New User's First Post, Sleepy in GV's therapy thread

[palerider]

Awesome! I guess those flat lines at the top of the exp. time weren't the clippings I thought you were referring to. I apologize.

What mine looked like like if you had taken the whole insp time chart and just clipped off the top third of it.

I am so glad I bought that machine! Honestly, I just loved the way it felt. Thank you for taking a look and analyzing it for me.

I know everyone says this, and I hope it doesn't get old, but you (and Pugsy) and everyone else here who does their part to be a part of the family (as Pugsy so eloquently described in another post- wish I knew how to reference it here- it was so beautifully put it almost brought tears to my eyes)- you are so VERY MUCH APPRECIATED!! I feel beyond lucky there are people here with the expertise to help people like me. (BIG HEART EMOJI).

Knowing that I've done something to help someone sleep better is what makes all this worthwhile.

[Sleepy in GV]

Good morning! I hope whomever is reading this slept well . I was just importing my sleepyhead data, enjoying some coffee, and perusing the forum. I came across this post very informative post on the Vauto settings. Toward the beginning of it, Palerider gives comprehensible explanations on things like TiMin, TiMax, cycle, trigger, PS, etc.

viewtopic.php?f=1&t=173578&p=1275337&hi ... e#p1275364

Palerider, you mention this:

You have to zoom in(up arrow on the keyboard) close enough to see individual breaths. Right click on the chart title, pick 'dotted lines' and turn on the zero line. Then you can see any inhales (anytime the trace goes above zero. what I was seeing were breaths, then smaller breaths, then finally tiny humps where it looked like (guessing, since I wasn't awake to know ) I was trying to inhale, but nothing was happening. the mask pressure line showed no response from the machine.

After setting trigger to very high, these all but disappeared, and my AHI went down.

note: I don't advocate people just twiddling with the settings, or setting theirs to very high just because it helped me. But, if they see something along those lines, then it might work for them, if they've got a Resmed S or Vauto machine.

I think I see that a lot in my flow rate charts, both before and after switching to the Vauto. Though I believe they are now much less frequent (but still nightly). Here is an example from last night. Is this what you are referring to, the "tiny humps where it looked like.. I was trying to inhale, but nothing was happening"?

If this is an example, should I adjust the trigger?

2019-02-23.png (176.64 KiB) Viewed 9918 times

Next question, I think I saw the "chopping off" you referred to earlier this week. Is this it?

2019-02-23 (1).png (177.3 KiB) Viewed 9918 times

[Sleepy in GV]

The next question I have is in regards to the blue inspiration line. There are times where it is right at the tippy top of the chart (2.0), it isn't chopped off, but it stays up there for long periods. Here is an example:

Should I adjust anything because of that?

2019-02-23 (3).png (177.77 KiB) Viewed 9917 times

Finally, overall my AHI is improving. I only have memory of waking up once or twice a night, which is an improvement over my Resmed for her model. The other night, I did have more OAs than I would have liked. Something keeps waking me up around 4:30 ish every day too. When I wake up, the pressure in my mask is HIGH, so I am assuming it is always in relation to either flow limit, snore, or an event. Any thoughts on adjusting something to try to prevent that? I would love to sleep through it. It has happened for the last three nights in a row (since I stopped taking the Nyquil for my head cold).

Here's the bad night with more OAs than is typical:

2019-02-23 (4).png (216.86 KiB) Viewed 9917 times

Thank you so much! I know I am not supposed to apologize for having questions, but I do feel badly for having so many all at once. It is just that I don't always have time mid week to post and ask because of work. I probably had more, but forgot what they were !

[Pugsy]

I will let PR address the tweaking comfort stuff. I am not any good with that stuff.

But the 4:30 wake up with higher pressures from something....could be REM stage sleep related...after all those wee hours of the morning are when we have more REM. It's common to need more pressure in REM because our OSA can worsen in REM. My own OSA is 5 times worse in REM and have been known to need 6 to 8 cm more pressure during probably REM...sometimes upwards of 15 to 18 cm during REM and in non REM 9ish pressure does a bang up job. Big pressure needs difference.
Also it is normal to wake after a REM cycle...so the wake up you are having might simply be a normal wake up that is happening because the REM cycle is over.
Google "sleep stages" and look at the normal hypnograms. See the pattern for REM and note that it's normal to have a very brief awakening at the end of REM. Most of the time we aren't awake long enough to form a memory but sometimes we are.
When we do wake up and can then notice the pressure and stuff....we tend to think that the pressure caused the wake up and it might have but it might also have been a normal post REM wake up...or it might have been the airway related stuff that the machine was trying to fight that was going on during REM.

