Tobiathan therapy thread

[tobiathan]

One night is too small a sample, I'm guessing, but so far setting the minimum to 10 has not been an improvement.

Aug 3, pressure range 8-20
[attachment=68008]

Aug 5, pressure range still 8-20, no other changes
   

Aug 6, pressure range 10-20
   

[Old Steve]

Can you post a 2 minute section of the flow rates for the CA's on Aug 6th at 3:50 AM & 4:45 AM times.  This may help determine if the CA events are actually Central Apneas.  I think the 1:20 to 1:50AM may be positional apnea and the sections at the beginning of sleep and when you are waking are sometimes loaded with events.  Although, you are correct the move to 10cm the first night did not produce the desired results.  

[tobiathan]

Thanks Steve, I appreciate your willingness to take a closer look. I'm not sure how to interpret these. Hope I got the screenshots right - here's 3:50
   

and 4:45ish
   

I went back to 8cm min last night, AHI 3.2... It would be nice to improve on that if I can, but I'm glad at least it's back to the 3ish range instead of the 6-10s I was seeing at times this summer. I seem to do better with the nasal pillows mask for some reason.

edited to add: what the heck was going on at 1:30...
   

[Old Steve]

The 3:50 AM CA appears to be normal breathing then an arousal and then you held your breath which is pretty normal. Although, I would  expect your breathing to return to normal after the CA event but it didn't .  The second CA at 4:45 is impossible for me to determine what is going on.  Keep posting some of your charts, I may see if someone on the forum more knowledgeable than I can take a look at your charts. 

[Old Steve]

The 1:30 CAs looks similar to the 4:45AM one.  I am not sure what is going on.  I will have someone else check your charts.

[tobiathan]

Thank you Steve, much appreciated. Here's a CA from last night as well.
   

If I zoom in on some of these charts, I see weird stuff going on with the flow rate even when it's not picking up an actual apnea; is that normal?
[attachment=68052]

[Jay51]

It seems like in most of your charts, your CA's are few and either appear at the beginning of sleep or just as you are waking up.  This is most likely sleep wake junk (transition back and forth from sleep to awake and awake to sleep are not 100% effective in the brain).  Happens to several people.  

Your flow limitations are 0.08 95th percentile.  This is kind of borderline.  Not bad, but not great either.   You are already using EPR 3 to help combat these flow limitations.  

Your one large CA cluster might be from a mask leak.  Here are some tips.  Look these over to see if anything can help you personally.  Mask Primer

Lastly, you have some OA's still in your chart.  A few look like clusters, too.  Some things to try other than pressure increases are lowering your pillow height; possibly side sleeping instead of back sleeping; and if those 2 fail to stop your OA's, you could try a soft cervical collar.  

Old Steve has done a great job helping you so far.  We will try to help you optimize the current machine that we can the best.  If after it is optimized the best, and you still don't feel good in the morning, it might be time to try a different machine (probably a bilevel next).  

Any questions, feel free to ask.

[tobiathan]

Thank you Jay, I appreciate the analysis and advice. Here's a sample from Aug 5, which was a little rougher a night, based on the numbers. Flow limitation 0.16 95% percentile. I zoomed in on one OA in the middle of the night. 
   

It sounds like I need to try the flatter pillow again. The apneas look less clustered than they did for a while, I thought, but I'm struggling to interpret these. 

Example from July 19 with a lot of clusters. Full face mask. 
   

I feel reasonably good in the morning, although maybe it's all relative and I don't know what normal feels like. Definitely feeling better than I did before starting APAP in 2019. I'm not seeing symptoms that would drive me back to the sleep doc, it's just that my AHI has been more erratic and higher than it was for the previous few years, especially when I was trying out the full face mask. With the FFM I was seeing more CAs and fewer OAs, with the P10 I'm seeing the reverse. I need to read up on flow limitations, I'm not sure what it all means. In case it's relevant, I do have a deviated septum and some nasal congestion. Very reluctant to do septoplasty, I've had bad surgical experiences in the past.

[Jay51]

Here are some articles from your Wiki on flow limitations.  I noticed on one of these charts that your pressure was driven all the way up to 20 (the max).  I still think you have too many OA's - you shouldn't have as many as you have.  Hopefully we can figure out how to minimize these.  You can try raising your min pressure to 10 or so to see how that goes.  I don't know if you like your pressure low with a ramp when you are going to sleep or not.  

• Flow Limitation
  
  
  
  • Flow Limitation/UARS and BiPAP
    
    
  
  

[tobiathan]

Thanks, I will check those out. 

The chart with the high pressure, I was using an F20 mask. My charts look noticeably different with that vs the P10 that I went back to; high pressures, more CAs, fewer OAs. 

I did try upping the min pressure to 10 at Steve’s suggestion but it didn’t seem to fix anything. Granted, I only tried that for one night. My chart from that is a few posts up on this thread.

No ramp — my current minimum is 8, and I remember when it was at 5. I felt air-starved with the P10 mask (turned out I also was using too small a cushion on it). 8 seems comfortable to start at and seems somehow sufficient to get through the nasal congestion I tend to have at night.