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Increasing Stage 3 and REM sleep

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DonMidwest +0 points · about 1 month ago Original Poster

Another good night. Slept almost 7 hours straight through. Should I stay the course for a while longer?

Some not so good news. Got up early and went with daughter in law for a robot competition her for my 12 year old granddaughter.

I had an aphasia, a speech TIA that lasted about 5 minutes. Before that I had a sense that something was not right and gave my daughter in law to be on the lookout. Fine now. Did not go to doctor. Had a head and neck scan a couple years ago and they found nothing.

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Sierra +0 points · about 1 month ago Sleep Patron

Sorry to hear about the TIA. My mother had those issues from time to time. Despite them she made it to 96 without a real stroke. That said, I think it would be prudent to talk to your doctor about it.

The overall AHI is not as low as I would expect but I don't see an obvious way to make a change. I find I go in cycles with CA events. I can be in the low 0.5 or less range and then shoot up to 2.0 or more. I would stick with this pressure for a while.

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DonMidwest +0 points · about 1 month ago Original Poster

Another very good night.

I washed off the cushion. It looks like we should stay on this course for a while longer to see if it stabilizes at these settings

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Sierra +0 points · about 1 month ago Sleep Patron

Agree. Things look pretty good.

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DonMidwest +0 points · about 1 month ago Original Poster

Another great night. I put in a screen shot with the device settings so you can see them. Are we at the point of going for a few days and check in only if something strange happens? Or, are there more fine tuning adjustments that you recommend.

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Sierra +0 points · about 1 month ago Sleep Patron

I think at this point I would just leave things as they are to collect more data. The Statistics tab will display a summary of the results since the last change to the settings. When it has been two weeks since that last change we can have a look to see how it turns out. I think you may be at the "Yes" answer to the old question "Are we there yet?".

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DonMidwest +0 points · about 1 month ago Original Poster

Started CPAP 13 years ago so it might have been 20 years of disturbed sleep. Early days of CPAP worked OK

Average of 7 hrs per day last week. Had not done that for years.

No naps in over a week.

As noted in the first post, I was beside myself because I could only see failure on the horizon. Sleeppy doctors did nothing.

Never consistently had AHI less than 5. Only occasionally.

Learned so much and need to learn more. Still not that good at understanding the graphs.

I will check back in a week if things go smoothly as we suspect,

If there is a breakdown I will contact you that day.

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Sierra +0 points · about 1 month ago Sleep Patron

That sounds like a good plan!

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DonMidwest +0 points · 26 days ago Original Poster

Some updates. I think that we are the longest, or second longest session here on MyApnea. Always thank you.

You suggested changing to a ResMed F40 mask. I am in the process of doing that. Medicare has a 6 month cycle that allows an entire change. I am putting things off to fit that cycle and change to F40 mask system. I was able to get the head gear but they sent 3 F30i cushions by mistake. They will send a mailing label, I will return the 3 cushions, and then they can send 3 F40 cushions.

I probably mentioned that I sent a message through My Chart to my "sleepy doctor" asking if F40 would be available on May 19 for my titration study. I did get a call back from the sub organization, related organization, or whatever's its connection is to the practice of the "sleepy doctor" and they will ensure that there will be a F40 mask for my titration. They mentioned that Ohio Health, the large system has not yet put F40 into their inventory. This probably explains why my "sleepy doctor" has not responded. I will let it rest.

I did look up Functional Medicine sleep doctors and will probably change after finishing the titration. I don't want to upset the various systems: US, Ohio Health, Medicare, Insurance and who knows what else.

When I go for the sleep study I will take my statistics and my memory card will be in my AirSense 10. Now that I am well below 5 I am not sure what they can do for me. I began this session with concern for Stage 3 and REM stages because they are important for the treatment of Alzheimer's disease. I hope to get that information from the sleep study since it is not available from OSCAR. In particular, OSCAR doesn't work with sensors of eye movement.

