk of obstructive pulmonary diseases and this may be a factor in your residual flow limitation. I think if we focused on your flow rates where the events begin, and after, we would see longer time of inspiration there that PS could help overcome. As you can see from my profile, I use the Vauto and I'm a strong believer in its benefits, however, in Canada it will be very difficult to obtain authorization for the device without a diagnosis of a significant comorbidity like COPD.
As far as quitting smoking, a pack a day is not an insurmountable habit. There are lots of prescription therapies to ease withdrawal from the nicotine, and in Canada you have access to CBD. The best way to get past it is during a trip or vacation where your routine is disrupted and you have less tendency for the habitual, "now it's time to smoke". It's not will power, it's a change in attitude that you're not a smoker. Most of the challenge in quitting is mental. The tough part is first few weeks of withdrawal from addiction, then the attitude change that you can't have even one more, ever. I dealt with the same thing myself and like most reformed smokers, have a strong dislike for being around cigarette smoke today. A common consequence of quitting is weight gain, so if you can quit smoking without gaining, that would be a win. It starts with confidence you can do this, and you can use medical and online support to see you through the process.
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
The logical starting point is EPAP min 7.0 IPAP max pressure 20.0, PS 4.0. This resembles your current pressure profile, but with 4-cm pressure support. More PS can be evaluated as needed to make breathing easier and reduce upper airway resistance, pulmonary resistance and respiratory effort related arousal (RERA). As a smoker, it would be logical to request a pulmonary function test at your next appointment. These are routine evaluations that help the doctor to track changes in respiratory function and to diagnose early emphysema, asthma and other pulmonary issues related to smoking. It simply involves blowing a full breath into a spirometer and recording the flow rate/time to measure pulmonary compliance and elasticity. In addition to detecting any issues, this may be motivating to quitting smoking, and if you do quit, can help you see the measurable benefits.
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
Quote:I think if we focused on your flow rates where the events begin, and after, we would see longer time of inspiration there that PS could help overcome.
I found that I could print a report from OSCAR that shows what you mention.
I am submitting the report so you can check the wave forms.
The information can be displayed in the Oscar Daily Details by selecting the view menu/reset graphs/ Advanced view. Set it up to contain:
Events
Flow Rate
Mask Pressure
Tidal Volume
Minute Vent
Inspiration Time
Expiration Time
Flow Limit
It's an interesting view that can inform you on what is really happening with your respiration when events or flow limitation happens. I can show you an example from my data. In the attached image you will see increasing flow limitation at 03:23 with tidal volume and flow rate all diminishing. At 02:23:25 this results in a clear arousal and increased "recovery" breathing. There a many variations of this, sometimes with changes in very little change to inspiratory time but static tidal volume and minute vent, or in my case, the volumes drop with increasing flow limitation. Either way, we can interpret that obstruction or effort results in an arousal.
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
Those views are as expected. During events there is a lot of variation, but your minute vent is surprisingly consistent. You have a lot of flow limitation indicated, and if you can post a zoom of the flow rate, perhaps we can discuss it and give you something useful for the doctor. As I said before, the resolution of flow limitation is usually much better when using bilevel therapy than CPAP with limited EPR.
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
