New to APAP - 50 days in

[jaswilliams]

It sounds like it may be positional apnea which you didn't show in the charts above. Post a chart and we can confirm.  Positional apnea is typically demonstrated by clusters of events.  The best fix we have seen though your pillows may have been doing the job is a soft cervical collarvfitted looselyvto keep the chin from tucking.

Fred

This is what starting a night on a foam bed wedge looks like. I woke up around 2pm as usual and got rid of the wedge. I didn't see any any major difference around that time though. I'm starting to understand how there can be an entire science discipline on sleep alone. Tonight I'm going back to just the two pillows and I'll check my chart in the morning. Oddly enough I'd expect the taller than normal pillow height to cause the chin to tuck and exacerbate the problem.

Steve

Steve can you turn off the VS2 events, they clutter up the flow graph and don’t really provide us with any additional information to do  that click the events drop down on the bottom left then slide the slider on VS2 so it becomes red, this will clean up the graphs. During the first part of the night your max pressure of 13 was not sufficient to clear all of the events there was a period where you were at max pressure exhibiting snores and hypopnoea with the pressure at 13.

[Sleeprider]

I agree with turning off VS2, possibly increasing maximum pressure. I'd like to see a close-up of the flow rate (2-minute segment) and see what the flow limitation looks like.

[Steve.G]

It sounds like it may be positional apnea which you didn't show in the charts above. Post a chart and we can confirm.  Positional apnea is typically demonstrated by clusters of events.  The best fix we have seen though your pillows may have been doing the job is a soft cervical collarvfitted looselyvto keep the chin from tucking.

Fred

This is what starting a night on a foam bed wedge looks like. I woke up around 2pm as usual and got rid of the wedge. I didn't see any any major difference around that time though. I'm starting to understand how there can be an entire science discipline on sleep alone. Tonight I'm going back to just the two pillows and I'll check my chart in the morning. Oddly enough I'd expect the taller than normal pillow height to cause the chin to tuck and exacerbate the problem.

Steve

Steve can you turn off the VS2 events, they clutter up the flow graph and don’t really provide us with any additional information to do  that click the events drop down on the bottom left  then slide the slider on VS2 so it becomes red, this will clean up the graphs. During the first part of the night your max pressure of 13 was not sufficient to clear all of the events there was a period where you were at max pressure exhibiting snores and hypopnoea with the pressure at 13.

I couldn't identify the slider you referred to but under File/Preferences/Events there are check boxes you can uncheck to remove events, which is what I did and VS2 is now gone. I'm not going to consider the first part of the night because that's when I was sleeping with my upper body elevated on the foam wedge as an experiment. The lesson I think I can take from that experiment is that a) I'm highly positional sensitive, and b) I'm not doing that again. It appears to me that at the point when I threw the wedge on the floor and finished off the night on my side my flow requirements decreased. However, without VS2 the chart looks like this.

[Sleeprider]

If you ever get an opportunity to try a Resmed Airsense 10 Autoset, don't turn it down.

[jaswilliams]

You graph looks cleaner I wonder if the wedge caused your chin to tuck down towards your chest increasing the pressure required to keep your airways open, your graphs show hypopnoea and snores even on the second part of the night which indicates more minimum pressure required as the Philips is always trying to get back to the minimum pressure of 5, I expect you will have lower events and snores if your minimum pressure is raised to a value closer to 10cm it might feel high to start with but you spend most of your night over that anyway and the Philips is slow to respond to changing pressure needs. Can you provide the 2minute zoom that sleeprider was requesting ?

[Steve.G]

If you ever get an opportunity to try a Resmed Airsense 10 Autoset, don't turn it down.

What makes the Airsense different than the DreamStation? I'm limited in choices since the VA is issuing me the equipment but they've been responsive when I can make a valid argument. Right now I'm just so frusterated and angry. When did my body become so dang delicate? Last night was another bad night, I had mucus in my upper sinuses again causing the usual eye watering pain in my forehead, and the air pressure made it worse. I couldn't get it to clear until dawn this morning. I'm thankful I'm off work today, and I've got to believe there's a solution for me out there. I just have to find it :-)

Sorry for the rant, it was a very long night. I pumped my sinuses full of saline and I'll try napping in a recliner for a bit.

Steve

[Steve.G]

I agree with turning off VS2, possibly increasing maximum pressure. I'd like to see a close-up of the flow rate (2-minute segment) and see what the flow limitation looks like.

Here are two, both from after I removed the bed wedge and went back to my usual starting position on my side.

