wickedsleepy - Sleep Therapy Analysis

[PeaceLoveAndPizza]

Will EPR make you tired? I have no bloody idea. It does not to me, but others may have had a different experience.

What will make you tired are the flow limitations, positional apnoeas, and pressure swings caused by flow limitations.

Consider setting your pressure range to something like 10-14 or 10-15 with EPR 2 full-time. Your median is hovering around 10 anyway, so you can skip the pressure rise at the start which seems to cause some sleep-wake junk. Adding a bit of EPR will help with the flow limitations, so the continuous rise and fall of pressure should even out a tad.

Also ponder using a soft cervical collar or mouth tape to help handle the positional apnoeas. It also should help with the flow limitations as it does not allow your head to drop fully to your chest, so the airway is kept more open.

[wickedsleepy]

Thanks, I know my OSA is clearly worse on my back, but as far as kinks in the airways, I used to sleep with my head slightly elevated (two or more pillows), but I knocked that down to just one pillow as of a week or two ago, albeit a bulky single pillow.  I will try something a bit flatter tonight.

[Crimson Nape]

Thanks to UnicornRider's pickup on you having multiple threads (6) that all deal with your therapy, I will be merging them into one thread. I will be naming the thread, "wickedsleepy - Sleep Therapy Analysis". This allows the reader to see your history and prevent cross-posting. Please keep all posts that concern your therapy in this thread.

- Red

[UnicornRider]

I agree with PL&P,
    EPR - Full Time
     EPR - 2
     Pressure 10 to 15

   Tie a rolled up towel under your neck to  prevent chin tucking, if it works and gets rid of the clusters. Invest in a soft cervical collar.

    Meanwhile post back with future OSCAR Reports and we can fine tune that therapy.

[wickedsleepy]

Hi everyone,

I've tried setting the floor to 10 and the ceiling to 16, with EPR setting of 2.  I wasn't willing to go lower than that with the ceiling based on things I was seeing.  As I anticipated, with 16 as the max, I was still getting issues with reaching and hovering around the max, even without major leak issues.  So, I bumped the max up to 18. 

I've posted the charts from last night's sleep, below.  I see that there were a few times where the pressure raised to 18 (the max) and stayed there for a bit.  Do I need to put the ceiling back to 20?  One thing that concerns me a little is my respiration rate, which can hover for longer periods of time around 50 (not as much last night but more in past nights over the last few weeks).  It's something I'm keeping an eye open, because I wake up feeling like I've been jogging in my sleep.  Here's what I noticed from remembering my sleep and looking at the charts.  I tend to roll on my back, which causes some apneas, then the pressure ramps up, my jaw relaxes and sags back, the mask leaks because the seal breaks, and the pressure climbs more.  I experience some uncontrolled apneas, I even snore some (my wife says), and then I wake up, roll back on my side, and fall back to sleep.  Some nights this seems to be more of an issue than others.  Happened a little bit last night, more on other nights.

Anything you can see from this that I should change in my settings?  It's still hit or miss on how tired I am.  Seems like these back-events make me more tired and mentally foggy.


       

[PeaceLoveAndPizza]

Your flow limitations are going to continue driving up pressure, which is typically dealt with by increasing EPR. You still look to have some chin-tucking going on given the way events are clustering. Something I would recommend a soft cervical collar to help combat. I use an Evora full-face mask and still need to use an SCC to keep my airway open and manage mouth drops.

Some of your leaks look to be fairly well lined up with some of the events as well. Something to keep an eye on as there is a cause/effect in some of the cases.

Your median respiration rate is fine. An occasional burst of fast respiration, but it is all likely inter-related to the flow limitations, dream states, etc. Look closely and the flow limitations are lined up or closely aligned to your higher respiration rate. If you are concerned post an example being sure to include the charts for full respiration rate, minute vent, flow limitations, and mask pressure. There are some on the board who can look at those and offer more information and advice.