Supine sleeping...same scenario as above in terms of pressure needs.
And maybe you have the double whammy....supine and REM combined makes for an even harder to deal with airway situation.

We have no control over REM nor do we want to limit it. It's a needed part of the sleep cycle for the restorative powers of sleep to work their magic.

The Nyquil probably sedated you just enough that you slept through whatever it was that caused the wake up or you went right back to sleep and was awake so briefly you simply didn't form a memory of it.

[Sleepy in GV]

Ah, yes that does make sense. You are right Pugsy, it probably is REM related. The only bummer lately is that when it occurs, I’m wide awake and ready to go. I’ve been just getting up, because I can just tell there’s no chance of falling back to sleep. I thought maybe I could prevent something and then keep sleeping. I see what you are saying, the machine IS trying to prevent something already. I’m trying to recall.... I think I am always on my back when I wake up and the pressure is high. Thank you (sleep) Detective Pugsy !!

[palerider]

I came across this post very informative post on the Vauto settings. Toward the beginning of it, Palerider gives comprehensible explanations on things like TiMin, TiMax, cycle, trigger, PS, etc.

Nice to know someone reads that stuff

Palerider, you mention this:

You have to zoom in(up arrow on the keyboard) close enough to see individual breaths. Right click on the chart title, pick 'dotted lines' and turn on the zero line. Then you can see any inhales (anytime the trace goes above zero. what I was seeing were breaths, then smaller breaths, then finally tiny humps where it looked like (guessing, since I wasn't awake to know ) I was trying to inhale, but nothing was happening. the mask pressure line showed no response from the machine.

I think I see that a lot in my flow rate charts, both before and after switching to the Vauto. Though I believe they are now much less frequent (but still nightly). Here is an example from last night. Is this what you are referring to, the "tiny humps where it looked like.. I was trying to inhale, but nothing was happening"?

If this is an example, should I adjust the trigger?

Two problems with your graph that prevent me from answering that question.

1) the y axis on the flow rate is too large to see what's going on. I think those are normal (but small) breaths, leading up to an arousal, probably caused by flow limitation. right click on the 'flow rate', pick y axis, scaling mode, override, and put in something like -60 to 60.

2) you've got pressure, not mask pressure under the flow rate, so I can't see if the machine is triggering or not.

Here's an example of what I meant, It looks like I was trying to breathe, but not triggering the machine to IPAP a couple times before where the apnea is flagged:

apnea.png

Next question, I think I saw the "chopping off" you referred to earlier this week. Is this it

I don't know what you're talking about. what "chopping off", where?

[palerider]

The next question I have is in regards to the blue inspiration line. There are times where it is right at the tippy top of the chart (2.0), it isn't chopped off, but it stays up there for long periods. Here is an example:

Should I adjust anything because of that?

I realize I haven't explained that well, so I went back to summer of 2014 in my charts and found one that shows what I saw... I'll go back to the original post and update it with this pic:

insptime.png

See how it's lopped off at the 2 second mark? Not just a moment or two here or there, but a lot of the night.

Your top pic *may* be that, I'd raise the TiMax to 3, I think the default setting is too low for some people.

Finally, overall my AHI is improving. I only have memory of waking up once or twice a night, which is an improvement over my Resmed for her model. The other night, I did have more OAs than I would have liked. Something keeps waking me up around 4:30 ish every day too. When I wake up, the pressure in my mask is HIGH, so I am assuming it is always in relation to either flow limit, snore, or an event. Any thoughts on adjusting something to try to prevent that? I would love to sleep through it.

Can't tell, you don't have snore, or flow limits on that last overview page. (don't forget to scroll back up, and turn off the calendar before taking the screenshot).

Thank you so much! I know I am not supposed to apologize for having questions, but I do feel badly for having so many all at once.

Just split them up into individual posts, it makes it a little easier to answer one at a time

[palerider]

I will let PR address the tweaking comfort stuff. I am not any good with that stuff.

Teamwork

[Sleepy in GV]

I came across this post very informative post on the Vauto settings. Toward the beginning of it, Palerider gives comprehensible explanations on things like TiMin, TiMax, cycle, trigger, PS, etc.

