David1447's Therapy Thread

[David1447]

Edit: I'll keep updating the thread with my progress here. I've decided I'll need a scoring system to gauge how I feel day in day out. This seems to, obviously, correlate with AHI numbers, but sometimes it doesn't, or the correlation isn't pronounced enough. I do this because, to me, CPAP is about fixing my depression and anxiety. Days I feel normal in are 9's. Others are close. As I'm writing this, I'm at 8.5, as part of the day I felt pretty normal, and it since went down a bit. I know, it's highly subjective and maybe not very scientific, but I think it'll help me connect the ### with real life.

1 - 10. 9 Being ideal.

This score is solely based on how I feel. I'm a human, I do experience negative and positive emotions and this will change this score obviously and skew results. However, I'll make an effort to minimize distractions and do it in a neutral time, probably around lunch.

I'll periodically post updates on what I'm changing. Scores will be updated in this main post with date and synopsis of changes of said date.

7/1/19 - 8.5. Lowered pressure to 12/20 (Second half of night. First half was spent in not a great sleep, at 16/20. This brought on a lot of Clear Airway Hypoapneas/events in the graph). Tightened mask an extra bit due to beard growing out. Still using the Full Face Weinmann Mask, a huge improvement over the Chinese iVovle FFM, which was not adequate in any way for me. Also, skin on bridge of nose doing a little better since previous days. Skin is still bare though, so hoping that improves further tonight. Went to the gym today, Deadlifted 110kg for 4 as a final set, had a pretty okay workout considering I'm on 1138 calories for today. Day 4 of diet.
8/1/19 - 6.5. The day went by pretty well. I did wake up tired. In some aspects, I'm calmer than a regular day, but I don't know why that is. The sleep itself, I don't remember dreaming, but I do feel like I slept pretty deeply at least part of the night as I don't remember waking up (once at 5 am, took a minute to get back to it so no real harm done). Usually nights I don't remember dreaming, or I remember really small fragments of dreams, are a good indicator for me that something's up, and something is. I had a lot of Clear Airway Hypoapneas and did feel as though I was getting too much air during, before, and even when I tried to nap this afternoon - I've decreased the pressure from 11.5 (was 12/20 last night) to 10.5, 10, and finally 9.5. 9.5 felt comfortable, but I later changed it to 10, to be safe, as that was what I had considered my "optimal feeling" pressure for sleep and the day after the sleep.
So to sum it up, a valuable night, feedback-wise. I ended up not falling asleep during my nap, or if I did it was brief (might actually be this one, as the relaxing music video I set up shows up at 49 minutes by now, which makes me believe at least 20-30 minutes were spent in something of a light sleep). Tonight I shouldn't have too much trouble falling asleep, even with the caloric deficit, which I am growing more used to by the day. Day five, as of now, around 1100 calories today as well. Sorry for the verbose update.
9/1/19 - 5.5. Similar to yesterday, but at a pressure of 10/20, I slept for six hours and fifteen minutes. Changed ramp from 2 to 1. Upped pressure to 10.5/20. Worst night in a while. Appetite going wild, not going to the gym due to extreme tiredness.
10/1/19 - 5.5. This sucks. Did something drastic as I thought maybe the DreamWear required more pressure than the other types of masks. Tried 17.5 pressure / max 20. The results were 80L leaks throughout the night and generally not the best sleep. 7.5 hours, but still somehow better than yesterday. Not going to the gym today either - utter lack of energy. Appetite seems under control, we'll see how today goes. Will shave and try my last mask again tonight at the pressure it worked at last time - 12/20.
11/1/19 - 8. Yup. It was the mask. Changed it along with the machine's response into "normal" and slept a lot better tonight. 10.5 hours better... I was beat. The mask's name is JoyceOne, just found it. My beard is still kicking and I'm planning on ordering the ResMed AirTouch F20 for a better seal, when it gets too unruly. Tonight I'm changing response to "Fast" just to try it. I'll post graph.
12/1/19 - 5.5. Edit: I've deleted the last entry. During the day I felt awful and very anxious. 5.5 hours sleep, non-shaved face, no chinstrap to prevent mouth droop.
13/1/19 - tba. Night felt alright, but I've learned my lesson about posting a score too soon. If the day goes to the #2 dispenser, the sleep did too.

