Newly diagnosed severe CSA & OSA (AHI=108) seek advice

[Liteheart1]

Dormeo pid='336031' dateline='1582430404']The spiky-looking leaks are more likely to be your mask moving and making a leak. The plateau-like leaks are more likely to be mouth leaks.

As Dave suggests, try a hose cover. It provides me with the insulation I need. In fact, I use an 8 foot cover on a 6 foot hose and scrunch it up, but that’s probably overkill.

Thanks all, good info. Are the plateau leaks shown below (and therefore likely mouth leaks) high enough/long enough that I should try to address them? While during sleep study I tolerated chin strap at home and just getting started I have found chin strap too confining and a bit much to get used to. If I can postpone chin strap for a while longer I think it'd make adjusting to mask and therapy for longer time periods easier. I do understand that if you have mask on for longer duration but much of the time there are mouth leaks that the latter makes the therapy less or completely ineffective.

How do you get OSCAR screenshot to be <700KB? paradoxically I had to increase the size of OSCAR window to reduce the file from 1.1MB in order to get file to 608KB

And experimenting with the very bottom of OSCAR app I realized that the LL I referred to and the up/down arros allows you to toggle which events are shown in the topmost Event Flag "module." I'm getting more comfortable with OSCAR and expect that if I screw up settings there is some reset to defaults button, or at worst would re-install. OSCAR is great way to start to see what was happening during sleep.

[Sleeprider]

Going back to your dealing with rainout post, a hose cover can make everything much better. It insulates the tube and makes it softer to touch. Routing the tube upward from the CPAP then back down allows more condensed water to drain back to the machine, and prevents you from pulling the machine off the night stand. I don't know where you heard a more horizontal position is favored, but that is exactly the opposite of anything I have ever suggested.

Mask leaks disrupt your sleep, interferes with the function for your ASV, and makes therapy data much less reliable. You need to deal with the extensive mouth leaks. Other members have recommended the Knightsbridge Dual Band chin strap as comfortable and effective, and it does not draw the chin back, but upward. Might be something to consider.

[Liteheart1]

Sleeprider pid='336072' dateline='1582466385']Going back to your dealing with rainout post, a hose cover can make everything much better. It insulates the tube and makes it softer to touch.  Routing the tube upward from the CPAP then back down allows more condensed water to drain back to the machine, and prevents you from pulling the machine off the night stand. I don't know where you heard a more horizontal position is favored, but that is exactly the opposite of anything I have ever suggested.

Mask leaks disrupt your sleep, interferes with the function for your ASV, and makes therapy data much less reliable.  You need to deal with the  extensive mouth leaks.  Other members have recommended the Knightsbridge Dual Band chin strap as comfortable and effective, and it does not draw the chin back, but upward.  Might be something to consider.

Thank you for clear recommendations. 1) I will again raise hose (and as others suggested probably add hose cover as well; 2) Seems like I must deal with mouth leaks, and will order Knightsbridge, in the meantime I do have these which I tried one night and will try again ("You could try mouth tape to keep the mouth closed or specifically Somnifix.")


Given that I expect feedback on sessions last night still allow for significant improvement to therapy what might  I as a novice with OSCAR be looking at so that I don't incorrectly conclude that AHI of 0 and Large Leak at 0% is not all that "great?" Perhaps someone can point to a post (especiallly someone using ASV) with OSCAR data that is fairly ideal.

[Dormeo]

Quick question: Do you have CAs turned on (green on the bottom left of the daily chart)?

I don't think there's an "ideal" data profile. You want to see your AHI generally under 2, ideally 1; don't worry about chasing 0s. And you want to get your leaks low enough so that you're getting all the help from the machine that you can. You're hitting your target for ventilation, so that's good.

You need to be using the machine all night, getting around 8 hours of sleep, and going to bed around the same time every night. You want to see the number of breaks per night go to zero, if possible. You can track that kind of information on the Overview page; you're looking there at longer-term trends.

Beyond that, though, I think you need to go more on how you feel, both at night and during the day. Tossing and turning at night, waking up frequently -- not so good. Brain fog, irritability during the day -- not so good. Short and infrequent wake-ups -- good. Mentally sharp and psychologically mellow -- good. One thing I found helpful in the early months of treatment was to keep a little notebook and jot a few notes about each night and day. That helped me spot correlations and trends.

[Liteheart1]

Quick question: Do you have CAs turned on (green on the bottom left of the daily chart)?

I don't think there's an "ideal" data profile.  You want to see your AHI generally under 2, ideally 1; don't worry about chasing 0s.  And you want to get your leaks low enough so that you're getting all the help from the machine that you can.  You're hitting your target for ventilation, so that's good.  

You need to be using the machine all night, getting around 8 hours of sleep, and going to bed around the same time every night.  You want to see the number of breaks per night go to zero, if possible.  You can track that kind of information on the Overview page; you're looking there at longer-term trends.

