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

[UsuallyTired]

G Szabo: 

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.

FYI I purchased and received a Wellue O2Ring yesterday. I decided to stick w/ Wellue b/c it's compatible w/ Oscar, I believe it's compatible with SleepImage analysis (which my dentist uses and is a proprietary analysis of the data to produce Sleep Fragmentation data), and b/c some other users on the forum supported this brand. The SleepU doesn't alarm on heart rate, so that was out. (Actually, I mistakenly thought it didn't even track heart rate, but checking just now, it clearly does.) And, it was a toss-up between O2Ring and CheckMe. The CheckMe costs more and is bigger. So, I figured I'd go with convenience and price between the two. 

I have not yet tried importing the data. I will do that later today or later this week. I'll let you know how that goes. I may have some difficulties here b/c I'm in daylight time (but my CPAP doesn't track that), so all my Oscar data is 1 hour off. I know others have had sync issues with this, but I'll find out soon enough. 

Any questions, let me know. 

[G. Szabo]

Thanks for the update. I am waiting for your experience, and if it is positive, I will follow your lead.

[UsuallyTired]

G Szabo, 
Here's an update regarding the O2Ring. 

• The ring is easy to take on & off, so I find that convenient. 
  
• It uses micro-USB instead of USB-C, and that just annoys me. 
  
• It took a bit of time to figure out the best way to transfer files to my computer. Once I got my system down, it's easy. 
  
• The O2Ring starts recording data exactly 2 minutes after putting it on. This is important. 
  
• For me, the easiest way to sync the data is to: 
  
• 1. Put the ring on at the same time that I start the CPAP
  
• 2. Manually rename the O2Ring binary file to 2 minutes after the CPAP start time
  
• 3. Note the CPAP start time is likely a bit off from real time. My CPAP is 5 minutes and 26 seconds in the future. 
  
• Having done all this, I don't know if the data is useful!  Yes, I see some drops, but none of them are currently serious. (I'm also on 1 lpm of O2.) If I had more serious drops, that would be important to know. 
  
• I see some of the drops coincide with events but most don't. 
  
• The ring has an optional alarm which you can set to go off if your O2 drops too low. I may play with this in the future. 
  
• Right now, I don't see how the ring helps me change any of my behavior at this time. So, it's a neat toy but not particularly useful at the moment. 
  

Any questions?

[G. Szabo]

Thanks, UsuallyTired, for all the details,
I trust they will help others as well.

I hope you are doing better with your treatment. I believe the ring is a safety beacon to ensure everything is in order.

[UsuallyTired]

Thanks and you're welcome. 

I'm writing the following partially b/c I want to share it but more so just get it off my chest and help process all the avenues I'm pursuing. 

I continue to struggle with treatment, but I am making progress. Lately I've been trying a slew of masks and settings to see what works and doesn't. 

I simply can't get pillows to work for me at anything above 6 pressure. I vent orally (with or without tape), and it wakes me up. 

Over-the-nose FFMs don't work b/c I have to wear them relatively tight, and they tear up the bridge of my big nose. I've tried the AirTouch in two different sizes. 

I'm working with the under-the-nose FFMs F30i and F40 currently. I particularly like how the F40 fits. However, both have had leak problems, but I think I'm making progress on good fits. I also have some oral venting at times which, though much better than with a nasal cushion, is still a bit uncomfortable. 

I've been playing around with using a cervical collar, and I think that makes a huge difference. 

Next I need to try some RemZsss liners to see if they help. 

I also have a couple interesting doctors appointments coming up. One will give the results of a different home sleep study which, I was told, might give insight into UARS. We'll see. I seemed just like a normal study, but I'll await the interpretation of the doctor. I'm hoping he's more knowledgable than my current sleep doctor.  

I am seeing a TMJ/jaw/airway specialist soon, and he will do a CBCT scan. He comes highly recommended, and I'm expecting his expert opinion on my airways -- both nasal and throat -- to see if that sheds light on treatment options. 

