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General Discussion on any topic relating to CPAP and/or Sleep Apnea.
Ruinednose
 
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Re: Maybe need a pressure increase?

Postby Ruinednose on Mon Jan 08, 2018 11:33 am

Pugsy wrote:I don't know that your sleep quality is necessarily related to your sleep apnea totally nor if you would feel better if the AHI is lower or not.
I have been down that road myself and for some people a nice low AHI does mean they can actually feel the difference in terms of how they feel during the day but for others (like myself) a nice low AHI doesn't mean much.
I don't know which way you will go or be.

If the last couple of hours of your night is highly fragmented then those 7 to 8 hours of "sleep" may not necessarily be the "best" sleep quality.
So the overall total of good sleep hours may be less and thus impacting how you feel.
Example....7 hours of total overall sleep but 2 hours of highly fragmented sleep means about 5 hours of "good" sleep...and that's a low enough number of hours to impact how we feel during the day. If you "sleep" 10 hours but only 5 hours is "good" solid sleep...you will still feel like crap...see what I mean?

I don't know that is what is going on with you but it's possible.
It's also possible that the small evidence we see in the software reports of continued minor airway flow reductions could be impacting sleep quality.
It is also possible that you need to give these new changes a bit of time for the body and mind to adjust to. Trust me...I have seen it first hand.
When I first started bilevel therapy and was titrating to an "acceptable" AHI I had to pick something and stick with it and see where it went.
I picked something that gave me about what you are seeing from last night in terms of AHI and snores and Fls ...and stuck with it for 6 weeks with some good nights of better numbers happening occasionally and some nights which were "bad" and I really had to resist the urge to change something.
Over the 6 weeks I noticed that my AHI and the clutter (that stuff that isn't part of the AHI) slowly started to reduce and I started having many more good nights than bad nights. My overall AHI average at the end of the 6 weeks experiment for the last week was 1/2 what it was for the first week of the experiment.
My point....numbers can improve simply with time.

Give yourself a week at these settings and make special note each night (keep a diary) of how you feel and the number of awakenings, etc along with hours of total sleep vs "good" solid sleep.
See how things are going....then re-evaluate the possible need for another increase in EPAP.
Don't be afraid of more pressure...I don't see you being one of those people where Centrals are caused by pressure.
I think that the bulk of your centrals are likely centrals getting flagged while you are awake or semi awake...since most of them are happening during the last couple of hours of sleep where we know you had more awakenings. If you notice your pressure doesn't do much during that time frame anyway....because you are awake and the airway is open and the machine doesn't sense the need to do much.

Always....always... include how you feel and how you perceive your sleep quality in your evaluations of anything.
This sleep quality thing is very, very important and it isn't always something we can blame on OSA or the therapy. I wish it were that easy.
This is something I am fighting right now myself. My numbers are to die for good but I don't always feel those good numbers because I know that some nights my sleep quality or hours of good sleep is simply in the toilet.
Getting "good" numbers is the easy part...feeling them is a totally different story.

At the end of a week if the numbers hold pretty much the same and you are feeling pretty much the same then try another increase in the minimum EPAP and try it for a week and seen how you do.
We don't sleep the same each night so basing changes on what we see last night is really pretty much chasing our tails. Unless the results are horrible...give things a chance to settle in and let your body and mind get used to the changes.
Remember....the overall picture and not just numbers is hugely important. So how you slept and how you feel is very important.

At some point if you ever get in a position to get another machine....try to get a ResMed auto adjusting something (either apap or bilevel) because I really think that you might do a bit better with the ResMed algorithm.


Resmed is better?
OK thank you so so much, I sure hope things go ok

1 question,

If my IPap max was 14, and my epap was lower than 14...does this mean inhaling no apnea and exhaling apnea?

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Pugsy
 
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Re: Maybe need a pressure increase?

Postby Pugsy on Mon Jan 08, 2018 11:44 am

Ruinednose wrote:Resmed is better?


For some people....yeah, I think the ResMed auto adjusting algorithm is "better". Not necessarily everyone and most people would do just fine with either.
I have used both brands...so first hand experience with both brands and based on what I see on your reports and your complaints and what I know about how these machines work...if you can get a new machine at some time in the future I would strongly urge you to at least try the ResMed.
Will it help?? Dunno but it won't hurt and it might help improve things a bit.

Ruinednose wrote:If my IPap max was 14, and my epap was lower than 14...does this mean inhaling no apnea and exhaling apnea?