Beyond that, though, I think you need to go more on how you feel, both at night and during the day.  Tossing and turning at night, waking up frequently -- not so good.  Brain fog, irritability during the day -- not so good.  Short and infrequent wake-ups -- good.  Mentally sharp and psychologically mellow -- good.  One thing I found helpful in the early months of treatment was to keep a little notebook and jot a few notes about each night and day.  That helped me spot correlations and trends.

Thanks, very helpful. Bottom left where there is an up and down arrow has these choices (LL OA UA H) all turned on green; nothing for CAs. Night B4 this Events displayed on top section were all LL and 3 were H so the flags are working properly I believe.

I am going to bed/sleep much later than typical and will get more into regular routine as I adjust. Always get up once for bathroom. I don't seem to be restless at night, and am falling asleep I believe within 10 minutes, and getting back to sleep after brief break in 5 minutes. Yes I have started notebook. With all that is going on, subjectively I feel pretty good (not tired, probably less irritable than before therapy ... has only been 8 days).

[sheepless]

the resmed asv reports all apnea as unclassified (ua); no ca & no oa.

[Dormeo]

the resmed asv reports all apnea as unclassified (ua); no ca & no oa.

Thanks, sheepless; I'm learning every day!

[sheepless]

me too!

[Liteheart1]

    Treatment update; and two related goals/?s.
1) About 3 weeks into Rx and actually have more energy, however tiredness was not an issue before therapy probably because I predominantly have central apnea with some OSA. GraduAlly adopting to mask, cleaning, etc. AHI has been always <1.5 and 7 day avg of 0.75; large leaks masks happen but <2%. Been practicing the tongue suck exercise to reduce mouth breathing and that seems to be effective. Tried Knightsbridge chin strap only 1 night; put it on 1st and then nasal mask, and while I adjusted straps somewhat large leaks were terrible that night - at least for now have abandoned chin strap as taping mouth and more recently using tongue suck method has been quite effective without the need for more apparatus (chin strap). Slight condensation reported previously was fixed by reducing humidty to 4; still wake up with some but tolerable mouth dryness. Attached a recent OSCAR data set.

?s and goals which are interrelated:
2) Goal of longer sleep sessions with ASV: Prior to Rx I slept on avg 7 hours per night getting up only once at night. Initially on Rx I was getting up 3 or 4 times per night. I am down to getting up twice; generally get back to sleep fairly easily (unless one of my cats needs some attention); however the duration of my sleep sessions is too short.

My son suggested that I might try a time released melatonin. I'll check with my sleep Dr, but anyone have thoughts on that?
I've tried unsuccessfully to discern in my OSCAR data whether there is a pattern just before I wake up (when such waking seems premature). Sometimes there is a large leak; sometimes an apnea; sometimes nothing in particular that I see other than perhaps time for bathroom break. Figured if I could see some pattern of what triggered waking up that I might then be able to address it. Still seems like a worthwhile approach especially if I find that large leaks are a precursor to waking up. Now that I am getting used to mask etc. I will return to have a much more regular sleep routine (when I go to sleep and when I get up) and for last 2 weeks this has been all over the map.

3) Goal to increase mask physical comfort which might also lead to longer duration of sleep sessions. Considering trying nasal pillow. Wisp mask is only one in sleep mask consultation that DME had me try. Using large nose piece and since it creates some discomfort (noticed upon awakening) I tried XL nose piece but while that helped with comfort led to terrible leaks so I went back to large. This seems to fit well, seal well, but leaves very little room below my nostrils, and the right side of nose toward the tip feels ever so slightly sore upon awaking, but that goes away within 30 minutes of being awake. I intentionally go to sleep on left side and also wake up like that. I am a not a restless sleeper.  The few times I sleep on back I have pretty bad large leaks, perhaps from mouth leaks and/or chin tucking, and since I don't want to sleep on my back haven't tried to adjust mask for sleeping on back. I probably will play with moving Wisp mask a bit down from bridge of nose

Since I believe that mouth leaks are somewhat minimal now, and that as needed I seem fairly OK with using a mouth tape (Somnifix) in lieu of trying a different nasal mask I am thinking of trying a nasal pillow. Any thoughts on that, specific suggestions?

[Sleeprider]

You have improved many aspect of therapy since I last looked in February. You still have room for improvement on mask leaks and time in therapy (asleep), and your assessment of your situation shows you have a lot of insights on how to get to your objectives in both those regards. It's good to see this progress. I don't have any experience with taping so can't help there. I'm sure other members have more experience with the use of time-release melatonin, and taping. Mask leaks seem to be the thing to focus on as they can be disruptive to sleep. I think we're seeing more mask leask rather than mouth leaks as before. Good solutions to try may be the nasal pillows mask like the Resmed Airfit P10 which is easier to seal, and we have heard good feedback recently on the Bleep mask which actually tapes into position.

Good work coming this far, and good luck as you move forward.