Just don't feel any better

[lynninnj]

I meant it as a term of deference.

I meant it as good-natured banter.

Kid.

lol ok

got my butt reamed out the other day for asking a direct question and thought maybe I need to move on

tone and inflection is lost here

[Rubicon]

got my butt reamed out

ewww.

[lynninnj]

got my butt reamed out

ewww.

tone/inflection completely flown out the door

[The Tired Vet]

So if you're sleeping "soundly", respiratory parameters should be stable. Using tidal volume as a surrogate for sleep (and making up rules as we go along) you got only a small amount of quality sleep and a ton of SWJ.

Looking at an area of sleep (I'm pretty confident that's sleep) IMO that's significant flow limitation. At 14 cmH2O, one questions the source, and if you're using nasal interfaces, is the obstruction fixed, and if so, you can cmH2O it all day and it won't improve.

Do you have the file from a FFM?

And the sleep studies to try to figure out how you got to this point.

I think I need a translation on the acronyms to give you an answer (well, to give you a good answer ). What is SWJ? FFM, is that full face mask?

I do have sleep studies--two, with the last one in November of 2021. The other one was done two years before that. I just looked at both and they only show graphs of AHI events, SpO2, HR and body positions. I had not yet been on a CPAP for either of these studies. The one in 2019 had me at around an 18 for AHI and the one in 2021 was 23 AHI, by their measures. If there are specifics you'd like to see let me know and I can post.

Full face mask: funny story, the DME company never included an SD card in my machine so I thought I was recording data the first five months, only to discover I wasn't. That was the period I was using a full face mask. I used one for around four months and while I had a low AHI and usually zero leaks at night, I only managed this by tightening the mask down a lot. I would wake up in the morning with the AHI and leak looking great but feeling like I had run a marathon (and I do know that feeling). After reading some materials, including on this forum, that perhaps overtightening might be pushing my lower jaw back and causing a different sort of obstruction I switched to nasal. TBH, I hated the chronic cracking and sores at the corners of my mouth from the full face, and I could either keep it lose enough to be able to breath through my nose and have TONS of annoying leaks, or tighten it enough not to feel any leak and not be able to breath through my mouth. And yeah, I have tried many types of masks. I guess I just have a weird face.

[The Tired Vet]

got my butt reamed out

ewww.

Y'all need to watch Season 3 of the Boys if you would like to see a graphic illustration of such an event. Great show. Not for the queasy of stomach.

[The Tired Vet]

Are you experiencing much…..if any…..nasal congestion?

None. I don't seem to have any problem breathing exclusively through my nose, and don't wake up with congestion.

I've actually had a couple of separate ENT exams of my nose and throat relatively in the last few years (the last one was this past spring) and none identified any problems with breathing through my nose, nor need for surgery or enlarged glands (e.g., my tonsils are normal-sized).

[Pugsy]

Okay. That eliminates nasal congestion as the cause for the increased flow limitation activity.

[Rubicon]

What is SWJ?

Sleep-Wake Junk. Dozing. In and out of trash sleep.

I do have sleep studies--two, with the last one in November of 2021. The other one was done two years before that. I just looked at both and they only show graphs of AHI events, SpO2, HR and body positions. I had not yet been on a CPAP for either of these studies. The one in 2019 had me at around an 18 for AHI and the one in 2021 was 23 AHI, by their measures. If there are specifics you'd like to see let me know and I can post.

Scan and post everything you got. If it's only a summary might need a long report. If it's like ApneaLink or WatchPat might be an issue.

[Okie bipap]

As stated above, SWJ stands for Sleep/Wake Junk. As we transition from being awake to going to sleep and from sleep to being awake, our breathing becomes irregular. The machines are programmed to expect regular, even breathing. Anything else can be identified as apneas or hypopneas.

[Pugsy]

So I zoomed in on the Aug 21 report.
I counted at least 40 plus segments of arousal breathing and as suspected pretty much all the flags appeared to be arousal related flagging.
What was even more alarming was the duration of the segments of arousal breathing....some were quite prolonged and not the usual short duration we often see.

You may think you are sleeping soundly but you aren't. It's no wonder you still feel like crap.

It might be interesting to know if you had a lot of spontaneous arousals reported on your sleep study.
Evaluating sleep study results is more in Rubicon's department when it comes to anything more than general data points.

The short version is your sleep quality is a train wreck but we don't know why.
Is it possible that the flow limitations are a factor??? It's possible because FLs are part of the driving force that will make the machine (when in auto adjusting mode) want to increase the pressure. FLs can impact sleep quality negatively.

If you were on medications that might be messing with sleep we could maybe blame medication side effects. I didn't research your OTC stuff but if I have time later I will just to see if any of them are known to mess with sleep.

