LuminousOne Therapy Thread

[LuminousOne]

Thanks for this advice. The AirSense 11 is on trial. The MD wanted to try this first because my titration test was not administered appropriately and was inconclusive. The tech kept me on an ineffective treatment level 7 for close to two hours, delaying test progression, and the time was up before an optimal level was established. I was also chin-tucking the whole time. I did not have any centrals during that test. 

I really appreciate your advice.

[LuminousOne]

Hello,

Last night I fully awoke during a sudden significant pressure rise and large mask leak. I turned the machine off briefly to better reposition the mask. In reviewing the OSCAR chart for today, I noticed a cluster of centrals following the break. After critically examining my charts, I noticed the timing of central clusters are early in the morning when I often awaken before the alarm goes off, or other times when I suspect I have awakened for a short while to attain a more comfortable position. I often forget my awakenings. 

It will be a couple of weeks until I have an appointment with my provider to negotiate a change to a bi-level. In the meantime, would turning the EPR down be effective in identifying whether the CA's are treatment emergent? I had no centrals during my in-lab titration study.

A greater question is what mask would be recommended for pressures of 15 and over? The F40 is not working well for me and I heard on a youtube mask review by a sleep apnea therapist (and patient) that it is not a good mask for pressures around 15 and higher.  

I greatly appreciate any advice. I am determined to get this sorted out. Oddly enough, last night was my second best night in relation to AHI and centrals.

   

[LuminousOne]

Hello All,

I switched to the F&P Evora on Monday. The first night was off because I was uncomfortable in general-not mask related- and, at one point, the hose disconnected from the mask (wasn't  tightened enough) and I awoke to that.

Last night was a great improvement overall. Reduced AHI, no leaks, did not need a high pressure. 


I still feel washed out-tired and depressed. I mentioned my concern about the CA's to my sleep therapist on Monday. He believed they are treatment emergent and said that the MD would want to see more than two weeks to decide if a change to a bipap is warranted.

   




I hope this improvement lasts.

[LuminousOne]

Here are my latest three days. I've been uncomfortable due to the heat and back pain and sleep have been less easy during this time.

My OA's are decreasing. My CA's are variable and increase during leaks and around 7AM which is when my alarm goes off (even though I have been remaining in bed due to fatigue). I believe these are times when I am awake to some extent. I also believe that position changes due to discomfort while asleep are responsible for the leaks. The second screen represents an awful night when I had trouble sleeping and got up numerous times for various reasons. Ironically, the numers are not too bad. 

It was recommended here that I switch to a bi-level. I brought this us with my therapist, but he believes that these are treatment emergent and said that my MD would not issue a prescription without more data (I started pap therapy less than three weeks ago).    

I would appreciate advice on flow limits, whether they are excessive and if changes would be recommended. 
I may have to tighten the straps of the mask to prevent leaks. I find that wearing the smaller of the two SCC's results in fewer leaks. 

Thank you for reading this. I appreciate any advice you offer.

                                      

[PeaceLoveAndPizza]

One further idea to try is using a lower fixed pressure with no pressure support. That would help get a better understanding of whether EPR is part of the problem.

Mode CPAP
Pressure 8
EPR off
No ramp

Note that your flow limitations will likely go off the rails, but that is to be expected. Whether it will significantly impact sleep quality we will not know until you try it. You could also add EPR 1 at some point and see how it goes.

From there you can increase pressure as needed by a bit every few nights until you get to around 12. If it has not improved things, then you are no worse off than continuing down the current path.

I realise it may sound balmy, but this way you can then go back to your quack-in-the-box and truthfully say you have exhausted all the machine can offer.

[LuminousOne]

This plan is not at all balmy. I need to collect valid data to support a possible need for change in machine. The reason I asked for a bipap was so I could have the versatility depending on my needs. My titration test was inconclusive due to being poorly administered (left in a low ineffective setting for 2 hours before advancing it - time ran out in the end and I was at 16). In addition, my neck was kinked the whole time which rather skewed the data. I had no centrals during the test, though.

Anyway, I will give these settings a try. I'm going to be careful because I don't want to go backwards until I feel better - I'm functioning poorly due to the brain fog and exhaustion and need seriously need relief.

My sleep MD is a pretty good guy. He didn't give me the standard-one-size-fits-all setting prescription, but had to keep it a bit wide. In any case, it's time for experimentation.

Thank you so much for your support and valuable advice. I very much appreciate it.

[LuminousOne]

Back again. Had trouble with OSCAR.

I'm starting to feel better, but was thrown off by mask-seal issues made worse by my sleep movement and pillow mashing with head. 
I've tried a satin neck support pillow from my comfort pillow archives and it seems to do the trick - it's flat, I can support my head on it, and it's shape avoids the mask.

My AHI is dropping and OA's have been under one for the most part. I still have "clear airway" events and dropped down to EPR of 2. I'll try EPR of 1 today and see if I can stand it. I'm trialing a pressure range of 10-16, which seems to be good with a goal of narrowing the range. I'm not ready for a CPAP setting.

This OSCAR is from a few days ago and the leak situation has since then.

   

Recommendations for improvement would be appreciated.

Happy dreams...........

[LuminousOne]

Discouraging night. I thought I slept well but the leaks! 
I have a bad back and find sleeping on my side to be uncomfortable. I changed position more last night than any other night. I am attaching OSCAR from last night. I was also wearing my soft cervical collar which I think may be interfering with my mask when I change position in my sleep.  

   

[LuminousOne]

I gave up on side sleeping last night. I slept mostly on my back with two pillows and a soft cervical collar. Events are still higher than I like, but obstructive events have decreased steadily over the last week or so and are generally less that 1 AHI per night. Even so, during the month since I've started, my AHI has only been below 5 eight times. I'm getting discouraged. 


I've posted last night's OSCAR report below.

Questions:
1. What is an acceptable leak rate as recorded on OSCAR?
2. What is a likely reason for clustered clear airway events?
3. What sleeping position is best for low back pain?
4. If eyes are puffy in the morning, does that suggest that the mask is too tight?
5. What are the indications that it's time to go to another mask?

   
  
Please advise.

[Jay51]

1.  The lower the leak rate the better.  If it gets above 24L/min, then your data will most likely be skewed.  
2.  Sometimes clusters of CA's can happen in transition from awake to sleep and vice versa.  They are at the beginning and ending of charts.  You have some leaks that line up with the large clusters of CA's early in your night.  Mask Primer
3.  For me personally, I liked sleeping supine best to decrease back pain.  Side sleeping might help also.  But, sleeping supine is usually the worst position in regards to sleep apnea.  Sleeping on your stomach could hyperextend both the spine and neck in some people.  
4.  Not necessarily IMO, but it could.  The only way to tell would be to try different levels of tightness.  Try it a bit looser.  If you have to tighten it a lot and still have the problem, you might need a different mask.  I use mask liners successfully also.  If you want, you could try a mask liner.  Your choice.  Washing your face before bed might remove some oil that could be interfering with a good seal.  I do this. And wash the mask silicone also.  
5.  Fantastic question.  For me, I just know.  When I have had enough and tried everything I could to make a particular mask work, and it doesn't, it was time to give up on that mask.  How do you feel in the morning?  If you are feeling good enough, you might get away with the current mask you have.  If not, it may be an indication for a mask change.  Not everyone's facial features are the same.  Many different mask styles and sizes.