Well, I spent more time on OSCAR learning or reinforcing terms. I am sure Sierra knows about the two links from Apnea Board:

https://www.apneaboard.com/wiki/index.php?title=Soft_Cervical_Collar

https://www.apneaboard.com/wiki/index.php?title=Optimizing_therapy#Positional_Apnea

Things were going so well last week that I started looking into the breaks where there is No flow, No Pressure and No Mask Pressure. These can be seen on the bottom graphic in the chart below as breaks in the Mask Pressure graphs. I think there are 4 of those before the longer bathroom break. Do you know what they mean? I zoomed in and couldn't see anything.


Last week. Sat April 20, 1.65, Sun 2.21 Mon 2.84 Tue 0.53 Wed 1.73 Thurs 1.66 Fri 1.53 Sat 3.41


Then there was last night. I spent 2 evenings at with my granddaughter whose mother was out of town. Friday night was OK - that is the new normal that I thought I was on. Then last night some strange things happened and the AHI jumped up to 3.41.

Some things that might have contributed: not in own bed, glass of wine about 9PM, later to bed than usual, snack food at the event after 9PM but didn't eat much. Can you make sense of what happened between 01:05 and about 01:40?

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Sierra +0 points · 26 days ago Sleep Patron

Hi again, I think the breaks are being caused by the mask slipping out of position long enough for the SmartStart feature to shut the machine down. Then when the mask is back in position it restarts the ramp which in most cases is very short as you are likely asleep or asleep in a minute or so. I don't see it causing any subsequent apnea events though.

About the only thing I see unusual about the Daily graph you provided is that between 1:00 and 1:30 you got some OA events in quick succession. That usually suggests body position or a kinked neck. Perhaps the collar was not as tight as usual or you were sleeping on your back for a while.

Unfortunately like me you are stuck with this complex (mixed) apnea situation. It tends to be erratic with most of the variation in the number of CA events. I seem to have transitioned from having event frequency less than 1 to more like 1.3. I hope the lower levels return, but it is only a hope, as I don't see anything that would help. My current chart below. The magenta bars are the CA events which are most erratic and basically responsible for the day to day variation. I think I get the lowest scores when I sleep between 6.5 to 7 hours, and the worst when I sleep over 8 hours. Sometimes nearer morning when I am not sleeping soundly I thing I get some false CA event indications when I am transitioning between being awake and being asleep. Some call that "Sleep-Wake" junk.

In any case I typically get most of my CA events in the second half of my sleep, possibly during REM sleep...

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DonMidwest +0 points · 26 days ago Original Poster

Thanks for the explanation of the blank interval as mask slipped.

I sleep most of the time on my back. Some nights I wake up on my back and assume been on my back all night.

I have attached my summary chart. Since I have started working with you my AHI has been less than 5. I noticed on your graph, the max is 5 while mine is 20!

Also it is clear when we switched to a constant pressure of 11 with the red bars

My big night was April 18 when I forgot the cervical collar! Really stands what a difference it has made. Note my total time in apnea was 1 hour! And that was the only night with a huge Large Link since we started. That graph is not attached.

Should I squeeze down the rows and move rows around so that they match the selection of rows you use for this summary page?

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Sierra +0 points · 26 days ago Sleep Patron

You may want to drag the Pressure chart down below the Large Leak chart so it shows, and the Pressure chart is hidden. It will become pretty boring with a fixed set pressure. I should move mine down too...

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DonMidwest +0 points · 16 days ago Original Poster

Going to put date in the posting. March 5, 2023

I was doing fine with the F30i mask. After working together we got it down to 2 AHI per night and it was stable night to night.

My brand new F40 mask arrived on May 1. I immediately switched up to this new model.

The air tube comes out of the front which makes it easier to take off when I get up to go P. On the F30i it is on the top.

The first day with the new mask was OK. Then I started getting leaks other things. The max AHI is less than 4, but it is inconsistent.

With the F30i mask I took the initiative to adjust the straps on the mask (4 0f them) and the cervical collar. I usually could make adjustments that would show up as improvements the next day, or not making things worse.

I have attached 2 screen shots. The first one from 3/3 with the excellent AHI less than one but it had some mask leaks.