I don't understand your question.
EPAP is always going to be lower than IPAP when PS is used.
I may have to RISE but I refuse to SHINE.

Ruinednose
 
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Re: Maybe need a pressure increase?

Postby Ruinednose on Tue Jan 09, 2018 9:36 am

Pugsy wrote:
Ruinednose wrote:Resmed is better?


For some people....yeah, I think the ResMed auto adjusting algorithm is "better". Not necessarily everyone and most people would do just fine with either.
I have used both brands...so first hand experience with both brands and based on what I see on your reports and your complaints and what I know about how these machines work...if you can get a new machine at some time in the future I would strongly urge you to at least try the ResMed.
Will it help?? Dunno but it won't hurt and it might help improve things a bit.

Ruinednose wrote:If my IPap max was 14, and my epap was lower than 14...does this mean inhaling no apnea and exhaling apnea?


I don't understand your question.
EPAP is always going to be lower than IPAP when PS is used.



Thank you so so much

Here is today's report

https://imgur.com/a/D1Nxz


I feel ok, I went to bed later today than usual, I still had late morning arousals.

Maybe the CA is from turning around in bed, I tend to hold my breath when turning

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Pugsy
 
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Re: Maybe need a pressure increase?

Postby Pugsy on Tue Jan 09, 2018 9:52 am

A decent enough report. Continue for a total of one week and then evaluate results and consider maybe another small increase in EPAP minimum.

Those late morning arousals. I hear you. Annoying as hell. I only got 4 hours of sleep last night because of them...woke up at 4 AM and couldn't get back to sleep.
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Ruinednose
 
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Re: Maybe need a pressure increase?

Postby Ruinednose on Tue Jan 09, 2018 9:25 pm

Pugsy wrote:A decent enough report. Continue for a total of one week and then evaluate results and consider maybe another small increase in EPAP minimum.

Those late morning arousals. I hear you. Annoying as hell. I only got 4 hours of sleep last night because of them...woke up at 4 AM and couldn't get back to sleep.



Thank you so so much

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Ruinednose
 
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Re: Maybe need a pressure increase?

Postby Ruinednose on Wed Jan 10, 2018 10:01 am

Pugsy wrote:A decent enough report. Continue for a total of one week and then evaluate results and consider maybe another small increase in EPAP minimum.

Those late morning arousals. I hear you. Annoying as hell. I only got 4 hours of sleep last night because of them...woke up at 4 AM and couldn't get back to sleep.



Today I woke up feeling *ok* a little tired.
About the same arousals in The morning hours as usual, turning and flopping, I think that's what Thr CAs are. I made sure the last time I woke up and also turned The machine off, I held my breath for a few seconds to see if it creates at CA and it did.

With that said, max IPap reached 15 this time which is my highest setting, but the 95% pressure was lower.

Check out the report if you would

https://imgur.com/a/us3ba

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Re: Maybe need a pressure increase?

Postby Pugsy on Wed Jan 10, 2018 10:27 am

You had that one little spike to 15 but the rest of the night the machine didn't seem to want to need much higher pressures so it doesn't surprise me that the 95% number is lower. Remember all the 95% number is..the definition "at or below" that number for 95% of the time. If you don't spend much time at the higher pressures the 95% number won't be very high. 95% numbers can vary a lot from night to night and they really don't mean much unless you look at them over a really long period of time (like 6 months) and even then they aren't the holy grail of anything.
We don't sleep the same each night. Things are going to vary in terms of position, airway patency, sleep stage, etc. Some people will see more variations than others. It's just a fact of cpap life.

Your reports aren't horrible but they do have more "clutter" than I would like to see if it were my report and I was still complaining of not feeling as good as I want. Now is this "clutter" why you don't feel your sleep quality is optimal or how you feel during the day is optimal??? That's an unknown.
Not all our problems are related to sleep apnea and what we see or don't see on these reports. I wish fixing bad sleep and feeling bad was as easy as getting a nice clean report but it is rarely that easy.

So if it were me and this is what I was seeing and I still wanted to try to improve my sleep quality and hopefully how I felt during the day....and after using these settings for a week to make sure the trend/pattern is constant...then I would again increase that minimum EPAP 1 cm.
I see no need to increase max IPAP though..the machine doesn't seem to want to go higher anyway. Though it really wouldn't matter if you did because if the machine doesn't want to go higher then it won't no matter how high it can go. If you feel better with a limited IPAP max it hurts nothing to limit IPAP max. Now if you were seeing prolonged periods of time where the machine was pegged out at 15 then we have a different discussion.
Occasionally kissing the max...doesn't make it an urgent thing to let it go higher.

