JKan Therapy Analysis

[JKan]

Hey Expat31,

Great link on back sleeping. Thank you for that! You know, I'm glad I did this test the last couple days, because I know there is no way I'm going to sleep on my back anymore. It's good to know you feel the same way about that position for yourself. I'll stick to the left side, I feel much more comfortable that way and fall asleep pretty quickly as well.

My whole problem with my eye is that the straps, tubing, or headgear from the masks I've used so far (F30i, F40, Vitera, P10, and F20) during the night move very close to my eye, thus causing irritation.

I think you may have just solved the issue. An eye patch is genius! I'm going to see what I can find on Amazon and take a shot at it.

Thank you, as always. You have helped me greatly with this experience.

[JKan]

A couple of observations from tonight

During the auto-ramp time, I felt air-starved. I used the F20 AirTouch, and Oscar has me at 0.00 on leaks.

I woke up to pee at 12:50 am. Remembering how I felt at the beginning of the session, I changed the auto-ramp setting to 5 minutes. I’m wondering if I should drop the ramp completely at this point. Last night, I felt no benefit from the ramp at all.

It appears I hit my maximum pressure around 11:30 pm. My FL graph seems to have more activity than normal.

I’m not sure how the whole CA treatment-emergent thing works; is it possible I took a step backward with my “sleeping on the back” experiment?

I have an eye patch coming today, and I am curious to see how that works out. There is the potential to be great when I wear a nasal, pillow, or hybrid mask. I’m wondering if it will affect the seal on a full-face mask. 

Thanks for the help!

Last night, June 15th
   

[Expat31]

- Ramp definitely off, if you can. 

- Experiment on back sleeping - no step  backwards, but you will inadvertently roll over on your back from time to time.

- Too early to comment ln flow limitations and centrals. These things can come and go. 

Let things settle a bit to be able to get a clearer picture..

[JKan]

Sounds great! I'll report back in a few days. Thank you so much!

[JKan]

Hi,

I followed your suggestion on the ramp, and I like it much better off.

Here are the last 3 nights on Oscar; the middle night was a little rough. I went through a few masks that night. My mask trial with the DME just ended, and they wanted to know which one I wanted supplies on going forward. I was down to two: the AirTouch F20 and the F&P Vitera. I was having some aerophagia lately, and I zeroed in on it happening with the F20. I am shelving that mask and told the DME to supply the Vitera. The P10 I have had the most success with, and since the cushions are only $22 to purchase, I will pick those up myself when I need them and let the DME supply the $54 Vitera.

I was surprised to see that I hit the maximum pressure that night—the first time that has happened. I'm blaming the F20; what do you think?

Last night was the best sleep I've had since starting therapy; I spent close to 7 hours sleeping. I feel pretty good this morning as well. I was surprised I had so many CA's though.

Aside from June 14th, back-experiment day (maximum pressure was 15 that day), I have had the same settings for the last 11 days. 
10 minimum
13 maximum
3 EPR

June 16th
   

June 17th - multiple mask night - started P10 -> F20 medium cushion -> F20 large cushion -> Vitera
   

June 18th - Last night
   

Thank you for your time, guidance, and advice!

P.S. I returned my O2 ring yesterday. I was disappointed in it's use. I thought I'd better get my money back before it's to late. I would like to get something else in the future, but I need to do some more research on what model to buy.

[Expat31]

Hi, 

The maxing out of your pressure is easily explained by glancing down at the flow limitation graph, you will see they are directly related. 

You may know there is a quick way to find which session is causing the problem, you can isolate any session by clicking on the coloured boxes under the settings, which will disable that particular session. You will be able to see the impact in the statistics window immediately .
So obviously you start by clicking on all but one, then work systematically to find the culprit session.
When finished, you click again to reactive each one.

Regarding the F20 Airtouch, I have mixed feelings now on the mask that I used as a backup for when I needed a break from mouth taping with my Breveda. For some illogical reason, I hyperventilated with it, so now it's parked in a drawer! 

You did well on your last night sleeping right through without a break. I don't think you should be concerned about centrals. Some of it can be explained by a cluster just before waking, and could be either positional, or simply just sleepawakejunk.

The 02 ring has done its work in establishing that your oxygen profile is normal. However I think it is good to have eventually some sort of device, so as to be able to check from time to time.