With more EPR you may be able to drop pressure as once the flow limitations are controlled, the pressure will not rise to the current levels so you may be more comfortable. You can try narrowing the range for comfort, something like the 10-15 or 11-16 range, with EPR 3 full-time.

You may also end up being a candidate for moving to a bilevel like the ResMed AirCurve 10 Vauto. With its ability to offer more EPR and extra parameters to tweak it may be the next step. Before going that route let us consider all possibilities with your current Autoset. Using me as an example, an Autoset with EPR 3 could not handle the flow limitations and once I got a Vauto with EPR 4 my flow limitations are gone, and my pressure was no longer 16-20 EPR 3 or higher, it is now 7-11 PS 4.

Some things to ponder…

[BoxcarPete]

1. Your respiration rate spikes appear to co-incide with flow limits to some extent. One thing that happens sometimes is that the machine will double-record breaths if they have a certain pattern to the inspiration flow. Look closely at a zoomed in chart to put your own eyeballs on it to see if this might be happening.

2. Looks like you have event clusters, and your bed partner is even confirming that it's positional. What are you currently doing to prevent chin-tucking? A chin strap won't do it because you can still tilt your whole head down and kink your airway even without your jaw sagging. A soft cervical collar may help with both leaks related to jaw opening and keeping your neck straight to stop positional airway blockages.

[UnicornRider]

I agree with PL&P and Boxcar,

     Moving over to the AirCurve 10 Vauto, greatly reduced the pressure settings required for my therapy.

    Try these setting:

     EPR - Full Time
     EPR - 3
     Pressure 12 to 20

    Invest in a soft cervical collar. local Pharmacy or wallyworld should have a selection.

    Meanwhile post back with future OSCAR Reports and we can fine tune that therapy.

    Be sure to include how you felt with the pressure and any info the wife can provide.

[wickedsleepy]

Thanks, everyone.  I was not able to obtain a soft cervical collar, last night, but I used one of those thin, rubbery ace bandages around my jaw and over the top of my head, not too tight, and worn under the Evora mask, to help manage the jaw opening.

I used the setting suggested by UnicornRider.  Min 12, Max 20, EPR 3.  

The charts *look* pretty good.  You can ignore the far left of the graphs -that's when I was playing with it while trying to take a nap earlier in the day.  You can see that overnight, however, there was only one real cluster of OA events -looks like four together.  The pressure never exceeded 17.  Question:  when it says there is an OA, does that mean it was detected and NOT corrected successfully?  Or does it just indicate that there was an event, regardless of whether the pressure was able to open my airways back quickly?  And what does the number mean next to the event when I hover over it?  Is that how long I stopped breathing for??? :O

Anyway, even though the graphs look pretty good, I am totally wiped out, today.  It kinda felt like 12 as a floor/baseline was high to sleep with?  I don't know.  I just know that the numbers look good, but I am very tired physically, including in my chest, and I feel out of it, mentally.  This is what I don't get.  I would assume I feel good, even rested?  Any idea what could be causing me to feel like this?  I use humidification, otherwise, I can wake up stuffed up on one side.  Could that be a factor?  

Here they are:
       

[UnicornRider]

All of your  events appear as though they are clustered, they probably are positional, that is driving up your Flow Limits, therefore the machine responds by increasing pressure,

Are you using a Soft Cervical Collar(SCC)? Or some device to prevent chin tucking?

You could try lowering your Pressure Max to 16, Keep EPR and Pressure Min the same and try to get rid of the chin tuck.

That Evora FFM is a good mask, try to work the leaks out.

Post back with an OSCAR Report and feelings. 

I understand the frustrations and fatigue, I did not get to my current machine and pressure without some struggles.

Your OA's were definately clustered possibly 5 each. The number beside each event is the duration in seconds.

Your Hypopnea and RE are also close enough to be considered clustered. If you zoom in on them and scroll beyond them you will see the wave shapes are distorted, therefore the Flow Limits trailing those events.

Try reviewing The Guide:  https://www.apneaboard.com/wiki/index.ph..._The_Guide

Hang in there