New (UARS) -- lots of questions

[zan]

Bed at ~11:30, wake at 7:30. Caved in to taking Trazodone (75mg) and 3mg melatonin soon after the first time I tried to fall asleep at 10:30.

Settings: Same as before. Min EPAP 6.6, PS 5.6, Max IPAP 20.

Subjectively: Groggy, feeling sleep deprived, although maybe it's a side effect of the Trazodone. Getting to sleep was unpleasant and waking up was hard. I woke up a couple times to adjust the hose but otherwise slept soundly. Lots of aerophagia, but surprisingly little discomfort from it, and my mouth was a little dry but not too bad overall.

OSCAR: My graphs actually look alright, the FL graph is relatively sparse and the pressure curves are normal, not much craziness in the flow rate chart, so I'm wondering how much of my tiredness is due to a Trazodone hangover.

It's so frustrating that I really don't have much to go on here -- I can't swear off Trazodone entirely without putting myself back into last year's state, where my insomnia got so bad that I was up all night for 1-3 nights a week. But I also can't identify whether Trazodone is messing with my energy levels while I'm taking it on such a consistent basis. I can stay at these pressures for a few more days to gather more data on how it's working for me, but I wish there was a clear indicator of what's wrong so I have somewhere to start.

[Miss Emerita]

Have you tried splitting a Trazodone pill and taking half?

[Pugsy]

Don't try to change too many things at one time like doing without the trazadone.
You've added cpap/bilevel to your normal routine....keep everything else your normal routine.
Worry about not using trazadone later.

Again...pick a routine...setting...whatever....and stick with it and evaluate for at least a week. Then decide if you want to alter the routine/setting for another time frame.

[zan]

Have you tried splitting a Trazodone pill and taking half?

Yep, used to do that when I was trying to wean off of it but it wasn't strong enough. I've found that the minimum dose for me is three-quarters of a pill, and as of late I've been needing to take one and a half pills to fall asleep.

I'll do as Pugsy says and keep things regular... not sure how much of a choice I have anyway, since the alternative is being up all night. :p

[palerider]

I can't swear off Trazodone entirely without putting myself back into last year's state, where my insomnia got so bad that I was up all night for 1-3 nights a week.

You might be able to wean yourself off now that you're on cpap.

[zan]

You might be able to wean yourself off now that you're on cpap.

I'm waiting to do that until I get closer to my optimal therapy and no longer need the Trazodone. Sometime in the future, definitely.

Last night was uneventful, won't post the graphs because there's nothing new in them. I am definitely ready to start inching my pressure up after tonight -- I want just one more night at these settings to make extra sure there are no problems, but I'm otherwise very comfortable wearing the mask through the night and I can tell the settings I'm at right now aren't actually treating any SDB. We had a little debate about it earlier, but I'd rather stick to a plan in which I'm making minimal increases (0.2 - 0.4cm) at a time, very gradually, since I'm most concerned with ensuring the change in pressure doesn't disturb my sleep. In the end, it's more important that I take my sweet time and get to know how the machine affects me than try to jump around while guessing at the right pressure.

I'm going to be gradually inching up the EPAP or PS according to what "feels right," which is unfortunately hard to work with in a public forum. Right now I just don't feel a difference between sleeping on CPAP and sleeping without it, which is a good starting point to help me acclimate to the mask, but I think I've graduated from that stage and am ready to start pursuing treatment. So after tonight I'll begin to make this slow transition, raising the EPAP / PS and sticking with it for a few days to see how it affects me.

Edit: I've noticed that my jaw gets super tight during the day and sometimes at night. No teeth grinding, but I've heard that sometimes being unable to relax your jaw can contribute to insomnia? Idk

[palerider]

You might be able to wean yourself off now that you're on cpap.

I'm waiting to do that until I get closer to my optimal therapy and no longer need the Trazodone. Sometime in the future, definitely.

Last night was uneventful, won't post the graphs because there's nothing new in them.

When it comes to Oscar reports... Boring is good.

[slowriter]

I'm going to be gradually inching up the EPAP or PS according to what "feels right," which is unfortunately hard to work with in a public forum. Right now I just don't feel a difference between sleeping on CPAP and sleeping without it, which is a good starting point to help me acclimate to the mask, but I think I've graduated from that stage and am ready to start pursuing treatment. So after tonight I'll begin to make this slow transition, raising the EPAP / PS and sticking with it for a few days to see how it affects me.

I think you need a better working understanding of how and why you change these settings.

And as a number of us have said here, you should only be changing one variable at a time.

My suggestion: you find the min EPAP setting that eliminates obstructive events (the last night you posted showed only one), and then only worry about the PS.

Your goal in adjusting PS is to eliminate RERAs, and so, per pugsy's point earlier, it would help if you can identify RERAs in your flow graph.

But I suspect you're pretty close to where you need to be with the vauto pressure settings. If I'm right, it's possible extensively playing with your settings not only won't improve your outcomes, but will make them worse.

[zan]

I'm going to be gradually inching up the EPAP or PS according to what "feels right," which is unfortunately hard to work with in a public forum. Right now I just don't feel a difference between sleeping on CPAP and sleeping without it, which is a good starting point to help me acclimate to the mask, but I think I've graduated from that stage and am ready to start pursuing treatment. So after tonight I'll begin to make this slow transition, raising the EPAP / PS and sticking with it for a few days to see how it affects me.

