robbob2112 -Adventures in Therapy

[robbob2112]

Hi, 

I started using the aircurve 10 asv about a week ago now and it seems to be going good.  My AHI is typically around 4.   Still having fun getting used to the nasal mask but in general wearing it while sleeping doesn't bother me at all.

The first night really sucked and I felt like my eyes were gonna pop out of my head, but nothing bad since.

I've read a ton of stuff on this board and learned a lot, but still to new at it to interpret the output Oscar is giving me.

I have started to notice I am not sleepy in the afternoons like I used to be so that is already a plus.

I've attached a picture with all the graphs on it and zoomed into one area that I don't understand (well I don't understand most of it at this point)

If you only want certain graphs enabled verse all I can retake the snapshots

So, can anyone explain what this repeating pattern means?  I've also included the whole day in case someone sees something else of interest.

Thanks 

Robert

[robbob2112]

Hi all, 

Last night was probably the worst I've had since getting the machine.  I am groggy and can barley string 2 words together.

How is it that I had an AHI of 0.34 when I was up and down and tossing and finally woke at 4am and just couldn't go back to sleep?

I turned my humidity up to 7 but it only shows as 4 in Oscar which is funny as well.  I finally woke without a dry mouth this morning which is great.

Robert

[gainerfull]

What was your lowest sp02 for the night? It looks like you're spending significant portions of your sleep at unsafe blood oxygen levels.

[robbob2112]

I hit 82 for a couple of minutes just before I woke up.

I live at 9144ft altitude so I am generally happy with anything higher than 90 verse what lowlander would be happy with.

I think my O2 hose from the concentrator might have been loose it got jiggled loose when I got up once.

but you are probably right, my wacked O2 is probably the answer.

Begs the question of just what AHI is measuring.  I haven't looked at that part of the code to see yet.

Robert

[robbob2112]

So, 

I checked over the graphs once I had a few extra hours of O2 and my head cleared and I could think straight.  

It looks like my real issue was massive mask leaks almost all night.  This tracks with the tossing and turning.  Normally once I am asleep I hardly move at all.  And, it caused my low SPO2 readings.

I've never really found a concrete answer written on what an acceptable SPO2 at altitude is supposed to be.  All the dr's I've asked just say keep it above 90.  I know when I walk to the mailbox or exert myself at all my breathing increases and my SPO2 drops a bit.  Going up the stairs and I can hit as low as 80.  But it goes back to 90+ within a minute or two.

Robert

[Sleeprider]

When you have leaks with an oxygen bleed, the oxygen becomes nearly ambient, lowering your FiO2. If you rely on a higher FiO2 to maintain normal saturation, then leaks are definitely something to avoid. Why are you using ASV, and how did you arrive at PS 0.0-5.0?

[Sleepster]

It looks like my real issue was massive mask leaks almost all night.  This tracks with the tossing and turning. 

Looks like mouth-leaking. This will disturb your sleep and ruin your therapy. I recommend a full face mask. You can also try a chin strap (available from your equipment provider) or a soft cervical collar.

[robbob2112]

Hi, 

After a few more nights of fiddling with everything I have come to the same conclusion.  I am mostly a nose breather but sometimes I wake with my mouth very very dry on one side.  Also when I turn my head and the mask doesn't turn with me I end up with a leak at the bridge of the nose.

I called my DME to switch the N20 for a F20 and we will see what happens.  On my own I ordered a F&P nasal pillow + chin strap from vendor #1 so I will have an option.

Still within my first 30 days so free to swap.

Robert

[robbob2112]

Well, 

I cycled through the F20, F30, F30i, N30i, and P30i...  The bigger the mask the worse the leaks and the worse my AHI.  All the top attaching masks pull up at the nose.

I added chin straps and mouth tape and can't stand either.  With the chin straps I woke up sweating and/or with a sore jaw.  Tried the type that holds the jaw vertical and it was way to hot.

I like to sip water in the night so the mouth tape interferes and doesn't stick especially well.

With any of the masks the facial hair interferes with the seal.

But less is more and I found a mask (N20 touch) that works pretty well and my leak rate is way down and I just had my 4th night with an AHI under 1.

The foam does a good job and I don't hate it.

My real issue that is left it all masks pull up towards my forehead including the N20.  At night I sleep hugging the hose and it stays ok, but isn't ideal.

[SarcasticDave94]

A few things I'm seeing...

You had some leaks, as mentioned they could have been mouth leaks.

Your ASV settings may not be ideal. You're missing the benefit of an EPAP range by not running in ASV Auto mode. Also, it appears to me that your max pressure which is IPAP max (EPAP Max plus PS Max) is seeming to flat line at the top of your pressures chart. EPAP range, different PS Min, and higher PS Max maybe will need to be considered.

Continue to try getting leaks under control as best as you're able to. I'd consider changing to ASV Auto mode which as I said will add a second EPAP number to set.

Finally, you're on ASV and an oxygen concentrator. What medical background lead up to that combo? Asking because maybe you're supposed to be on a different machine than ASV, which is for Central Apnea. Docs do get it wrong sometimes.