If some of the "clutter" you are seeing is real and not related to SWJ post arousal stuff then a little more EPAP should better prevent those flagged events. Will it make you feel better if it is cleaned up....dunno...might and might not but it is sure worth at least trying.
If the bulk of the "clutter" is post arousal SWJ stuff then more pressure is unlikely to fix it and one would need to again try to investigate the cause of the arousals themselves and often it isn't anything related to sleep apnea that is causing them.

If you were sleeping great and feeling great then I wouldn't change anything but you aren't so I don't blame you for wanting to try changing something just be aware that if the problem isn't related to sleep disordered breathing then it may not matter if you get a perfectly clean report and still don't feel like you want to feel. Trust me...I have been down that road and experienced it first hand. Not all our problems can be fixed with machine setting tweaks. Doesn't mean we can't at least try though.

Quit worrying about giving yourself central apnea with the pressure increases. I just don't see it happening in your situation. If it was going to then when you hit 15 there should have been a truck load of centrals...and as you can see it didn't happen.
Quit worrying about the random central.....real or not. Nothing you can do about them anyway and you aren't having enough of them to warrant doing anything anyway. I think the bulk of your centrals are just a symptom of the arousal and if we can better prevent the arousal itself then the centrals should reduce as a by product.
A random real central...normal and nothing to worry about.
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Re: Maybe need a pressure increase?

Postby Pugsy on Wed Jan 10, 2018 10:36 am

Do you wish to learn how to try to evaluate the flow rate in an effort to determine if the events flagged are real or are instead SWJ post arousal junk?
It's not just centrals that can be mislabeled...it can be any of the events flagged.

It takes some work and some education and even then there are always some flow rates that we simply can't tell for sure if they are real or not.
It's taken me years of examining flow rates to get half way comfortable with flow rate work and even then I still see stuff that leaves me scratching my head sometimes.

What I am getting at is sometimes what you see on these reports isn't real as in related to the airway actually collapsing fully or partially and instead are more of a symptom of poor sleep quality in general because of some sort of arousal that is unrelated to the airway collapse itself.
I don't know that is what is going on in your situation...only that it wouldn't be impossible and if you do end up with another increase in pressure and you don't see things clean up very much....might be worth talking about that possibility.
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Re: Maybe need a pressure increase?

Postby Ruinednose on Wed Jan 10, 2018 12:33 pm

Pugsy wrote:Do you wish to learn how to try to evaluate the flow rate in an effort to determine if the events flagged are real or are instead SWJ post arousal junk?
It's not just centrals that can be mislabeled...it can be any of the events flagged.

It takes some work and some education and even then there are always some flow rates that we simply can't tell for sure if they are real or not.
It's taken me years of examining flow rates to get half way comfortable with flow rate work and even then I still see stuff that leaves me scratching my head sometimes.

What I am getting at is sometimes what you see on these reports isn't real as in related to the airway actually collapsing fully or partially and instead are more of a symptom of poor sleep quality in general because of some sort of arousal that is unrelated to the airway collapse itself.
I don't know that is what is going on in your situation...only that it wouldn't be impossible and if you do end up with another increase in pressure and you don't see things clean up very much....might be worth talking about that possibility.


Thank. You so much, I think the early morning of tossing and turning is due to some Stress and anxiety. Lately no matter what I csnt just shut my mind from thinking. It always thinks and runs. Sometimes I wake up and mind is just rushing.
No bad events happenning in life right now. Lately. Sleep hygiene hasn't been good. I need to fix that.

But thanks so so much, I'll keep a look out on my graphs, if I see something that is unusual I'll post a photo for help.

Your help is so so valuable, thank you so much

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Re: Maybe need a pressure increase?

Postby Ruinednose on Thu Jan 11, 2018 9:49 am

Pugsy wrote:
Ruinednose wrote:Resmed is better?


For some people....yeah, I think the ResMed auto adjusting algorithm is "better". Not necessarily everyone and most people would do just fine with either.
I have used both brands...so first hand experience with both brands and based on what I see on your reports and your complaints and what I know about how these machines work...if you can get a new machine at some time in the future I would strongly urge you to at least try the ResMed.
Will it help?? Dunno but it won't hurt and it might help improve things a bit.

