Severe mixed apnea at the age of 35

[Rubicon]

Then I don't get why I should turn it on knowingly it will only worsen periodics but not help with FL

Because that's not what I said:

the hope... would be to prevent more FLs that cause arousals than the amount of PB (or even CAs) that adding EPR will generate.

IOWs, fix more problems than it creates for a net gain.

[Herbert]

okay but then I was wrong about epr only being a comfort feature

[Pugsy]

okay but then I was wrong about epr only being a comfort feature

"only a comfort feature"....like it is worthless otherwise but IMHO being comfortable is a large part of being able to get good sleep quality. Yes it is a comfort feature but it also can do other things that might be therapeutic for some people.

For some people adding in EPR (or similar bilevel settings) actually reduces flow limitations and that's a lot more the "comfort only".

Now in your situation adding in EPR may or may not cause your other issues to worsen. You may or may not just be trading one problem for another or more problems.

But you don't know until you try.

[ozij]

EPR basically means you have an exhale pressure lower than your inhale pressure.
Your recent nights have been at a pressure of 7 - identical for inhale and exhale.

Rubicon's suggestion:

CPAP 10 cmH2O EPR 3.0.

Which means: Your exhale pressure stays at 7. Your inhale pressure is set to 10 to try to fight your flow limitations which could be disrupting your sleep.
At an inhale pressure of 10, exhaling against a pressure of 7 will be easier, and maybe - if the flow limitations are better controlled, you will sleep better.

In addition, I find myself wondering if your statement

I'm a total fact and figure person, so for important topics I really prefer such clear statements with as less room for interpretation as possible (im the living German stereotype I guess).

does not also mean your mind is overactive with continuous analysis, possibly keeping you from relaxing into more restful sleep.
Have you ever considered Cognitive Behavioral Therapy for your bad sleep?

You write:

Neither do I have bad habits besides phone time before sleeping.

Phone time before sleeping could be one heck of a sleep disruptor - depending on what you use it for.

[Herbert]

I wrote "only a comfort feature" since for me it's not necessary, at least at the pressures I operate the machine. It feels a bit weird to breath against the pressure for 5 breaths or so, then afterwards I don't even feel it anymore. sometimes I turn it off and on again to see if it's still working.

But let's see how it will be when increasing to 10 cmh2o (which woll probably not be tonight, since I have to go to the office tomorrow, so no experiments this night).

@ozij and pugsy: thanks a lot for the explanation. I never considered it to be therapeutic as well.

Regarding me overthinking and the possible influence on my sleep: that's the only thing I can say with certainty about my holidays. When being away I was generally relaxed, distracted and due to the low ahi very also relaxed in regards of my condition. Basically it wasn't a topic for me during vacation. Still I did not feel much better in the morning. So I think while I'm very sure that worrying too much makes everything worse for me, being relaxed is not sufficient to make me feel well rested the next day.

[ozij]

So I think while I'm very sure that worrying too much makes everything worse for me, being relaxed is not sufficient to make me feel well rested the next day.

Precisely.
And that's why I said, "in addition". Not as an alternative.

[Herbert]

For me it's really interesting, that FL are now a suspect of interest. So far I thought there was nothing obstructive going on in my breathing. But as it seems there is. This is very significant for me, since if it would be proven correct, it would mean that the periodicity might not be due to "something serious" like heart or brain issues, but maybe is caused by the underlying obstructive issue. But I can't tell how likely that really is...

[Rubicon]

For me it's really interesting, that FL are now a suspect of interest.

Actually, they always were. This was noted on your second day here:

Flow limitation graph is very active....I don't know how important that fact is.

Not to forget o.:

This means you interpret the flow limitations as being obstructive.

Yes.

However, the treatment for FL is more pressure, and more pressure will likely send the PB through the roof. What we'll find out tomorrow is how far through the roof it will actually go, and if improvement in sleep > increase in PB.

It should be more clear at that point how important ASV is to expecting any progress.

If you're still not optimized after ASV, then concern a long-acting pharmaceutical to increase arousal threshold.

UARS-ish.

[Rubicon]

So far I thought there was nothing obstructive going on in my breathing. But as it seems there is. This is very significant for me, since if it would be proven correct, it would mean that the periodicity might not be due to "something serious" like heart or brain issues, but maybe is caused by the underlying obstructive issue. But I can't tell how likely that really is...

Me neither.

Going back to the study, without CPAP:



They sure like unadulterated centrals, complete with desats. If you could get the raw data (edf files) we could throw that under the microscope and try to answer that.

Especially since we determined that they're a bunch of LSOS.

[Herbert]

I doubt that they will just give the raw data to me unfortunately.

ASV will only be possible for a trial in November

[Rubicon]

I doubt that they will just give the raw data to me unfortunately.

Not so.

Your Section 630g in the German Civil Code says they have to.

[Herbert]

Ok, let's see. What exactly would you like to find there? I didn't quite get it.

[Rubicon]

Go back to the posts of January 31. They confessed that they used unchecked autoscoring. Unchecked autoscoring could call obstructives centrals . If so, you would have been given a major misdiagnosis, which overall would make a lot more sense right now.

If they refuse my working theory is they're hiding something.

[ozij]

Unchecked autoscoring could call obstructives centrals . If so, you would have been given a major misdiagnosis, which overall would make a lot more sense right now.

Which would also fit in with the "miraculous" (Herbert's adjective) results of the plain CPAP during the titration.
And: there were no mixed ("gemischte") apneas at all, and all those "centrals", interspersed with Hypopneas happen in one position ("Lage").

Would you believe it that I have draft post in which I asked if it was possible to mis-identify obstructive apneas as centrals because of an effort belt malfunction, or something like that?

By the way, Herbert, am I right in assuming that "with 35" is a translation of the German "mit 35" and you actually mean "at 35 years old"?

[Herbert]

Sorry, I've been on a business trip. Let me catch up:

- "with 35" is indeed a literal translation > bad English and supposed to mean at the age of 35... could I or a mod change that?

I really like the current working thesis of my apnea being of obstructive origin and the SL just having made mistakes. Unfortunately there are several counter arguments that I would like to mention. Not because I wouldn't prefer the thesis to be the truth, but just because I'm aware of them:

- I was doubting the result in the SL so much, that they brought into their oberservation room and showed me the raw data (eeg, straps, breath, snoring, video) and even printed out the graphs showing the periodic pattern of the chest belt etc. (I think at some point of this thread I posted this as screenshot)

- The confession of using autoscore wasn't made about the initial stay in the SL but "only" about a part (resp. arosusals) of my control night in November. yes.. as Rubicon already remarked this could hint to a general "low quality" and using auto score more frequently than confessed, but it's only a thesis so far

- And last the sole fact that I barely ever audibly snored and my Autoset10 also only scored max. 5 OAs in nearly 1 year of nightly usage but hundred of centrals. as much as I'd cheer for all of them being misinterpreted by the machine and Oscar, I'm just skeptical...

Then on the other hand what would speak for the thesis being right is:
- miraculous effect of cpap
- no comorbidities of central apnea being diagnosed (neither heart nor brain)
- the FL that you observed in my data

What's also unclear to me: How does the periodicity (which is obviously there at any pressure level I tried so far) fit to the thesis?

I guess we will only find out if I can gather the raw data. BTW how big are such datasets? I'm afraid I might have to go there with a USB stick in order to pick it up, since it might be too big for an email. and cloud space is just too fancy and modern for German institutions