End Of Rope...New Sleep Study??

[msr0459]

Again not a lot on the report to blame the poor sleep quality on unless we want to maybe wonder about the Flow Limitations.
They aren't horrible but they are there. If you were using an apap machine in auto mode the machine would want to try to kill some of those FLs.

What happens if you were to use a little bit higher pressure? Ever tried that?
I don't know that it would help but it is something to try to see what happens.

You need to talk to your doctor about what could maybe be used to help sleep quality and reduce those awakenings.
Not everything out there comes with as much potential baggage as the temazepam. Sometimes we just need a little help and there is a time and place for that sort of help.

In terms of sleep studies. Here's the deal, while they can tell us when we wake up or have an arousal they can't really tell us why it happened unless the arousal happens with a known apnea event of some sort.
If you have ever read sleep studies you will see mentioned so and so number of spontaneous arousals. That means not related to a respiratory whatever but out of the blue and no known cause that they can put a label on.
In other words the information available during a sleep study doesn't always point to a reason for the arousal...just that the arousal happened.
Obviously extremely hard to fix a problem if we don't know the cause of the problem.

Are the 'flow limitations' you speak of simply the hypopneas I have?

I've tried all the usual sleep meds, i.e., ambian, Lunesta, etc... but the only thing that worked, albeit temporarily was the clonazepam, and now the temazepam.

I have experimented with higher pressure a while back, didn't seem to help much, I may try a bit higher again and see how that looks.

[Pugsy]

Are the 'flow limitations' you speak of simply the hypopneas I have?

No, flow limitations are reduction in air flow that don't meet the criteria for a hyponea or OA.

Example...50 % reduction in air flow but only lasts 9 seconds...that's a flow limitation but it won't get a hyponea flag because it only lasted 9 seconds and all the events that get flagged (central, OA, hyponea) must last a least 10 seconds to get a flag.

Now in terms of what the FL might be doing to your sleep...there's really not a lot of difference between 9 seconds and 10 seconds...but one gets a flag and the other doesn't. It's one of the reasons that these auto adjusting pressures will try to kill Flow Limitations even if you aren't experiencing any flagged events.

I don't know that your FLs are your problem...but it wouldn't be impossible...and I have seen much worse looking FL graphs but I have also seen much better looking FL graphs.
Here's one of mine from years ago. Compare yours to mine. I don't know if FLs are contributing to your arousals or not...but it's worth trying to kill them to see if it helps or not.

[msr0459]

Are the 'flow limitations' you speak of simply the hypopneas I have?

No, flow limitations are reduction in air flow that don't meet the criteria for a hyponea or OA.

Example...50 % reduction in air flow but only lasts 9 seconds...that's a flow limitation but it won't get a hyponea flag because it only lasted 9 seconds and all the events that get flagged (central, OA, hyponea) must last a least 10 seconds to get a flag.

Now in terms of what the FL might be doing to your sleep...there's really not a lot of difference between 9 seconds and 10 seconds...but one gets a flag and the other doesn't. It's one of the reasons that these auto adjusting pressures will try to kill Flow Limitations even if you aren't experiencing any flagged events.

I don't know that your FLs are your problem...but it wouldn't be impossible...and I have seen much worse looking FL graphs but I have also seen much better looking FL graphs.
Here's one of mine from years ago. Compare yours to mine. I don't know if FLs are contributing to your arousals or not...but it's worth trying to kill them to see if it helps or not.

So to improve flow limitations I should increase my pressure?

[Julie]

A lot of people use soft cervical collars - it keeps their heads up, airways more open and jaws (if not lips) closed.

[Pugsy]

So to improve flow limitations I should increase my pressure?

Yes, more pressure should reduce the FLs.
The exception being if the FLs are from nasal congestion.

You can also try Julie's suggestion of a cervical collar but it might not be all that comfortable and might disturb sleep even more. It's a cheap experiment though.
I don't like them....just what I don't want to do...add more crap on my face and head.
And since I do well with my pressures I just let the machine handle things.
Some people like them and do well with them....so worth a shot.

Again...please realize that I don't know that your FLs are your problem. I am just going out on a long skinny limb trying to come up with something that might (stress the might) help you sleep better. It wouldn't be impossible..now as to how likely it is...in all honesty I have no idea. It's a cheap easy experiment to try though and it might help.
Some people find that they sleep better at slightly higher pressures than what "looks good" on the AHI side of things.
We don't know why but it can happen and for me...all I care about is sleeping better and anyway I can get it done is okay by me.