I tightened the straps last night, 3/4, and now the AHI comes in at almost 4. Went the wrong way.

And the mask feels funny on my cheeks. I don't think it fits my face as well as F30i.

I go in for a mask fit on the evening of May 19 and I will come in with reports and a lot of questions. I hope they are allowed to speak and problem solve. During a sleep study the technicians cannot talk about issues. Frustrating. Must wait for the sleepy doctor to bestow wisdom on the findings.

I am going to take in reports from OSCAR, my AirSense 10 CPAP, both masks and my pillow. Maybe before that I will go into the local outlet for the CPAP supplies which are sourced out of some other state for the equipment - and ask them about the fit on the side of my face.

In any case here are the two nights mentioned above. As a note I had some strange things going on during these days, have been terrible with my exercise.

Thoughts. Pressure. Ramps, Prayers, Masks Thanks

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Sierra +0 points · 16 days ago Sleep Patron

That certainly is a good result on the night of May 6th, and less good on May 7th. But, nothing is different in the setup, so that is just the quirkiness of central apnea. I am not a believer that the mask has any big impact on AHI. It certainly can on leaks and the 7th is better. With central apnea some of them can be sleep-wake noise. Is there any chance the sleep was not so good on the 7th compared to the 6th. If so, that may have been the cause - a restless sleep.. Masks always take some time to get adjusted properly. The last thing I do at night with my mask is pull it away from my face slightly so it leaks, and then I release it slowly back to my face. I think the air pressure inflates the flexible part of the cushion and gets it to seal equally all around the fit area. It may not stay in that position long and it only makes me feel good, but I think it at least gets the night started right!

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DonMidwest +0 points · 16 days ago Original Poster

Thank. I will continue with the same strap settings for a while.

Interesting that you don't think the mask makes that much of a difference. Some people go wild trying different masks and all sorts of things. Without OSCAR, some understanding, and guidance when needed, they can run around the barn over and over. There are so many interacting things.

And I was thinking that the F40 would be a magic mask. The marketing makes it seem that way.

I will take both masks to the mask fitting on May 18 and see what they have to say.

I don't think that they can say less than my sleepy doctor.

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Sierra +0 points · 15 days ago Sleep Patron

Masks make huge differences to comfort and the air leakage, but to overall AHI, I think not so much.

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DonMidwest +0 points · 9 days ago Original Poster

Well, the latest mask from Resmed, the F40, arrived last week. It doesn't work as well as the F30i so I am going back to the F30i.

It was uncomfortable and it leaked.

The biggest problem was that the cushion was too wide. I couldn't get it adjusted. Maybe for someone with bigger jowls. From the web

"What are jowls? The term 'jowls' describes sagging, loose skin below the jawline, which most people develop with age. Aside from ageing, a number of other factors can also contribute to having jowls."

I also fired my 'sleepy medicine' doctor. I mentioned previously that she has only provided a technology, no discussions on SLEEP. And when I mentioned the book "Why We Sleep" I was dismissed -- who was I to bring up something like this to an exalted doctor! They provides a prescription for a CPAP? They are deploying a technology - a pseudo pill to follow in the successful business model of Big Pharma.

I mentioned that I had a sleep study on 2/18/24 and scored 64 on Apnea index thus eligible for Medicare support. I had a titration study scheduled for this Sunday evening. The sleep lab is a separate company. I wanted to talk with the sleep technician about a couple of graphs that my wonderful helper here, Sierra, does not deal with. And I wanted to talk with the technician about the difference between the F30i and the F40 mask and how they fit on my face. FAIL. The technicians can only put machines on and send the results to the exalted doctors. The very doctors who for 13 years have only deployed a technology. I can go in on my knees and have a consultation with the "sleepy doctors" on the graphs that I produced. I declined. I am so upset with them that I don't want to see them again. The same doctors that scheduled a TITRATION study that lasts one night. That produces a REAL fact. Daily monitoring with 14 graphs from OSCAR is not real in their business model.