[Sleeprider]

You're not comfortable and not sleeping well. You have persistent flow limitation which is that flattened top on the close-up flow rate graph. Your machine doesn't know if you're coming or going (inhaling or exhaling), so your respiration is chaotic. That is why it persistently reports your expiration time is shorter (1.5 seconds) than your inspiration (2.44 seconds) time. A typical respiration cycle for you is a good start to inspiration as flow rises from the zero-line but then flow flattens out and even acquires a downard slowing flow rate like we see at 04:35;35. This breath cycles out to exhale and quickly shows zero flow (flat across the zero line) or in some cases a brief blip above zero, but not inspiration. This is your machine quitting on exhale relief (Flex) and as you can see, you don't respond well to it.  These persistent reductions in flow represent increased respiratory effort and potential arousals.  In this segment we see a near-hypopnea from flow limitation from 04:35:10 until 04:35:50. It is not flagged because the flow reduction is not more than 50% less than the preceding period, however it's disruptive, and we see a snore.

Four minutes later at 04:40:50,  your next segment has chaotic breathing suggesting an arousal occurred.  Breathing here is about 27 BPM and is not typical of a normal sleep cycle and is irregular. At 04:41:50 your breathing tails off close to apnea range, followed by recovery breathing with higher volumes and flow rate, before becoming much slower at 15 BPM.

So why Airsense 10?  Next post.

[Sleeprider]

Why Resmed Airsense 10 Autoset? Because it delivers a true bilevel pressure and does not try to predict your breathing, but instead follows it.  The machine provides up to 3-cm of pressure increase during inhale (or 3-cm pressure relief during exhale depending on how you want to look at it). This makes respiratory effort easier and reduces flow limitations, snores and hypopnea. This in turn reduces RERA.  On top of that the Autoset provide preemptive treatment of hypopnea and apnea by increasing pressure as a result of any flow limitation and stops the event before it happens. The Dreamstation just sits there and watches it, sometimes increasing pressure after the event.  The reason the Airsense 10 Autoset will work for you is that it won't get caught up in your irregualar breathing rate and flow limitation and try to predict when to decrease or increase pressure (Flex), instead, it will just follow along. A graph of typical Resmed mask pressure and flow rate is in the third chart down.  Most doctors and equipment suppliers have no clue these machines are fundamentally different, but the Airsense 10 gets you a bilevel at the the price of a a CPAP. My observation of thousands of Sleepyhead charts is that your results are typical for an individual with moderate flow limitation using a Philips machine.  With a Resmed we can resolve this with EPR.

I am going to attach a couple images that shows how the machine applies pressure and how it responds to flow limitations to prevent apnea. These are not ideal sleep breathing, but intended to show the response when needed.  Notice the normal breathing coming into events shows good inspiratory strength and machine pressure follows each breath, increasing pressure as the flow rate comes up. In this case, the user has flow limitation that disrupts the breathing rate, volume and pace. The flow limit is the flattened peak.  Here we note the mask pressure follows the flow limit and some chaotic breathing exactly, it doesn't get in the way, but the machine promptly increases pressure and stops the event.  Your Dreamstation won't do that, go look.

[Steve.G]

You're not comfortable and not sleeping well. You have persistent flow limitation which is that flattened top on the close-up flow rate graph. Your machine doesn't know if you're coming or going (inhaling or exhaling), so your respiration is chaotic. That is why it persistently reports your expiration time is shorter (1.5 seconds) than your inspiration (2.44 seconds) time. A typical respiration cycle for you is a good start to inspiration as flow rises from the zero-line but then flow flattens out and even acquires a downard slowing flow rate like we see at 04:35;35. This breath cycles out to exhale and quickly shows zero flow (flat across the zero line) or in some cases a brief blip above zero, but not inspiration. This is your machine quitting on exhale relief (Flex) and as you can see, you don't respond well to it.  These persistent reductions in flow represent increased respiratory effort and potential arousals.  In this segment we see a near-hypopnea from flow limitation from 04:35:10 until 04:35:50. It is not flagged because the flow reduction is not more than 50% less than the preceding period, however it's disruptive, and we see a snore.

Four minutes later at 04:40:50,  your next segment has chaotic breathing suggesting an arousal occurred.  Breathing here is about 27 BPM and is not typical of a normal sleep cycle and is irregular. At 04:41:50 your breathing tails off close to apnea range, followed by recovery breathing with higher volumes and flow rate, before becoming much slower at 15 BPM.

So why Airsense 10?  Next post.

Well, the VA got back to me today and I asked explained what is happening. I was asked to check some numbers and their diagnosis was that my low end pressure is too high (I'm currently 9-13), and they asked me to drop that to 6-13 and give it a couple days. So for better or worse, they pay for it so I have to try it (laugh)

Steve