[Wulfman...]

Nobody can see your "graph". All it says is "image".
I'm guessing it's only visible to you because you have privileges to it and we don't.


Den

.

[djams]

Hi! And welcome to the forum. You've found the right place to come for help, I can assure you. Based on personal experience.

I can't see your posted image either. Might try deleting and re-adding it.

Please update your profile with your machine and mask information too.

[DreamDiver]

Here's the image:

[Pugsy]

I can see the image if I right click the mouse over the word image.
It takes me to imgur.
Give me a bit and I will get the image posted for everyone. Edit...never mind...DreamDiver did it for me. ...thank you DD.


I am not familiar with the reports from that brand of machine and didn't even know SleepyHead would work with it...but if what is shown is accurate....it's a bad report.
For sure need more maximum and a good chance of more minimum and I can't tell if CAs/centrals are flagged or not.

I would like to see the events graph larger...it's scrunched up and I can't easily see the categories shown.

I suspect the dense clustering is probably when the person is sleeping on their back...it's too long of a duration for it to be REM I think.
Needs more pressure at that time...and the machine is maxed out...it wants to go higher but can't.
If the results are as SH reports...obstructive in nature and more pressure is needed.

[DreamDiver]

Interesting machine!
I'd like to learn more about epoch flow limitation (eFL) in contrast to flow limitation (FL), because you've got a lot of that happening all up in there.
Also Epoch Severe Obstruction and Epoch Mild Obstruction.
I couldn't find them in the wiki.

Chris

[palerider]

That's not an 'img' it's a web page. Don't click the 'img' button unless it's just an image.

[palerider]

Interesting machine!
I'd like to learn more about epoch flow limitation (eFL) in contrast to flow limitation (FL), because you've got a lot of that happening all up in there.
Also Epoch Severe Obstruction and Epoch Mild Obstruction.
I couldn't find them in the wiki.

Chris

Well, I'd *guess* it's this definition:

ep·och
a period of time in history or a person's life, typically one marked by notable events or particular characteristics.

And since it's a percentage, It looks like SH is saying that's what percentage of the night OP was having those events.

[David1447]

Hi! And welcome to the forum. You've found the right place to come for help, I can assure you. Based on personal experience.

I can't see your posted image either. Might try deleting and re-adding it.

Please update your profile with your machine and mask information too.

Thank you. I've added a full day's report, this is from yesterday. Mind, there was alcohol included. 10min/11max.

I can see the image if I right click the mouse over the word image.
It takes me to imgur.
Give me a bit and I will get the image posted for everyone. Edit...never mind...DreamDiver did it for me. ...thank you DD.


I am not familiar with the reports from that brand of machine and didn't even know SleepyHead would work with it...but if what is shown is accurate....it's a bad report.
For sure need more maximum and a good chance of more minimum and I can't tell if CAs/centrals are flagged or not.

I would like to see the events graph larger...it's scrunched up and I can't easily see the categories shown.

I suspect the dense clustering is probably when the person is sleeping on their back...it's too long of a duration for it to be REM I think.
Needs more pressure at that time...and the machine is maxed out...it wants to go higher but can't.
If the results are as SH reports...obstructive in nature and more pressure is needed.

Hey Pugsy, thank you for the response. I've tried upping max to 14 from 11 and I mostly don't sleep well. I've found 10min/11max is the sweetspot, so to speak, but it's still not good. It's just the best I can manage. Attached are a full night's report from yesterday. I'm feeling quite depressed and tired. It wasn't a terrible night.

Nobody can see your "graph". All it says is "image".
I'm guessing it's only visible to you because you have privileges to it and we don't.


Den

.

I've reattached five images that should be visible. It's from yesterday night.

