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Narual therapy thread - narual - 10-25-2022
Hi there! I've been very bad about complying with therapy (since I bought out of pocket, there's no insurance company yelling at me to give me extra motivation).
I'm hoping if I get the settings dialed in a bit better I will be better with compliance.
I haven't had a good sleep study yet. My at home one in December only got an hour or two of data -- they wanted it returned early in the morning and I didnt fall asleep til after 4, didn't sleep well, and managed to move the chest strap to the wrong location, too. The in-clinic one I had a few weeks ago was a complete wash. They scheduled it for 8PM to 5AM, and I rarely fall asleep before 2, especially when I can't take a sonata or a cannabis gummy to help - I had about 65 minutes of sleep in 2-4 minute batches by the time I left.
in both cases, I showed somewhat moderate apnea with pretty significant drops in oxygen - down into the low 60s sometimes. (I have my study results from December here somewhere, I'll add them when I find them)
They scheduled me for another one and for this one they'll accommodate my actual sleeping schedule, which doesn't really meet their night shift workers or the regular schedule, and it's supposed to be a test and titration in one night... but if I can get the info dialed in using Oscar in advance, that will make things a lot easier.
So, here's a night from a few weeks ago (before I managed to leave my pulse oximeter ring in Las Vegas
), where I wore it for a few hours and was asleep for most of that time. Any help with settings would be most appreciated. 
RE: Narual therapy thread - narual - 11-23-2022
I managed to wear the mask through an afternoon nap that felt like I got pretty good sleep. Forgot to put the oximeter ring on. It shows my AHI as 9.52.
I'm attaching the full graph and a ~3 minute slice before a series of obstructive events. Can anyone suggest settings changes that might improve my results from what little I have here?
Thanks!
RE: Narual therapy thread - Sleeprider - 11-23-2022
Well, that's spectacularly bad looking. Let's start with a read of the positional apnea and soft cervical collar wikis. Do you feel you can't exhale from your nose sometimes, or are you exhaling orally?
http://www.apneaboard.com/wiki/index.php/Optimizing_therapy#Positional_Apnea
http://www.apneaboard.com/wiki/index.php/Soft_Cervical_Collar
RE: Narual therapy thread - narual - 11-23-2022
I don't usually have a problem exhaling from my nose unless I'm sick. Inhaling can be tough sometimes, but worlds better since I had septum/turbinate surgery last year, and using Flonase regularly. When I can't inhale comfortably, I use Afrin (as rarely as possible since I've been hooked on it way too many times in the past).
When I'm wearing the mask and open my mouth, the air comes straight out. I don't know if that's normal - it doesn't happen to my wife when she does and the other people I've asked wear masks that cover their mouths.
I typically sleep either on my side or in a prone position with my head mostly on my arm, turned to my right side.
From what my wife said when I first asked after reading those wikis a while back, I don't generally have my chin tucked while I'm sleeping, but I'll ask her to specifically watch, or set up a night vision camera to record myself sleeping.
I can pick up a collar this weekend, it can't hurt to try.
Thanks!
RE: Narual therapy thread - Sleeprider - 11-24-2022
The appearance of the chart is clusters of obstructed breathing with relatively high leak rates. I think part of the problem there is the very low starting pressure of 4.0 which does not enable EPR to be available to you. With a pressure of 4.0, your pressure in bilevel terms is 4/4 (IPAP/EPAP). Full EPR of 3 is not available until you reach 7.0 cm pressure for 7.0/4.0. It's pretty clear you need a minimum pressure of 7.0 with your EPR of 3. This should be well within your comfort tolerance, so let's increase minimum pressure.
Your zoomed shot starts with oral expiratory breathing where the inhale is followed by a flat expiratory wave of zero flow. At 14:24 you have an arousal or change in sleep position which is followed by increased flow limitation or inspiratory airway resistance, then a cluster of OA. This is positional, and can occur in a prone position with the head turned to the side, just as easily as if you were on your back with the chin tucked. Higher minimum pressure will help, but you can do an objective evaluation of how much airway resistance is likely to occur, by simulating those positions while awake and fully relaxing. If you feel airway resistance, then those are positions to avoid. In your case, using side-pillows to prevent rolling onto your stomach , or at least enabling a body position that is less intrusive to your airway, may be more effective than using a collar. If you have a means of observing your sleep position and correlating that with these clusters of obstruction, you will have what you need to make appropriate and effective changes. The Positional Apnea article points out that airway resistance can occur in any physical body position, often with a chin-tuck, but other mechanisms are also equally obstructive. Learning how your particular flavor of positional apnea is triggered, will go along way towards finding a solution.
RE: Narual therapy thread - narual - 12-06-2022
I ordered a ReLeaf neck rest and it arrived yesterday. I also went down one size on nasal pillows as the larger ones were leaking a bit when I laid on my side.
Pretty dramatic difference with it on.
[attachment=46206]
[attachment=46207]
RE: Narual therapy thread - Sleeprider - 12-06-2022
Any time you can knock 93% off your AHI, that's a pretty good sign. Multiply your current AHI by 14 times and you still won't reach your previous result. Pressure is much more stable now and this looks like it's going to work. Hopefully you soon feel the benefits of this improvement.