Please help with treatment review

[DaveL]

Thanks so much.

I'll start searching for an ASV.

I'm taping.
I have a soft cervical collar that is working better as I break it in.
I'm using about my 5th ResMed N20....and feeling it doesn't work as well as I like.

My ResMed S10 *for her* is about 16 months old. I had to fight hard to get it. Going to sleep docs is extremely stressful for me. He will require a sleep study; that will cause issues with mask choice...full face will be prescribed. F30i didn't work for me Tried it. Angry I bought two Knightsbridge Dual Bands. Not in use right now.

Thanks so much!

[DaveL]

Taped--but two pieces. With a gap in the centre.  I've always used a single piece with no gap

Cervical Collar--it's fitting better

N20 mask.

Took a holistic remedy for stress/anxiety before sleep.

Feeling relaxed but tired this morning.  

Dave

[nightgagger]

Have you tried other masks like the Fischer & Paykel Brevida? Or have you tried nasal pillows?

I used/use the N20 and if I rate my masks that I've used for treatment, it's third in line.
For myself and my treatment, which I think is successful at the moment, I have to use tape all the time, the KB cap has really improved my leak problems as I must have jaw/chin drop when relaxed, and finally the use of the P10 pillow has totally been the game changer.

In your graphs I noticed that the pressure curve is pretty constant, and not showing big swings of pressure changes. That's good as I believe you've targeted a good pressure range that will give you effective therapy.

I guess if you're going to move to another mask, that F&P Brevida mask would be a good one to consider.

[Geer1]

I honestly don't think you will qualify for ASV even with a sleep study. They are only going to focus on obvious issues like ahi instead of trying to idealized your breathing like what I am proposing an ASV will do. I don't guarantee an ASV will solve your sleep/symptoms but it is the best chance to do so if these issues are related to your breathing.

If you know ways to trigger your central apnea/ahi (like higher pressure, max epr, not using collar, tape etc). You could try that for a while to collect data to make an argument you aren't treated and need a asv or follow up titratiln study but if you get the sleep study you need to get lucky and have bad central apnea that night and have a tech willing to use asv.

Every once in a while you can find good used deals which is what I would keep my eyes open for.

[sheepless]

"In your graphs I noticed that the pressure curve is pretty constant, and not showing big swings of pressure changes. That's good as I believe you've targeted a good pressure range that will give you effective therapy."

I agree. however:

based on little more than intuition, I think a dense compact flow rate is best. you, Dave, have a lot of white space in yours and I suspect that indicates labored breathing and that figuring out how to fix that will be to your advantage. on the one hand, more or less constant pressure is a good thing and you've had settings with enough range to think it ought to have adjusted to your needs. on the other hand, the fact that it hasn't produced a nice compact flow rate is what led me to the suggestion you try a different modality.

asv will more effectively treat ca but IF you have rls/plm going on, you can't limit max ps enough because max has to be at least 5cmw higher than min in order to combat ca. ps will rapidly rise and fall with plm breathing without fixing flow limitations and raising minute ventilation. this activity can be quite disturbing (leaks, aerophagia, arousals, awakenings).

otoh, max ps can be limited much more effectively with vauto and for many of us a high or very high trigger setting minimizes ca. given your low ahi, including your ca usually under roughly 3/hr, there's a good chance the higher trigger setting will handle yours.

this is why I alternate between asv and vauto. my ahi is usually lower with asv (but rarely above 3 with vauto) but the asv ps activity wears me out. so, I'm not sure which is better for me, having had similar results to yours when I used apap. when I feel the wheels falling off with one, I switch to the other.

I'm not advocating one or the other or both for you and I can't say with any certainty that you'll fare better with either of them. I'm just suggesting you not pass up a vauto if you find one for a reasonable price. they're cheaper than asv and there are more of them out there. for reference, I paid $1000 usd for my used asv, $250 for my used vauto. both had about 3000 hours on them if I recall correctly.

[DaveL]

Incredible.

Thank you. As a young high schooler I know Had less lung capacity than others; or than anyone. They confirmed that when I had my broken leg in 2003.

Then much later I found out I had a hole in my heart from birth. Don't know where.

I had played many years of football. Coach typically said that I was out of shape because it took me a long time to recover after exertion.

And for years and years I ran 5 miles a day at 8 minute pace to handle stress.

Combining those...I'mnot surprised that I have a messed up flow rate....what do you think?

Dave

[Ratchick]

Hole-in-the-heart usually refers to a hole between the two sides of the heart - the heart is basically two pumps in one - one on the right that pushes blood to your lungs to get oxygenated and then a second, stronger one on the left that pumps the blood around the rest of your body. Before you are born, it's normal to have a hole between the two sides (called the foramen ovale) along with a blood vessel (called the ductus arteriosus) that connects two of the big blood vessels coming out of the heart. This lets blood bypass the lungs, because of course, you're getting your oxygen and excreting carbon dioxide through the umbilical cord and placenta. Usually, those close off at birth, or shortly afterwards. But sometimes they don't, or there is a birth defect that causes a hole between both sides separate from that. Little ones can go unnoticed until adulthood, but big ones obviously can cause many issues.

[sheepless]

"Combining those...I'mnot surprised that I have a messed up flow rate....what do you think?"

sounds like a medical question I can't answer other than to say I'm sure there's a reason for the choppy flow rate. grasping at straws at this point, to me it's a visible representation of something awry. depending on its source, pap may or may not help. for example, if it's a consequence of movement, particularly involuntary movement like plm, pap won't help & in fact may make things worse by ineffectively raising pressure (hence my point about vauto being more capable than asv of limiting pressure fluctuation). idk but think it kind of a no-brainer that pap won't overcome heart & lung issues & they would similarly have to be addressed independently.

I guess I will go out on a limb to speculate, based solely on intuition & nothing more, that I'd think you'd see the pattern all night if a consequence of a heart/lung issue. but that's just baseless speculation on my part.

[DaveL]

Thanks sheepless. It's logical.

Much appreciated.

Dave

[DaveL]

Your comment made me realize....

I keep falling asleep in front of the tv. No cpap anywhere near.