OK. Found button at top of page.
I messed up last night. The high levels of leakage messed up any of the numbers. I realized after the fact that I had not replaced my cushion! I have 2 new ones and will replace it now.
Even with the high levels of apneas, the 7 and one half hours sleep last night was one of the best in the last few months. With the new mask tonight we should get valid data tomorrow.
Ok, it is probably best to see another night or two, hopefully with less leakage, before making any more adjustments. The one section in the middle of the night looks pretty good, but I wonder if you were actually asleep then?
Could you go back to Saturday March 23, and specifically to the start of the sleep about 23:00. There is a section highlighted in green indicating CSR. If you left click on that area repeatedly the scale will zoom in. You can fine tune the zoomed section with the up down and sideways arrow keys. The idea would be to get a highly zoomed in section that includes the three CA events that occurred during the CSR. If you could do a screenshot and post it, I would be interested to see what it looks like. That may be a clue as to what the nature of the CA events are actually about. Here is an example of a night when I was flagged for CSR. I have some theories in what is causing it, but need to see the nature of what you are having to be sure.
The only change was a new cushion.
I am baffled by last night. I did tape my mouth mostly closed but by morning most of the air was through my mouth Many, many apneas. Blank part with no flow. Don't know what that was.
I sleep most of the night on my back. I think. Only after get up to pee and try to go back to sleep will I move to side.
Hopes dashed that there would be linear progress
I learned how to use the editor for the text.
I slept through last night without waking up. Feel good this morning. Maybe with a night with such high large leak I shouldn't feel good. Thus if I can get things in order, maybe I will feel really good. No Tape. Used soft pillow.
When I am at pilates, they put an extra pillow under my head because my head leans forward. I have been to over thirty sessions of myotherapy - a physical therapy focusing on the fascia. The treatment is for scoliosis but along the way, there has been work to loosen up the neck so it rotates and I can see cars because I turn far enough. The two accidents in my live were within the last couple of years and both because I couldn't rotate my head and see out the left side far enough.
Here is my change for this evening. I will go back to the special pillow which I bought as a CPAP pillow. It is fairly hard foam. On my back it supports my head and that might be the problem. On a soft pillow my head is thrown backwards when I need to have it up so I look straight up.
Because of the leak over 70% probably none of the data is valid. GOAL: get valid data every night.
Great night! But first a word from Truth Central.
It is a racket! It is a racket I tell you! The mail came yesterday, my wife opened it, I didn't see it until this morning. And WTF. The bill for the Feb 18 sleep study was $6,500! I have Medicare Advantage through United Health Care and my former employer Bell Labs then Western Electric, Lucent then Alcatel and now Nokia. They changed names a few times as the country ditched manufacturing and became a full bodied country where the banks control the country. My charge after Medicare is $91. And I mentioned many times that from a data integrity point of view the Feb 18 study was a failure, but for the sleep mafia it was a smashing success because they got an AHI of 64!!! Incredible. Must keep this person in CPAP. Am I a masked rider, no a masked sleeper?
I think you said, but please repeat if correct, that the "sleepy doctors" only get the high level info over the data link. The same info I get on my Resmed Air Sense 10 screen. They provide a few tools so they can determine the average pressure needed, but not much more than I can get from Resmed web site.
The day before yesterday the AHI was over 15 and the Leak % was 70%. I drove for 5 hours and spent maybe 8 hours on my feet in a museum and was not tired. No nap. In other words, before I met you, I would have considered a good night's sleep. I had no idea what I was missing from excellent sleep!
Making the changes noted yesterday, my AHI of 5.12 is great! Big question can I do at least this well day after day? The biggest success last night is that for the first time I may have attained valid data because my air leakage level was low. I don't know enough yet to make sense of the various apneas so you have an easier time saying something useful than before when I was data deficient, or had a data disability. Ha! Maybe my stupid joke contains a way to characterize the "sleepy doctors" as having a data disability. They are childish. I know it is not politically correct to look down on a human being with a disability, but there are times one has to leap out of the box and be politically incorrect.
Before I sent this out I looked at the ResMed web site. The scores for the 4 variables was: time 63/70, mask seal 0/20, events per hour 5/5, four mask off/on 3/5 for a total of 71/100. I assume that this is the data sent over the data link which the doctors can see. From this there is no way they can properly advise about sleep. Furthermore, reading this shows the goal is compliance: use your mask 7 hours per day, stop leakage, don't take mask off and on -- comply and you will be doing fine. Only 5 points for apnea. I thought that was the reason for the device?
My wife made an interesting point. Maybe there are security reasons for not transferring all that data over the internet. In any case they have never shared any data except when my PA said that my pressure settings were good.
