David1447's Therapy Thread

[David1447]

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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.

Thanks for the detailed post. I've taken note of the infrequent changes thing. I'll try to find a comfortable pressure point and stick to it for a week. But I've been known to jump to extremes after a bad night. I just don't want to repeat it. It feels like a whole day is wasted, which, it actually is.

I get the argument about a consciousness so entrenched in its own emotional havoc it doesn't see the big picture. But, eh, that doesn't matter beyond consoling me by letting me know it gets better. I guess it will. I'm looking for concrete solutions, no offense.

I am, 100% on board with you about the age thing. 95% of people I read about are so old (well, when you're 23 I guess 30 seems really old. Which is like a child in today's terms, so what do I actually know). I am lucky I've had this resource at such a young age called the internet, and that I'm self aware enough to realize, hey, some days I'm not acting like my best self, and I could probably do more about it, even though my condition isn't bad enough to know straight away it's a sleep related thing and requires therapy. Although that's a perk as well, I guess my damage isn't as bad as others with say, severe apnea.

And no. I love parties. I love socializing. I mostly love people and I have serious aspirations that have been put on some serious backburners. And it sucks. It feels like life's being so utterly wasted right now. I know I'm a bright kid, in more ways than one, and in some ways that really matter when you're trying to succeed in this type of world. And I want to be there. I want to be happy and be so happy I'd do a lot of good as a by product of my own great existence and reality. Ever see a real grumpy fart walk the street and do something awful? Those people have nothing. Sometimes I feel like them. That's not me, friend.

Maybe I'm not meant to succeed, or even meant to be happy. But I'd like to get some sleep, for starters.

Edit: Full face. But it's burning a hole on the bridge of my nose so I'm taking a break with my opus 360 nasal pillows mask tonight. I'll have to tape my mouth though.

[Jas_williams]

The CA’s are nothing to worry about the quantity of them are too small it’s more likely you holding your breath whilst rolling over or your awake at the time

[Pugsy]

Hey David...where are you located?

If not in the US...the cpap.com 30 day return thing isn't going to help you.

I get the impression you are in the UK or Europe or somewhere other than here in the US.

[David1447]

Hey David...where are you located?

If not in the US...the cpap.com 30 day return thing isn't going to help you.

I get the impression you are in the UK or Europe or somewhere other than here in the US.

Hey Pugsy, you are absolutely right. I'm not from the US. I'm planning on meeting up with a guy from a local craigslist-like website and checking the mask with machine before purchasing. I'll update whether it was any good in a few days. Thank you for the heads up, figured they wouldn't be cool with international returns.

[DreamDiver]

Maybe I'm not meant to succeed, or even meant to be happy. But I'd like to get some sleep, for starters.

Edit: Full face. But it's burning a hole on the bridge of my nose so I'm taking a break with my opus 360 nasal pillows mask tonight. I'll have to tape my mouth though.

It might take time, but a number of us have hit the exhilaration phase, where we feel like we have a lot more energy and have gotten plenty of sleep. I hope the new year finds you heading in that direction.

You can make some decent full-face liners cut out of t-shirt material that may help prevent the nose crushing thing. Is it possible your mask is the wrong size or the upper straps are too tight?

[David1447]

It might take time, but a number of us have hit the exhilaration phase, where we feel like we have a lot more energy and have gotten plenty of sleep. I hope the new year finds you heading in that direction.

You can make some decent full-face liners cut out of t-shirt material that may help prevent the nose crushing thing. Is it possible your mask is the wrong size or the upper straps are too tight?

Seems it was just cheap and perhaps the wrong size. I got a new one (Weinmann brand, name slipped my mind and is probably lost forever. Until I look at the box again, but that's at the top of my closet so yeah lost forever) and it's really good. Granted my standard was really low, but, it doesn't leak and is semi-comfortable on a more-than-stubbly face so I'll definitely take it. My nights have been really impressive (last two) feeling-wise, I feel like I can actually think. I've calibrated therapy a little, going from 10/11 to 10/20 to 12/20 to 14/20 tonight based on the data and my assumptions. Adjusting the ramp on the APAP pressure increases during the night to the lowest settings for a gradual increase was a big one.

Things are looking better. Last night's AHI is down from 5 to ~2.4. I'll post some reports in the coming days.

I might try a T-shirt liner as well. Wonder if I could grow a beard ever again with the help of one...

[David1447]

Okay, so an update. I slept pretty okay tonight, but have found quite a few hypoapneas within my chart. Is this something to be worried about?

jan-7-night.png (193.97 KiB) Viewed 784 times

What changed is I wear a new mask now, the DreamWear Full Face Mask. It's pretty cool, I like it better than my old one. I've reduced the pressure from 12/20 to 11.5/20, as the night before was even worse, graph-wise.

If anybody has any idea of what's up, I'd appreciate the help. Thanks for all the comments thus far, they've not gone unappreciated.

[Pugsy]

I wouldn't worry about the hyponeas right now. They aren't horribly high in numbers and you say you slept better and I assume feel better.

You are using new pressures and a new mask...give yourself a week or two for the body to adapt to the new way of doing things and then lets see what happens with the hyponeas. There is no urgent need to do anything about them at this time.
Some of them may not even be real...as in you weren't asleep when they got flagged.

You probably should learn how to zoom in on the flow rate and distinguish real from not real events before you start worrying about killing any more events with more pressure. Awake flagged events or post arousal flagged events....we can't fix those with more pressure because they aren't related to asleep breathing airway collapses. Instead if we see a lot of them we have to try to fix the cause of the crappy sleep in the first place...which is often a much harder job than just killing apnea events.
http://freecpapadvice.com/sleepyhead-free-software

[David1447]

I wouldn't worry about the hyponeas right now. They aren't horribly high in numbers and you say you slept better and I assume feel better.

