djam's therapy thread

I would have given you a pass also if you really didn't want to give up EPR.
All I needed one was tiny whine "I like my EPR" and I would have said "forget reducing or ditching EPR".
I know I wouldn't give mine up come hell or high water. I would be cranking that minimum up if I was wanting to see what more pressure would do.

I have been down the "what would happen with more pressure" road myself. It was some years back and I was using a different apap machine brand at the time and I was wondering what would happen with my AHI and my reports and my sleep if I used more pressure.
So I decided to try increasing the minimum...base starting point was 10 minimum and 20 max.
I increase the minimum 0.5 cm a week for a period of 6 weeks. Worked my way up to 13 minimum over 6 weeks. The only thing I changed was the minimum. At the end of the 6 weeks I evaluated the results.
AHI was still about the same 1.0 to 2.0 range.....so no real change with the AHI except for minor to be expected nightly variations.
No change in average hours of sleep. No change in sleep quality itself. No change in how I felt during the day.
I then decided to abort the experiment since nothing was changing and I really didn't want to use an even higher minimum and I had no real need to anyway.

Pugsy wrote: ↑

Mon Aug 13, 2018 9:30 pm

I would have given you a pass also if you really didn't want to give up EPR.
All I needed one was tiny whine "I like my EPR" and I would have said "forget reducing or ditching EPR".
I know I wouldn't give mine up come hell or high water. I would be cranking that minimum up if I was wanting to see what more pressure would do.

I know you would. Couldn't pass on the opportunity to be cute. And it looks like I'm going to end up in the "hell or high water camp" too!

Pugsy wrote: ↑

Mon Aug 13, 2018 9:30 pm

I have been down the "what would happen with more pressure" road myself. It was some years back and I was using a different apap machine brand at the time and I was wondering what would happen with my AHI and my reports and my sleep if I used more pressure.
So I decided to try increasing the minimum...base starting point was 10 minimum and 20 max.
I increase the minimum 0.5 cm a week for a period of 6 weeks. Worked my way up to 13 minimum over 6 weeks. The only thing I changed was the minimum. At the end of the 6 weeks I evaluated the results.
AHI was still about the same 1.0 to 2.0 range.....so no real change with the AHI except for minor to be expected nightly variations.
No change in average hours of sleep. No change in sleep quality itself. No change in how I felt during the day.
I then decided to abort the experiment since nothing was changing and I really didn't want to use an even higher minimum and I had no real need to anyway.

I've seen you relate this story before. I'll treat this in a similar manner. Funny thing about that 10.2 pressure I stayed at, is that I never got the "signal" to increase it. On my slow run up from 8.0, every week at some point I got that "I'd like more air" feeling. Normally when returning from the bathroom break. Never happened at 10.2 - was actually one of the reasons I felt it was time to stand pat.

Here's something strange. Screenshot is from the 6 minute test yesterday, where I upped min pressure and reduced EPR from 3 to 2. You can see, flow limitation and pressure increase. While laying there awake. Don't understand this at all. But I was doing unusual things - I was in clinical menu and made EPR change(s) during the session. Maybe this confused the machine? This "pressure increase while awake" never happens when I turn in at night. Any thoughts?

All I can say about that 6 minute experiment is these machines are easily fooled by awake breathing irregularities.

Pugsy wrote: ↑

Tue Aug 14, 2018 7:33 am

All I can say about that 6 minute experiment is these machines are easily fooled by awake breathing irregularities.

I have no problem believing that. PR said the other day, "it's the meatbag at the end of the hose" (<-or something close). I'm not sure I'll ever get past the psychological aspect of settings changes.

djams wrote: ↑

Tue Aug 14, 2018 7:00 am

Here's something strange. Screenshot is from the 6 minute test yesterday, where I upped min pressure and reduced EPR from 3 to 2. You can see, flow limitation and pressure increase. While laying there awake. Don't understand this at all. But I was doing unusual things - I was in clinical menu and made EPR change(s) during the session. Maybe this confused the machine? This "pressure increase while awake" never happens when I turn in at night. Any thoughts?

If you look at your breath shapes there... they look like crap. and you're clearly awake, even if you hadn't told me, I'd have known) because awake breathing isn't the same as sleep breathing... two different 'systems' handle it in your body, and that's part of the reason people often have a bunch of events as they're going to sleep, or waking up... "transition apnea" as the body switches from one mode to the other, sometimes back and forth as you doze in and out...

