New to CPAP, feeling like a zombie

[NessunDorma]

SarcasticDave94 pid='419384' dateline='1635443955']PS I've forgotten to mention, to act against your CA, consider lowering EPR by 1 and take note how your CA change after a night. Post a chart tomorrow, it'll be evident if EPR made a difference in lowering CA.

The negative of this is that Obstructive, Hypopnea, Flow Limits will probably increase with a lower level EPR. Obstructive vs Central, actions to counteract them oppose one another, 2 sides of a teeter-totter with CA on one side, Obstructive on the other. Acting on either side makes the other go up, at least in the majority.[/quote]

Since I'm concentrating on the positional first, I didn't lower the EPR yet.  I'm also wondering if I'm allowed to make any changes right now since I'm still under compliance.  

I used just the CPAP pillow last night and both CA and OA increased. The previous day I had 46 CA and 30 OA.  Last night I had 89 CA and 40 OA.   

It's been interesting learning about complex apnea and this inverse relationship that they have.  It reminds me of the TSH vs T4 relationship in the thyroid.  Maybe my hypothyroidism is contributing to the OA.

Can you still see evidence of positional apnea in these graphs?

I'm thinking about sleeping on a recliner to see if it makes a difference.  Maybe this weekend.

       

[SarcasticDave94]

Positional Apnea evidence? Yes, I'm seeing the telltale clusters at about 23:00, 02:20, 03:40-04:20. Look at the clusters of blue flag ticks. That's your sign of them.

As for changing settings? EPR isn't likely on the docs or DME's radar to even be important to them what you do with that setting at any time ever. As for any other pressure setting, they don't really care what you set, even if it were pressure 4 straight. An example only. The point is they don't care what settings there are, only that you use the PAP 4 hours every night to meet compliance to make insurance happy. Yes that's really it.

Trust me, I've asked my former Medicaid insurance when I was being tortured on Auto BPAP in '17. I reset my pressures and called to ask what comprises "compliance". Were settings considered, for example if I edited my pressures? Nope, settings didn't count, only did I use it x hours, x days.

[NessunDorma]

That's good to know! Thanks! I've got the 'hours' compliance covered

[SarcasticDave94]

Ok, keep at it and keep us informed. And if course ask questions.

[NessunDorma]

PS I've forgotten to mention, to act against your CA, consider lowering EPR by 1 and take note how your CA change after a night. Post a chart tomorrow, it'll be evident if EPR made a difference in lowering CA.

The negative of this is that Obstructive, Hypopnea, Flow Limits will probably increase with a lower level EPR. Obstructive vs Central, actions to counteract them oppose one another, 2 sides of a teeter-totter with CA on one side, Obstructive on the other. Acting on either side makes the other go up, at least in the majority.

I turned off EPR last night and it made a big difference.  I think the mask was less tolerable though since I removed it after 6 1/2 hrs. 
         

[SarcasticDave94]

OK, some trade off there, to be expected really I think. Your mention of the mask removal, could it have been described as air starvation? You felt you needed air? That might be addressed at some point with a small Min pressure bump, but probably not just yet.

There's some Obstructive events, flow limits, and leaks present, that any or all combined could be a disruption. Right now we'd need ignore flow limits as the best tool, EPR, needed to go to reduce Centrals. That leaves a bit of Obstructive events and the pretty high leak pattern. Of these 2, the leaks are likely the much bigger issue. Literally your therapy can be blown out by a leak.

Give us a regular non-zoomed OSCAR shot please. I want to see specifically the leak chart in whole. It can show shape patterns to signify if this is a mouth or mask leak. Feel free to adjust the straps over and see if that helps, just don't tighten so that it's painful or uncomfortable. Which mask or masks have you tried? Which did you like best? Comfort should be top of the list in choosing.

To me, there's 3 things that make a complete mask success story, the right type for you, the right sized cushion, the right adjustment. Type is pillows, nasal, full face, hybrid. Size of the cushion is about choosing the correct sized seal for you. Adjusting is about how much to tighten the straps and in the proper order.

[NessunDorma]

OK, some trade off there, to be expected really I think. Your mention of the mask removal, could it have been described as air starvation? You felt you needed air? That might be addressed at some point with a small Min pressure bump, but probably not just yet.

There's some Obstructive events, flow limits, and leaks present, that any or all combined could be a disruption. Right now we'd need ignore flow limits as the best tool, EPR, needed to go to reduce Centrals. That leaves a bit of Obstructive events and the pretty high leak pattern. Of these 2, the leaks are likely the much bigger issue. Literally your therapy can be blown out by a leak.

Give us a regular non-zoomed OSCAR shot please. I want to see specifically the leak chart in whole. It can show shape patterns to signify if this is a mouth or mask leak. Feel free to adjust the straps over and see if that helps, just don't tighten so that it's painful or uncomfortable. Which mask or masks have you tried? Which did you like best? Comfort should be top of the list in choosing.

To me, there's 3 things that make a complete mask success story, the right type for you, the right sized cushion, the right adjustment. Type is pillows, nasal, full face, hybrid. Size of the cushion is about choosing the correct sized seal for you. Adjusting is about how much to tighten the straps and in the proper order.

I can't remember exactly why I took it off.  I remember the leaks were annoying me and I made sure not to over-tighten the straps.  No marks on my face this morning :  I did take a xanax last night so I could get a good night's rest.  So I was probably adjusting my mask a lot less than usual.  I also did not use a mouth strip last night.

Do you mean that we need to ignore the flow limits for now but is usually used as a tool for trouble-shooting?  This is the only mask that I've had.  It's a small but I feel like I need one even smaller.

I'm really glad that you are helping me address these problems now before my Monday appointment.  I feel more knowledgeable about all this than I did 2 months ago.  Is CA no longer a problem for me?  Will I not have a need for ASV?
       

[SarcasticDave94]

OK great OSCAR shot, the first was the one needed. Take a look at the leak trace line. The flatter, rounded leak areas are likely a mouth leak while the spikey areas are a mask leak. There's a bit of both here. If you think a smaller cushion will help, you can try to get it. The missing tape was likely the reason for mouth leaks it appears.

To help you understand what to look for on the left panel of OSCAR, leaks have Min, Med(ian), 95%, Max. The way I handle mine would be note the max number but treat it as reference only, 95% I took more notice to, as ResMed's machines have 24 L/min as the redline like in a car, go past that 24 and leaks are a serious issue. I allow a few leak blows showing in the Max, but the 95% needs to be below 24, and I prefer a safe distance below 24 in the 95% area, median helps to know where your middle ground is but if there's a large max blow then median is less helpful. Bottom line is to get the 95% less than 24 and that you're doing so with a very reasonable comfort level.

As for the ASV necessity, we need to try building a trend with the PAP you have now. IF you can comfortably adjust the PAP to avoid the CA consistently AND you can gain and maintain a well rested state, then ASV can be likely dismissed. However, if any of that cannot be gained consistently, ASV is a best case scenario.

[NessunDorma]

Ok, I'll return to the mouth tape tonight and post my graph in the morning. If I stick with the mouth tape, do you think I can switch my mask to just nasal pillows? Like either the minimalist or the freedom mask? This full mask does not help my anxiety. I guess I need to research which masks are compatible with the AirSense 11 AutoSet.

[SarcasticDave94]

You can choose whichever mask you want that you can gain comfort from and that you can have a reasonably controlled leak rate. ResMed 11 should work with whatever masks you've got now.