It's a prudence move.

[JKan]

Ahh, I see what you are saying about the correlation between the pressure graph and the flow limitation graph.

I just woke up from a nap and probably slept 30 to 40 minutes out of the hour+ I laid down for. I still take a lot of naps, hoping to get away from that in the future. My wife takes a nap most mornings around 8 (she gets up at 3 am), so I just lay down with her.

When I just woke up, I came out of a very vivid dream, and I recalled the last several minutes of it. I remember you telling me that sometimes you can see evidence of the dream in your resp. rate graph. I made a close-up of that time on Oscar. I believe I was in the dream at the time of that tall FL line at 8:52. I so rarely remember my dreams; it seemed very real while I was in it.

Here is today's Oscar with the nap added, plus a close-up of when I was dreaming.
   

Close-up of dream with resp rate
   

Honestly, I think I felt better coming out of the main sleep session than I do coming out of this nap. I still feel good, but I think I felt better this morning.

[JKan]

I've been having some aerophagia lately; I backed off my minimum pressure by 1 cmH2O for a couple days. I have felt better since the reduction. But my events did increase during those days.

I pieced together a Dreamwear nasal cushion off of Amazon a couple days ago. This is the only type of mask that I haven't used yet. It looked like it came from Phillips, but it did have a strange chemical smell. Yesterday was going to be my first night with it, but the scent was too strong, so after 45 minutes I had to take it off.  I gave it a thorough washing yesterday, and it did the trick, as I used it for the first time last night and I didn't smell anything odd.

I brought my pressures back to where they had been, 10/13 EPR 3, and ended up having a pretty good sleep.  I had several arousals and a big leak around 11:38, but was able to get back to sleep easily. Despite being on the leaky side, I feel the first run with the Dreamwear nasal was successful.

aerophagia adjustment days
          

Last night with new mask - normal 10/13 EPR 3
   

[Expat31]

Hi, 

You seem to have a pretty good handle on your therapy,  

The first two nights you had some positional apneas that pushed up your AHI a bit. 

Minimum of 10 seems to being the job just right, keeping hypopneas and obstructives under control. 

There is not a lot that  can be done with centrals, as you are already at maximum EPR. 

However reducing the gap between  minimum and maximum pressure can sometimes help reducing excessive centrals if they are caused by flushing out carbon dioxide tricking your brain into stopping breathing as thing not nessarary. 

But in your case I don't think it is relevant, as especially as demonstrated in your last night as you only had 4 centrals, with a total time of 55 seconds. That I think is nothing.

As I noted previously, they come and go as they please. Often without any rhyme nor reason, (excluding any side effects of some prescription medicines or other health issues). 

You are really well and truly on the right track. 

You will find that there will be ups and downs, but now at least with OSCAR you have the tools to see what is going on. 

Information is, as always, the key.

[JKan]

Hi,

I've been doing some testing the last couple weeks, experimenting with lower minimums, tighter min/max windows, and EPR 1, 2, 3, and OFF.

Last night, I think I had the best night of sleep so far in the two months of therapy. I don't focus on the AHI so much (I have been under 0.98 for the last 10 days) and try to be more objective about how I feel in the morning. I do have a few events, and my flow limitations are higher at times. In general, I feel more rested, and I have been sleeping longer in recent weeks.

Here are a few Oscar charts
all of these snapshots were taken over several days with similar numbers

June 26th: tried a tighter window with a lower minimum - 8.8 min 9.2 max EPR 3  (ran this setting 3 nights in a row)  AHI - 0.98   7 CA's, 1 OA, FL 0.08
   

July 2nd: bigger window, lower EPR - 8.0 min 10.0 max EPR 1 (ran this setting 3 nights in a row)  AHI - 0.14  1 CA FL 0.09
   

Last night, July 7th: fixed rate of 9.6 min 9.6 max EPR OFF (ran this setting the last 3 nights with similar results) 
Last night was probably the best night of sleep in the last 60 days. I had no urge to pee during the night and slept for over 8 hours.
For the first time in a long time, I don't feel like I need a nap.  AHI - 0.48  2 CA's, 2 H's, 1 RERA FL 0.15
   

so far so good, I look forward to figuring out flow limitations. I am enjoying having a better attitude and feeling more rested lately.
The journey continues...

Thank you for all the help!!!