Interesting machine!
I'd like to learn more about epoch flow limitation (eFL) in contrast to flow limitation (FL), because you've got a lot of that happening all up in there.
Also Epoch Severe Obstruction and Epoch Mild Obstruction.
I couldn't find them in the wiki.

Chris

As was quoted in the thread by another user whose name I can't recall (sorry), they might be what percentage of the night a person is obstructed, or something to that effect?

[Julie]

Tiny tip for the future - ditch the calendars... not needed and take up too much of the room below them - hard †ø read those needed parts.

[Jas_williams]

Your overall AHI is less then 2 which is pretty good, you have a lot of events flagged as RERAS this would be good to try and reduce. At this point in time it looks like a small increase in minimum pressure may help to reduce pressure changes but you will need to creep up on it try a minimum of 10.2 for 3 days see how it goes you are in a fine tuning phase, it’s more about how you feel rather than numbers. Is there anything else we should kno eg any medications etc. There is more to poor sleep than just Apnoea

[David1447]

Your overall AHI is less then 2 which is pretty good, you have a lot of events flagged as RERAS this would be good to try and reduce. At this point in time it looks like a small increase in minimum pressure may help to reduce pressure changes but you will need to creep up on it try a minimum of 10.2 for 3 days see how it goes you are in a fine tuning phase, it’s more about how you feel rather than numbers. Is there anything else we should kno eg any medications etc. There is more to poor sleep than just Apnoea

Nope. I'm 23, nothing on the medications side. I am having some clear airway events and also pressure above 11 seems to trigger more events rather than less. So I'm keeping it at 10 fixed cpap mode and maybe even switching to my nasal pillows mask with mouth tape to check how that feels. I can't increase in smaller increments than 0.5 so it's either 10 or 10.5.

Are these clear airway events/hypoapneas cause for concern? They cluster as well. Would you recommend trying an asv in the future? The reasoning for me here is - I get a lot of events around certain periods most likely when lying on my back as that's what the sleep study suggested too. I can't prevent sleeping on my back, I've tried, tennis ball backpack for of towels you name it, I just roll halfway there and it doesn't help. So I need more pressure. More pressure = more events. But less pressure = also more events.

Sweet spot = 10 pressure with a full face mask. If APAP - 10/11 settings. This is by feeling and also by trend of events with my sleepyhead data.

I want NO events. I want perfect sleep. Maybe this is greedy. This is what I aim for.

Is it reasonable to think that more pressure from an ASV would help reduce or eliminate residual events, while ALSO eliminating clear airway events/hypoapneas by forcing air in at certain times, as an ASV does? This is fine tuning yeah, but I don't mind investing $1000-1500 for a used ASV if it means there's a good chance (like an educated guess) my sleep will improve or stabilize itself into the best it can get. Even if that's "pretty good", long as it stays there I don't mind. The sleep I get now is inconsistent. Yes I sometimes change stuff so that could cause that. But sometimes I just sleep like crap, no idea why. Mostly, it's a lot better with cpap. But I want consistency. I want to get up and be able to hit the gym like I used to. Maybe it's an ego thing, just knowing I'm not wasting my life not being the best version of me I could be. But that's my goal. Could ASV help me out with it? Or is it a complete waste of money in my situation?

Sorry for the rant.

Thoughts? I might make a separate thread for this ASV conundrum if this is too much information for a reply.

[DreamDiver]

Nope. I'm 23, nothing on the medications side. ...
Sweet spot = 10 pressure with a full face mask. If APAP - 10/11 settings. This is by feeling and also by trend of events with my sleepyhead data.

I want NO events. I want perfect sleep. Maybe this is greedy. This is what I aim for.

Is it reasonable to think that more pressure from an ASV would help reduce or eliminate residual events, while ALSO eliminating clear airway events/hypoapneas by forcing air in at certain times, as an ASV does? ...

Sorry for the rant.

Thoughts? I might make a separate thread for this ASV conundrum if this is too much information for a reply.

