Resmed 10 or Tennis Ball T-shirt - Help???

[Windswell]

73 yr old, 5'9”, 154 lb, 15” neck, active but not a gym rat, Boston area
2005 – Girl friend mentions that I stop breathing while asleep, then gasp, all while remaining asleep. My primary doctor laughs as my body type doesn't suggest sleep apnea, but agrees to a hospital sleep study. Results – “Yes, you stop breathing at night, but blood-oxygen is always fine, so you're OK.”

January, 2022 – visiting baby grandson in Seattle, sudden onset of horizontal double vision. 36 hours + $15,000 Medicare in excellent neurology wing Seattle hospital, blood, CT scan, MRI, etc., NOTHING WRONG with me except the double vision which is a little scary.

Feb, 2022 – neuro-opthalmologist in Boston says double vision will go away untreated in 12 weeks and “is as common as dirt”. But she wants a sleep study as my wife mentions snoring. Nerve next to my eye MAYBE O2 starved at some point. Double vision may be an after-effect of Covid or something else, maybe my use of Benadryl as sleep aid and she changes me to 3mg Melatonin and B12.

April, 2022 – Double vision goes away untreated on schedule. Sleeping great on Melatonin. Reading a lot about snoring and sleep apnea.

April 15 – Home sleep study, annoying instructions, somewhat faulty equipment and difficult support, so I wasn't in a great mood. SlHomestudy.jpg attached, see “Events by Position” table. Problem events occur when on my back. So I sew a vertical pocket in the back of a T-shirt for 2 tennis balls and start sleeping on my side. And I complain to my insurance company, so they'll pay for another home sleep study (which I haven't done yet).

May 20, 2022 – Major Boston research hospital asks me to join a 14 week sleep research/CPAP clinical trial study.

July 13, 2022 – overnight until 2pm next day in Boston Research hospital. Wired sleep study, lots of blood tests, Echo heart study, carotid-femoral speed study, multiple blood pressure checks, some ultrasound evaluation data and a reaction speed test. They wouldn't let me wear my tennis-ball T-shirt as they wanted me on my back for at least half the night. They FAILED to wake and roll me onto my side after 4 hours, as I requested. I did roll over myself for the last 2 hours of sleep.

July 21 – I received their “summary” (attached Researchsleepstudy.png) which included NO analysis of the time sleeping on my side. I've asked for that analysis and am waiting for the full report.

July 31 – My O2ring arrives. Attached are 2 nights of tennis-ball side sleeping (SLRing7-31_8-1) . I'm still a beginner at all this, but scores of 9.5 and 9.9 sound pretty good. With no serious drops in O2. And the April home sleep study suggests no problem when on my side (or does it??-your comment).

Aug 1 – My hopes of professional science-based evaluation by the research hospital are waning for a number of reasons. Resmed Airsense 10 Autoset arrived yesterday with NO SD card. Hospital will send me one.

SUMMARY: I am still committed to trying the CPAP for a month to see if I “feel” better, and if it keeps my wife awake. Though I generally feel pretty good. I'm 73; I do take a 20 minute nap 3 or 4 times a week. I windsurf, garden, walk, etc. I'll record O2 data for 2 more days with just the T-shirt. Then start on the CPAP with Tshirt. The Hospital says they did NOT set any particular pressure, that it's automatic. Please advise if you suggest any settings. But if my T-shirt O2 scores continue to be as good as the first 2 nights, am I getting any benefit from CPAP? I will continue to wear and report the O2Ring data while using the CPAP. Your thoughts?

[OpalRose]

Hi Windswell,
Welcome to Apnea Board!

When you receive your SD card, be sure to insert it in your Pap machine. It must be in the machine while you are sleeping. After a night or two of data, post a chart here for review if you wish.

The Obstructive Apnea needs treated. A good starting point for pressure settings would be 7cm minimum with 15cm maximum. Set EPR to 2. Adjustments can be made after we see your data.

Follow the link below in my signature line to guide you in Organizing a graph and posting it here.

If you need a Clinicians manual, order it here:
https://www.apneaboard.com/adjust-cpap-p...tup-manual

[Windswell]

Well, after days of struggle I'm getting more competent with the Resmed 10, Oscar, my nose, etc. I was feeling pretty excited about my first "full" night of CPAP sleep until I uploaded the data file which suggests a lot of leaking. On advice found here about base of the nose pain, I did recently move to the Large pillow. The headgear doesn't come off, but is definitely not snug, as I thought I understood that snug was bad. Obviously there's all different understandings of snug.
Attached here is my first shot at an Oscar screenshot and a screen shot of O2ring data from last night. As mentioned in my post above, so far my 02 and ODI scores are "healthier"- I think - when I'm not using the CPAP, but maybe that's because my sleep is disturbed by the machine which I may get used to. Also attached are 2 nights of 02 ring date when NOT using the CPAP machine. SLring7_31-8_1

[dnldcs]

Your leak rate suggests that your are breathing through your mouth, but it could be fit though. 

Ideally, leak rate on an S10 should be less than 6. So I would start by trying to fix that. Trying a full face mask and checking leaks before you go to sleep with a mask fit check. 


I don't see a benefit in having your Pressure setting so wide, a smaller window, such as Min 9, Max 11 may suit you better.  