Ruinednose wrote:If my IPap max was 14, and my epap was lower than 14...does this mean inhaling no apnea and exhaling apnea?


I don't understand your question.
EPAP is always going to be lower than IPAP when PS is used.


Decided to post today as CA has been flagged consistently through the night.

https://imgur.com/a/3ATCn

I feel ok, once again bad sleep hygiene. Went to bed later than I wanted to.

What do you think?

And as always, I just can't thank you enough

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Re: Maybe need a pressure increase?

Postby Pugsy on Thu Jan 11, 2018 10:16 am

Roughly half the AHI is central flagging....and we don't know if they are real or not.
You might go to the events tab and then the CA list and open it up and pick one of the centrals and click on it so that the graphs on the right will zoom in on that one event flow rate and look around and see if it looks like asleep breathing or awake breathing.
You won't always be able to know for sure awake vs asleep but sometimes it's pretty clear what is going on.
Remember we have to be asleep for the events flagged to be real.

See the area I circled here....that's asleep breathing
Image
Same thing here but zoomed in closer
Image

Now look at this one and note the big gulp of air before the flagged event. Looks like I took a big gulp of air and held my breath briefly...not fully awake breathing but not asleep breathing right before the flagged event. This might have been a turn over in bed hold your breath central.
Image

Now these are probably real ...or at least the first one...notice the nice regular breathing pattern and then it pretty much stops
The second one...probably asleep but it could be a post arousal if the first event caused an arousal.
Image

This one is pretty much all asleep breathing. Fairly easy to see.
Image

This one isn't a real event. It's most likely SWJ...either awake or semi awake because it's flagged pretty much in the middle of breathing that isn't nice normal asleep breathing.
Image

And here is an example of the wave form flow rate graph that Encore gives us and you can see the time when the breathing is nice and regular and smooth and then where I circled the area...that's arousal breathing and if there were any events flagged within that time frame they would be SWJ events. This one doesn't have any flags in it.
Image

And this one I didn't circle anything but pretty much all the flagged events are SWJ events. This person doesn't have OSA (had an in lab sleep study that resulted in AHI less than 1.0) and I ran this graph (and others) by a sleep tech to see if he agreed with my thoughts as this being SWJ and he did.
Image

This wave form graph is really the only thing I like about Encore because it makes it so easy to compare asleep and awake/semi awake breathing.
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Ruinednose
 
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Re: Maybe need a pressure increase?

Postby Ruinednose on Thu Jan 11, 2018 1:21 pm

Pugsy wrote:Roughly half the AHI is central flagging....and we don't know if they are real or not.
You might go to the events tab and then the CA list and open it up and pick one of the centrals and click on it so that the graphs on the right will zoom in on that one event flow rate and look around and see if it looks like asleep breathing or awake breathing.
You won't always be able to know for sure awake vs asleep but sometimes it's pretty clear what is going on.
Remember we have to be asleep for the events flagged to be real.

See the area I circled here....that's asleep breathing
Image
Same thing here but zoomed in closer
Image

Now look at this one and note the big gulp of air before the flagged event. Looks like I took a big gulp of air and held my breath briefly...not fully awake breathing but not asleep breathing right before the flagged event. This might have been a turn over in bed hold your breath central.
Image

Now these are probably real ...or at least the first one...notice the nice regular breathing pattern and then it pretty much stops
The second one...probably asleep but it could be a post arousal if the first event caused an arousal.
Image

This one is pretty much all asleep breathing. Fairly easy to see.
Image

This one isn't a real event. It's most likely SWJ...either awake or semi awake because it's flagged pretty much in the middle of breathing that isn't nice normal asleep breathing.
Image

And here is an example of the wave form flow rate graph that Encore gives us and you can see the time when the breathing is nice and regular and smooth and then where I circled the area...that's arousal breathing and if there were any events flagged within that time frame they would be SWJ events. This one doesn't have any flags in it.
Image

And this one I didn't circle anything but pretty much all the flagged events are SWJ events. This person doesn't have OSA (had an in lab sleep study that resulted in AHI less than 1.0) and I ran this graph (and others) by a sleep tech to see if he agreed with my thoughts as this being SWJ and he did.
Image

This wave form graph is really the only thing I like about Encore because it makes it so easy to compare asleep and awake/semi awake breathing.


Oh wow, thank you for your in depth explanation and very hard work to link everything up like that I really appreciate it

I'm about to put some hrs in sleepy head and dissect everything, thank you so so much

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Ruinednose
 
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Re: Maybe need a pressure increase?