Hi David,

It would be great if you could add the information about your machine and mask in your signature. I know yours isn't in list of machines available, but there's an editable text area where you can put extra info, including pressure settings and other masks you use alternatively.

AHI of 0 is a great goal. It's unusual for anyone to consistently have AHI of 0 who needs CPAP. Insurance companies are happy if you're below 2. Most of us would be happy to be dialed in at about 0.2 on average. That's not to say some nights won't be higher.

Have you already tried an ASV and are you cleared for a prescription for one? I am not using ASV, but I've heard that the algorithm is considerably different in that it anticipates whether you're breathing or not. Under certain circumstances, until you're used to it, the therapy itself can act as a wake trigger. If you're at average AHI 1.55 and you haven't been on APAP long, I wonder if your doctor isn't going to suggest letting the machine you have do it's magic. It may take weeks or months for your body to adjust. However since you're under 25, that time may be shorter. The fact that you're at such a low AHI now is a success even if your nights feel like crap.

Also, it looks like your machine's algorithm shoots you from about 10.5 to 11.5 with no ramp. Is that acting as a wake trigger for you? It would do for me. As soon as it shoots up, you get all these events and short leaks.

For others following along: What's triggering the pressure to go up to 11.5? As soon as Dave is at that pressure, he's showing all these events. When he's back down at 10, the events magically disappear.

Chris

[David1447]

Nope. I'm 23, nothing on the medications side. ...
Sweet spot = 10 pressure with a full face mask. If APAP - 10/11 settings. This is by feeling and also by trend of events with my sleepyhead data.

I want NO events. I want perfect sleep. Maybe this is greedy. This is what I aim for.

Is it reasonable to think that more pressure from an ASV would help reduce or eliminate residual events, while ALSO eliminating clear airway events/hypoapneas by forcing air in at certain times, as an ASV does? ...

Sorry for the rant.

Thoughts? I might make a separate thread for this ASV conundrum if this is too much information for a reply.

Hi David,

It would be great if you could add the information about your machine and mask in your signature. I know yours isn't in list of machines available, but there's an editable text area where you can put extra info, including pressure settings and other masks you use alternatively.

AHI of 0 is a great goal. It's unusual for anyone to consistently have AHI of 0 who needs CPAP. Insurance companies are happy if you're below 2. Most of us would be happy to be dialed in at about 0.2 on average. That's not to say some nights won't be higher.

Have you already tried an ASV and are you cleared for a prescription for one? I am not using ASV, but I've heard that the algorithm is considerably different in that it anticipates whether you're breathing or not. Under certain circumstances, until you're used to it, the therapy itself can act as a wake trigger. If you're at average AHI 1.55 and you haven't been on APAP long, I wonder if your doctor isn't going to suggest letting the machine you have do it's magic. It may take weeks or months for your body to adjust. However since you're under 25, that time may be shorter. The fact that you're at such a low AHI now is a success even if your nights feel like crap.

Also, it looks like your machine's algorithm shoots you from about 10.5 to 11.5 with no ramp. Is that acting as a wake trigger for you? It would do for me. As soon as it shoots up, you get all these events and short leaks.

For others following along: What's triggering the pressure to go up to 11.5? As soon as Dave is at that pressure, he's showing all these events. When he's back down at 10, the events magically disappear.

Chris

Is there any ramp setting to change here, or is this just a feature of the machine? Any machines you know of that don't have said feature? Could it be because the machine doesn't think 1 pressure point is that big a deal?

On average, my AHI is about 4-5. So this isn't really fixed. In addition, I'm more concerned about all these events. RERAs, clear airway events, hypoapneas... At 4 major events per hour, those are a lot of awakenings.

I'm not clear for anything. They told me I need to pay $1700 for a custom fitted brace and use a tennis ball on my back. I did the latter and got myself a used somnobalance e (common here, no, I'm not from Germany) for $230 (the guy even gave me two! He had a spare, I have it as a backup).

