Please help with treatment review

[DaveL]

sheepless I changed the settings...
* *for her* selected
* Pmin reduced


I slept well; woke up took mask off. Checked settings & a few things. Then went back to *trying to sleep*
Tried to attach 3 screenshots. I had attached too many. Used up my allotment. So I deleted a bunch of screenshots that were among the earliest.

Flow rate is choppy. Me? Or because I've been a hoser for about 35 years? Side effect.

My first two machines (13? years) were bricks. My third was my S9E that I put 21,000 hours.

[sheepless]

it's great you slept well & I hope it keeps up. I haven't re-read how the for her setting works so I really have no idea if that could be the reason why. that plus the fact that your results have been inconsistent leave me hopeful but waiting to see a trend.

you can find different height collars online but your collar will collapse a bit as it softens & curls with wear.

I'm not very confident about this but there's a small chance the first screenshot in previous post is showing limb movement.

[DaveL]

Thanks sheepless you help me a lot.

I'm grateful for any improvement. I want to leave things be for a bit so that things even out. Spend some time at these settings.

(The day after my surgery in '03 I was in the hospital. I fell asleep. I kicked--restless leg syndrome. Dam- it hurt. a lot. right leg. I had 2 new plates and 14 screws under the new cast. From then on I wore my mask/machine turned on even when I was awake. They were also concrened about lung capacity way back then. I had been using my cpap brick for about 7? years.)

Dave

[DaveL]

Woke up felt ok-better

read the machine with glasses off.  AHI=0.0

Put glasses on.  AHI=6.0

Gotta stop wearing glasses.

Dave

myAir says score=100.  AHI=3.5.

Good mask seal.  

Everything must be ok.

No, I don't drink at all.  Maybe I should. Happy New Year.

[sheepless]

I wonder if anyone can explain why myair and oscar ahi's are different?

even though your ahi is a little over 4.9, all that really matters at that level is that you felt "ok-better". this chart looks very good apart from the clusters of oa which should be relatively easy to reduce. as you know, those are most likely positional and collars are the best way to keep from chin tucking. low pillow height, raising the head of the bed, etc. help too. oa's are reduced for some of us by staying off our backs as much as possible as well. in some cases epap (min - epr) needs to be raised, easy to overlook when using epr.

whatever you're doing for leaks worked that night!

the csr with no ca is not likely csr. could be rls/plm but surprisingly my periodic plm pattern is never flagged csr. if you haven't ruled csr out completely by now, post a 10 minute view including the ca around 6:25am.

[DaveL]

I've ruled out csr

Night before and most nights I have had no csr

sheepless I was wearing my soft cervical collar, and using my cpap pillow which is contoured and pretty low. I'm using my hose caddy too. I broke my left shoulder about 4? years ago. I don't lie on it. I'm mostly on my back.

It wakes me up turning onto my right shoulder.

I've had frozen shoulder in each shoulder....

I'll bump up Pmin I see. EPAP is Pmin-EPR and EPR is 3 now.

So for tonight (date is wrong on my OSCAR) I'll increase EPAP, leave EPR at 3. I'll tape and use the soft cervical collar.

Dave

[DaveL]

Tired.
Awake through the night.

today--brain fog.  weary.

N20 mask
Tape
Cervical Collar

It's going to be a long day.  Falling asleep watching tv. 

I increased Pmin one notch before sleeping.

Dave

[sheepless]

Dave, aside from treating rls/plm, I'm out of ideas. your ahi is acceptable to the system so it'll be tough to get help there.

your results are inconsistent, due perhaps to movement & a tendency for ca. video might be a next step.

maybe the apap isn't best for you (i had similar stats on apap & never felt it was good enough). if you're inclined, look for private sales of vauto & asv to try. honestly I'm not sure which might be better. I use both w mixed apnea & plm & get pretty similar results.

maybe more knowledgeable members have some insight. I think the answer is in finding out why your flow rate is so variable & stabilizing your breathing effort.

[DaveL]

Thanks sheepless. I appreciate your help so much.
Dave

[Geer1]

I took a brief peek through recent data posted (past 5ish pages). I see some examples that indicate obstructive apnea, some obvious central apnea and central related periodic flow (which I can see is present to some degree most nights by seeing the fluctuations in TV charts). I also see that especially some nights you have a lot of leaks.

I know you have been fighting this a while and I assume you have tried all sorts of different pressures, ranges etc. My gut thought is that you should try to get your hands on an ASV and test it out. It will fight the centrals and periodic breathing, allow you to try a higher PS (although I would start low) and it should help blast through the odd obstructive apnea still occurring. Unfortunately you probably won't have good luck finding a doctor to get on board with a trial of ASV since your AHI isn't all that bad and central apnea isn't an obvious enough issue meaning you would probably have to buy a used machine out of pocket to try it out. I personally would jump to ASV instead of a vauto because of the indication of a central aspect, if you see a dirt cheap deal on a vauto then there are a couple things you could try with it (timing controls and higher PS) but I think it would be a long shot (although I bought my vauto on kijiji out of Ontario for $400 so you might get lucky like I did).

Getting leaks under control is this other obvious step whether that is by trialing a FFM or some combination of mouth tape, chin strap, collar (sounds like you already do some of this).