From a previous opinion, I don't expect to need palatal expansion. But, I'm curious if this specialist recommends turbinate reduction (which an ENT has already recommended) or MMA (jaw advancement) or something else. I *hope* he doesn't recommend MMA. That is not something I want to go through or would be able to go through for a couple years. 

Anyway... that's what's been going on.

[UsuallyTired]

Hi all,
I've been working on different settings of the past few weeks. My impression is that the higher pressure I go, the worse my charts look and more pressure is indicated. What is going on? This all seems to be working backwards. 

Here is last night's chart, and I feel like absolute trash today. 

At the beginning of all this, I was at CPAP 5 (EPR 0) and had better numbers. 

Thanks


   

[G. Szabo]

Looking through your posted APAP results, it is striking that the higher the EPR setting, the higher the flow limitations are, contrary to the general wisdom. Higher EPR usually reduces the flow limit if the pressure is correct. 

The second thing is clear: according to the instrument APAP algorithm, you need higher pressure than your CPAP 5 cm pressure because you hit the 10 cm ceiling on June 25, the 9 cm ceiling on June 20, and the 12 cm ceiling on August 17.

I can think of the following alternatives. 
1) Some people do not tolerate APAP. In such cases, you want to find the optimal CPAP pressure by manually setting the constant pressures and finding the best setting.
2) You should stay on EPR=0 or EPR=1 with APAP (and with CPAP, for that matter) 
3) Your condition is changing and becoming worse. 

I would suggest testing alternative 3) and using the CPAP setting of July 19. If its outcome is similar to the previous result, then you should not use APAP, and you should find your optimum CPAP pressure, which gives you the lowest flow limits at the EPR=0 condition. Once found, you can increase the EPR setting to reduce your flow limit further.

[AshSF]

If your AHI and other nos. look okay and you are still feeling tired, there could be 2 reasons:
1) Your O2 saturation is dipping during the night.
2) Your sleep architecture is out of whack. (Time in REM sleep, Slow Wave Sleep, L1, L2 sleep).

Typically O2 saturation can be addressed by:
1) Increase the EPAP. Raising exhalation pressure improves oxygenation. So this would mean set the minimum pressure higher. You may go about it incrementally with 0.5cm change per week.
2) Take supplementation oxygen at x litres per minute.
3) Increase pressure support (PS/EPR). This helps in efficient washing out of CO2 leading to better O2 levels. But this may raise CAs. Those may be treatment emergent CAs so you may need to be patient in letting those settle.

The sleep architecture can be addressed by:
Going to fixed pressure mode. With fixed IPAP and fixed EPAP.

I would recommend you go to fixed pressure mode. And start with an EPAP of 5cm h20. That would mean a setting of 8cm with EPR of 3. Try at least for a week. And then go to the next approach.

[SeePak]

Welcome to the Board 'Usually tired' !

Your post comment...."

• 3 screenshots from last night, one of the best nights I've had, and I do feel better (but not great) today. 
  
  With experience i have, with suggestions from admin on this board.....Make small changes, wait a couple days, "don't Pfaff around with settings" !

So, using the settings you had for this 1st post of yours, 5cm     EPR=0

Logic would say increase to 5.2 for a couple days and see how you feel, don't worry about the numbers! Seriously

With my own experience, which mimics a few of your characteristics....
High anxiety, stress even when there is no reason for it ! From childhood, impossible to break out of without considering Breathwork !!
High bridge on nose
High palate, narrow upper arch ( years of mouth breathing from childhood!)
Don't like higher pressures( more leaks, air in stomach ! )
One of My phenotypes is definitely  Low Arousal Threshold.
EPR screws things up some or a lot of the time
My minute vent is between 4-7
And CPAP works good at set pressure, no APAP ( disclosure: i've never had APAP in 35 yrs)

And here's what i also see on your results
FL  95 % is 0.06 !   What's wrong with that?

And also, i have had great sleep with FL around 0.3 !

These are my experiences.
Others here have opposite experiences, so...

how to know which way to go?
I get it.

Much more to say, hope i have provided another viewpoint worth considering, with merit as well!?