That looks much better, but one night is just one night. Some suggested changes for the settings:
You may want to consider rearranging the order of your graphs. You just left click on the title of the graph and drag it up or down. You can also scrunch the height of each graph down until it starts to mess up the title, but left clicking on the border between the graphs and dragging down. This lets you see more on one page. Your apnea issues are not much different than mine. Here is the order I have mine set up in. I don't find the Tidal Volume graph useful and push it down near the bottom. But I do find the Minute Ventilation graph quite useful. Ideally you want to see that quite constant and not cycling up and down. That can be the source of CSR and CA events. Sometimes what happens is a OA obstructive event messes up the breathing and after that Minute Ventilation start to cycle, and if it gets to the point that breathing stops, then you get a CA event. If the cycle continues then you can get one CA even after another.
I still think you should try the soft cervical collar if you think you can sleep with it. Some of your obstructive events, hypopnea, and flow limitation events (around 4:15 AM) look like they may be caused by your sleep position or a kinked neck which is obstructing the flow. If your neck is kinked then it makes it hard for pressure to keep the airway open. Reducing the kinking may allow you to lower the pressure used.
At some point, but not now, it may make some sense to try a fixed pressure. Currently it looks like a fixed pressure of 14 cm might work ok. But, leave that until it is more certain what pressure you need.
It is interesting that your apnea profile is similar to mine.
This message is now number 51. It is clear why the sleepy doctors don't want to touch the detailed level.
I will go out and get a cervical collar.
I brought up the Minute Ventilation graph. And I made them smaller. Are there any other graphs you would like on the page and others to move down.
Incredible! AHI= 1.72!
Your suggestion about the neck collar, and my wife said that when I sleep I throw my chin back --- both of these led me on a trek to find a collar. I went to three drug stores, one Kroger and one WalMart until I found it at a Walgreens drug store. Their brand is just right. First night success! The F40 rides higher on the sides of the face which might be better than the F30i which has a lower strap on the cheeks.
I saw that large leak started 22:40 and lasted 2 hours until 1:40.
The later leaks at 05:00 and 06:00 may have been when I slept on my side.
I read the post on Complex Apnea a couple of times. I went to his Harvard web page and brought up abstracts of some of his papers. They all, so far, seem to be behind pay walls. Hopefully we can continue and get a few days of this.
The Harvard guy has a sleep lab with a continual source of data so he can continue fiddling with the complex set of graphs for some more years. Invent some new conditions. But he is not into nutrition I suspect. He is doing physiology, but at first glance, not doing nutrition and spiritual approaches like meditation and breathing exercises.
Are you familiar with the term Functional Doctors? They treat a patient rather than relying on averages and handing out pills or surgery. In my new found health focus I follow several functional doctors on line. And I have on line, but not listened all the way through, a so called Dr, Talks series on sleep,. And following various series on the web on cognitive issues and longevity who bring up sleep. And a daily dose of Dr. Mercola.
In addition I have read, but forgotten so need to reread, recommendations of Gaba and Ashwagandha Root which arrived yesterday from the on line supplement store I started using about 6 weeks ago named PipingRock.com. I have not started taking these because we are in the middle, or maybe at the start, of an experiment and it will take some more time for things to settle down and get fairly reliable data over a decent time period.
I am now shaving each evening and for some time I have gone to bed about he same time each night: 10:30 PM. And I try to cut down my screen time near bedtime. We seldom watch TV. Bedroom is dark and cool and the only electronics are wife's cell phone and hearing aid chargers.
Could it be? Large Leak 0.00% ? Well, I adjusted my straps: 2 at top and 2 at bottom. 1/4" for each one.
With the automatic start and putting on the collar for the first night with the collar, things got jumbled.
This time I first put on my mask. And realized that it could be tighter. Tightened the straps and ....
at 04:30 approximately I got up to pee. This is the break in the graph. I didn't think I went back to sleep, but maybe I did. I seem to be awake from 5:30 on, looked at screen a few times, and finally got up when time was over 6 hrs elapsed. On my screen AHI=.9
I have noticed for over a year that I can lie awake and AHI can often go up. I knew this was fishy. Something strange going on. Now I know that it was mask leakage that messed up AHI.
In any case, can you believe it, AHI = .98, and only CA at .98. Incredible.
Any suggestions on what to try next?
Fairly early on someone else posted here and mention that they had used a chin strap. The collar works like a chin strap I would like to give that person an update. I have tried a chin strap and for the most part it was a failure.
Update: I ran a red light this morning after dropping my daughter in law off at work. No one injured. 2 cars totaled.
another AHI well below 5!!! Only change was H20 to 5. Setting of 4 almost no water used.
As you can see, I woke up and went to the bathroom. 'Why We Sleep" book says to try getting up and reading. I did that. Went back to bed and fell asleep woke up cold.
With the mask and the chin strap and the instant starting of the CPAP, I have had to figure out new approaches. I now put my mask on first. Then lie down and attach the tube and off and running.
We keep the bedroom about 64 degrees. Someone recommended sleeping without socks and not being too warm. When I wake up I am usually cold. On my second wake up I put on sweat pants to keep warm. From this experience, when I wake up, I will have change of warn sleeping gear already laid out, change into them and get back into bed.
Interesting that only CA apnea. And CSR appeared. A short discussion about their interaction and their meaning would be helpful.
This morning have been dealing with insurance and rental car pickup from my accident yesterday. Still have full day ahead.
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:
