Khavoqi - Therapy Thread

[OpalRose]

Khavoqi,
In order for you to receive more targeted advice, I have combined your OSCAR threads. This keeps your history in one thread and makes it easier for those wishing to advise.

Starting a bunch of separate threads will hinder advice.

Please, going forward, post your OSCAR graphs and questions here in this thread.

I also edited the Thread Title.

[Sleeprider]

Looking through your charts, there is surprisingly little difference of AHI between the nights. You tried no EPR on July 5, and all of your other charts are EPR 3. I think it's worth trying the same settings from July 2 with minimum pressure 7.0 maximum pressure 11.0 and EPR 2. There really is nothing that stands out as a problem with your therapy, so we are left with some trial and error to find what works and is comfortable.

[Khavoqi]

Hello again.

The last couple nights have been somewhat hectic (family emergency one night, then a power outage till 7 AN the next), so my data isn’t all that conclusive, but, at least from how I felt subjectively, reducing EPR doesn’t seem to be the way to go.

I also tried shifting the pressure range up by 1 cm to 8-11, but that doesn’t seem to do the trick either.

I think I’m just going to stick with my 7/2 settings (7 - 10.6 with EPR 3) and ride it out from there. I felt the best that night, and maybe I just have to stick with one pressure range to see consistent results.

One thing that does concern me are my wave patterns though; I seem to be getting a flattening of them. What does this mean in terms of pressure and my therapy?

I wish I could attach screenshots, but unfortunately I’m on my phone right now.

Thanks.

[Sleeprider]

Generally a flattening of inspiratory peaks indicates a flow limitation in peak flow just before exhale. This represents a bit more inspiratory effort. Mos t doctors and therapists are completely oblivious to the finer details of respiration like flow limitation, but it can increase arousals. With EPR you are limited to 3-cm of pressure differential between inhale and exhale pressure, so you have already maximized pressure support. With bilevel, pressure support greater than 3 is possible along with some timing and trigger/cycle controls that usually eliminates flow limitation.

[Khavoqi]

Thanks for the insight. If that's the case, I might try getting a bilevel through my insurance then. If not, I guess it'll be time to try Airbreak 

Also, one other thing. My data from last night looked disgusting, and, if you don't mind, would you be willing to go through it and recommend certain adjustments based off of it? I think I may have set the pressure limit too high at 11.0 cm, and, like you said, may need more EPR / pressure support based on my flow limits. I guess I also need to work on my mouth taping rig, as I keep on getting leaks. Not 100% sure if those were caused by the mask getting loose or actual mouth leaks though. Anyways, here's the link to the data: https://sleephq.com/public/84d1501d-b6c1...b32ac9199c

Thanks again for all the help; it's giving me much needed hope that I'll get better

[Khavoqi]

Hello again.

I'm still in the process of figuring out whether or not I can get a bilevel through my insurance, so for right now, I'm stuck with my Airsense 10.

I tried changing the pressure to a static 7.4, as that seems to be where my breathing is most consistent. 

Would y'all mind going through my data? For some reason, at the beginning of the night, I seem to have a huge tidal volume with weird breath patterns, shown in the first picture. I also still seem to be taking off the mask at night, something I have absolutely no memory of.
https://sleephq.com/public/36442c5d-a4b3...7224933579

How do I keep the mask all through the night, and what do those weird breath patterns mean? I did some throat, tongue, and jaw exercises yesterday that were supposed to open up your airway and help with sleep apnea, and I'm not sure if those significantly thicker (as in tidal volume) breaths are a good or bad thing.

And, one last question. Do most people usually need two different pressures for REM and non-REM sleep? With my Autoset data, I keep on getting an increase in pressure about every hour or so. If I wanted to use a static pressure, would I need to set it at my REM sleep pressure in order to get maximum benefits? 


Thanks.

[Khavoqi]

Could y'all help me out please? I have my data from last night, and I still seem to be getting the oddly thick, deformed wave patterns. Here's a link to my data:

https://sleephq.com/public/b5f64fa5-2c4d...68a93670a7

Also, despite taping the mask on my face, I still seemed to rip off the mask with me having no memory of it. What am I doing wrong here? How do I keep on the mask all night?

[Sleeprider]

Based on the zoomed chart at 02:54 the machine is under-stating your actual flow limitation. Clusters of apnea may indicate a positional issue. There are wide variations in tidal volume at differnt times in the charts and I'm not sure what is contributing to such differences in flow.

[Khavoqi]

Back again with another update.

So, I tried changing the pressure to a range of 8-13, just to see how it would go. I seem to be maxing out at it; does this mean that I maybe need pressures upwards of 14 or maybe even 15? I'm thinking of changing the range to 10-15, as I think I feel somewhat better than usual today.

Also, do y'all have any idea why I have a huge cluster of central apneas? I'm not sure if it's related, but around the time it shows up on the graph, someone out back was making my ears bleed with a powerwashing job. Lol I woke up and thought there was an apache attack helicopter buzzing outside. 

And, one last question. Do y'all have any idea what my odd, high tidal volume wave patterns could be? I know Sleeprider was a little puzzled, but if anyone else has an inkling as to what it could be, I'd greatly appreciate the insight. 

Thanks again everyone for all of your help. Glad to have y'all helping me along each step of the journey

[Sleeprider]

Realized pressure is a function of the device algorithm and what is detected in your respiratory flow. In this case your pressure reaches maximum during a cluster of OA most likely positional. If your max pressure was 20 it may still have maxed out. No CPAP is going to open a physically obstructed airway. Your Resmed responds strongly to flow limitation ad especially OA. No need for higher pressure. It would make no therapeutic difference.

The initial cluster of CA happened right after you started a second therapy session after the positional OA cluster. Hard to say if you’re asleep, but it probably establishes a pattern of hypo/hyper ventilation. Not a concern as an isolated incident, but certainly disruptive.

You have shown median tidal volume between 500 and 840 mL. There are many drivers of respiratory variation and speculation is not going to be productive.