Your O2 stats don't reveal anything out of the ordinary for a "normal" night of sleep.


I am not a DR, nor any type of medical professional. All views expressed are my personal views, and not medical advice.

[Windswell]

Thanks for your reply. About mouth breathing. I am aware that my mouth fills up and feels inflated occasionally and which point I just blow it out. I am also now remembering that at some point last night I was feeling a little annoyed with the machine and chose simply to breathe in and out of my mouth a little.

[clownbell]

@ Windswell - What you describe sounds like "chipmunk cheeks." If you will search for posts on that topic, you may find some strategies that will work for you.

Large leaks are an important issue to deal with. You are in Large 33% of the night, which significantly effects your therapy. https://thrive.kaiserpermanente.org/care...s-contents

Settings are wide open at 4-20. I would recommend starting at 7-10 with EPR=3 full time. EPR should help with your high flow limits.

I am not an expert. Hopefully one will come along soon.

Also, there are "mask leaks" and "mouth leaks" and they are not the same.

[Windswell]

Another night, another couple charts. On waking, I felt "accomplished", made it masked through the night without nose pain (lanolin) and a little less dry mouth. But my AHI, ODI,  O2 and Leak Rate scores are getting worse or not improving, but I'm still new to all this. As mentioned in my first post, I am part of a Boston hospital based clinical trial, so I'll ask them for a face mask and try that out. if they'll send me one. The 4% drops to 88%  last night occurred while awake, fiddling with the nose cushions, and under a LOT of personal stress. Thankfully I was able to get to sleep, though woke at 4 am and slipped in and out of sleep for the last 2 hours. 
I did adjust the max - min from factory 4-20 to 6 - 16, and made the headgear slightly snugger. I always sleep on my side, and noticed that when my head rocks slightly in the pillow the velcro strap is stressed/tightened and dislodges the nose cushion, but I think it reconnects pretty quickly.  As suggested in a previous reply, I expect I'm mouth-exhausting while asleep. I'll read about chipmunk cheeks now.

[dnldcs]

Do you have any data from your sleep studies, like your AHI? This would be helpful information.


You might be waiting for a minute for your mask.  While some medical professionals frown on it, many people tape their mouth closed and use a nasal mask, instead of using a full face. This could be a temporary solution for you, to see if you can get your leaks down, and if you are breathing through your mouth at night. 


A note on higher AHI and other data: the machine has difficultly discerning all that data when you have high leaks, As you start controlling your leak rate, those numbers will start accurately reflecting your night. The trend seems to be once you get leaks under control, then you can focus on adjusting your therapy. 


O2 stats look good.

[Windswell]

My sleep studies are in the original post, but here they are again.
Note my RED outlining on the home study where I had dramatically fewer events on my side, rather than supine.
On the research hospital study, there was limited time on my side and NO events so they chose not to score it, entering"insufficient data".
The research hospital study was really looking for scoreable events and wouldn't let me spend all night on my side, using the tennis ball shirt.

[Windswell]

As noted in my earlier posts, after recovery from a winter-time 12 week bout of NOW-likely Covid double-vision, I was home-sleep-study diagnosed April, 2022, with mild-moderate SA when sleeping on my back and NO-mild SA when on my side. These results were sorta confirmed by a July, 2022, research hospital sleep study funded by National Institute of Health (NIH) to study impact of CPAP. Both studies are attached in earlier posts here. Since then, I ALWAYs sleep on my side. I was admitted to the NIH clinical trial and started using Resmed_10 on August 4. On my own, I purchased an O2ring which I've used since July 31. Attached is a spreadsheet comparing 43 nights of SpO2, ODIs on nights with and without the CPAP. Also attached are two Oscar nights of lower leak rates and good AHI scores.
I have struggled with leak rates, nose pain, different masks, Resmed settings, nose-pillow cushions. I currently use a chin strap, nipple cream, Xylimelt mints, 3mg Melatonin, and I don't wake up with dry mouth or during the night and almost NO snoring in 43 days with or without CPAP. Below is a summary of those 43 nights.
19 days No cpap O2score 9.6, ODI>3% 1.6, ODI>4%  0.5
24 days CPAP      O2score 9.3, ODI>3% 1.8, ODI >4% 0.8 
The hospital research folks are not much help, so I'm turning to ApneaBoard as my earliest Pulmonologist appointment is in late October. As reflected in my amateur spread sheet and the numbers above, I seem to be slightly SpO2 healthier with NO CPAP, as long as I sleep on my side using my tennis-ball-Tshirt. The results are very close if I eliminate CPAP-struggle-nights from the spread sheet. My wife is perhaps the MOST understanding/generous woman in the world, but CPAP does degrade her already spotty sleep. And it is not good for our sex life.

I realize that CPAP is important therapy for many of my friends and I expect for ALL of you who are reading this.
I do not intend here to challenge any of that and recognize that I may have some degree of Central Sleep Apnea. But I still have what I understand to be very healthy SpO2 scores and plan on continuing to use the O2ring EVERY night for it's alarm function. But I am thinking of returning the Resmed and dropping out of the remaining 8 weeks of clinical trial.
Your thoughts??? And thank you for this Board. It has been invaluable to me in this journey.