Did you ever have an in lab sleep study using cpap to help determine optimal pressures?

[The Tired Vet]

I have a sleep study coming up in two weeks for CPAP titration. It's been kind of difficult convincing anyone to do a follow up study with the CPAP. Given that everyone seems to derive their boat payments from sleep studies, I'm not sure why.

I'll work on getting the sleep studies posted

[The Tired Vet]

So I zoomed in on the Aug 21 report.
I counted at least 40 plus segments of arousal breathing and as suspected pretty much all the flags appeared to be arousal related flagging.
What was even more alarming was the duration of the segments of arousal breathing....some were quite prolonged and not the usual short duration we often see.

You may think you are sleeping soundly but you aren't. It's no wonder you still feel like crap.

It might be interesting to know if you had a lot of spontaneous arousals reported on your sleep study.
Evaluating sleep study results is more in Rubicon's department when it comes to anything more than general data points.

The short version is your sleep quality is a train wreck but we don't know why.
Is it possible that the flow limitations are a factor??? It's possible because FLs are part of the driving force that will make the machine (when in auto adjusting mode) want to increase the pressure. FLs can impact sleep quality negatively.

If you were on medications that might be messing with sleep we could maybe blame medication side effects. I didn't research your OTC stuff but if I have time later I will just to see if any of them are known to mess with sleep.

Did you ever have an in lab sleep study using cpap to help determine optimal pressures?

The FLs don't seem particularly awful, though, do they?

One thought I've had for a while is Upper Airway Restrictive Syndrome. The only problem being that CPAP is a treatment for it and it's not working.

[Pugsy]

Well I have seen worse FL graphs but I have seen much better as well.
Take a look at mine here and you can see what I mean.

One thought I've had for a while is Upper Airway Restrictive Syndrome. The only problem being that CPAP is a treatment for it and it's not working.

It's very possible that the pressure you are using, while it is dealing with OSA stuff very well, isn't doing such a good job with UARS (if you have UARS).
I know a woman with documented UARS (sleep study with Pes device) who was put on cpap/apap and her machine only wanted to go to 7 or 8 cm but then she had another sleep study using cpap and the Pes device and come to find out she needed 13 cm pressure to deal with the UARS and it wasn't until she had used the 13 cm pressure that she started feeling her symptoms improve.
These machines just aren't designed to fight the subtle changes that go along with UARS. Sometimes a lot of pressure experimentation is needed.

[The Tired Vet]

Well I have seen worse FL graphs but I have seen much better as well.
Take a look at mine here and you can see what I mean.

One thought I've had for a while is Upper Airway Restrictive Syndrome. The only problem being that CPAP is a treatment for it and it's not working.

It's very possible that the pressure you are using, while it is dealing with OSA stuff very well, isn't doing such a good job with UARS (if you have UARS).
I know a woman with documented UARS (sleep study with Pes device) who was put on cpap/apap and her machine only wanted to go to 7 or 8 cm but then she had another sleep study using cpap and the Pes device and come to find out she needed 13 cm pressure to deal with the UARS and it wasn't until she had used the 13 cm pressure that she started feeling her symptoms improve.
These machines just aren't designed to fight the subtle changes that go along with UARS. Sometimes a lot of pressure experimentation is needed.

Ah, I see what you mean by the FL. I had been looking at a video of someone else's SleepHQ results and he had much worse FLs, but then he also had much worse sleep apnea.

I would prefer to try things and see if they help. Would you suggest I try higher pressures? I am on 12-15 right now, after trying straight 14 for a week (some of the ones i posted are the straight 14. This all seems very high, but I could go higher if that's worth trying. Conversely, I am wondering if the high pressure is part of the problem, maybe is what's needed to open my airway but is perturbing my normal breathing pattern.

Again, I'm happy to try things (pressure change, EPR, whatever). Just don't know where to start.

[Pugsy]

Do those leaks bother you? You have a lot of leaking going on and they could be causing arousals that you don't remember.

I forget....what mask are you using?

I don't know what Rubicon might suggest but if it were me I would suggest working on leak management for one thing just in case the leaks are causing arousals and I would give auto mode a try and add in EPR and see what happens to the FL graph.
I wouldn't go increasing the pressure at this point and I would put UARS thinking on the back burner for now and instead work on known documented problems first.

I don't know that you need 14 cm fixed without any EPR to deal with your OSA anyway. The biggest part of your AHI is SWJ flagging anyway.
I don't like making a lot of changes at one time either because with multiple changes at one time if we see a change in something we don't know which change brought about the new result.

I think auto mode instead of fixed....keep the 14 cm pressure as the minimum....set max to 20 cm just to see where the machine wants to go to fight the FLs but add in 3 EPR full time.
At least that is what I would suggest if you were my hubby in this situation.
See what happens and how you feel and go from there.