zonker's crib--somewhere over the rainbow

[zonker]

FWIW....I agree with PR here.
Let's see what a few nights at these new settings without EPR bring you and cross our fingers that the aerophagia monster stays away.

FWIW, indeed! like i'd discount your opinion.

okay will come back in tomorrow with a new screen grab.

[Jas_williams]

But even if your using epr I see no need for extra pressure. More pressure won’t help your AHI as I do not believe the elements that are left are obstructive based on the graphs you showed me so more pressure won’t help in fact it will wash out more CO2 and probably make you AHI higher..

I have to disagree, more pressure, though probably less EPR, will smooth out the pressure trace, which is pretty active.

However, that may end up causing more aerophagia, so it's 'delicate balance' time....

last night, i turned off epr. there was a BIT more aerophagia, but i think it was mostly down to me eating too much yesterday. unless someone says different, i will keep my settings as is and see what sleepyhead shows tomorrow.

I agree the pressure line is pretty active but EPR is key here IF it will reduce the amount of periodic breathing.

[palerider]

I agree the pressure line is pretty active but EPR is key here IF it will reduce the amount of periodic breathing.

Pressure support *increases* CSR in people with high loop gain.

[djams]

FWIW....I agree with PR here.

FWIW, IWAL (it's worth a lot!)

[zonker]

I agree the pressure line is pretty active but EPR is key here IF it will reduce the amount of periodic breathing.

Pressure support *increases* CSR in people with high loop gain.

can you please define "high loop gain" and what it would mean to me?

thanks!

[zonker]

here's last night-

screenshot-10-6-18.png

yes, i know, we are doing a couple of days average, but just felt like putting it up before i lose the file in the bowels of my computer!

[Pugsy]

Please include how you slept, feel and any aerophagia issues when you do this. I am going to ask and it matters.
You know me....there's more to this stuff than just numbers.
Document it while it is fresh in your mind before it gets lost in the bowels of memory issues.

[zonker]

Please include how you slept, feel and any aerophagia issues when you do this. I am going to ask and it matters.
You know me....there's more to this stuff than just numbers.
Document it while it is fresh in your mind before it gets lost in the bowels of memory issues.

sure thing. i slept no better or no worse, when it comes to actual sleep. my sleep has always been fragmented and still is with cpap. so nothing either better or worse last night. the break you see was me getting up to shoo the dog out of the bedroom. he dislikes thunderstorms so has to come in the bedroom. but i kick him out in the early morning, pee and go back to sleep.

the aerophagia raised it's head around 3. i wish i'd thought to bookmark it by turning cpap off/on! it was minor and i just sort of put it out of my mind and went back to sleep prolly within 10-15 min.

i woke feeling a wee bit foggy, but no headache. fairly typical for me in that ahi range.

as always, please ask any and all questions that come to mind!

[palerider]

I agree the pressure line is pretty active but EPR is key here IF it will reduce the amount of periodic breathing.

Pressure support *increases* CSR in people with high loop gain.

can you please define "high loop gain" and what it would mean to me?

thanks!

Well, to attempt to put it simply, you're more sensitive to changes in the amount of CO2 in your blood, more pressure support (in this case, EPR) creates more ventilation, more ventilation blows off more CO2, that lowered CO2 depresses your respiratory drive, till it builds up again, and you get those cyclic patterns you displayed here:


Or, to put it less simply:

Before addressing this question it is necessary to define loop gain (LG) in the context of obstructive sleep apnoea (OSA). In a closed loop system, such as the breathing system, a perturbation in the controlled loop component (the respiratory apparatus, or ‘plant’) elicits changes in the feedback (blood gas tensions) received by the controller (respiratory centres), which in turn effects a compensatory response in the plant. The initial response may partially correct the blood gas changes, with the residual changes being gradually corrected later. This is a stable response. However, the initial response may result in over-correction of the gas changes (‘overshoot’) such that they are better than what existed before the perturbation. The ventilatory apparatus is then inhibited through the same changes in blood gas tensions that resulted in the initial response, and a second hypopnoea results. If the second hypopnoea is less severe than the original one, the disturbance in gas tensions will also be less severe, eliciting a lesser response and a less severe hypopnoea results, and so on. Ultimately, the system stabilizes. If the overshoot results in such improvement in gas tensions that the second hypopnoea is more severe than the initial one, the cycle can perpetuate indefinitely. LG is the ratio of the initial response to the initial perturbation. A LG of <1.0 is consistent with stable breathing while a LG >1.0 results in perpetual cycling.

[zonker]

I agree the pressure line is pretty active but EPR is key here IF it will reduce the amount of periodic breathing.

Pressure support *increases* CSR in people with high loop gain.

can you please define "high loop gain" and what it would mean to me?

thanks!

