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+--- Thread: Maybe I have apnea, maybe not, are all sleep doc jerks? (/Thread-Maybe-I-have-apnea-maybe-not-are-all-sleep-doc-jerks)
RE: Maybe I have apnea, maybe not, are all sleep doc jerks? - 2SleepBetta - 05-01-2021
Some musing below, cathyf, nothing surprising to you I'd guess. This post was begun after reading yours that it refers to. I haven't checked back to see whether others have (as is likely) been more helpful.
Re your overall view for 5/1:
I see in my FR signal the same attenuation levels as yours from very large leaks during those episodes near 0150, 0250 and 0440. I strongly suspect those periods for you are another manifestation of positional IFL--probably from one or more of supine positioning or other idiosyncratic position, tissue or phlegm impediment to airflow.
Your variations FR, I, E and RR support thinking The.5 level of FL at 0255 is correct in that fuzziier FR curve (larger leak) segment just prior to 0300.
Inspiration time shows you working hard to breathe enough air--don't know how you have withstood that so much of your sleep time.
The smoother, almost invariant FR curve shape, in the attenuated curve after 0300, explains to me the lack of FL signal--the signal trigger, airflow drop, is lacking. "No changeee downward, no trigger", so no FL flag. There is insufficient change in RR/duty cycle, amplitudes, wave shapes, ventilation, the factors SR and NIH cite as the contributing co-indicators of flow limittation.
Re one zoom (your third image, same sleep session):
What amazing uniformity--the time after 0130, even where centered at about 0340. The lack of mask pressure suggests to me that after 0130 you are breathing almost unaided, or even handicapped by PAP, with wind blowing in your face.
Constancy of high leak--no outliers--in leaky stretches along the Leak curve did raise a question in my mind whether your blower's output could be deficient. Unlikely. I haven't gone back to look at your earlier presentations. Your whole-session FR curves are far smoother than my "spikey caterpillars". Most of my leaks--now-- are brief, small and incidental to a burst of motion with large FR amplitudes. There are occasional LL. Sometimes I lift the mask clear for 3-4 seconds to mark a spot in the session. Those leaks are huge and stand out.
I've come to see the value of your 10,000 ft views, 10-20 minutes wide, and am using that view more. But I find interpretation of those graphs more difficult than selections 1-3 minutes wide. And in that vein, it helps me, while spinning my wheels, to zoom the signal heights to nearly span the display window height and display a narrower range of signal level numbers at left. One can see and correlate many of the levels and their changes. Your TV graph does seem to be zero before 030430, the third graph.
RE: Maybe I have apnea, maybe not, are all sleep doc jerks? - Sleeprider - 05-01-2021
Your leaks are most likely oral, and specifically appear to be oral expiration with nasal inspiration. My wife is really good at it, and as you can see the expiration wave is clipped, and inspiration is flow-limited, so I mostly agree with 2sleepbetta. You seem to make a positional or mask adjustment and everything returns to normal, so the leaks are disruptive. Try it, and you will see how easy this is. In through the nose, out through the mouth.
RE: Maybe I have apnea, maybe not, are all sleep doc jerks? - cathyf - 05-01-2021
Does this mean that the nasal mask is hopeless and I should just give up and go back to the FFM?
RE: Maybe I have apnea, maybe not, are all sleep doc jerks? - jaswilliams - 05-02-2021
Cathyf Your leak rate does not seem to be adversely affecting your treatment and your leak rating does not go over the magic 24l/m to trigger the Resmed large leak. I would stick with whichever mask you find most comfortable your numbers are good
RE: Maybe I have apnea, maybe not, are all sleep doc jerks? - cathyf - 05-02-2021
After last night, I think I have a better handle on what's going on...
It was a veritable leak fest!
[attachment=31955]
So part of the joy of living life as me is that everything is too big! Although I had succeeded in removing 4 inches of foam from the collar, because of the way that I had stitched the stockinette back together (as in sloppily) it was stretching a bit and seemed a bit big. So I tightened it up by overlapping the fat ends. Which was pushing on the bottom of the headgear and just pushing the mask off my face all night long. (The Dreamwear nasal mask is pretty minimal in structure...)
So here's me, mask pushing away from face, waking up enough to futz with it, going back to sleep.
[attachment=31956]
If it's not one thing it's another
I ripped out my stitching, cut another 1/2-inch of foam, then used some pins to secure it better when I sewed it back up.
The collar is now a good 4-1/2 inches shorter than when it got put into the box at the factory! Tonight we try again...
RE: Maybe I have apnea, maybe not, are all sleep doc jerks? - cathyf - 05-04-2021
Last night after the further shortening of the cervical collar, things were much quieter.
[attachment=31977]
45 minutes at 2:00ish and a half-hour at 4ish of leaking, which close up has the characteristic shape of mouth leaks. (squashed down inspiratory wave, with sharp tall spike down on the expiratory segment) Only one isolated hypopnea, at a point that I had just fallen back asleep, and my fitbit scored a 30-second arousal about a minute later. 95th %tile flow limit of only 0.14, with the only interesting segment of extended flow llimits but no leaks at 8:11-8:44, the period that my fitbit thought that I was in REM sleep.
getting the hang of this!
RE: Maybe I have apnea, maybe not, are all sleep doc jerks? - DaveL - 05-05-2021
Well done! That's a big improvement!
I like the way you've linked your fitbit. (My Garmin tells me how long I've slept; whether I've been up during the night. And it tells me how long I was in deep sleep, and light sleep. It's often over 2 hrs of deep sleep now. With my old cpap ResMed s9E it would be 30 minutes max.) I can see a FirBit or iWatch or something in my future.