sleeplessincali

Having used both the Phillips and the ResMed, the ResMed felt better, though things still needed dialing in. Also, Kaiser doesn't support the Phillips, including having tools to look at the data. If I'm to get any support from Kaiser, I'll have to switch to the ResMed.

Kaiser lent me a BiPAP and my results were worse than the Airsense 10 they had lent me. They had also set it for higher default pressures which was blowing the fit of my full face masks and blowing my mouth open with the nasal pillows.

At this point, I managed to get them to refer me to an in-clinic sleep study. Hopefully, that will get me closer to a therapeutic solution

I had my appointment with the sleep tech at Kaiser last Tuesday, April 11th. The plan, in my mind, was to get evaluated for a BiPAP. I talked about what I was doing with OSCAR and my Phillips machine. The tech knew nothing about OSCAR and of course did not trust it out of ignorance. He assumed OSCAR was manipulating the data and I insisted it just showed the data in a graphical form. Also, I asked him if they even looked at the data for my Phillips at their end. They did not. He gave me a Resmed Airsense 10 as a loaner for a week and I have a follow-up appointment tomorrow. He asked me to not mess with the settings. I assured him I would not. I asked him what the settings were and he told me 5-20 cmH2O. I asked him to raise the lower to something like 10-13. I told him my current weight and he did raise it to 10 cmH20. I've been using the Resmed consistently. It has been surprisingly more comfortable than the Phillips. Unfortunately, the tech did not put in a SD card, so I was unable to upload the data. I do know that the settings are not getting me better sleep or rest and I am waking to often. Most nights, the numbers look good on the Resmed, including leaks, but I know how deceptive that report card can be. I'm concerned the tech will just go by those number and say I'm good to go.

Here are screenshots since my last post. I don't know or remember the rules (looked for them). If it is okay, I can post a link to a google drive location where I can post these instead of putting too many in a post here.

I raised my min from 13.5 to 14.5 and left my max at 16 and A-Flex at 1 two days ago. Woke up more (as opposed to arousals). Some difficulty exhaling at the start. I've never been one to panic, but CPAP definitely triggers panic in me and I have to be conscious of not hyperventilating. It may take some time, but I believe I will get there. I kept the same settings last night thinking that I need to get used to the settings and compare the results with the same settings. Second night (last night) was worse. I'm really pushing myself to find the right levels, but I guess I can't rush the process. I know that even when I find the right levels, they will change as I get healthier.

Here's the two graphs from last night and the night before with the same settings:

Raising the minimum has been my primary target :) While I may not have found the right pressures yet, I'm feeling optimistic that I will get there. I'm happy that my sleep stages are getting better.

The main reason I even started dropping the max pressures was mask and mouth leaks. I feel I can now raise the max pressures, if needed, with the nasal mask.

I changed my pressures from 13 min and 15 max to 13.5 min and 16 max. No other changes. Other than waking up to use the bathroom, I also woke up to find I had rolled towards my back and had a mouth leak.

I've included my graph for last night, a comparison of my daily Details since my first post, and last night Apple Sleep graphs.

Thanks, John

I think the feature I think is favorable about BiPAP, if I understand them correctly, is that the min and max are set pressures, instead of relying on the pretty bad algorithms of APAPs to make correct adjustments, if any. Again, I'm looking to be evaluated. It may not be the right solution. Frankly, I'm hoping I'll have my APAP dialed in before my appointment.

I have a rectangular pillow and sleep on my side. I have always been a side sleeper. The pillow helps eliminate shoulder pain and, depending on the mask, minimizing interference with the mask and hose. I think my head position is okay. I have a fat neck and I don't think I could tolerate the collar.

I do find LL somewhat arrogant and I weigh his advice against others, like Nick on CPAP Reviews.

The only problem I've had with the iPhone app for the Libre 2 is that it wasn't available for a while. It's been fine for me (iPhone 11 Pro Max with iOS 16). I do hate that there is not Apple Health integration and I don't think Abbott intends on ever supporting it.

Phillips encrypted the data on the DreamStation 2. OSCAR has since been updated to decrypt that data.

I'm using the Libre 2. It's what alerted me to my low blood sugar while I was trying to sleep.

I haven't given up on the idea of turning Flex completely off. I may have better response to having it off with the nasal mask. I will test this out again at some point. Meanwhile, I'm going to raise the lower pressure to 14 and the upper to 16. As you mentioned before, the CPAP is being kneecapped by limited it to 15. I wasn't able to do 16 before because the full face mask would leak too much, but I think I will get better results with the nasal mask.

I am trying to move towards fixed pressure CPAP mode. It seems, from what I've seen on the LankyLeft27 and CPAP Reviews YouTube channels, the best path. I am trying to get evaluated for BiPAP.

Thanks for all the guidance.

1) I tried turning Flex off without changing pressures. Oh man it screwed with me. I couldn't exhale, was getting more leaks, and found myself panicking. It did not help that I was having a low blood sugar event (type 2 diabetic) and I was a bit disorientated. First time I've had that experience. I gave up using the CPAP for the evening.

2) Next night, I turned Flex on to level 2 (of 3), set the pressures to 12 min and 15 max, and switched to a nasal mask. I tried the Mewing technique to keep my mouth closed. I don't buy the fad that it will fix your jaw and all that, but I did find that the tongue position did create a seal and I was able to sleep throughout the night, except for one bathroom trip, with an unbelievably low leak rate and no dry mouth. I still had too many OAs, Hs, etc, but I still considered it progress. Even with a full face mask, I was getting dry mouth and woke up several times a night.

I had tried a full face mask when I first got my CPAP, but was unable to tolerate it. I felt like my mouth was being forced open by the pressure. Either that, or I'd end up getting stuffed up. In hindsight, I realize that I was poorly trained by the technician and that the 5-20 cmH20 I was set up with was too high and was enflaming the turbinites of the nasal cavities. I believe the lower max pressure I used, 15 cmH20, helped me tolerate the nasal mask. I would say it was almost comfortable (Phillips Respironics DreamWear Silicone Nasal Mask). I woke up in the end almost refreshed.

3) Last night, I turned Flex on to level 1 (of 3), set the pressures to 13 min and 15 max, and continued with the nasal mask and Mewing. Again, I only woke up once to use the bathroom and had no dry mouth and an amazing leak rate. Still too many OAs, etc. Lots of snoring.

Also, per my Apple Watch, my REM and Deep sleep cycles are vastly improved. I used have had none of either for for the longest time.