Breathing disturbances still causing awakenings?

[Rob K]

Have been on xpap for 6-7 years. The forum members helped be a ton. I went from feeling like death to doing halfway decent over the years. Feeling well enough that I can have a somewhat normal life. Now that I understand more about my therapy I'm seeing things that need to be addressed. I'm hoping to take it to the next level and get back to doing what normal people do at my age. I very much could use some help to figure out what to do next.

I still wake 6-10 times per night that I'm fully aware of. Usually I can go back to sleep after some adjustments to sleeping position and equipment. Getting plenty of sleep 7-8.5 hours, but it is not very restful. Pretty tired and low energy levels most days. Enough energy to get my job done but not much more than that. Feeling quite sleepy and very drained starting in the early evening. Needing to lay down and take it easy so not getting much done in my personal life outside of work. By the weekend I'm shot. Will do a few things around the house that need to be done with a bunch of resting. 47 years old and feeling much older. Hoping to get closer to normal so I can better take care of personal responsibilities and maybe enjoy life some more.

Recently I've been studying my flow rate chart and have noticed that I seem to be quite sensitive to breathing disturbances. I know what awake breathing looks like now and it is often triggered by a 10 second apnea event or quite often I stop breathing for a lesser duration than 10 seconds but it still wakes me up. My breathing flat lines a fair amount still but a lot are not flagged because they are less than 10 seconds. Unfortunately these events are waking me up sometimes. This makes me wonder how often my sleep is disturbed that I am not cognizant of at night.

Resmed bilevel machine. Pressure 11-15, Exhale relief 2. Set to auto mode. Pressure will increase at times up to 13-14. AHI is below 1 most nights. No medications. Melatonin as needed before bed to help get to sleep. Varies from week to week. Sometimes regular usage and other times not at all. Doesn't seem to affect sleep but does help getting to sleep.

What direction do I go with this to improve quality of sleep and life?

[palerider]

]
Resmed bilevel machine. Pressure 11-15, Exhale relief 2. Set to auto mode. Pressure will increase at times up to 13-14. AHI is below 1 most nights. No medications. Melatonin as needed before bed to help get to sleep. Varies from week to week. Sometimes regular usage and other times not at all. Doesn't seem to affect sleep but does help getting to sleep.

The settings you related aren't applicable to that machine.

please read and follow the instructions in this post: viewtopic/t172378/Sticky--Newbies-PLEAS ... STING.html

Breathing disturbances, cause awakenings, whether you remember them or not.

[Rob K]

You are correct sir. I posted in a way that would make it easier for people to understand. Here's what you are looking for.
Ipap 15, Epap 9, PS 2

[palerider]

You care correct sir. I posted in a way that would make it easier for people to understand. Here's what you are looking for.
Ipap 15, Epap 9, PS 2

Posting something that is wrong doesn't make it easier to understand.

Your numbers that you just posted are also nonsensical.

15/9 gives a PS {which is defined as IPAP - EPAP), therefore the PS would be 6.

Are you trying to say that you have minEPAP of 9, PS of 2 and maxIPAP of 15?

You're not new, you know the drill, post some charts.

[Rob K]

I thought both of my posts on machine settings were clear. Talk about making things complicated. The second time I just posted the settings as they are listed in the menu of the machine. I'll read your link and see if there is a different way to post machine settings. I didn't post charts right away because I'm not sure exactly what you would want to see. Bare with me on posting charts I have to reread all the info on that, it's been a few years. I'll get the info straightened out right away. Thanks for the help and cut me some slack.

[palerider]

I thought both of my posts on machine settings were clear. Talk about making things complicated. The second time I just posted the settings as they are listed in the menu of the machine.

There's a very large difference between EPAP and MinEPAP, as well as IPAP and MaxIPAP,

EPAP and IPAP are fixed settings, whereas MinEPAP and MaxIPAP define a range.

What you said isn't possible, and isn't what the machine says.

[Rob K]

You are correct sir. I was wrong. When you think you know something you don't, lol. Reread my machine menu and clinician manual and it does say maxIPAP 15, minEPAP 9, PS 2. Now I see there is a big difference and how it is confusing. Thanks for clearing that up.

Before anything else lets make sure I understand this correctly. With the Vauto set to automatic mode and with the settings listed above. My understanding comes from info the forum members posted in the past and from reading the clinician manual. The inhale pressure will vary from 11-15cm depending on what the machine determines that is needed at the time. Exhale pressure will be 2cm less than the inhale pressure. This is what I was trying to convey in my first post. To me this seems the easiest way to describe how the machine is operating with the given settings. Is my understanding correct?