Postby Ruinednose on Thu Jan 11, 2018 9:39 pm

Pugsy wrote:
Ruinednose wrote:Resmed is better?


For some people....yeah, I think the ResMed auto adjusting algorithm is "better". Not necessarily everyone and most people would do just fine with either.
I have used both brands...so first hand experience with both brands and based on what I see on your reports and your complaints and what I know about how these machines work...if you can get a new machine at some time in the future I would strongly urge you to at least try the ResMed.
Will it help?? Dunno but it won't hurt and it might help improve things a bit.

Ruinednose wrote:If my IPap max was 14, and my epap was lower than 14...does this mean inhaling no apnea and exhaling apnea?


I don't understand your question.
EPAP is always going to be lower than IPAP when PS is used.


Also been having anxiety attacks in the evenings lately, maybe ca is stress symbol?

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Re: Maybe need a pressure increase?

Postby Pugsy on Fri Jan 12, 2018 8:33 am

Ruinednose wrote:Also been having anxiety attacks in the evenings lately, maybe ca is stress symbol?

a
Stress messes with us in many, many ways especially in what it does to our sleep.
If stress causes insomnia and the CAs are SWJ then its the insomnia that in turn creating the situation for the CA flags.
The CAs end up being a by product of the insomnia sometimes.
Note...I am not blaming all CAs on SWJ and some CAs are going to be real centrals but a real central here or there isn't a big deal. It's only when centrals are present in large numbers and creating problems that they become a big deal. Even if every single one of your CAs was the real deal you aren't having enough of them to be a problem that doctors would start worrying about.

We talk about them in terms of being possibly SWJ because that in turn means the chance of them being a symptom of poor sleep quality more than as a problem causing central.
More along the lines of thinking....is what we are seeing a cause of the poor sleep or a symptom of poor sleep type of thing.

Nights where I sleep fitfully due to lots of pain I always have more centrals (and sometimes other flags) than when I sleep more soundly with not many remembered arousals. I have gone and looked at a lot of those increased number of events under the microscope and almost always they look more like SWJ breathing than they look like asleep breathing events. So I know it does happen. Not saying it happens to everyone but it can happen and for that reason we keep it on the back burner. Don't totally poo poo it off but don't spend a lot of time worrying about stuff that is likely SWJ and instead we spend more time on trying to do whatever we can do to prevent the SWJ chances....which means trying to improve our overall sleep quality and trust me...that is much easier said than done.
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Re: Maybe need a pressure increase?

Postby Ruinednose on Fri Jan 12, 2018 9:57 am

Pugsy wrote:
Ruinednose wrote:Also been having anxiety attacks in the evenings lately, maybe ca is stress symbol?

a
Stress messes with us in many, many ways especially in what it does to our sleep.
If stress causes insomnia and the CAs are SWJ then its the insomnia that in turn creating the situation for the CA flags.
The CAs end up being a by product of the insomnia sometimes.
Note...I am not blaming all CAs on SWJ and some CAs are going to be real centrals but a real central here or there isn't a big deal. It's only when centrals are present in large numbers and creating problems that they become a big deal. Even if every single one of your CAs was the real deal you aren't having enough of them to be a problem that doctors would start worrying about.

We talk about them in terms of being possibly SWJ because that in turn means the chance of them being a symptom of poor sleep quality more than as a problem causing central.
More along the lines of thinking....is what we are seeing a cause of the poor sleep or a symptom of poor sleep type of thing.

Nights where I sleep fitfully due to lots of pain I always have more centrals (and sometimes other flags) than when I sleep more soundly with not many remembered arousals. I have gone and looked at a lot of those increased number of events under the microscope and almost always they look more like SWJ breathing than they look like asleep breathing events. So I know it does happen. Not saying it happens to everyone but it can happen and for that reason we keep it on the back burner. Don't totally poo poo it off but don't spend a lot of time worrying about stuff that is likely SWJ and instead we spend more time on trying to do whatever we can do to prevent the SWJ chances....which means trying to improve our overall sleep quality and trust me...that is much easier said than done.


You poor thing... 4hr sometimes... Wow... It would cripple me.

Last night I had a better night, last night ahi was better and I also do feel I got better sleep. Shorter however (I really reslly gotta work on my sleep hygiene)

https://imgur.com/a/KBemy


What ia Tidal volume? Is mine good or bad?
What abiut pressure pulse? Good or bad?

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