Cartab’s therapy thread

[Crimson Nape]

Without looking at the data, do you wake up with a dry mouth?   Your flow rate graph in another indicator.  Here are typical waveforms. Take a look at the second to last.


I forgot to add; Right-click on the Flow Rate label next to the graph. Select Dotted Lines ⇾ Zero. This provides a better view of the crossover line.

- Red

[cartab]

Update: 06-06-22

Setting: CPAP Mode
Pressure: Fixed 12 chH20
EPR: 2 (Then switched to 3 at 6am)

Switched EPR back to 3

Another night of AHI under 3. This time I experimented with a lower EPR (to 2), but I just couldn't handle it. I was having a hard time breathing out, and at 6am I woke up, and I switched the EPR back to 3. (Graph A)

Swapped mask to N20

Then a little later at 6:30 , the P10 felt strangely tight around my head. It normally feels comfortable. So swapped it out for the N20. I just realized how much that mask leaks, specially through the diffuser at the front. Is that normal? I ordered the 'memory foam' insert, to see if it is less leaky. 

Second night of upper back pain in the AM

This is the 2nd day in a row, where I feel back pain. Back pain that goes away after taking off my mask. I was reading up on this, and could be related to muscles getting used to CPAP? 

Tidal Volume Graph:

Why does the tidal volume look so different between B and C? The only difference might be 1. Was I not fully asleep? (I do not know). 2. Mask? 3. EPR change?

Settings for tonight:

Since my AHI's have been getting better the lower I go, what do you think of lowering pressure down to 11, EPR 3? Alternatively, what settings would make sense if I went back to VAuto BIPAP settings? Would the bi level help me alleviate the exhalation pressure?

I appreciate all the support through this journey.

[cartab]

Update:

Had a fantastic session with a registered sleep tech. We reviewed my Oscar data in detail, and determined my main problem are mouth leaks.

So next up we will be testing 1. Full face mask options, and 2. Nasal pillow masks with mouth tape.

Will experiment the next 6 days with the following settings:

- CPAP Pressure: 10, 11, 12 (2 days each) no EPR
- BiPAP Pressure: 12-8 (2 days) 4 ps
- BiPAP Pressure: 13-9 for 2 days 4 ps

[SevereApnea]

Hi Cartab,
 
"Tidal Volume Graph:
 
Why does the tidal volume look so different between B and C? The only difference might be 1. Was I not fully asleep? (I do not know). 2. Mask? 3. EPR change?"
 
Good job on scaling the Tidal volume graph.
 
I find a number of factors affect my Tidal Volume (Vt):
The higher my Flow Limitations, the less air is will be moved and the lower the recorded Vt.
The higher the leaks, the lower recorded Tidal Volume.
When I use higher pressure support on my Vauto my Vt goes up, which leads to to chest discomfort, hence I am slowly dialling down my PS on my Vauto.

Also consider the stage of sleep, REM etc (maybe even supine/side sleeping, no ways to correlate this at the moment) I am sure there are others.
 
Here you can see that the higher my leaks are, the lower the Tidal Volume. 
I see this all the time on my charts.....
[attachment=44102]

Here are some correlations, not perfect, but all part of the picture.


[attachment=44101]

I am also starting to see that one way to lower my Med Vt is to increase my Min EPAP, the higher my Min EPAP the lower my Vts, so you can see there are many factors, making it hard to find one super-correlator. This means as the pressures change during the night in response to your FL, so will your Vt.

I suspect that if you use fixed pressures, this will force your body's ventilation into a different type of mode and may also change things.

PS: Your leaks will look much more impressive when you scale the leak chart a bit differently!