Newbie Oscar results insight

[mper!?]

Hi, Nevergiveup, dear folks

_ Happy I am learning a lot with all you guys. As Nevergiveup's situation is rather similar to mine at my beggining, let me make some points based on what I think I have learned with my therapy:

_ not sure on septum deviation effects on your respiration. However, a closer look at your curves appears to suggest your increasing in pressure and poorer respiration would be associated with REM stages, as very often occur to many people (including myself). Then, it may happens you would have upper airway resistance other than just septum deviation, maybe. I have a slightly deviated septum to the left nosestrill, as well. At my very beggining, my ENT said my slight deviation only would be a problem should it affectedt CPAP usage; a long while later, these days, I know it does not affect my respiration under my FFM Airfit f20 (sometime there is congestion in the left side, easily worked out. Congestions appears to occur with higher IPAP, say, > 11.8, and night following hose's washing). Nonetheless this, I would strong suggest you to consult a good ENT. Hope for the best for you;

_ agree that How You Feel may be pretty much everything on this CPAP world; it may be that proper tackling and ruling out of respiratory issues would be first thing. However, If were me, I would have some concerns on possible "side effects" while waiting too long to change to tailored machines. No sure what would have happened to me, though, as I used APAP only for 1.5 months;

_ for instance, it looks to me Nevergiveup is currently facing some drawbacks, such as (1) not feeling well; (2) anomalous constricted respiration in terms of FL (for me what is important here would be his all-night widespread profile), E:I ratio, TV/MV, FR pattern ( I would bet on flatted-top inspiration all night long, and, maybe, a somewhat ratty, working-against-the-machine expiratory limb. It would be nice closer zoom to see if confirms this latter);

_ as occured in my case and a few others I used to follow closely, at least all problems mentioned in (2) would disappear pretty much overnight on BPAP. Not sure what would be immediate and long term benefiets of this to Nevergiveup;

_ coincidently, about one year ago I had performed a quick analysis on this E:I ratio, PS, and so on, which I would like to share and ask for your opnions, hereinbelow.

all the best

[mper!?]

Sometime ago, when revisiting what happened overnight, while moving from APAP (EPR:3.0) to BPAP (PS:4.0), I realized that not only pretty much all FL gone way, but also there was a complete rearrange on respiratory patterns. There were sudden changes on the E:I ratio and MV, as well as on the expiration limb of the FR, which was plagued by flow reductions, seen as a ratty aspect, distinct from the flat top of the inspirations. This could reflect well on the aerophagia I faced at the time, with the APAP (Pmin: 8 to 10.8).

I am aware this would be well known for many here, but for me, still learning day after day, was a rather surprising, particularly when I started seeing same happenings and patterns in similar cases posted elsewhere. Then, I had quickly gathered data from some three more fellows, with regard to E:I ratio and PS, while moving from APAP to BPAP (see attached hereinbelow).

What has come out was a pattern of APAP/BPAP blow-up expiration time, overnight, followed by a complete rearrange of the I:E median ratio. Such blow-up, based on the four cases I have analysed, appears to be proportional to the ultimate tailored PS of each one. It appears the higher the tailored PS, the larger the effect, which, in fact, could be expected?.

However, what has looked far more important for me, if we look the phenomenon backward, would be the potential detrimental and deleterious effects of APAP respiratory pattern, with a I:E ratio close to 1:1, on account of decreasing expiratory time. “Normal I:E at rest and while asleep is 1:2 or less. On great effort (exertion) I:E is 1:1”. Therefore, I have concluded that while on APAP, trying to tame FL under higher Pmin’s, would be somewhat analog to entering in a rush rather than into the night to sleep.

Now, a question for you guys, with longer term experience in historic cases, and which has been intriguing me: even we consider that APAP could treat FL/RERA/UARS, would it be possible for individual waiting too long to get acquainted with the machine, without some risks?

all the best for you all guys, and good luck

[Nevergiveup13]

Hi All,
Thanks for the insight Mper. I wanted to follow up with what my doctor said right after this post and my lastest night oscar. Below is what my doctor said when eventually responding to my questions and to nights similar to those nights I have posted. She was right about not sleeping so I have been really working on that. She wanted me to try trazadone but when I did, it was no different than benadyl and made me feel really weird and tired the next day. I finally gave in last Friday and took 1/2 5mg diazepam which I never use and had from last summer. I took that last Friday and Saturday and then 1/4 Sunday and 1/8th the last 2 nights. Last night I had my best night. See attached. THe good news is the mask doesn't even phase me anymore. I wake up not perfect but feel like I did not toss and turn. I definitely notice my energy turning around. One thing I have noticed still and maybe more is my chest has muscle strain when I move it a certain way-like when moving my shoulders forward and tensing my chest. My cardiologist said its not related to my heart and pulmonologist sees it as no problem. My I/E ratio was 1.04 last night for the 95% number. Is that more in line with what is should be? Overall progress in the right direction but a lot more to learn! Thanks again for your help.

...I think I am wondering if all these parameters are being affected by you potentially having the mask/ machine on and not actually sleeping? I am looking and it is marking your respirations at 15-19. That in itself would explain the I:E times - if you are awake and basically panting against the machine. It is recording 8 hours of use and if you are only asleep 3-4 that is going to affect all of the above- even flow limitations go up when you are tossing and turning ( we basically grimace, hold our breaths and turn etc). That being said the overall count is still negligible so I am doubtful that any of it has clinically relevant physical symptoms - other than you may be exhausted ( !) if you still are having trouble sleeping. Are you taking the trazodone?
REPLY

[mper!?]

Hi, Nevergiveup

_ that's interesting what you have experiencing. No surprise for me, you felt much better on the Benzo;

_ I had a 40-year-not continuous experience with Benzo's (in particular, Clonazepam 0.5mg; first, without PAP for much longer period, then, Clonazepam + PAP for some 2.0years); not anymore since some 5 monts ago. They look indeed work very well, with high benefit/cost, by basically bringing great stability on respiration and RLS/PLMS, improving MV, shortening and diminishing number of arousals/awakenings, and wake ups and trips to toilet. Not signficant long term side effects, except for some loss of memory maybe (would have not been worse without sleep?!);

_ it looks intrincated links among respiration, anxiety and muscle rigidity. And, also, connection between sleep stabilization and drugs, including Benzo's. Be patient, and see, for instance, the insights from the Harvard-MD, Robert J. Thomas (third part of this invaluable Webnar): https://www.youtube.com/watch?v=Syv7YcH ... z&index=63

_ it looks, on Benzo, you moved smoother through REM stages, would have had less arousals (need FR 10min - duration to make sure), had a slight improve on MV, and so on. No improve on the E:I ratio (as usual);

_ As I said, I am strongly negatively biased toward Autoset machines to treat UARS. I would not believe you would be able to signficantly improve your sleep quality with this machine, even though you could try a Pmin:7.0 while in EPR: 3.0. On BIPAP, as I said, there would be gains, yet not sure they would be enough to completely work out your sleep stability;

_ curious to see 10min-duration windows with FR, MV and TV, as well as some 2.0 min duration to see how are going your FR limbs of the curve, as running through higher pressures;

all the best and good luck