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Sierra

Sierra
Joined Jul 2018
Bio

CPAP: AirSense 10 AutoSet

Set to CPAP Fixed Mode

Pressure 11 cm

Ramp: Auto

Ramp Start: 9 cm

EPR: 2, Full Time

Mask: ResMed AirFit P10 Nasal Pillow

Canada

Sierra
Joined Jul 2018
Bio

CPAP: AirSense 10 AutoSet

Set to CPAP Fixed Mode

Pressure 11 cm

Ramp: Auto

Ramp Start: 9 cm

EPR: 2, Full Time

Mask: ResMed AirFit P10 Nasal Pillow

Canada

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!

Ouch on the car accident. Good that nobody was injured.

The cervical collar seems to have been the silver bullet for your OA, Hypopnea, and flow limitations. Because they are lower the upsets to flow rates is likely less and they may have been the trigger for the instability that is causing the CA events, as they are down too. Pressure is simply holding at 13 cm, the minimum, all night. That is good.

I think it would be safe to lower both the minimum and maximum to 12 cm and 13 cm respectively. Try that for a night to see what happens. You seem to be making great progress on the leaks too. That helps. On my reports I watch the "Time over the Leak Redline" and like to see it at zero or close. You got 0% which is great.

With the ramp in Auto, the time it holds pressure constant is a good indicator of how quickly you are going to sleep. It will hold it for a maximum of 30 minutes if it does not detect you are asleep. It looks like you went to sleep in about 15 minutes when you first went to bed, and about 5 minutes after the pee break. After 4:40 or so it looks like you did not sleep and there were two very brief breaks in flow when the Auto timer reset. From that time on the Ramp stayed in Auto and did not increase to the minimum pressure, which is fine.

You may want to zoom in on the CA events that occurred at about 2:35 AM and a bit of time before that to see what let to them occurring. In any case things are improving significantly. Hopefully you can find a pressure that controls the OA that is lower than it is now. That may also reduce the CA's. Once that pressure is found, it may make sense to switch to a single fixed CPAP mode pressure.