I'm baaaack!

[HalfAsleep]

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I disappeared for a month while I made some adjustments and got some clarity about where I am.

I discovered this is true consistently:

—I had to reduce the top number to 13 from 14 (14 was the Apneaboard recommendation), because at 14, my mask was blowing off my face.
—At about 5 am (or 5 hours into sleeping) my sleep changes. I get CA's, the top number holds steady at 13, the mask leaks after behaving all night, and I have developed a snore which I never had before. How does Oscar even know you're snoring? I could be gagging? Smacking the mask? Yelling at the dog? Having a nightmare?
—I often can't continue with the mask when I get to 5-6 hours total sleep: it's possible it's too messed up to keep the mask on.
—I slept on my back and wore a cervical collar for all these 3 Oscars. I have an almost flat pillow. I have other reasons for not being able to sleep on my side, but also, the mask knocks off.
—I tried a nasal mask somewhere along the way, but only for about 30 seconds. I have a condition on my face which doesn't allow me to wear a nasal mask.

I had my follow up visit at the Sleep Center yesterday. They had never seen Oscar before, and were not unimpressed with the amount of info I had. I was shocked how little info they had from my unit: a vague chart. When I held to the observation that my sleep was messed up after 5 am, they decided on a new titration. They will titrate an ASV.

Interestingly, the sleep PA didn't understand that a biLevel didn't have to be fixed settings. They were quite shocked when I showed them the 160 CA's when I had the setting fixed.

[Sleeprider]

Welcome back! I find it interesting that you trust an organization that is clueless about Vauto to titrate ASV, but that might just be me. ASV titration is like...set the machine to default recommended settings in ASVauto and see if it works. I usually results in zero or very low AHI.

[HalfAsleep]

The sleep tech is fab at the Sleep Center where I've been going. The other staff are good at listening and very gracious. The PA, who is their go-to, didn't seem to know a whole lot, but she's the authority there on-site: IMO in practice, it doesn't matter what she knows or not. Her only job seems to be to triage, order sleep studies and be a good listener and sign compliance documentation. However, there's a separate doc who writes the prescription. He definitely has a clue. He even called me at home to follow up with my last sleep study.

I'm not really concerned about the Sleep Center. As far as the technical readings and monitoring, those belong to the 2 sleep techs. The first sleep tech (about 2 months ago) was fantastic. He told the doc what to prescribe and that the main issues might be centrals during REM under pressure, and this would take follow up: exactly where I am. I had no REM mask-on at the last sleep study, and that's what he projected. He eliminated CPAP, put me on a biPAP (very quickly), and said "wait and see" how that would work, and go from there.

The techs are given serious attention in their department and IMO know their stuff. The tech actually wrote the bulk of the sleep study.

The main job of the PA and the lower staff member I met with is really to confirm compliance. That's their total obligation, since they have to satisfy Medicare. I'm pleased that they listened enough to refer me on to a more advanced titration, even though, as they stated, I am getting an A+ on compliance, and the numbers look great. And I'm pleased there's a plan in place.

If I get an ASV, it has to be through Medicare and supplement. There are hoops.... The PA can't just give me one: she said she has to motivate it. On the other hand, she brought up the ASV idea, not I. Good sign that she's open to the idea.

[HalfAsleep]

@Sleeprider...My other question. How does Oscar interpret "snore", since the unit doesn't have ears or feel vibrations?

Lol, I did get a little wild in my sleep, and my AppleWatch thought I had fallen, and since I had fall detection on, the watch offered to call 911. And started counting in case I didn't respond. Good thing the buzz woke me up, so I could abort the call. Otherwise, I might have been woken up by the fire department in my driveway.

[HalfAsleep]

My current Oscar. 3 months in with the biPAP. I have been watching overall trends for the last few weeks to see how things settle out. I'm posting a bad night and a better night. My AHI is occasionally under 3, but it's been trending upwards.

Many nights I get much longer uninterrupted sleep than I have for years. My bathroom breaks are much more reduced, which is also interesting. However, I have a pattern of my stats going hyperactive after about 5 in the morning. Almost all my AHI occurs then (so my average is kinda irrelevant).

My snore line has become really active, but I don't believe I snore at all. But, as I look at the snore profile, it is almost an echo of the mask leak profile. I'm thinking the F40 might vibrate and create a snore effect, especially the divider under the nostrils.

I am not concerned about a leak here and there: sometimes I need to scratch my nose. However, the mask gets very leaky after 5 am.

Settings changes?

   

   

[Jay51]

I see a correlation on your chart between leaks and CA's.  When you mask starts leaking, CA's slowly start to increase.  Great job noticing the leaks and "supposed" snoring increase.

[HalfAsleep]

Thanks @jay51. Yes, it goes like that. All the action is after 5 am, almost on the dot: leakage, at least some CA's, high pressure. Some mornings, at 7:30-8, I toss the mask off: I'm likely in the midst of a "difficult to breathe" episode. But all these elements are interacting, so I'm not sure which variable to maybe adjust. My OA's have become not very significant to my sleep experience IMO. I rarely get hypopneas, but I notice several on one of these charts.

One idiosyncracy of the F40. It sounds like it's leaking sometimes, even when it's not. I know it's not, because I can trace the edges with my finger and not hear hiss-back. However, I could in my sleep be responding to the sound of "leak", and other times to the fact of "leak".

[HalfAsleep]

Could I please get settings input relative to my Oscars?

[Phaleronic]

I'd raise your max Ipap to 15cm and raise your timax to 3.4.

[HalfAsleep]

Is there some fine tuning I could do for this chart? It's pretty typical. I've been feeling tired again lately.