Nice to know someone reads that stuff

Palerider, you mention this:

You have to zoom in(up arrow on the keyboard) close enough to see individual breaths. Right click on the chart title, pick 'dotted lines' and turn on the zero line. Then you can see any inhales (anytime the trace goes above zero. what I was seeing were breaths, then smaller breaths, then finally tiny humps where it looked like (guessing, since I wasn't awake to know ) I was trying to inhale, but nothing was happening. the mask pressure line showed no response from the machine.

I think I see that a lot in my flow rate charts, both before and after switching to the Vauto. Though I believe they are now much less frequent (but still nightly). Here is an example from last night. Is this what you are referring to, the "tiny humps where it looked like.. I was trying to inhale, but nothing was happening"?

If this is an example, should I adjust the trigger?

Two problems with your graph that prevent me from answering that question.

1) the y axis on the flow rate is too large to see what's going on. I think those are normal (but small) breaths, leading up to an arousal, probably caused by flow limitation. right click on the 'flow rate', pick y axis, scaling mode, override, and put in something like -60 to 60.

2) you've got pressure, not mask pressure under the flow rate, so I can't see if the machine is triggering or not.

Here's an example of what I meant, It looks like I was trying to breathe, but not triggering the machine to IPAP a couple times before where the apnea is flagged:

apnea.png

Next question, I think I saw the "chopping off" you referred to earlier this week. Is this it

I don't know what you're talking about. what "chopping off", where?

I reformatted my chart to adjust y axis. I also moved mask pressure back up and got rid of the calendar. Now that I changed the y axis, it does not look like the chart you gave as an example. Here it is:

[Sleepy in GV]

Next question, I think I saw the "chopping off" you referred to earlier this week. Is this it

I don't know what you're talking about. what "chopping off", where?

That chopping off was what you had earlier referred to as "clipping off". I guess I used stronger synonym for "clipping". I'm referring to this:

What I see there is just smooth, regular breathing. There's nothing in your machine to try to make you take a breath before you're ready, which a clipped lower limit on exp tome would indicate.

This is when you were helping me last week to see if my inspiration or expiration time was "clipped off". Here is the pic again so you don't have to go searching. Just to be clear, I see that clipping about 1-2 times a night, 3 at the most.

[Sleepy in GV]

I realize I haven't explained that well, so I went back to summer of 2014 in my charts and found one that shows what I saw... I'll go back to the original post and update it with this pic:
insptime.png
See how it's lopped off at the 2 second mark? Not just a moment or two here or there, but a lot of the night.

Your top pic *may* be that, I'd raise the TiMax to 3, I think the default setting is too low for some people.

Just split them up into individual posts, it makes it a little easier to answer one at a time

I didn't read this until right before bed and I didn't have time to make adjustments. I'll try TiMax to 3 tonight.

I am also going to split everything into individual posts.

[Sleepy in GV]

Finally, overall my AHI is improving. I only have memory of waking up once or twice a night, which is an improvement over my Resmed for her model. The other night, I did have more OAs than I would have liked. Something keeps waking me up around 4:30 ish every day too. When I wake up, the pressure in my mask is HIGH, so I am assuming it is always in relation to either flow limit, snore, or an event. Any thoughts on adjusting something to try to prevent that? I would love to sleep through it.

Can't tell, you don't have snore, or flow limits on that last overview page. (don't forget to scroll back up, and turn off the calendar before taking the screenshot).

[Sleepy in GV]

Alright! I think I corrected everything from yesterday .

I want to explain what I did last night and ask for advice. My tape finally arrived (micropore by 3m). I watched a few you tube videos on it. I ended up taping using this guy's method "TheLankyLeft27" https://www.youtube.com/watch?v=D45Fmzcty8E. He shows putting two pieces together horizontally, slightly overlapped (4mm), about 3 " long, then placing that horizontally over your lips and face. I was going to also use my nose cushion for the first time, but decided not to tape and try a new "mask" all in the same night. So, I taped up, put on my trusty dreamwear full face, and layed down to slumber to determine if I can successfully be converted to a nose breather.