[msr0459]

So to improve flow limitations I should increase my pressure?

Yes, more pressure should reduce the FLs.
The exception being if the FLs are from nasal congestion.

You can also try Julie's suggestion of a cervical collar but it might not be all that comfortable and might disturb sleep even more. It's a cheap experiment though.
I don't like them....just what I don't want to do...add more crap on my face and head.
And since I do well with my pressures I just let the machine handle things.
Some people like them and do well with them....so worth a shot.

Again...please realize that I don't know that your FLs are your problem. I am just going out on a long skinny limb trying to come up with something that might (stress the might) help you sleep better. It wouldn't be impossible..now as to how likely it is...in all honesty I have no idea. It's a cheap easy experiment to try though and it might help.
Some people find that they sleep better at slightly higher pressures than what "looks good" on the AHI side of things.
We don't know why but it can happen and for me...all I care about is sleeping better and anyway I can get it done is okay by me.

Hello again, I've been gradually increasing pressure, which isn't that high compared to a lot I'm sure. It's currently on 8.6 I believe. I've noticed that there has been a slight increase in hypopneas in all but one higher pressure night's.

Is it possible that increased pressure could cause 'more' events...in my case, hypopneas?

[Pugsy]

Is it possible that increased pressure could cause 'more' events...in my case, hypopneas?

No.

More likely it is simply a coincidence probably related to sleeping position (supine) or REM sleep.

It's common for the number of events, as well as the type of events, to vary (sometimes considerably) with positional or REM stage sleep changes.

[tmoody]

I was doing a search on "spontaneous arousals" and this thread came up. Without going into full back story, I've also had the experience of low AHI but feeling seriously unrested the next day. My situation has been neither as severe nor as protracted as yours, OP. It's not an every day thing, and I haven't tried any meds, but on a "bad" day, even though my AHI was, say 0.7, I might feel seriously jetlagged all day. And that might even be with 7:20 minutes of allegedly "uninterrupted" sleep, i.e., no wakeups and trips to the bathroom.

I have my titration study from about a year and a half ago. This was for an ASV machine because at the time I was getting a fair number of centrals. The titration study tracked OAs, CAs, AHI, HAs, RERA, RDI, and SAs (spontaneous arousals) for various EPAP pressures, from 5 to 9. The lowest AHI was at EPAPmin=8, but the lowest RDI of 2 was at EPAPmin=9. The reason for this discrepancy was the fact that at EPAP=8 the SA index was a hefty 12.8, whereas at EPAP=9 the SA index was only 4. The lowest SA index was actually at EPAP=7, but at that pressure the AHI was 5 and RDI was 5.6.

Anyway, the prescription the doctor chose was EPAP=8 (plus various other settings that I won't get into). It seemed odd to me that he chose this pressure despite it being associated with a higher number of SAs. When I asked him about this he said "We have to treat what we can treat", which is AHI, in his view. But in my view, if those SAs were truly spontaneous and not linked to breathing issues, they wouldn't cluster so much at one EPAP pressure. In the early days after getting this machine I experimented with a lot of settings, but I didn't do much with EPAP=9 because the few days I tried it my AHI went to 4 or 5. But then again, in those early days my AHI was mostly over 3 anyway. It's an ASV machine and it was taking me a while to get used to it.

Cutting to the present, a few days ago I set the EPAPmin to 9. My AHI has stayed about where it's been lately, which is 1 or less, but I'm noticing a definite improvement in how rested I feel. I have no way of measuring SAs, so this is just guesswork on my part, but I believe I'm getting fewer SAs, and since my AHI hasn't gone up, at least not yet, it's a win-win.

I have a feeling there's a strong stress component to these SAs. I've been experimenting with "adaptogen" herbs, with mixed results. But my main purpose in posting this was to share my experience concerning SAs. I don't know if it will help but I think it's worth experimenting. Just remember to let any change in settings go for at least a week before drawing conclusions, unless it seems like an absolute train wreck from the start. I think the doctor's decision to base his prescription on AHI alone wasn't the best.

[Krelvin]

And from last night. I did take naproxen, 2x220 mg and 1x 500 mg Tylenol, more of an experiment since I really didn't have any perceivable pain.

If you are not having pain why are you taking pain meds?

My kidney doctor would have a cow. NSAID's are off the table even if I have pain. If you are not dealing with pain, using pain meds even over the counter ones can cause more damage that any benefit.