Plmnb's Never Ending OSA Journey (Data)

[Plmnb]

Here we go.  I did take 3 screen shots so I could get info about what everything means.  I hope it isn't info overload.  I believe these results are just last night.  Even though I had that darn card in and out of the machine multiple times it appears it did record all my other nights info as well.  Not sure how the earlier data is of help at this point.

I do want to mention that so far, I am so tired and miserable every morning, even with my CPAP.  I have an appointment today to pick-up a different mask.  I'm not sure what it is called, but it is a different type of full face.  I think it will not have the soft nasal area.



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[Sleeprider]

The image below is the ONLY chart we need. It can be improved by minimizing the monthly calendar by clicking on the triangle in the date-line. These results are pretty much what I expected to see with some pretty significant flow limitations, hypopnea and a some obstructive apnea.  The patterns of obstructive clusters suggests you have a chin-tucking problem that might need to be addressed with a soft cervical collar.

My recommendations are to increase the minimum pressure to 8.0 and increase EPR from 2 to 3.  This will give you a head start on the pressure you need to keep your airway open, and may help to reduce the flow limitations by giving you more inspiratory pressure support using the higher EPR.  Notice your median pressure is nearly 13 cm which is near the maximum setting.  The pressure is being driven upward by the flow limitations you can see in the chart and statistics.  These flow limits are likely arising from an upper airway restriction, and is made worse by chin-tucking that reduces the amount of air passing through. If you zoom into the flow rate graph, you will see the flow waves are flattened. This is caused by the restriction in your airway. Like kinking a hose, the amount of flow that can pass through the restriction is limited.  I think you need a soft cervical collar to help keep the airway open.

[Plmnb]

Wow! Amazing. When I go pick up my new mask should I have them make the adjustments you mentioned? I will also see about the cervical collar.

So thankful for your help!

[Osiris357]

Wow!  Amazing.  When I go pick up my new mask should I have them make the adjustments you mentioned?  I will also see about the cervical collar.

So thankful for your help!

They probably won’t do it. You have to do it yourself. They can only do what the doctor says I believe. You need to go into the clinical menu to do that. You can find a clinicians guide in another part of the forum. Sorry I don’t know where exactly. Another more knowledgeable member will be along shortly to help you with that. It’s very easy to do. I would tell you how but it’s forum rules not to. The clinicians guide will tell you. You can also google how to do it. That’s what I did. Very simple

[Plmnb]

I will only post the charts you cite in the future.  Thank you for letting me know.  I do just this once want to know about any info that can be gleaned from this report.  Only because I am just starting over and I would like to know if this report says I am making progress since the first day?


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Ok, will give it a try.  I really appreciate your help.

[Sleeprider]

The change of settings is very easy. Just press the control knob and home button below the screen at the same time, you can then enter settings. Scroll down to highlight minimum pressure, press and change to 8.0, press again. Then scroll down to comfort settings and change EPR from 2 to 3. Easy peezy, and this is a DIY, the DME will never know. Here is a picture tutorial https://www.apneaboard.com/resmed-airsen...setup-info

[Osiris357]

I will only post the charts you cite in the future.  Thank you for letting me know.  I do just this once want to know about any info that can be gleaned from this report.  Only because I am just starting over and I would like to know if this report says I am making progress since the first day?

It’s only been a week so it’s hard to tell. One thing I recommend is trying to get at least 6 1/2 or 7 hours of use each night. More would be better but that’ll get you going in the right direction and feeling better sooner. If you’re only sleeping for 4 -5 hours you may feel the effect of sleep deprivation which will make it hard to tell if cpap settings aren’t right or are you just exhausted

[Sleeprider]

I will only post the charts you cite in the future.  Thank you for letting me know.  I do just this once want to know about any info that can be gleaned from this report.  Only because I am just starting over and I would like to know if this report says I am making progress since the first day?

Here is what I have on your chart:
With pressure of 6 to 15 and EPR 2, this chart shows a relatively high AHI of predominately obstructive events. Upon starting therapy, pressure rapidly rises to a median of 13/11 cm and flirts with the maximum of 15 cm through the night.  The main driver of pressure increases are flow limitations and obstructive apnea.  The first session from 00:10 to 02:20 shows a fairly normal profile without clustered events. Flow limitation peaks at 75% at 01:10 and subsides, and pressure follows. The restriction is sufficient to cause several hypopnea, RERA and is interspersed with OA. Events stabilize with pressure at 12.0 to 12.4 cm leading to the first therapy break at 02:20. We can disregard the event there as the mask is removed and triggers a leak to shut down the machine.

At 03:00 therapy resumes with a strong cluster of hypopnea, and series of recovery breaths (higher flow) causing RERA to be flagged.  Flow limitation is extreme and nearly overcomes inspiratory effort suggesting a positional factor such as chin tucking.  This is clearly an uncomfortable condition and therapy is stopped at 03:35.  The final session starts at 03:50 and continues to 05:54. This session is punctuated by clusters at the beginning of therapy (how tall is your pillow) and a cluster from 04:50 to 05:10. This again suggest a chin tuck that might correct with a soft cervical collar. Following the last event cluster, flow limitation persists, but we see some of the most even breathing flow rate of the night, and this is likely restorative sleep.

Impression is that measures to correct positional apnea such as using lower or different shape pillow or a soft cervical collar will likely help , however flow limitation is constant and may be the result of physical obstruction in the nose or upper airway.  Higher EPR will slightly improve this flow limitation by offering more inspiratory pressure support, but flow limitation may not resolve without bielvel pressure support of 4 to 6 cm.  A professional medcal evaluation of airway (nasal pharyngeal) to identify the cause(s) of upper airway restriction should be considered. Overall, while the event rate is mild with CPAP treatment, this kind of sleep disruption is very difficult to tolerate and the sufferer normally complains of non-restorative sleep and poor therapy results.

[Plmnb]

So grateful for the reviews of my data. Have spoken to the dr.s assistant about the data. Will probably be going for a visit early next week. I find it strange that the medical equipment provider’s RT and my dr.s office have never heard of “chin tucking” and had to look it up to get info.

Working on cervical pillow acquisition. My pillow is not high or hard. I think what may be happening sometimes is extra pillows stacked under my pillow so that I can nestle my head against my husband are creating a problem. I’ll have to figure out this particular issue.

I have a new mask to try tonight. I tried it on when I got home and I think it will be better than the prior one. This one is the ResMed AirFit F20. I do like not having to stress about my nose with the pillow thingys of the first mask. I’m a little apprehensive though because the new mask is so similar to the types I used to find on the floor beside my bed every morning.

I’ll let you all know how it goes! ?

[Sleeprider]

Don't give up the snuggle, just find a way to do it without cutting off your airway. To help, you should experiment with head/neck positions to see where breathing resistance occurs. In the Flow Limitation wiki, i talk about sitting in a chair and relaxing and letting your head drop toward your chest, and using the back of your hand to press gently upward against the soft tissue at the back of the jaw, while being aware of how this restricts your airway. You may be surprised how little pressure is needed to occlude the airway. The key is relaxation because when we are awake we compensate by using muscles in the throat to protect the airway. In your case, just think about sleeping positions and find out where the problem areas are and then think of ways to avoid that. One of the tricks I use is to pull a very thin part of my pillow between my lower shoulder and the jaw. This acts the same way as a cervical collar, and prevents the head from tucking. Individuals with severe forms of this clustering pattern often need a soft cervical collar as they are unaware of when it is happening. Your obstructive clusters are present, but not very severe. See the soft cervical collar wiki in my signature for example of other member's graphs.