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+--- Thread: Newly diagnosed severe CSA & OSA (AHI=108) seek advice (/Thread-Newly-diagnosed-severe-CSA-OSA-AHI-108-seek-advice)
RE: Newly diagnosed severe CSA & OSA (AHI=108) seek advice - Gideon - 02-15-2020
Mouth breathing can be detected in two ways.
1. a Plateau on the leak rate chart
2. Less "volume" on the expiration than is inhaled on the flow rate chart (need a zoomed view)
We are a closed system, what goes in, has to go out. If you are not exhaling thru the mask the flow rate doesn't detect it, thus lower volume and expiration/ mouth breathing.
read the Mask Primer on Mouth Breathing http://www.apneaboard.com/wiki/index.php/Mask_Primer#Mouth_Breathing
RE: 1st OSCAR data Newly diagnosed severe CSA & OSA (AHI=108) seek advice - Liteheart1 - 02-16-2020
[attachment=19999][attachment=19994] 1st OSCAR data from 2nd night of ASV treatment. Sorry I couldn't get all in one screenshot or absolutely preferred order (OSCAR doesn't work quite as wiki says if on Mac laptop as I am). I did NOT wear chin strap and sleep study indicated some mouth breathing, but chin strap is for now too much to get used to along with all else. I got up once in middle of night for bathroom and so "session" it seems covers two "sub sessions" to comprise 5.5 hours of use. I woke with some dry mouth. Felt somewhat less rested with ASV than without treatment, but felt OK. Slept a bit more after session ended without any mask ASV. At least AHI is down considerably but perhaps is NOT truly accurate if mouth breathing had occurred. In comparison to my . very first night it felt to me that there was some air leak; and the side of one nostril got very itchy and at one point I partially lifted mask to scratch.Thanks for your impressions of data and cutting my learning curve in understanding how to look at it. As needed can zoom in and post that later on. Much thanks as usual.
RE: Newly diagnosed severe CSA & OSA (AHI=108) seek advice - jaswilliams - 02-16-2020
Overall the graphs look very good the ASV is working hard at times to keep you breathing and reaching its max configured pressure, that is normal. The leaks are only for a short duration so have not adversely affected your treatment. I see no need to use a chinstrap at the moment.
RE: Newly diagnosed severe CSA & OSA (AHI=108) seek advice - Sleeprider - 02-16-2020
For a first night on ASV this looks pretty good, and your dry mouth problems were a result of some persistent leaks through the night. The charts need some work, and if you can get Events, Flow Rate, Mask Pressure and Leaks to line up, that would be ideal. The most important feedback now is how you feel. We don't expect your to wake up with sunshine blazing and a Spring breeze blowing through your hair, but a realistic, today is better/worse than yesterday should do.
You had leak problems from the beginning of this thread, but your AHI is negligible on ASV. The therapy will get more comfortable and less disruptive, especially if you can resolve the mouth-leak problem. I think you're off to a great start.
RE: Newly diagnosed severe CSA & OSA (AHI=108) seek advice - SarcasticDave94 - 02-16-2020
Obviously some leaks are present, and though not bad, that would be my first focus if I were you. Address leaks to diminish a bit more, absolute zero not needed, just better than present.
I'd consider the switch to ASV Auto Mode to give EPAP a range as opposed to the straight assigned value as is now. To me it was partly for therapy and part comfort. An EPAP range is better comfort wise because it diminishes the otherwise steep PS step up.
RE: Newly diagnosed severe CSA & OSA (AHI=108) seek advice - Sleeprider - 02-16-2020
Dave, ASVauto mode is a tough call here. AHI is only .5 or so per hour, so the minimum EPAP is working fine. I don't see a lot of advantage to changing up at this point. Nomrally, I'm all-in for ASVauto mode, but I don't think it will make much difference.
RE: Newly diagnosed severe CSA & OSA (AHI=108) seek advice - Liteheart1 - 02-16-2020
Thanks to all of you for comments/evaluation; I will re-read them all. My take aways and tentative plan, any comments appreciated.
1) Off to a good start.
2) Will avoid chin strap for now as that might be the hardest thing to adjust to with all of the rest, but will use a commercial mouth/lip seal product to see if that can reduce mouth breathing, and will continue with the tongue tuck and other exercises. If can avoid or postpone chin strap at least for now that'd be great but happy to revisit that in perhaps a week.
3) Will work on mask leaks and fit to try and pull those numbers down. First night was I think better than the 2nd night, as 2nd night mask felt slightly less comfortable. Will look at slight adjustment in tension on straps.
4) Will spend at least several more nights just getting used to the basic routine and treatment. Since prior to treatment I never felt especially tired in morning or during day there aren't a lot of subjective elements for me to look for in improvement. Even though apnea events are way down (and in 1st sleep study it had AHI at 108) so far I am waking up somewhat less rested than prior to treatment. Nonetheless I expect each night I will be wrestling less and less with equipment and can relax into things which should result in better subjective experience of sleep. It seems from numbers that at least parts of my body are probably happier with better air flow so that is good news.
5) I'd be fine with actual suggested numbers for going to ASVauto mode should that become advised but want to out of respect include my sleep doctor in that. She has been very helpful so far and I don't want to alienate her. She loves that I am so involved in my treatment. I expect that once there is more data and self report and I simply let her know that some users have suggested trying this small tweak to settings, what do you think? That she would be fine with it and interested in seeing what impact it has on results/numbers
RE: Newly diagnosed severe CSA & OSA (AHI=108) seek advice - SarcasticDave94 - 02-16-2020
Point noted on mode Sleeprider. I chalk it as I said majority under therapy as needed, some weight to comfort. Probably best to see what the trend of several days show us I guess. I put on hold the suggestion of ASV Auto mode for now then.
RE: Newly diagnosed severe CSA & OSA (AHI=108) seek advice - Dormeo - 02-16-2020
Liteheart1, your outlook sounds just right to me. And I think it makes sense to show respect to a good doctor, especially because, as time goes by and you work together, she will see that she can trust you. There are some sleep doctors -- not enough, but some -- who encourage patients to use Oscar and do fine-tuning on their own. You may well have one of these; wouldn't that be grand?
RE: Newly diagnosed severe CSA & OSA (AHI=108) seek advice - Sleeprider - 02-16-2020
Dave, I can see the ASVauto mode both ways. I think it would be interesting to see the pressure response in auto mode, I would probably limit it to EPAP 5 to 8. I don't think it will make much difference as there are not apparently obstructive issues here. The Resmed ASV is beautifully designed to use the EPAP pressure changes appropriately, so that is what we normally recommentd. When I say it would not make much difference, It is probably more accurate to say, i don't expect much pressure change.