ASV: Hypopnea Index Remains High

[Passiflora]

Great stuff, deltadave.

I just toned down my ASV Advanced to make it run a bit more like an Auto CPAP. That's one nice thing about this machine, is that you can do that. I was having some horrible nights of sleep but last night was so much better with an AHI of 2.0 and reasonable energy/motivation so far today.

Previous settings: EPAPmin 10, EPAPmax 16, flex 2, MaxPressure 20, PSmin 2

Last night's settings: EPAPmin 10, EPAPmax 13, flex 3, MaxPressure 15, PSmin 0

Ha, I can't wait for the day when I wake up and don't feel like I need to revise my settings again!! Last nights settings seemed fairly good... maybe I'm getting close. Decent energy/mood upon waking, no ear pain, no feelings of suffocation, still some aerophagic discomfort though... and then there's the mask leaks that kept bugging me all night. Still debating purchasing Mepitac or painter's tape so I can wear the Swift FX. Ah, decisions, decisions...

[deltadave]

Out of curiosity, did they ask for, and if so, did you submit a Sleep Log to the Sleep Physician and/or Laboratory where you had the other 4 studies?

I haven't yet had a new study at Stanford.

If you go there, what are you looking for? More dial wingin', or actually look at sleep (analyze sleep during a sleep study? Who woulda thunk!)?

If your base sleep pattern is ~0200 - 1000, but they're looking at you from 2300 - 0600, what's the point of resulting this Highly Scientific Data Carried Out To The First Decimal Place if the architecture they are measuring isn't really yours?

[BrianinTN]

Can you post the last few months on nightly compliance data? I think those will be quite helpful.

Compliance? What's that? Seriously, while I was pretty religious about using the CPAP, BiPAP, and ASV pretty much every night when I could, now that I'm in school, I've started doing so only when I can afford not to get a good night's rest. I switched back over to the CPAP in APAP mode in mid December, so below is some data, including the latest waveform. One thing I've done is stopped using Ambien or Lunesta with the machine. It always seemed to worsen my quality of sleep. The result is that, as you'll notice, there are a lot more nights now of me ripping the mask off after a few hours than I used to.

Out of curiosity, did they ask for, and if so, did you submit a Sleep Log to the Sleep Physician and/or Laboratory where you had the other 4 studies?

Nope. Epworth test on studies 1 and 4, and that's it. I informed them that I typically go to bed very late and get up very late, so the most they were willing to do was put me to bed at the end of the queue of patients (11:30ish).

If you go there, what are you looking for? More dial wingin', or actually look at sleep (analyze sleep during a sleep study? Who woulda thunk!)?

Obviously the latter would be great. What I don't know is how to make that happen. My fear of more dial winging is precisely the reason I haven't gone in for another study so far. I believe it was Einstein who defined insanity as doing the same thing over and over and expecting different results.

If your base sleep pattern is ~0200 - 1000, but they're looking at you from 2300 - 0600, what's the point of resulting this Highly Scientific Data Carried Out To The First Decimal Place if the architecture they are measuring isn't really yours?

Really good question. If the answer is "not much," as I suspect, what can I do about it? At least at the last sleep lab, they didn't seem tolerant of changing their "regular" hours.

Anyway, data dump below. I pity anyone not on broadband.

[deltadave]

Eewwww.

For a broader look, let's take a look at "Patterns of Use". Archangle posted an example of this in July 2011:

I find this very useful to show me my bad sleep habits like staying up too late, sleeping a few hours at a time, too many naps, etc.

Eewwww.

[BrianinTN]

Here you go. As I alluded to above, the wake-up times are going to be off because of my tendency to rip that damn mask off in the middle of the night when not using sleep meds. Also keep in mind that the time zone is still set to Central (where I was until September), but I've been mostly on Pacific time since then.



Also, electrolytes results will be in Thursday.

[BrianinTN]

Also, here's last night's waveforms. I'll stop posting these after this set, unless you think they're useful.

[deltadave]

Here you go.

Eewwww.

Also keep in mind that the time zone is still set to Central (where I was until September), but I've been mostly on Pacific time since then.

Oh.

In that case--

Eewwww.

I suppose the good news is there's a ton of room for improvement.

Hopefully the lytes might reveal something. Certainly, leg discomfort with someone on HCTZ forces one to look at K+, and we can fix that with some bananas.

And you really need to R/O low iron as a contributor to PLMs.

The waveforms don't look too ratty, some isolated central stuff, probably post-arousal (normal response).

[BrianinTN]

Eewwww.