I don't know what to do. For now, I'll try staying at 10cm of pressure, and playing around with that while checking the reports. I'm a perfectionist and refuse to not have the best possible results, and this doesn't necessarily go for the report and numbers- I KNOW when I've slept like crap. It's such a subtle difference. It's not my body getting used to the machine, some nights, something just goes wrong. I wake up a different person, one that's not able to feel much of anything. Numb. Unproductive. Anti-social.

It's a terrible existence. I refuse to be a part of it. I'm not looking for perfect sleep I guess. I'm looking for sleep. Actual sleep.

[DreamDiver]

...
I don't know what to do. For now, I'll try staying at 10cm of pressure, and playing around with that while checking the reports. I'm a perfectionist and refuse to not have the best possible results, and this doesn't necessarily go for the report and numbers- I KNOW when I've slept like crap. It's such a subtle difference. It's not my body getting used to the machine, some nights, something just goes wrong. I wake up a different person, one that's not able to feel much of anything. Numb. Unproductive. Anti-social.

It's a terrible existence. I refuse to be a part of it. I'm not looking for perfect sleep I guess. I'm looking for sleep. Actual sleep.

I hear you. You sound exactly like I did when I started, so I know this boat you're rowing. Yes, whether you feel rested or not is important, and yes it's going to impact your attitude and sociability. There are going to be good nights and bad nights. However there will be a turning point after which you'll have mostly good nights. You may even get a sort of exhilaration at feeling better. There may be ups and downs. Provided you stick with therapy, things will trend better. Right now, you're in what many here have called the "waking dead" stage of sleep apnea recovery. Your brain has to heal, basically reconfigure its firmware to accommodate your new conditions.

I assume you've learned how to change the pressure settings, since you started at 10.5 to 11.5 and have graduated to 10.0 to 11.0.

I did a lot of reading and learning when I first started, and it's obvious you're on that same journey. It may seem like a good idea to make changes to settings every night, but it isn't.

1. Change infrequently. The body has to get used to it's new sleep environment, so that usually means pressure titration changes happen in small increments maybe once a week or once every two weeks. Making adjustments more often is less likely to give meaningful feedback because each night is different, and we're looking for long-term trends.

2. Small Increments. It looks like you just changed your settings from 10.5/11.5 to 10.0/11.0. Why not leave the settings there for at least a week?

3. Leaks. There are a number of small leaks during your 11.0 pressure. I wonder if your mask is sealed well enough around your nose/mouth. I can't remember. Are you using nasal or full face? If you're experiencing leaks, you're not getting therapy. Worse, small face farts and mask whines act as wake triggers, also reducing therapy effectiveness. If you're leaking you're not getting therapy. Before you do any more pressure settings changes, it will be worth the effort to button down leaks.

4. Existence. We've been bestowed the opportunity of consciousness in a universe that is so vast we don't know if we have company beyond our own planet. It is what we make of it. Actual sleep will come. Part of the objective is to assess scientifically without emotional prejudice exactly what's happening. It's hard for us meat bags to not let our emotional guts get in the way, especially when chronic sleep deprivation finally comes to collect its toll. The people on this forum understand crappy sleep.

I'm a little jealous about one thing. You're fortunate you are to have caught this so early. Imagine being 40+ years old after a lifetime of dipping unknowingly below 86% SpO2 levels night after night, never having been diagnosed because you don't snore and your BMI is only borderline obese. Brain damage is bound to be worse for those of us who caught it late. Because you're younger than 25, you're likely to bounce back faster than the rest of us who were diagnosed so late in life.

About the anti-social thing. I wonder if part of what's happening to you is what happens to most of us around 25. Many of us realize we're just not interested in going out night after night to social events like bars or dance floors, parties or whatever anymore. Our bodies seem to tell our younger friends, "Yeah, you go do your thing. I'm going to curl up here and binge-watch Black Mirror." (Note: I've never watched Black Mirror. ) I'm not saying it's necessarily true for you, but please take into consideration the possibility that some of what you may be considering antisocial behavior is just part of approaching age 25.