You are using new pressures and a new mask...give yourself a week or two for the body to adapt to the new way of doing things and then lets see what happens with the hyponeas. There is no urgent need to do anything about them at this time.
Some of them may not even be real...as in you weren't asleep when they got flagged.

You probably should learn how to zoom in on the flow rate and distinguish real from not real events before you start worrying about killing any more events with more pressure. Awake flagged events or post arousal flagged events....we can't fix those with more pressure because they aren't related to asleep breathing airway collapses. Instead if we see a lot of them we have to try to fix the cause of the crappy sleep in the first place...which is often a much harder job than just killing apnea events.
http://freecpapadvice.com/sleepyhead-free-software

It's an odd kind of thing. I feel like I slept deeply, but something still wasn't quite right. I can't call it a bad night, but I'm still a little out of it. I hypothesized that because I'm using this DreamWear mask I breath almost exclusively via my nostrils (due to the mask's build) as opposed to the mask I used this past week, which makes me open my mouth for some reason.

Anywho... I think I might need to lower the pressure because it feels like I need a lot less of it when breathing through my nose. I hope that makes sense. It's a relief to hear the hypos may be flukes, but based on how the current flow at 11.5 feels like a little much, I did end up deciding to get back down to 10, since it was a previously optimal pressure for me.

I'll go over the link you sent, I indeed don't know nearly enough to make any accurate assumptions about my graph, so getting educated will certainly help. Thank you.

[David1447]

One of the worst nights this month. I tried something extreme and went for 17.5 pressure/ 20 max, resulting in a lot of leaks. Still better than yesterday.

Tonight I'm switching out the DreamWear. I don't know why, but it seems to cause issues with me. I'm confused as the other two days' of use at my regular pressure range had leaks only up to 20L, which isn't very much and wasn't often. I only detect leaks on it through the nose, and again, only at higher pressures. I don't know what is it about it, but it just doesn't work for me. I really wanted it to.

I'll try my regular mask tonight and hope to god I don't wake up like this again.

[David1447]

Graph attached. Slept much better with my JoyceOne. Pressure at 12/20, response at "normal" which I'll be switching to "fast" tonight, just to try. I actually remember dreaming, and remember some of "plot", that's pretty big I think. Thanks to everyone who's helped so far with any type of response. I'm sticking to this mask and selling the DreamWear, and ordering an AirTouch F20 soon, for the better seal along my beard.

Edit: Sorry, didn't notice the leak rate wasn't on there! I have to run to work, but if anybody really wants it let me know, I'll upload first thing this evening. It's pretty clear, except a large leak at the end, which I'm not sure what it was, maybe me taking off the mask.

[David1447]

How do I get rid of these events? I just wait them out? Some are false positives sure, but the clusters seem legit in the flow rate graph.

[Pugsy]

False positives you can't do much about except try to get better sleep so that you don't get much SWJ flags.

Centrals/CAs you can't do much about either with your machine even if they are real. Your machine can't do what is needed to treat central apneas and you aren't having nearly enough centrals to warrant a different machine even if every single CA/central was real.

Now the stuff that is obstructive in nature....OAs, hyponeas, snores, Flow limitations....usually a little more pressure is used to obstructive in nature events.
When using auto mode...that usually means more minimum pressure.
Assuming of course not SWJ false positives.

[David1447]

False positives you can't do much about except try to get better sleep so that you don't get much SWJ flags.

Centrals/CAs you can't do much about either with your machine even if they are real. Your machine can't do what is needed to treat central apneas and you aren't having nearly enough centrals to warrant a different machine even if every single CA/central was real.

Now the stuff that is obstructive in nature....OAs, hyponeas, snores, Flow limitations....usually a little more pressure is used to obstructive in nature events.
When using auto mode...that usually means more minimum pressure.
Assuming of course not SWJ false positives.

I'll recheck my graphs, if the obstructive events are real I'll consider increasing the pressure gradually in the coming days.

Would getting a more mainstream machine, like an Autoset 10 For Her help? Or do you reckon the difference is not worth the a price tag?

[Pugsy]

Would getting a more mainstream machine, like an Autoset 10 For Her help? Or do you reckon the difference is not worth the a price tag?

I am sorry but I can't really give you a good solid answer on that one. I know nothing about your machine's auto algorithm and how it might compare to the ResMed Auto algorithm.

Each brand has their own algorithm or way of doing anything and sometimes the results from one brand to another is significant...and sometimes not so much.

I can give you a video that compares Respironics algorithm to the ResMed but I haven't ever seen a comparison of your machine brand to any brand. Doesn't mean it isn't out there though...I just haven't seen it.
https://www.youtube.com/watch?v=lzCCgNLya_g
You can at least see that different brands go about their jobs differently...now which does a "better" job...that falls under the YMMV category.
I have used the Respironics auto algorithm and of course the ResMed I now use....I much prefer the ResMed's way of doing their job.
With the Respironics I had to use 10 minimum and 20 max (about 2 exhale relief which is all the machine will give) to get a decent result.
With the ResMed I am using 7 minimum and 20 max and adding in 3 EPR (3 cm exhale relief)...and I get a better result and better sleep in general. I spend less time up around 15 with the ResMed than I did with the Respironics.

Is there any way you can rent the Resmed auto to just try it????