Yeah. Like I mentioned earlier, I can go for longer periods of time on the mask if I use Ambien, but I invariably wake up feeling more tired. If I were creating a "next day grogginess and uselessness factor" scaled between 0 and 10, I'd say my standard is about a 3, when on Ambien alone it's about a 4.5, when on CPAP alone it's about a 6, and when on CPAP + Ambien, it's about an 8.

Certainly, leg discomfort with someone on HCTZ forces one to look at K+, and we can fix that with some bananas.

Two things here - probably both irrelevant with respect to your comment. First, I try to be pretty good about taking a multivitamin every day around the same time as my other meds. Second, despite the PLMs, I've only rarely felt leg discomfort.

The waveforms don't look too ratty, some isolated central stuff, probably post-arousal (normal response).

Cool. I did take 1mg of clonazepam last night, just because my ability to fall asleep and stay asleep the last few nights has been so horrendous, so I was hoping for a little help there. Also, the data, waveforms, and pressures on the APAP make me look back wincingly at the days when they put me on a flat 13 cm for CPAP and 20/16 for the BiPAP S/T.

[deltadave]

If I were creating a "next day grogginess and uselessness factor" scaled between 0 and 10, I'd say my standard is about a 3, when on Ambien alone it's about a 4.5, when on CPAP alone it's about a 6, and when on CPAP + Ambien, it's about an 8.

Accounting for the messed up clock, your TIB should be:



once you correct sleep hygiene and improve compliance, your "next day grogginess and uselessness factor" should be about 17.

Two things here - probably both irrelevant with respect to your comment. First, I try to be pretty good about taking a multivitamin every day around the same time as my other meds. Second, despite the PLMs, I've only rarely felt leg discomfort.

Even if the multivitamin has K+ it would be nowhere near enough to correct a deficiency, and you should check K+ because of the HCTZ. Besides it don't hurt. Me, anyway.

Speaking of which, how about starting a food log? Everything you shove in, including all forms of caffeine, ETOH, cigarettes, pot, coke, how much and when.

...the data, waveforms, and pressures on the APAP make me look back wincingly at the days when they put me on a flat 13 cm for CPAP and 20/16 for the BiPAP S/T.

Not me.

I just sits quietly and sez to myself:

"Self?"

YOU CAN'T FIX BAD SLEEP WITH A CPAP MACHINE!!!
YOU CAN'T FIX BAD SLEEP WITH A CPAP MACHINE!!!
YOU CAN'T FIX BAD SLEEP WITH A CPAP MACHINE!!!
YOU CAN'T FIX BAD SLEEP WITH A CPAP MACHINE!!!
YOU CAN'T FIX BAD SLEEP WITH A CPAP MACHINE!!!
YOU CAN'T FIX BAD SLEEP WITH A CPAP MACHINE!!!
YOU CAN'T FIX BAD SLEEP WITH A CPAP MACHINE!!!

[BrianinTN]

once you correct sleep hygiene and improve compliance, your "next day grogginess and uselessness factor" should be about 17.

I think I wasn't clear about my scale. I feel WORST when on the xPAP + Ambien, mediocre when on either alone, and my best (but still not good) when on nothing at all. But, yes, I'm sure better sleep hygiene will help, to your real point.

Speaking of which, how about starting a food log? Everything you shove in, including all forms of caffeine, ETOH, cigarettes, pot, coke, how much and when.

Will do. It's probably a telling sign that I haven't officially started the sleep log yet because I keep waiting for a "normal" night to start it, and I still haven't had one of those yet, eh?

[deltadave]

...once you correct sleep hygiene and improve compliance, your "next day grogginess and uselessness factor" should be about 17.

I think I wasn't clear about my scale. I feel WORST when on the xPAP + Ambien, mediocre when on either alone, and my best (but still not good) when on nothing at all. But, yes, I'm sure better sleep hygiene will help, to your real point.

Right.

And also

YOU CAN'T FIX BAD SLEEP WITH A CPAP MACHINE!!!

Etc.

It's probably a telling sign that I haven't officially started the sleep log yet... eh?

Yes.

[BrianinTN]

Bloodwork's in. EKG was also normal.

[deltadave]

Where's the iron?

[BrianinTN]

Where's the iron?

Isn't that hemaglobin? Anyway, since she started me on lithium this week, I expect I'll have to go in for bloodwork again sooner rather than later. So if there's anything else missing that you think would be useful, lemme know.

[deltadave]

Where's the iron?

Isn't that hemaglobin?

No.