Please help with treatment review

[Geer1]

You have a central apnea effect visible in most of your data (even on good nights there are usually periods of fluctuating tidal volume). Something about the different masks just seemed to exacerbate it. If your results stabilize and you still have time on trial it would be worth giving the FFM another trial just to see if it was the mask and not the other setting changes that created the issue.

Fyi you can buy masks on amazon for about half that price (I assume you know that but if not it is the cheapest in Canada I know of)

[DaveL]

Geer1 thanks.

I took the loaner masks back. One week loan usually. I had them for almost 3. I got a brand new N20 mask with medium insert.

I asked if they have a Fishcer & Paykel Evora Full. They don't carry that mask.

I'll check my other supplier and see what cost the F30i is. I've had trouble with ama.... and knock off photo gear. copies.

[DaveL]

Woke up during the night. Felt pretty good.

I had bought a new nasal mask. Same kind.  ResMed N20. Got it from my DME supplier after discussion.  I had returned the loaner masks.
I was taped, and had pad under my chin.

Pillow on my left so I can't roll so much.

Back to sleep.  Woke again. Don't feel so rested.  That's ok.  AHI during the night was 0.5 IIRC.


(Observations.  Packaging was different with this mask.  They gave me this mask. Said take it home. Use it. If it works we'll charge you.  If not, return it.

Last one I bought on the internet.  The big A store. Wonder....old stock? The box it came in looked all right at the time.  But I never had good results with that cheaper mask. That's why I looked for a new mask.

Northern saying.  "Sometimes you get the bear.  Sometimes the bear gets you."

[Geer1]

You are back to results that show nothing clearly being an issue, even your leak rates were under control.

If not feeling fully rested it is either because you

a) Need more time with these good of results, adjusting to mouth tape etc.
b) Are not feeling rested for reasons other than apnea/CPAP.
c) Outside chance the minor remaining underlying central effects (see how your TV fluctuates almost all night) is having some effect. The only way to treat that is ASV though and although it would probably fix that breathing there is no guarantee it will fix your symptoms of tiredness.

Imo these are as good of results as you will get with this machine. I see no point in trying other settings, at most you could consider trying a FFM again to get rid of the mouth tape.

[Crimson Nape]

CPAP is just one facet of good sleep. Your sleeping environment and bedding account for a lot too. For instance, how old is your mattress? Subtle things can have an effect. A study I tripped across a few years ago found sleep quality was greatly improved by having warm feet. The wearing of socks improved all test subject's sleep quality in the study. I hope this may trigger some ideas and help.

[sheepless]

we knew when we started our recent excursion sometime in mid 2021 that your charts didn't really reflect any serious problems other than leaks (& imo
a ragged flow rate).

because you continued to have complaints, we tried a few things to stabilize breathing effort and address leaks, flow limitations, ca vs oa and movement.

that settings changes failed to produce better results proves, imo, the suggestion by geer1 & others, including me, that your troubles go beyond apap capabilities. however, while you would probably do better with asv or vauto, it remains to be seen that apap won't suffice.

I'm not suggesting you don't try a different modality, but that consistently lower leaks & movements are necessary to achieve more restful sleep regardless of machine type.

assuming your mask-adjusting arm movements subside once you settle on a well-fitting mask and consistently have fewer leaks, it's possible you could see less rls (or find it isn't as troublesome as the arm movements) & ca (or find they aren't as problematic as leaks & movement), & feel more rested as a result.

time will tell.

meanwhile, your trials of the last few months haven't been for nothing. you've more or less confirmed your best settings, learned a lot about your movement, given some thought to your sleeping environment (an uncomfortable mattress iirc?), hinted that anxiety might be an issue and you're actively venturing again into mask country. I think you're on the road to success.

btw, you might look into cbt-i. many people report improved sleep as a result.

[DaveL]

Thank you everyone. I appreciate it.

I shall watch sleep hygiene. The iWatch 6 helps with that.

I gave up on the video camera. Lights on it's face are awful. It was an A..... blink. I would not recommend it to anyone.

Pillow to my left keeps me from moving my arms much.
And sleep position is better.

The new ResMed N20 mask helped last night. It was worth the trip to the DME supplier, to stand outside and talk through an open door.

Meantime our Prime Minister has been exposed to C19 once again, so he is self isolating. and truckers are soon going to arrive in Ottawa to protest but Mr Trudeau is not available.

I appreciate your comments here. Thank you.

[DaveL]

we knew when we started our recent excursion sometime in mid 2021 that your charts didn't really reflect any serious problems other than leaks (& imo
a ragged flow rate).

because you continued to have complaints, we tried a few things to stabilize breathing effort and address leaks, flow limitations, ca vs oa and movement.

that settings changes failed to produce better results proves, imo, the suggestion by geer1 & others, including me, that your troubles go beyond apap capabilities. however, while you would probably do better with asv or vauto, it remains to be seen that apap won't suffice.

I'm not suggesting you don't try a different modality, but that consistently lower leaks & movements are necessary to achieve more restful sleep regardless of machine type.  

assuming your mask-adjusting arm movements subside once you settle on a well-fitting mask and consistently have fewer leaks, it's possible you could see less rls (or find it isn't as troublesome as the arm movements) & ca (or find they aren't as problematic as leaks & movement), & feel more rested as a result.

time will tell.

meanwhile, your trials of the last few months haven't been for nothing. you've more or less confirmed your best settings, learned a lot about your movement, given some thought to your sleeping environment (an uncomfortable mattress iirc?), hinted that anxiety might be an issue and you're actively venturing again into mask country. I think you're on the road to success.

btw, you might look into cbt-i. many people report improved sleep as a result.

Thanks. Good points.
I'll look into cbt-i  Good call.
Dave

[DaveL]

Crimson Nape thanks. I'll try socks!

[DaveL]

Geer1 thanks.

I've read Gideon's Bible. I hope that I'll learn enough to be able to help myself more. There is amazing information there. I've installed the latest version of OSCAR.

I used cpap bricks for the first 15 years of treatment.
I used my S9E long enough to put almost 23,000 hours on it.
Now I've used my S10 for a while.

Dave