If you don't like a story, please stop reading here and skip to the next paragraph. This is a little anecdote that some may enjoy. Plus, some might have some tips with how to avoid this scenario. Maybe 20 or so minutes after laying down, I realized I had to cough. I waited a few seconds, hoping it would pass. When I realized it wasn't going to pass and I definitely was going to cough, I panicked. I took my mask off (it was resting haphazardly on my nose blowing hard all over my face). For some reason, I thought I couldn't breath. I went back to my scuba diving days and my reflex was something along the lines of, when the regulator is out of your mouth, you have to hold your breath. So for whatever reason, I held my breath and I wasn't breathing through my nose. I was running out of air, I had to cough, and I couldn't get a hold of the edge of the tape to take it off. I was starting to freak out when realized, I could put the mask back to my face, hold it with my hand, and take some "rescue breaths". It was like I was underwater and I was getting a rescue breath from someone else's regulator. I took two or three rescue breaths, through my nose, because I was still unable to get a hold of the tape to remove it from my mouth. With that, I was able to calm back down long enough to finally grab the edge of the tape, pull it off for dear life, and cough. It honestly was the weirdest thing. I don't know why my brain thought, without the mask, I couldn't breath. I could have easily just taken a breath through my nose, but I wasn't and I didn't. I just sat there and felt like I was maybe going to "drown". I was at the end of my air when I took those rescue breaths. The weirdest part of all was I never did take a breath through my nose. And I easily could have. Is my survival instinct really that weak, that I wasn't going to take that nose breath and live?! I think if I hadn't put the mask to my face, I would have passed out. It was kind of scary. It was also BIZARRE! I guess since I have been a mouth breather since I was a little kid, the reflex to save myself by breathing through my nose is now nonexistent?! So, with the tape finally off, I coughed. I sat there for awhile and calmed down. I'd had a full blown adrenaline rush (which is a bummer because I'm low on adrenaline, I hate to waste it) Then I had a decision to make. Do I keep the tape off, or put it back on? I'm always one for "getting back on the horse" so I put it on, and went back to sleep. Long story short, I slept all night with the tape on my mouth!

Now, back to the reason we are all here. First night with tape on my mouth. I had 0 OAs!! The one "unclassified apnea" is my incident with the tape and the cough. There are way more CAs than I normally have, by at least double. I looked through them all and I would estimate about a third were real, the rest, SWJ. Why would nose breathing cause more centrals? I felt success mostly because I CAN breath through my nose with the splint of pressure!!! I can't even believe it. I am so happy !! Here is my chart from last night:

I notice more leaking than I normally have. Do you think that was due to the tape? It did go under and beyond the edge of my mask, I guess that could have been messing with the seal. Also, should I go another few nights taping before switching to the nose cushion (dreamwear)? Last but not least, how do you get the tape off quickly if you need to? It did kind of hurt a little to take that tape off this morning, but probably worth it if it means I can sleep all night and breath 100% through my nose.

[Pugsy]

To make it easy to remove the tape....fix a little edge on the tape with a little tab on it where you have stuck it to itself.
It's what I always do with any tape on a roll so that I can easily find the end of the roll and grab the edge to start the pull to take off some tape. A 1/8 to 1/4 of an inch fold over will give you something to quickly grab.

Go ahead and use the nasal mask and tape tonight. After all that's why we tape in the first place. .....so we can maybe use a nasal interface mask if we want to.

I suggest starting with just one horizontal piece of tape or one vertical and not do 2 at the same time. When I taped I just did one horizontal....sometimes one is enough and you might feel less anxious knowing only one strip needs to come loose should you just have to breathe through your mouth. Make it easy on your brain.

[Sleepy in GV]

To make it easy to remove the tape....fix a little edge on the tape with a little tab on it where you have stuck it to itself.
It's what I always do with any tape on a roll so that I can easily find the end of the roll and grab the edge to start the pull to take off some tape. A 1/8 to 1/4 of an inch fold over will give you something to quickly grab.

Go ahead and use the nasal mask and tape tonight. After all that's why we tape in the first place. .....so we can maybe use a nasal interface mask if we want to.

I suggest starting with just one horizontal piece of tape or one vertical and not do 2 at the same time. When I taped I just did one horizontal....sometimes one is enough and you might feel less anxious knowing only one strip needs to come loose should you just have to breathe through your mouth. Make it easy on your brain.

10-4! I’ll do a rescue tuck of tape, use my nasal cushion tonight and use one piece of tape rather than two.

Thank you Pugsy !