[Pugsy]

The inhale pressure will vary from 11-15cm depending on what the machine determines that is needed at the time. Exhale pressure will be 2cm less than the inhale pressure. This is what I was trying to convey in my first post. To me this seems the easiest way to describe how the machine is operating with the given settings. Is this correct?

Your understanding is correct but what seemed as the easiest way to describe your settings was really a bit confusing if someone didn't know bilevel machines. I will admit that I also did a sideways glance at the way you said it but I didn't see the need to make a big deal about it because it really wasn't a big deal for me. Sometimes other people do see it as a big deal though (as you have found out) because they are sticklers for being as exact as possible. I get my panties all in a wad when someone calls the ResMed bilevel machine a "bipap". That's one of my pet peeves in terms of being exact with terminology.

Actually the simplest and easiest would have been exactly as it shows on the machine.
Minimum EPAP 8
PS 2
Maximum IPAP 15

Then if someone didn't understand it ...at that time if they asked for clarification then you could explain it your other way.
Using exactly the correct terminology actually ends up being the best choice in the long run. It will avoid confusion more than cause confusion.

So with that....let's move on to those reports and see if we can figure out what you are seeing and think is happening.
I assume you are familiar with Jason's zooming in and figuring out arousal breathing from asleep breathing??
Here
http://freecpapadvice.com/sleepyhead-free-software

If you need help in remembering what to post or how
viewtopic/t158560/How-to-post-images-for-review.html

[Rob K]

Sounds good. I recently switched to using Oscar and didn't bother organizing the charts. Doing that right now. I read about organizing Oscar, but I cannot find a way to shrink the left sidebar in a vertical fashion. Not enough room to have all the machine settings displayed. Some of them are cut off.

[Pugsy]

hide the calendar
turn off the pie chart (preferences/appearance/remove check mark)
enough of the statistics will show on the left side and if some of the actual settings are cut off...no big deal.
Besides...sometimes OSCAR/SleepyHead got them wrong anyway..
As long as the statistics are there we can figure out the settings.

[palerider]

Sounds good. I recently switched to using Oscar and didn't bother organizing the charts. Doing that right now. I read about organizing Oscar, but I cannot find a way to shrink the left sidebar in a vertical fashion. Not enough room to have all the machine settings displayed. Some of them are cut off.

They're not very important (or necessarily accurate) we're still finding bugs in the reporting of the machine settings.

We can get most of what's actually important out of the graphs, or up above the AHI breakdown.

What's important are the stats, and the AHI break down parts at the top of the left panel, with the calendar (and maybe pie chart) turned off.

[Rob K]

I just figured it out. Even with the calendar and pie chart removed the some of the machine settings were still cut off. I reduced the text one size in the Oscar/Preferences/Appearance settings and all the machine settings are visible now. Now I will get to capturing the images and posting.

[palerider]

You are correct sir. I was wrong. When you think you know something you don't, lol. Reread my machine menu and clinician manual and it does say maxIPAP 15, minEPAP 9, PS 2. Now I see there is a big difference and how it is confusing. Thanks for clearing that up.

Before anything else lets make sure I understand this correctly. With the Vauto set to automatic mode and with the settings listed above. My understanding comes from info the forum members posted in the past and from reading the clinician manual. The inhale pressure will vary from 11-15cm depending on what the machine determines that is needed at the time. Exhale pressure will be 2cm less than the inhale pressure. This is what I was trying to convey in my first post. To me this seems the easiest way to describe how the machine is operating with the given settings. Is my understanding correct?

Well, as someone else just told me about something completely unrelated "well, you learned something anyway" after I did something stupid.

I get picky about things like this, because they do end up causing confusion, and using the right terms, everybody knows what everybody is talking about.

I've seen bad advice be given because someone used the wrong terms, and someone else made the wrong assumption... and then things are just a mess.

Yes, you have the basic idea of how the VAuto mode works with your settings.

It's a little more accurate to think in terms of the EPAP as your base pressure, with a Pressure Support added to that, because the machine will sit there at the EPAP pressure all night, until you take a breath, then the PS kicks in, for a couple seconds, while you inhale, then it drops back to EPAP... EPAP varies in VAuto mode, but PS doesn't, it stays to whatever you set it to.

The settings are sort of opposite of how the Autoset works, where you set a pressure, then dial in some exhale relief or how much you want the pressure to drop after each breath, With the VAuto, you set the base pressure, and then dial in how much you want the pressure to increase with each breath.

[Rob K]

No worries. Your reasoning makes sense. Moving on to charts. I have the image files, now I just need to get them posted.

[Rob K]

Jan 28 typical night. Jan 17 on the higher side of what I normally have to AHI. Trying to figure out why I'm waking so many times. Realizing my thread title should have had a question mark at the end.

Chart 1 & 2