01-11-2019, 09:19 AM
(This post was last modified: 01-11-2019, 09:22 AM by Sleeprider.)
RE: New to APAP - 50 days in
Oh look! No H events and flow limit and snores have nearly disappeared. You have some OA, and it may be because your EPAP pressure is much lower (8.8/5.8 median). You are now showing normal I:E time at 1.8:2.2 and tidal volume jumped from 520 to 580 mL While CA is higher here, everything else looks better, and the CA event rate is still less than 1.0, so not much of a concern, and will probably drop as you adapt to the EPR. This looks more comfortable IMO.
I think you can hold here, or add a little to the minimum pressure and take it to 8.4 to see if we can knock out a few OA events. Otherwise, I hope this fees better! It looks like you have Ramp on for 10-15 minutes. Your choice, but you probably don't need it. Your leak rate is up a bit, but not into large leak territory.
![[Image: attachment.php?aid=9781]](http://www.apneaboard.com/forums/attachment.php?aid=9781)
RE: New to APAP - 50 days in
(01-11-2019, 09:19 AM)Sleeprider Wrote: Oh look! No H events and flow limit and snores have nearly disappeared. You have some OA, and it may be because your EPAP pressure is much lower (8.8/5.8 median). You are now showing normal I:E time at 1.8:2.2 and tidal volume jumped from 520 to 580 mL While CA is higher here, everything else looks better, and the CA event rate is still less than 1.0, so not much of a concern, and will probably drop as you adapt to the EPR. This looks more comfortable IMO.
I think you can hold here, or add a little to the minimum pressure and take it to 8.4 to see if we can knock out a few OA events. Otherwise, I hope this fees better! It looks like you have Ramp on for 10-15 minutes. Your choice, but you probably don't need it. Your leak rate is up a bit, but not into large leak territory.
I set the ramp because my Phillips had it set and I wasn't sure what to expect from the ResMed. I'll go ahead and take minimum back up to 9, my original prescription was 9 on the Phillips then we tried 8 looking for comfort and to reduce the events. I can always back it down to 8.4 later if 9 is working well. Or leave it there, I'll decide that later. I'll go ahead an tighten the straps a bit too to reduce leaks, but then I'm going to give it a few days without messing with settings and get settled in.
I am curious, normal expiration flow from what I've seen has a roundness to it, I tend to spike. The sleep tech at the VA is convinced it's because I sleep with my mouth open but a chin strap ruled that out. I also noticed that with the Phillips on CFlex it rounded out. Last nights charts on the ResMed shows it back. Any thoughts? Is it of any concern?
Steve
RE: New to APAP - 50 days in
A chin strap does not rule that out. It does make it more difficult and has been the traditional medical solution but. . . We see better success with a loose fitting soft cervical collar.
01-11-2019, 10:17 AM
(This post was last modified: 01-11-2019, 10:23 AM by Sleeprider.)
RE: New to APAP - 50 days in
This looks normal to me, except the flat inspiration at 0:18:25 which is flow limited, with an expiratory snore or swallow right before it. Exhale is passive and this shows the usual quick start to exhale followed by gradually decreasing flow and even some near-zero flow before the next breath. Most of your events were at the end of the night, and may be sleep/wake junk. This looks really pretty good. In normal exhale, healthy lungs expel air rapidly and the flow naturally slows. The EPR on the Resmed helps you exhale quickly, while the Philips rebounds to full pressure before you're done. This is what we were looking for. People with COPD will have a slower onset to exhale and struggle to expel all of the air before needing to inhale again. This results in stacking. Trust me, this is great.
![[Image: attachment.php?aid=9782]](http://www.apneaboard.com/forums/attachment.php?aid=9782)
RE: New to APAP - 50 days in
(01-11-2019, 10:17 AM)Sleeprider Wrote: This looks normal to me, except the flat inspiration at 0:18:25 which is flow limited, with an expiratory snore or swallow right before it. Exhale is passive and this shows the usual quick start to exhale followed by gradually decreasing flow and even some near-zero flow before the next breath. Most of your events were at the end of the night, and may be sleep/wake junk. This looks really pretty good. In normal exhale, healthy lungs expel air rapidly and the flow naturally slows. The EPR on the Resmed helps you exhale quickly, while the Philips rebounds to full pressure before you're done. This is what we were looking for. People with COPD will have a slower onset to exhale and struggle to expel all of the air before needing to inhale again. This results in stacking. Trust me, this is great.
