(01-17-2024, 04:55 PM)BoxcarPete Wrote: Interesting, thanks for the info! I do have a small nasal/airway and have noticed that even breathing while awake can feel restrictive. After your nose procedures, do you still need the CPAP?


My take: find a good ENT who specializes in sleep medicine and get yourself scoped. Here's why:

1. RERA>>AHI in initial study
2. No O2 desaturation
3. Primary symptoms are mental
4. You're under 40 years old
5. Tidal volume a little low for size and T_inspiration>T_expiration
6. CPAP is only helping a little

These points all lead me to think you have a restriction in your airway that is not easily shoved aside with a little pressure. It's fragmenting your sleep and preventing your brain from truly resting, though the rest your body is not suffering from hypoxia. I am 33, felt much the same as you describe, and also tried a handful of things after my diagnosis at age 30: briefly tried CPAP, gave up, swapped to MAD for a year, but that little bugger caused all sorts of other problems (wife reported less snoring though), back to CPAP again. Finally woke up one morning and remembered that when I had my tonsils and adenoids out as a kid it changed my life, went to an ENT and within a minute of getting his camera out, he had read off a litany of minor maladies within my nasal cavity and pharynx that all added up to trouble. I came to him with all sorts of questions prepared, and he answered each one saying, "Let's fix your nose now, and talk again later." Well, later is now, got a 3-in-1 nose rebuild (septoplasty, submucosal turbinate resection, and adenoidectomy [yes, again]) last week and so far so good!

(01-17-2024, 03:40 PM)PeaceLoveAndPizza Wrote: Given the clustering of OA and H events, I suspect positional apnoea (chin tucking, not supine vs prone). A soft cervical collar should help. Consider a flatter (or CPAP specific pillow) to help as well.

I also suggest increasing flex from 1 to 2 (and possibly 3 later). We may need to increase pressure a bit, but let’s see how you do with the SCC and a bit more flex first.

(01-18-2024, 02:27 PM)BoxcarPete Wrote: I'm only 6 days past the surgery, and just had my one week follow-up today. Doc said days 4-10 are the worst because I had the adenoids zapped: they are sloughing off in bloody mucous chunks which I need to spit out. It's every bit as disgusting as it sounds. There's no question that breathing is easier for me now and I have not been using CPAP this week, but it's too early to say if I will still need it. I am not too worried about jumping back to it, even before the surgery my sleep study showed no O2 drops, so I'm guiding myself based on how rested I feel which should directly correspond to how fragmented my sleep is from breathing problems.

No idea why your results got so much worse overnight, but I suspect that the advice to have you increase flex was based on the fact that it's a similar function to ResMed's EPR. EPR is secretly a bi-level therapy setting with a limited scope of adjustment for the APAP machines, but Flex might work on a different principle that doesn't provide the same benefits. I would try turning it off and possibly even setting a fixed pressure at 10 to see how that goes.

Another thing I'd be curious to see is what Respironics thinks is periodic breathing, where you have the green bars. Can you show a couple 3-5 minute zoomed in segments from those times, maybe including a CA if it's in the mix?

(01-18-2024, 02:39 PM)PeaceLoveAndPizza Wrote: There is definitely positional apnoea going on there, along with not enough pressure. There are also no real flow limitations to be concerned about. You need a soft cervical collar and/or a pillow that supports good neck alignment.

I suggest setting flex back to 1 and increasing the pressure range to 9-14 to give more support when starting and a bit more headroom on the top end.

What we are trying to find is the proper settings to manage the apnoeas along with the pressure and flow limitations that drive it up, all while giving a better nights rest. It is a fine line we have to walk.

A word on your replacement machine. If you are buying a replacement for your Dreamstation out of pocket I recommend getting a Resmed Autoset (APAP/CPAP) or a ResMed AirSense (APAP/CPAP/Bilevel). The bilevel is more capable, but is more expensive. If it is insurance replacing it, then push for a ResMed. If it is a Philips replacement, you have no real choice.

(01-18-2024, 11:38 PM)BoxcarPete Wrote: That's two hours, I was looking for a handful of minutes to view the flow rates of individual breaths.