UARS, CPAP Helps, some. FL question

[Rise]

A little over 30 days in. Probably not enough sleep in study for optimal titration but a start (rx 7 cm reduced RDI from 24 to 11). Switching to Swift FX helped after acclimation. Still wake up after part night and/or take mask of mid-night. Sleeping without mask supports decision to go down this path in the first place as I wake significantly more tired and remain that way throughout the day, but still fairly froggy 'with'.

I know, "It takes time", etc, which I understand, that said -

Q: How much 'flow limitation' is 'interesting'?

This is mine from last night (two short hypopneas, half a dozen short centrals, no obstructive apneas. Slept an hour or so after w/o the machine). I feel better than the night before when I had trouble getting to sleep, dumped the mask, and slept eight ours through til morning, and I know I'm good relative to many here but subjectively there's substantial room for improvement. Quantitatively I'm suspicious of this graph.

I've tried giving the machine license to increase the pressure. It always does, and so far I wind up swallowing air. My current thinking is I'll try moving it up 0.2 at a time every week or two and see if it helps / I can get used to it.

I read quite a bit and understand it's hopelessly squishy overall but for people that wake up feeling well rested, what's your FL chart look like?



On a tangentially related note, I apparently still do the 'gasp' thing on the machine (spikes in the flow graph above). The sleep lab hasn't been forthcoming with the data disk for my study but I wonder to what extent these factor into my residual RDI (I can "see" these on my zeo raw output - increased EEG frequency, facial muscle movement)?



(machine thinks I leak )


Thanks in advance for any feedback.

[1041]

See where the exhalation (downward dropping part of flow graph) seems to disappear right when you have leak? I bet that's a mouth breathe. When you exhale through mouth and are using nasal pillows, the machine doesn't register the exhalation. For me when I have a mouth breathe leak like that it's when my nose has clogged up enough that I can't exhale through my nostrils.

Would you post a few zoomed-in views of your centrals?

[Rise]

See where the exhalation (downward dropping part of flow graph) seems to disappear right when you have leak? I bet that's a mouth breathe. When you exhale through mouth and are using nasal pillows, the machine doesn't register the exhalation.

Possible, but I suspect it's more of this (pre-CPAP pressure trace - flow squared so amplitude is magnified) -

(viewtopic.php?f=1&t=83041&st=0&sk=t&sd= ... s&start=15)

Would you post a few zoomed-in views of your centrals?

Sure

Some are the "uninteresting if the restart doesn't startle you out of falling asleep" sleep onset variety



(I've started to notice the forced oscilation detection sometimes now as well)

I believe most are just post arousal (preceeded by somewhat higher tidal volume here)



and more of the BIG breaths here - easily CO2 depleted



Less obvious but probably post arousal (small difference visible)



No detailed data for this odd cluster but fortunately so far a one-time ocurrence



(might have it on the other computer. if you want to see more let me know and I'll see if I can find it)

Open to feedback if anyone disagrees or thinks I should be more concerned.

[Todzo]

A little over 30 days in. Probably not enough sleep in study for optimal titration but a start (rx 7 cm reduced RDI from 24 to 11). Switching to Swift FX helped after acclimation. Still wake up after part night and/or take mask of mid-night. Sleeping without mask supports decision to go down this path in the first place as I wake significantly more tired and remain that way throughout the day, but still fairly froggy 'with'.

I know, "It takes time", etc, which I understand, that said -

Thanks in advance for any feedback.

Hi Rise!

The more I look at UARS the more it looks like the body fighting with itself.

I think the fight starts with too much stess in the life. Anything you can do to reduce that will likely help.

I think that the stress activates the central nervous system and that part of that activation results in more urge to breath. If you breath too much your CO2 levels get too low and circulation and metabolism are frustrated. One result is inflammation. That appears to lead to airway constriction - which activates the central nervous system so the cycle deepens. The flow waveforms are interesting. The flow to the outside flat tops. The pressure "pull" from your lung muscles increases with each breath until the arousal occures. It almost seems like each breath brings more inflammation and effort.

I have found that aerobic exercise and espically interval training (above 80% of your maximum heart rate in intervals - not for the out of shape - not a place to start) are good to help stablize the breathing.

FWIW

Todzo

[1041]

I was hoping your centrals looked like mine. They don't, so I don't have any ideas, sorry.

I don't know if your flow limitation line is the cause, but I would stay concerned about your situation. I think one can feel the effect of a good night's sleep instantly. I have Superman days that come right after a day where I felt like there was no hope. I always think about a quote from a paper by Weitzman et al. in 1980 on tracheostomy. "The most dramatic clinical change was the almost immediate reversal of excessive sleepiness and frequent sleep periods during the day. Within 2-4 days, sleeping with an open TR, all patients and their families reported striking improvement."