Night two. I went ahead and moved the minimum pressure up from 8 to 9 as the only change, and even to me it looks real good, and I'm going to hold of on changing any settings for awhile. I can scroll through each minute and find "funkyness" but I guess I'm not wearing this because my respiration is normal eh?
One last "big thing" I played with last night is I use a Philips Dreamwear Full in which the air comes down the inside of the straps on each side of the face. Hose connects at the top. I've become a side sleeper since that's the way I snore the least, and that traps one side of the air delivery between my face and my pillow. I spent some time lifting my head and laying it back down, and the air flow changes between when I let my face rest on the pillow and when I lift it up are quite noticeable. So I suspect trying another mask where air delivery isn't pinched by my head is in my future, but I'll recover from buying this machine first.
Steve
RE: New to APAP - 50 days in
Well Steve, two days in, what do you think of Resmed vs Philips based on how you feel?
RE: New to APAP - 50 days in
(01-12-2019, 11:14 AM)Sleeprider Wrote: Well Steve, two days in, what do you think of Resmed vs Philips based on how you feel?
Optimistic? I don't feel any more rested now vs before cpap/apap vs Phillips vs Resmed. If I want to wake up "refreshed" (or as refreshed as I get) I still need to go without a machine. Woke up with a horrible sore throat this morning also but that could be the woodstove that's been running with the snow, or anything else. I didn't magically recover from 15 to 20 years of bad sleep (would have been nice though!) but for the most part I sleep through the night. I really do think I need to find some money to look at a different mask though. I can seriously alter the sensation of airflow in the mask by lifting my face off the pillow.
But no regrets over the ResMed, just need to give it some time now ;-)
Steve
RE: New to APAP - 50 days in
Great looking chart, In theory one tube on the \dreamware should provide enough flow so no need to rush the mask change just continue sleeping with the machine and I guess your numbers will reduce further as the CA's should deminish as you get used to sleeping with the machine and mask
RE: New to APAP - 50 days in
(01-12-2019, 01:04 PM)jaswilliams Wrote: Great looking chart, In theory one tube on the \dreamware should provide enough flow so no need to rush the mask change just continue sleeping with the machine and I guess your numbers will reduce further as the CA's should deminish as you get used to sleeping with the machine and mask
I'm not afraid of insufficient flow really, but with both tubes open I can actually feel the airflow into my sinuses, and it's a pleasurable feeling. Once I lay down down and the one tube is restricted it's more of the sensation similar to being in a closed up room. Not uncomfortable but not really refreshing either. I'm not in a hurry to go out and blow $150 on another mask, just keeping it as an option.
I suspect I'm up against my own expectations here. I have a few friends on cpap and have heard them say they sleep so much better with it than without. That's not my experience, I sleep better without the machine and the morning haze takes less time to clear. I'm also used to taking the first 45 minutes of my day to chase away the headache, clear my sinuses, and get enough coffee into me to see strait. It's been that way for years. But with air my wife isn't as afraid I'm not going to wake up so there's a trade off. I guess part of me is hoping for that experience that makes me say "I WANT to use this because my quality if life is so much better", as opposed to now where it's expensive, I don't dream (I know I dream, I just don't recall), and the only visible benefit is a chart that says I'm probably not going to wake up dead.
That make any sense?
Steve
RE: New to APAP - 50 days in
Well, it's been a few more days Steve. How is are you feeling now?
It took me three two and a half months of being on the machine to start to notice a difference. Some people it helps them immediately. For me, it took some time figuring out which mask and pressure settings worked best to allow me to adjust to the mask and the whole process.
Let me tell you one thing that makes this process difficult to adhere to. If you start out with this new treatment in your life and the pressure settings are high from the get go, it will likely defeat most people. Force your doctor to prescribe a lower pressure setting to allow you to get used to this whole new process in your life.
Let us know how things are progressing. Thanks!
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