[Treatment] Help with treatment, questions, approach, understanding

[HalfAsleep]

I had a septoplasty and turbinate reduction recently. I’m not sure it made much difference to my xPAP experience, but it definitely made a difference to my life. AFAIK you have to “fail” Nasacort to qualify for the nose surgery. It’s likely that’s what the ENT was trying to convey to you.

I would be suffocating at a pressure of 5. That’s not a pressure for most adults. I can’t believe your sleep prescriber set it that way! No wonder you’re exhausted all day.

[HalfAsleep]

Your waves look normal to me. You can look up wave shapes on the Wiki. When you see a series of squiggles along the axis between exhale and inhale, it indicates an apnea of some type. If it’s significant, the unit indicates what kind of apnea it is.

My mantra is macros first before micros. Get the pressure settings sorted out before you hone in on other features. So much can change with correct settings. Deal with mask issues: sometimes these affect pressure or vice versa. Deal with positional apnea. Those are macros, big picture items.

Micros are pretty much everything else, and you may have mooted some of your many questions.

[UsuallyTired]

Saturday night: 
I tried APAP 7-9 and EPR 2, and I was a wreck on Sunday. Despite the good numbers, I think the large leaks woke me up and fragmented my sleep too much. Anything above 6, and I struggle with this. When I have tried to adapt in the past, I have not been successful. 

Sunday night 
I went back to CPAP 6 and EPR 2 b/c I was just exhausted and wanted to go back to something familiar. My numbers look good, except I woke up 2 hours too early.  I'll post the screenshot zoomed in about 10 minutes before I think I woke up. I suspect these flow rate fluctuations are causing me to wake up early. 

You are having a new experience in the APAP mode, and it will take some time to settle down and hopefully lessen the CA occurrences. Because of these, you want to adjust the EPR more slowly. I recommend starting with EPR=1 and seeing its impact on the CAs.

ok. Given your comment and others' comments, I'll try to slowly increment up. Tonight I'll try something higher but not sure I'm ready for APAP 8-10 w/ EPR 1. I don't know if I'll make it through the night at those settings; I might not even be able to get to sleep. In the past, I start venting as soon as I start to sleep, and I wake myself up before getting to sleep. 

To address your above question, I must first discuss it with the advisory members and comply with our policies. I might be able to respond later. 

ok! No problem at all. 

Try to mitigate the dry mouth by increasing the humidity setting. 

 ok. I had gotten rain out before when I had humidity at 4. It was very hot here so I had turned the heat down then off. 

your mask, which was okay for the lower-pressure CPAP regime, might have leaks at this higher regime. 

Are some masks better for higher pressures? Is a nasal cushion better? I was already considering that. I have a big nose and short beard, which make nasal or full face masks difficult or impossible. 

I would be suffocating at a pressure of 5. That’s not a pressure for most adults. I can’t believe your sleep prescriber set it that way! No wonder you’re exhausted all day.

I had horrible sleep for my 2 overnight titration studies, especially the first. First one recommended 5-12. The second recommended just 5. My AHI numbers were good, but my subjective experience was a disaster. 

My doctor and I settled on CPAP 5 at home b/c it seemed the best mix of low AHI and not venting and waking me up. 

Your wave patterns are not particularly concerning, and your flow limitation figure is okay. Let's focus first on the APAP setup.

Your waves look normal to me. 

Thank you

I had a septoplasty and turbinate reduction recently. I’m not sure it made much difference to my xPAP experience, but it definitely made a difference to my life. 

This is interesting. I'd love to hear how it did improve your life outside of xPAP. 

Deal with positional apnea.

I only recently ready the positional apnea section on this site. I just a few days ago started using the advice here and supporting my neck and straightening out my airflow. It has absolutely improved my apnea, so much so that last night I had none. I have a cervical cover arriving in a few days. 
-----------
Writing this response, I feel like I may come across as being difficult. That is not my intention! I simply in the past haven't been able to increase pressure without creating a new and worse problem with the leaks. 

I'm hoping with everyone's encouragement and advice that I might find tools (mask?, tape?), settings (EPR, APAP), or techniques (position) to overcome that. 

   

[UsuallyTired]

Hi, all! I have some updates. 