The machine isn't designed to respond properly to awake breathing, so any test, other than 'How does it feel" when awake, really doesn't mean anything. I can fake asleep breathing pretty well, because I've got equipment that gives me real time data readouts from the machine, but it takes concentration

Basically, Pugsy got it when she said:

Pugsy wrote: ↑

Tue Aug 14, 2018 7:33 am

All I can say about that 6 minute experiment is these machines are easily fooled by awake breathing irregularities.

palerider wrote: ↑

Tue Aug 14, 2018 1:04 pm

If you look at your breath shapes there... they look like crap.

Trying to decide if I should take offense to this.

palerider wrote: ↑

Tue Aug 14, 2018 1:04 pm

and you're clearly awake, even if you hadn't told me, I'd have known) because awake breathing isn't the same as sleep breathing... two different 'systems' handle it in your body, and that's part of the reason people often have a bunch of events as they're going to sleep, or waking up... "transition apnea" as the body switches from one mode to the other, sometimes back and forth as you doze in and out...

The machine isn't designed to respond properly to awake breathing, so any test, other than 'How does it feel" when awake, really doesn't mean anything. I can fake asleep breathing pretty well, because I've got equipment that gives me real time data readouts from the machine, but it takes concentration

Thanks for the description.

palerider wrote: ↑

Tue Aug 14, 2018 1:04 pm

I've got equipment that gives me real time data readouts from the machine, but it takes concentration

And this. You know, I can't imagine how much time and resources you've invested to become an expert on PAP therapy. And then spend the time here to advise and teach us. Pugsy too, she had so much stuff that she had to hold a virtual garage sale here recently. Don't know if this is job-related, or if sleep is just one of your hobbies. Whatever it is, we're sure lucky that you're here. I am grateful.

djams wrote: ↑

Tue Aug 14, 2018 2:01 pm

palerider wrote: ↑

Tue Aug 14, 2018 1:04 pm

If you look at your breath shapes there... they look like crap.

Trying to decide if I should take offense to this.

Well, you COULD... but pretty much everybody's breath shapes look like crap when they're awake (from a sleep breathing perspective).

Here's a really brief glimpse... http://www.osahelp.com/#6 awake sleep breath shapes are like what you did,
asleep breaths typically have a much faster exhale and then trail off then a pause...

djams wrote: ↑

Tue Aug 14, 2018 2:01 pm

palerider wrote: ↑

Tue Aug 14, 2018 1:04 pm

I've got equipment that gives me real time data readouts from the machine, but it takes concentration

And this. You know, I can't imagine how much time and resources you've invested to become an expert on PAP therapy. And then spend the time here to advise and teach us. Pugsy too, she had so much stuff that she had to hold a virtual garage sale here recently. Don't know if this is job-related, or if sleep is just one of your hobbies. Whatever it is, we're sure lucky that you're here. I am grateful.

I mainly learned all this just to annoy the people here that hate me

palerider wrote: ↑

Tue Aug 14, 2018 5:35 pm

Well, you COULD... but pretty much everybody's breath shapes look like crap when they're awake (from a sleep breathing perspective).

Here's a really brief glimpse... http://www.osahelp.com/#6 awake sleep breath shapes are like what you did,
asleep breaths typically have a much faster exhale and then trail off then a pause...

Thanks for that link. Lots of good stuff.

palerider wrote: ↑

Tue Aug 14, 2018 5:35 pm

I mainly learned all this just to annoy the people here that hate me

Hah! You devil you.

djams wrote: ↑

Tue Aug 14, 2018 8:17 pm

palerider wrote: ↑

Tue Aug 14, 2018 5:35 pm

I mainly learned all this just to annoy the people here that hate me

Hah! You devil you.

Right? It's like they're not even paying attention to the avatar!!?!? PS, do you like my tennis shoes?

palerider wrote: ↑

Tue Aug 14, 2018 10:14 pm

djams wrote: ↑

Tue Aug 14, 2018 8:17 pm

palerider wrote: ↑

Tue Aug 14, 2018 5:35 pm

I mainly learned all this just to annoy the people here that hate me

Hah! You devil you.

Right? It's like they're not even paying attention to the avatar!!?!? PS, do you like my tennis shoes?

The shoes make the man! Obviously should've said "sneaky devil".