Well, to attempt to put it simply, you're more sensitive to changes in the amount of CO2 in your blood, more pressure support (in this case, EPR) creates more ventilation, more ventilation blows off more CO2, that lowered CO2 depresses your respiratory drive, till it builds up again, and you get those cyclic patterns you displayed here:


Or, to put it less simply:

Before addressing this question it is necessary to define loop gain (LG) in the context of obstructive sleep apnoea (OSA). In a closed loop system, such as the breathing system, a perturbation in the controlled loop component (the respiratory apparatus, or ‘plant’) elicits changes in the feedback (blood gas tensions) received by the controller (respiratory centres), which in turn effects a compensatory response in the plant. The initial response may partially correct the blood gas changes, with the residual changes being gradually corrected later. This is a stable response. However, the initial response may result in over-correction of the gas changes (‘overshoot’) such that they are better than what existed before the perturbation. The ventilatory apparatus is then inhibited through the same changes in blood gas tensions that resulted in the initial response, and a second hypopnoea results. If the second hypopnoea is less severe than the original one, the disturbance in gas tensions will also be less severe, eliciting a lesser response and a less severe hypopnoea results, and so on. Ultimately, the system stabilizes. If the overshoot results in such improvement in gas tensions that the second hypopnoea is more severe than the initial one, the cycle can perpetuate indefinitely. LG is the ratio of the initial response to the initial perturbation. A LG of <1.0 is consistent with stable breathing while a LG >1.0 results in perpetual cycling.

this puts me in mind of a popeye cartoon. olive works to resuscitate a partially drowned popeye. as she pumps on his chest she mutters "out with the bad air, in with the good.". i've been searching but can't find a gif!

i kind of understand your explanation. thanks!

[zonker]

last night-

screenshot-10-7-18.png

feeling somewhat the same. tired and fuzzy and the slightest bit of a headache. oddly enough, no real aerophagia. just the slightest touch of gas.

i see the slight leaks and can correct that.

[djams]

Well, to attempt to put it simply,

Simply is much appreciated.

[zonker]

woke up today with no headache and feeling much less foggy or fuzzy. surely the direction to go-

screenshot-10-8-18.png

so, will continue on this path for a bit. will hold off now and post images for the next three nights all at one go.

is it just that i've been pushing it and it takes this long for my body to adapt? or are we too early in the data gathering stage to even come to any conclusions?

oh! and very, very slight gas, which again, visited me in the wee hours of the morning.

[Pugsy]

I can only share with you my own experience with this "body adapting" thing.
Some time back I was trying to figure out optimal bilevel pressure settings and I was sort of all over the place with results because that's just the way I have always been mainly because of poor sleep quality from stuff unrelated to sleep apnea.

So I picked a setting that gave me a real good night and decided to stick with it for 6 weeks no matter what happened.
Over the 6 weeks the AHI reduced by 50% on its own without my changing anything and time asleep increased by 45 minutes or so without my changing anything in my routine. There is some truth to the "give it time thing".

People get impatience and want to expect immediate changes in just about everything...doesn't always work out that way.

[zonker]

I can only share with you my own experience with this "body adapting" thing.
Some time back I was trying to figure out optimal bilevel pressure settings and I was sort of all over the place with results because that's just the way I have always been mainly because of poor sleep quality from stuff unrelated to sleep apnea.

So I picked a setting that gave me a real good night and decided to stick with it for 6 weeks no matter what happened.
Over the 6 weeks the AHI reduced by 50% on its own without my changing anything and time asleep increased by 45 minutes or so without my changing anything in my routine. There is some truth to the "give it time thing".

People get impatience and want to expect immediate changes in just about everything...doesn't always work out that way.

interesting! i'm always happy to read about your personal experiences with the therapy. not sure i could stick with something for six weeks without panicking about it. i'm sure at some point i'd just throw back my head, scream AAAARRRGGGHH and change something! anything!!

not much patience, me. but i think i'm slowly learning to have a wee bit of patience. it comes with my getting older. i won't make the blanket statement that we ALL get more patient with age. but i think i'm getting there.

i think part of my "problem" is that i've been very lucky health-wise. never a major illness, never a broken bone, never had surgery. so my experience with doctors and such generally come from fictional accounts. that is, television or books. and in either of those types of dramas, the heroic doctor makes the right call, prescribes the right medicine and a miracle takes place!

so i was VERY disappointed when i found out that cpap doesn't work that way. my perceptions were colored. i really expected the sleep doc i went to would be able to "cure" me.

that opinion has been eroded, of course, just by being on this forum. but, still...i hold on to it and can't imagine that it's been three years to get to "now". i feel like i should have this licked by now.

don't get me wrong. i know i'm much better off than when i started. it's just a case of me learning a touch more patience!