Taking in some advice from this thread, I've been experimenting, and I just received my Releaf cervical collar 2 nights ago. I believe it makes a real difference. I also think it may help limit oral venting, a problem I have at higher pressures. 

Any comments or insight about the attached Oscars? 

For me, my biggest question now is, what about those CAs? I always have had some, ranging from 0 - ~2.0. Is this a concern, or what can I do to minimize that? I suspect I may have some nasal flow limitations (UARS), if that helps. Note I am on O2 1pm. 

Second question is, are the Large Leaks significant? I usually have near-0 leaks. Or, does it just mean I need to tighten my mask? I'm using an N30. 

Last night (APAP 7-11 with EPR Off): 
   

Previous night (APAP 7-10 with EPR 1): 
      

Zoom in to a random Flow Limit fluctuation. Does this mean anything? Do healthy people have fluctuations like this? 
   

Thank you

[G. Szabo]

Your higher AHI index at EPR=1 is probably not due to the higher EPR setting. Instead you had a positional apnea problem between 4-5 am. 
Your number of CAs are not concerning. Keep experimenting with EPR=1 or even EPR=2.
Your mininim pressure is still low.  I suggest min 8 max 11.

[G. Szabo]

For me, my biggest question now is, what about those CAs? I always have had some, ranging from 0 - ~2.0. Is this a concern, or what can I do to minimize that? I suspect I may have some nasal flow limitations (UARS), if that helps. Note I am on O2 1pm. 

Second question is, are the Large Leaks significant? I usually have near-0 leaks. Or, does it just mean I need to tighten my mask? I'm using an N30. 

Once you are on supplied oxygen, the chance of having CAs increases. So, it is a complicated case to fine-tune. Ideally, first, you want to mitigate the low oxygen saturation by optimizing your CPAP/APAP treatment setting, and when you reach the limit, you start increasing the supplied oxygen. Your doctor probably followed this path. However, I do not understand why the APAP option was not considered.   

Your leaks are close to the upper limit, but you are still receiving the treatment with the intended parameters. Nevertheless, it would be best to reduce them to increase your comfort. You might need a different mask for these higher pressures.

[UsuallyTired]

G Szabo, great comments. Thank you. 

What's the advantage of increasing the lower limit of APAP? Is it to try to get ahead of flow limitations before they start to occur? 

My doc never once mentioned APAP.     But looking back in my records, it was one of the 2 recommendations from my original overnight study. Huh

I'll experiment with adding EPR back in. 

Regarding the oxygen, that was mostly by my demand b/c I was borderline but on the side of not needing it. I tried it and felt a difference, so stuck with it. But, given that this other tuning may be working, it may be time to start removing the O2 and see what happens. 

I've been wanting to buy one of the oximeters that Oscar supports but just haven't gotten to it yet.

[G. Szabo]

What's the advantage of increasing the lower limit of APAP? Is it to try to get ahead of flow limitations before they start to occur? 

 Precisely!
You will have a quiet night. Some of the high-resolution flow patterns you have been concerned about also indicate flow limitations at the inhalation peaks. This is followed by somewhat irregular breathing (both amplitude and frequency) because you are unconsciously trying to compensate. This disturbs your sleep, although it does not show up in the AHI index.

[G. Szabo]

I've been wanting to buy one of the oximeters that Oscar supports but just haven't gotten to it yet.

You seem to do things very methodically. Would you mind letting us know your conclusion about the best oximeter for OSCAR? I want to upgrade my one, but I do not have the time to read all the comments about the different models. 
You might want to consider that the precision of the ring type is not the best. The clip on your nail must be considered for a realistic reading, though the ring type is okay for the tendencies.

[UsuallyTired]

You seem to do things very methodically. Would you mind letting us know your conclusion about the best oximeter for OSCAR? I want to upgrade my one, but I do not have the time to read all the comments about the different models. 
You might want to consider that the precision of the ring type is not the best. The clip on your nail must be considered for a realistic reading, though the ring type is okay for the tendencies.

Happy to let you know what I decide. However, I'm losing my patience over all the back & forth and unknown information about the different models. I am going to follow the advice of someone in this thread and just pick one of the Wellue (Ring, SleepU, CheckMe). They all seem somewhat comparable to each other. I don't think any of them fit over the fingertip. 

With that said, I just dropped Wellue an email asking for more info about the 3 models. I'll wait until mid-week for a response and then decide.