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RE: mallar's therapy thread - mallar - 04-06-2024
Pete: thank you again. I see in my charts that sustained flow limitations are accompanied by the APAP increasing pressure. If I'm understanding you correctly, it's possible that I'm arousing from the breathing issues instead of the pressure increase that accompanies the breathing issue? Aren't my flow limitations relatively low 95% < .1?
You can more easily control the pressure changes than flow limitations -- so it's a good trial to see if a single pressure results in fewer arousals.
Jay: thanks for the response. it's very possible that I have some physical breathing issues. I very recently went to the ENT to examine why I get a lot of sinus infections. I had a septoplasty as a teenager (about 25 years ago) to fix my deviated septum. It seems that the septum has "re-deviated", at least in part, and that I have some other issues going on with my nose that could be hindering my breathing. It's hard for me to tell subjectively if I have a hard time breathing through my nose: I've breathed this way for so long that I don't remember it being any different. I am having a CT scan of my sinuses as part of this whole nose/breathing assessment this coming week.
Absent a possible surgical intervention for my nasal breathing, is it still possible to get better results from a regular APAP/CPAP machine? I still would like to have buy in from my sleep medicine provider, and want to get the machine put on settings "approved" by the provider from a titration -- which hopefully they'll approve.
I think what I'm going to do is try a continuous pressure of 8 for a couple of nights. If the results are markedly better (I stay asleep longer), I'll keep it and advocate for keeping it that way with the provider. If not, I'll advocate for the titration. The titration may or may not work, but at least i'll have the provider's acknowledgement that it's not working. And discuss the possible physical breathing issues as well.
And I'll of course be open to further optimizations suggested from the Apnea Board community!
RE: mallar's therapy thread - Jay51 - 04-06-2024
It seems like you have a great plan in place. Try the fixed pressure. See about possible structural abnormalities of your sinuses by CT. Another possible titration. Hopefully these steps will lead to a long term solution that you approve of.
RE: mallar's therapy thread - mallar - 11-17-2024
It's been some months since I last posted. I have had challenging experiences with mediocre providers with terrible communication, even worse small-time DMEs with limited products available, and many supplies purchased out of pocket. Sleep is somewhat better, and I know a great deal more about how my body responds to CPAP and apnea. My numbers look very good, but I don't feel great yet.
Changes:
- Full mask to nasal mask
- 2 EPA to no EPA
- Pressure settings from 6-15 to 9-12
Continuing challenges:
- Waking up and consciously feeling it 2 to 5 times a night
- Heart racing, gasping and chest pain(?) when I do wake up. I notice I'm usually on my back when wake up.
- Not feeling refreshed in the mornings.
- I haven't wore my Wellue CheckMe in a few weeks, but my O2 seems good with few drops.
- FWIW, I wear a neck brace as I notice I tuck my neck quite a bit at night. I don't know if I need this strictly speaking.
- I believe I'm very sensitive to leaks. I've even experimented with double taping my mouth, which might be helping?
Attached is last night. It's representative of the last week.
What might be causing me to wake up? What might be preventing me from getting a refreshing night of sleep?
RE: mallar's therapy thread - Jay51 - 11-17-2024
Great job with all of the effort you have put into your pap therapy recently.
Waking up with a racing heart rate and chest pain is something that needs to be addressed IMO (this is what got me into therapy initially). Do you have a Cardiologist? It may be good to present this data to them or try to get a Cardiologist just for peace of mind.
Tachycardia is a classic symptom of sleep apnea. Usually obstructive apneas (but could be CA's and H's as well) can deplete SPO2 enough to cause heart rate spikes and even cause changes within the heart for the worse. Mine was caught in time. I hope that your is as well.
Your CA's have come down a lot from the charts you posted at first. That is good.
Gasping is not good either (waking up gasping). Do you feel like your pressure is high enough? Sometimes if pressure is too low, a person can feel, "air starved". But, obstructions and flow limitations, etc. can cause this feeling as well.
Do you mind posting another OSCAR chart using this template (it will give us even more data to analyze and give suggestions. Thanks): Organize your OSCAR Charts