Why not talk with the sleep technician? That is forbidden for political/organizational/social boundaries. The sleep technician can only put on their machine and send the results to the doctors. The sleep technicians score the study which includes Stages 1, 2 and 3, and also REM sleep. But they are forbidden to talk with the patient. They are second class citizens.

But on reflection, what can the sleep technicians add? They don't go over daily results and do the real titration which is a human machine interaction over many days, they are lab machine operators, they don't have any contact with human treatment. So I probably placed too much faith in the technicians because they don't do what has happened in the dialogue here over these many days. I just looked and I have now posted here 73 times. In 13 years of experience with this 'sleepy doctor" practice I bet that they have never really done the job that has been done here on MyApnea. In other words this experience has exposed the fraud big time.

The REAL results only come from a LAB which is where SCIENCE is done. If TITRATION has the same charge as a sleep study, it will be $6,500 US dollars which for me after insurance was about $100 charge. (Wonderful!!! see what a bargain I got! Only $100 for this lab result!! I should be so happy! Does anyone care that the government got ripped off???) Like resource extraction of oil, health care is resource extraction - using humans to mine the system for $.

I got a new doctor. I searched for "Functional Medicine Sleep Doctor" That will be in a month or so. So far I only need them for the annual update of Medicare services.

With the new doctor I might be entered into yet another medical information system. Here in Central Ohio they use EPIC. And the different medical practices do not have interoperability between systems! Remember when Electronic Medical Record would make health care better and save money? It turns out to be another Mafia money laundering approach. USA health care costs are totally out of control and getting worse. (I was one of the initial system engineers in 1982 when AT&T was going to automate medical records. It was clear in the first week that the project would fail. AT&T spent $100 million dollars and the project failed. Now, 40 years later, many companies have information systems for medicine and they work as well as the automated telephone robot answering systems.)

Then there is the CPAP equipment. This is another company. I thought that the F40 would work better so I got the system - head gear, strap, tubes and all that stuff for the F40. I get the system replaced every 6 months on Medicare. So to go back to the old F30I, I will order itself on line at a cost of $159. Then I will stay in the regular rotation of equipment covered by Medicare. Sierra in his last note said that he finds that apnea score, AHI, can do OK with many different masks. And comfort is an issue.

The F40 did OK with AHI - max 3.8, min 1. But large leak was too much. And it was not comfortable, so I am going back to one that worked. Overall, it failed for me. But since the Resmed 4 scores are directed toward compliance: hours, mask seal, mask on/off and AHI, I was a "success" because my total was 100 on most nights. Hence a scoring system that is unreal. Using the system to cover up real treatment!

I know that people often try many masks so this is not unusual.

The arrogance of the medical Sleep "treatment" fraud that a one night TITRATION would be better than daily monitoring with OSCAR - arrogance unbound. They will do anything to preserve their prestige and payments. I hope the new sleep doctor will be one that is a real doctor, you know, an old fashioned doctor that you can talk to.

A friend of my wife was making an appoint for her physician and mentioned two conditions to discuss. For insurance reasons she could only discuss one condition in one 15 minute session. She asked if she could schedule two visits back to back. That was OK.

It is not a health care system, it is a sick care system to deploy pills and hospital treatments.

This site with Sierra has been a lifesaver for me. I will be eternally grateful.

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Sierra +0 points · 9 days ago Sleep Patron

Good to hear you are still doing well despite the mask issues. It is a trial and error process. "You have to kiss a lot of toads to find a prince!"

The apnea cpap industry is behind the times. A titration test is really only required to set up a fixed pressure cpap machine. With an Auto machine you just do a basic setup and then look at the results. The system in the US seems to be very claim process driven with the more you do, the more you can claim whether it is needed or not.

Funny you should mention Epic. I got a cortisone injection this morning for trigger finger. Almost before I got home there was an Epic report waiting for me. I kind of like it but I am not so sure it improves treatment. See below. All I know for sure is that I am having a devil of a time typing because my hand is still frozen!

ln any case stick with watching results using OSCAR, and if you have any questions just post.

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