Starting a New Thread - Still Struggling a Bit

[Iancdub88]

So I hope it's okay to start a new thread. I just wanted to ask for some help with my bilevel. Neither my doctor nor my sleep tech have responded to me all week. I will look into alternatives next week. I was given several pressures to try out and I did fairly well on 16/10 with trigger and cycle to turned up to very high. This is one of my decent nights where I felt reasonably rested the next day. https://sleephq.com/public/6ae5795d-369 ... 9863052e63

However, I was told that I should go up to 17/10 because my IPAP looks low. I don't seem to do as well on 17/10. This was Thursday - https://sleephq.com/public/c69c7f36-bf3 ... e339926a83 and then last night, I thought maybe turning down the trigger and cycle would be more comfortable but that led to a bunch of CAs - https://sleephq.com/public/4b119d08-611 ... 88f139c404

I had one person telling me they think I need ASV. I really hope not as it was really hard to get the bilevel. Any help is appreciated. Should I just stick with 16/10? Are there other settings I should tweak? Thanks!

[Miss Emerita]

You don't need an ASV. Clearly you don't have central or mixed apnea.

Go back to the settings that worked best for you. In addition, please change the mode from S to VPAPAuto. This will allow you to see flow limitations.

In VPAPAuto mode, set your minimum EPAP to 10, your maximum IPAP to 16, and your PS to 6. This will keep you at a steady 16/10. Also, return your trigger and cycle to very high, since those were part of what was working well for you.

I don't understand the comment about your IPAP looking low. What made the person who made the comment think it looked low?

[Iancdub88]

I don't understand the comment about your IPAP looking low. What made the person who made the comment think it looked low?

I will tweak those settings. Thank you very much.

This is the chart that they said IPAP looked a little low https://sleephq.com/public/aa598caa-af0 ... fab0530233. I think it's between 1:30 and 2am where it looks a little shallow.

[Iancdub88]

Here's last night: https://sleephq.com/public/a474a31a-296 ... c8b93f8d5c

I did toss and turn a bit so it might not be the best sample but I still think it looks better than when I was on 17. What do you think? Do the flow limits look okay?

[Pugsy]

What do you think?

How do you feel?

[Iancdub88]

What do you think?

How do you feel?

Certainly better than yesterday.

[Pugsy]

What do you think?

How do you feel?

Certainly better than yesterday.

well....you may have a partial answer to your own question there.
You need more nights at these settings though....you know that one night does not a trend make. Minimum of one week unless some sort of disaster happens.

BTW....in all my thinking about your problem.... needing an ASV for centrals was NEVER on my list of things to think about.

1....a handful of real asleep central apneas is normal and nothing to be concerned about.
2....The bulk of your central apnea flagging has always been post arousal...you weren't sound asleep and even if you had an ASV it wouldn't be able to "fix" those post arousal centrals.

As always...gotta try to fix the original problem first and not just a symptom of the problem and your problem has always been sleep itself.

[Iancdub88]

well....you may have a partial answer to your own question there.
You need more nights at these settings though....you know that one night does not a trend make. Minimum of one week unless some sort of disaster happens.

I was on 16/10 for about 6 nights before I was told to try 17/10. When I switched is when things seemed to get worse.

BTW....in all my thinking about your problem.... needing an ASV for centrals was NEVER on my list of things to think about.

1....a handful of real asleep central apneas is normal and nothing to be concerned about.
2....The bulk of your central apnea flagging has always been post arousal...you weren't sound asleep and even if you had an ASV it wouldn't be able to "fix" those post arousal centrals.

Good to hear. I actually have a suspicion that the guy that recommended an ASV was trying to sell me one.

As always...gotta try to fix the original problem first and not just a symptom of the problem and your problem has always been sleep itself.

The best nights I've had have been on the current 16/10 settings so I am going to stick to those for a while. In addition, my psychiatrist is working on getting me approved for Belsomra. I think I'm getting close to figuring this stuff out. Thanks to all of you.

[Miss Emerita]

Sticking with these settings for a while -- YES.

Just so you know: your IPAP was the same all night. Maybe the person who commented on your chart meant your tidal volume (the amount of air you move during one breath in/out). It's completely normal for tidal volume to be at different levels throughout the night. I'd have to say the person who commented wasn't well informed enough for you to pay any attention.

Your FLs look great!

[Iancdub88]

Sticking with these settings for a while -- YES.

Just so you know: your IPAP was the same all night. Maybe the person who commented on your chart meant your tidal volume (the amount of air you move during one breath in/out). It's completely normal for tidal volume to be at different levels throughout the night. I'd have to say the person who commented wasn't well informed enough for you to pay any attention.

Your FLs look great!

Thank you for the info. Super helpful! Just to clarify, you don't see anything alarming or any reason why I shouldn't be able to sleep well on these settings, do you?

[Iancdub88]

2nd night back on 16/10 and I honestly think this is one of the best charts I've had yet. I did take a Trazodone so I feel slightly hungover but I'm hoping to hear back on the Belsomra today.

https://sleephq.com/public/670e6fb7-a1a ... 851c183761

[Miss Emerita]

This looks really good! No causes for worry. While you're still having a fair number of arousals, I think there are fewer than there used to be. I'm going to bet you'll sleep more and more soundly as time goes by. Steady as you go!

[Iancdub88]

While you're still having a fair number of arousals, I think there are fewer than there used to be.

This may be an impossible question to answer because it may vary from person to person but how many arousals are normal? I've also been getting headaches during the day. Could that have anything to do with the pressure?

[Miss Emerita]

This study of arousals has some real limitations, but you can take a look:

Normal arousal rates: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2564772/

I doubt whether your headaches have anything to do with your pressure. If they are frequent and persistent, you might talk with your doctor about them.

I hope you had another good night last night!

[Iancdub88]

I hope you had another good night last night!

Thanks! This week has been good. Headaches have decreased and I've felt so much better during the day. Whether that means I'm having less arousals or that when I do sleep, I'm sleeping deeper, I'm not sure but I'm definitely getting there. Here's my full data lately

https://sleephq.com/public/teams/share_ ... 99c9cfab28