Sierra

In the last three years or so, I have had two bronchoscopies, and 2 cataract surgeries. None of the anesthesiologists asked about sleep apnea.

Millions of people have sleep apnea and 8 of 10 are undiagnosed.

https://www.cbc.ca/radio/whitecoat/sleep-apnea-canada-challenges-diagnosis-cpap-machine-1.7108832

I find that the shorter I sleep the lower my AHI score. When I get apneas they seem to get concentrated to the last part of my sleep, especially if I try to oversleep. I consider 7 to 7.5 hours per night, ideally in one stretch, to be the best for me. What I have read is that we need to build up sleep demand during the day, and get one good sleep at night. Naps during the day should be avoided, but I confess to dozing off in front of the TV from time to time. But, I never lie down on a bed during the day. I also avoid all caffeinated beverages after 10:00 AM. I also try to avoid all liquids after about 8:00 PM to reduce the need to get up during the night. That works most nights but not all...

That still looks pretty good with only one OA event that looks like it happened at 10 cm pressure. Still no indication that CA events are coming down with the decreased pressure. I think the next step would be to decrease both min and max pressures by 1 cm to 9 cm and 11 cm to see what happens. Lower pressure should helps with leaks too. I see this night was excellent for leaks.

I see your Ramp start pressure is at 9 cm and you should be able to keep it there. However, if pressure is lowered more, it may have to be reduced, as I think the Ramp start has to be equal or lower than the minimum pressure.

That reminds me of what I think was an extremely rare and close to fatal complication of diabetes. I use insulin and have gotten into the habit of holding the very small plastic cap that goes over the insulin needle in my teeth while I set the correct amount and administer the insulin. I've done it thousands of times. On this occasion I had the unfortunate luck to have an uncontrolled sneeze. I gasped and inhaled this little plastic cap. I went to the hospital emerg and got some X-rays. They of course did not detect anything and they did their best to convince me that I had swallowed it and it would pass. I knew that was wrong and could feel the restriction and noise this cap was causing in my lungs. My doc prescribed more X-rays and of course found nothing. You can't see a tiny plastic item with an X-ray.

The reader's digest version is that I saw an ENT who did the endoscope thing in my nose and found nothing. Then I saw two pulmonologists and both prescribed pulmonary function tests (all during COVID). Finally one got me in for a bronchoscopy at our university hospital. They used fentanyl and other stuff and that went well. They had success in finding and taking a picture of the cap in my lungs, but could not get it out. Then I was referred to the hospital that specializes in pulmonary issues. They used a full general sedation and got the cap out. However, there was an issue. They used a drug to immobilize my muscles to allow the tools to go down into my lungs. It was supposed to act for a few seconds. But, it turns out I have a genetic issue called a Pseudocholinesterase deficiency which made the succinylcholine drug they used act for hours instead of seconds. Essentially I was unable to breathe for about 2.5 hours. They got me through it, which was somewhat amazing as this was at the height of COVID and my daughter, who works at the hospital, told me that they were down to 1 or 2 ventilators.

I am not sure what I cost our healthcare system with my dumb mistake, but I'm sure it was many thousands of dollars, and it near cost me my life. It sure makes me think twice about agreeing to a general. I had my last cataract surgery with just a Ativan tablet under my tongue and the numbing drops.

So I do have a medic alert bracelet that warns I am a Type 2 on insulin, and also about the Pseudocholinesterase deficiency. However, it does not mention sleep apnea. I don't consider that a life and death critical condition. The effect of sleep apnea is long term, and not an immediate critical condition.

I think we are now officially way off topic!

That stuff is all in my "been there, done that" bucket. I was diagnosed with very high BG levels, and quickly got it under control and in the process lost something like 70 lbs. It did not cure my diabetes or even come close to that. Unfortunately the weight has slowly come back. But, my BG is best control it has ever been in.

That is looking pretty good. I now see one OA event which you have zoomed in on. I suspect you may have woken up during that zoomed in portion and the three CA and one OA vent is probably what some call "Sleep Wake Junk). I think you are reaching the optimum point for pressure. However, to confirm you should probably try just lowering the minimum pressure from 11 down to 10 to see if OA becomes a bigger issue, and if lower pressure may reduce CA events.

I have been a type 2 diabetic for nearly 25 years now. I currently treat it with metformin and two types of insulin. I also wear a FreeStyle Libre 2 sensor to constantly track my BG levels. This helps me a lot in controlling BG. For a while I tried the 20/30 Far & Fiber Plan by Gabe Mirkin. I think it is a very healthy diet, but it makes it harder to control BG for diabetics. However, I still try to minimize foods that have high glycemic index carbs.

Yes, that is it. This is just when you are going to sleep. It appears as the pressure increases the cyclic breathing starts, and at the end is classic CSR with a CA event between the two waxing and waning events. If this is still happening by the time you get to see the sleep doctor, I would bring a printout of one of these events, along with your running summary of how much CSR you are experiencing. Along with that you need to bring your SD card and request that they look at the detail. The issue will be whether or not they will actually take the time to do that.

At some point if you cannot control AHI to less than 5 you may also want to consult with a heart specialist and show them examples of the CSR details.

Just press the round button to "wake up" the machine. The top "My Options" window should be highlighted. Press the round button again to select it. The "Run Warmup" option will not be initially displayed but if you rotate the round button it will go further down. When it is highlighted, press the round button again to select it. And then once more to make it run. It will do the rest from there.

Another thing you can do with the humidifier if you are not already doing it, is to select the pre warm feature 15 minutes or so before you plan to go to bed. It is on the options menu, I recall next after the mask test option. All it does is warm the water up before you go to bed. It may make the humidifier work a little sooner each night.

I like to keep our bedroom cool too and around 65 deg F. We are just coming out of the winter season here where it goes below freezing each night outside. Our setback thermostat takes a while to adjust to the warmer weather, and sometimes starts warming the house up too early. You are right though. One has do dress right for the temperature.

If you can zoom the scale in on that green CSR section just before 7:00 AM, and post it, I can have a look to see what is happening. The flow graph and Minute Ventilation should show what is happening. I am not exactly sure how ResMed decides it is CSR. The normal CSR pattern has periods of waxing and waning breathing effort with CA events when flow stops between the cycles. This is what ResMed says it looks like but I have never seen anything in my charts quite that uniform.

This is an example of what I see:

Made a post and it seems to have disappeared. The short story is to reduce the min pressure to 11 cm, and max to 12 cm. Trying to find the point where OA events start to appear....