I think you need a better working understanding of how and why you change these settings.

And as a number of us have said here, you should only be changing one variable at a time.

My suggestion: you find the min EPAP setting that eliminates obstructive events (the last night you posted showed only one), and then only worry about the PS.

Your goal in adjusting PS is to eliminate RERAs, and so, per pugsy's point earlier, it would help if you can identify RERAs in your flow graph.

But I suspect you're pretty close to where you need to be with the vauto pressure settings. If I'm right, it's possible extensively playing with your settings not only won't improve your outcomes, but will make them worse.

I didn't pick up on the PS-RERA / EPAP-OA connection, that's really helpful. I had just assumed that the path forward was to raise the pressures until I started waking up not feeling tired anymore.
I'm re-watching the SleepyHead tutorial (how to review and evaluate your data) and I'm still not completely clear on how to look at my data to delineate a RERA vs the weird breathing one does when turning over in bed. How can I tell the difference between a brief awakening and a mere change in breath pattern while asleep? What do I make of breathing like this or this? What about when I get spikes like that but no corresponding flow limitation?

I understand that the machines are imperfect, and it's not easy to tell without the full setup that a sleep tech would have, but I'm trying to make sense of what I've got.

[zan]

I'm trying to look at my flow rate curves more carefully. I've been scoring for RERAs using the rudimentary skills I have (if it's a spike in breathing accompanied by several chaotic, irregular breaths, it may be an arousal) and I've found that:

- the flow limitations don't necessarily seem to line up with the "events" I'm scoring. Some times they do, but mostly they don't; all I see is disturbed breathing
- the irregular breathing (and also the leaks) usually begin by midnight and continue up until the point that I wake up at 7:30
- high leak rates make it hard to rate the data for accuracy. One of the other generous forum members is shipping me their P10 equipment, should arrive by Monday, so I'll be able to see if a different mask helps the leak rate at all
- something ALWAYS happens / has been happening by 2am. I don't have a single night where the flow rate for the 2am hour is clean. My breathing starts to get wonky, the leak rates pick up, and I usually start seeing the majority of my CAs. It's hard to say whether this is more a function of me changing sleep stages or me being deep enough into the night to get myself in a leak-prone position.
- after 2am, it is very rare for me to see more than 30 straight minutes of smooth breathing
- the flow limitation markers don't always line up with disrupted breathing in the flow rate chart, and plenty of unusual breathing goes on without being marked as FL. It looks like the FL graph may be about as useful as the AHI for me? (as in it can tell me when I've clearly had a crappy night, but not much else.) Maybe the leaks are messing too much with them for me to tell, though. My FL flags tend to be less than 0.50 / 1.00

Is there any value in these findings?

[zan]

Bad night last night. I managed to fall asleep before midnight without any pills, but was constantly waking due to mask discomfort / position changes / leaks. Finally got out of bed an hour before my alarm because I couldn't take it anymore. I noticed that, for the second time, one of the magnetic straps on the N20 had detached at some point in the night, so that may have been causing the spike in leaks after 3am. I keep seeing wavy breath patterns like this, what's up with that?? Since they seem to follow an event / arousal I'm guessing it's just my breath trying to return to normal as I fall asleep again? It takes over ten minutes for the curves to smooth out and become regular, which is probably related to my insomnia.

I made a video overview of last night and tried to count what I thought were RERAs. Am I anywhere close to doing this right?

[KandyX]

- the flow limitation markers don't always line up with disrupted breathing in the flow rate chart, and plenty of unusual breathing goes on without being marked as FL. It looks like the FL graph may be about as useful as the AHI for me? (as in it can tell me when I've clearly had a crappy night, but not much else.) Maybe the leaks are messing too much with them for me to tell, though. My FL flags tend to be less than 0.50 / 1.00

Yea I often go through my flow rate manually, I can have a FL chart of almost 0 but still a noticeable amount of FL when looking at flow rate.

[zan]

- the flow limitation markers don't always line up with disrupted breathing in the flow rate chart, and plenty of unusual breathing goes on without being marked as FL. It looks like the FL graph may be about as useful as the AHI for me? (as in it can tell me when I've clearly had a crappy night, but not much else.) Maybe the leaks are messing too much with them for me to tell, though. My FL flags tend to be less than 0.50 / 1.00

Yea I often go through my flow rate manually, I can have a FL chart of almost 0 but still a noticeable amount of FL when looking at flow rate.

What does FL look like in the flow rate graph?

[palerider]

- the flow limitation markers don't always line up with disrupted breathing in the flow rate chart, and plenty of unusual breathing goes on without being marked as FL. It looks like the FL graph may be about as useful as the AHI for me? (as in it can tell me when I've clearly had a crappy night, but not much else.) Maybe the leaks are messing too much with them for me to tell, though. My FL flags tend to be less than 0.50 / 1.00

Yea I often go through my flow rate manually, I can have a FL chart of almost 0 but still a noticeable amount of FL when looking at flow rate.

What does FL look like in the flow rate graph?

Beware newbies that leave their little droppings in various threads... Like that one.

[KandyX]

What does FL look like in the flow rate graph?

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4688581/