Well, since I've got the time this week, I'll ask about something that I've been considering asking about for a long time.

It's respiratory rate, and how (for me anyways), I can use it to nearly 100% tell when I'm awake. Screenshot below has the charts in the order that I use when I look at my data. In respiratory rate chart, starting off is always low (I'm awake). Then the gentle climb up to ~23 starts. This is me falling asleep. The spike at 22:40 is where I took my mask off to ask my wife a question when she came to bed. I woke up at 23:15 because my kindle slipped out of my hand (hate it when this happens). Around 3:30 I woke up with the urge to go to the bathroom, but I just laid there and went back to sleep. This is becoming a regular thing, and I'm hoping that this will eventually turn into no wakeup at all. Around 5:30 - that's not a wakeup. It's the CA, which looks real to me on the flow chart.

Is this the same for most folks? My gut sense on this is no, because I've yet to see a request for a poster to drag up the respiratory chart and post another screen shot. It's very reliable in my case. There are nights when I have wakeups that I'm unaware of, and it's useful to factor this in when evaluating how I feel during the day.

The other interesting thing is the small (for me) mound of FL's around 5:00. Pretty normal for me to have large FL's and events around this time, so perhaps this is an early indicator of success. We'll see. Also I see that my awake breathing at the beginning of the night does indeed trigger some FL's. Not big enough to start a pressure increase as during my 6 minute test.

Back to bore everyone with another weekly update.

Last week's min pressure change from 10.2 to 11.0 resulted in avg AHI = 0.48, and avg RERA = 0.38. Was looking to reduce RERA's, so far so good.

Not going to bump min pressure this week. Still not "used to it". When I can mask up and not notice the pressure - that's when I'll think about it. Really, if numbers stay the same, I see no need to change. Doing a small increment on the upper pressure. Gun shy here because of aerophagia.

In other developments, I became aware of a test release of SH from a post on the SH FB page. It looked safe to try, as it runs side-by-side with the version that I've been using. It uses a separate data folder as well, so existing data/profiles won't be affected by test version bugs. Seems like worst that could happen is contents of SD could get corrupted by new version (very unlikely, as I write protect the card).

Below is a screenshot from the test version. You can see that the session bar has been placed in the status bar area. Stays put when you scroll. Colored dark gray, which I don't care for. New Profile tab, intro screen cleaned up and improved. Ignore short sessions has been removed. Don't like that. Also the split day stuff, which I don't use. Imported summary data only now shows correct AHI's. Which is great! I can finally use SH overview charts to get an accurate screenshot showing what happens when you come here asking for help. I included that too, because it's pretty dramatic IMO. You'll see that the summary numbers associated with the graph are garbage. This was stated up front.

There are some problems with the charts, too. If there's any interest - be happy to show examples. Maybe in a separate thread it anyone thinks that's worth doing. I'm certain there's a lot of stuff I haven't noticed yet.

But the biggest problem I see is that the font in the left pane can't be changed (far as I can tell). They've made it considerably larger, which I appreciate for myself, but as you see, all that important information that the experts want to see in one screenshot isn't visible.

djams wrote: ↑

Sun Aug 19, 2018 8:19 pm

But the biggest problem I see is that the font in the left pane can't be changed (far as I can tell). They've made it considerably larger, which I appreciate for myself, but as you see, all that important information that the experts want to see in one screenshot isn't visible.

I see all I need to see on that left side. The settings we can deduce from the statistics and it's rare that we need the session information.
If for some reason we need something we can just ask.

Pugsy wrote: ↑

Sun Aug 19, 2018 8:46 pm

djams wrote: ↑

Sun Aug 19, 2018 8:19 pm

But the biggest problem I see is that the font in the left pane can't be changed (far as I can tell). They've made it considerably larger, which I appreciate for myself, but as you see, all that important information that the experts want to see in one screenshot isn't visible.

I see all I need to see on that left side. The settings we can deduce from the statistics and it's rare that we need the session information.
If for some reason we need something we can just ask.

That's good to know. Explains why I don't see requests for new screenshots when the pie chart doesn't get hidden.

That means this change is a good thing. Because it sure is easier to read. I don't even have to put my readers on to read the text.

The settings section is often wrong, in weird ways... Like the humidifier changing from yes to no when actually the humidity*level* changed... So I usually just ignore it.