Tyrone747's therapy

[Jay Aitchsee]

Interesting Sleepyhead changes EPAP and CPAP pressure on the graph with EPR on while in APAP mode but does not do it in CPAP mode. I hope this doesn't mean EPR is lowering my inhale pressure while in APAP mode.

It doesn't. ResMed doesn't report as much detail in the CPAP mode as it does in the Auto mode. A way around this, if full data with a fixed pressure is desired, is to set the Min and Max pressures equal in the auto mode.

EPR keeps the exhale pressure (EPAP) a fixed amount less than the inhale pressure (IPAP), which does, however, lower the overall effective pressure. As the machine changes IPAP in response to Flow Limitations, Snores, etc., EPAP will follow. The two pressures are reported in the auto mode and represented graphically in SleepyHead.

Since EPR lowers the overall effective pressure, an increase in IPAP Min may be required to compensate, if EPR results in increased obstructive events.

[zonker]

Thanks Zonker.

you are most welcome. now, if you can be that patient, you might want to stay with the settings you have for a night or two to see how they settle in.

i know-easier said than done!

[palerider]

Interesting Sleepyhead changes EPAP and CPAP pressure on the graph with EPR on while in APAP mode but does not do it in CPAP mode.

Huh?

I hope this doesn't mean EPR is lowering my inhale pressure while in APAP mode.

EPR lowers your *exhale* pressure, by however many CMs you have it set to.

You can see exactly what it does by zooming in on the Mask Pressure chart.

[tyrone747]

Zonker, you are right. I'm changing too much too quickly. I need to change one thing and wait and get a good sense of it's effect. I have three issues that I'm currently trying to tackle at once; Aerophagia, sleep apnea, and now central apnea. I seem to have tackled aerophagia by lowering the max pressure to 8 and turning EPR to 2. The question is did that increase the other two issues by doing that? From my reading today it seems possible that turning on EPR can cause central apnea in some people. With EPR, carbon dioxide levels in the blood stream don't reach the level where the "breathe" command gets sent. For that reason I'm going back to EPR off and fixed CPAP of 7. I'm taking your advice and just going to leave at that for a few days and see how I do before changing anything. Once I have a good baseline established I will decide which issues need addressing if any. Kind regards.

[zonker]

Zonker, you are right.

boy, THERE'S something i don't hear NEAR enough of!

I'm taking your advice and just going to leave at that for a few days and see how I do before changing anything. Once I have a good baseline established I will decide which issues need addressing if any. Kind regards.

yup, just makes sense. if you do it the other way, it's referred to as "dial winging".

and one night worth of data isn't really data, as i've heard pugsy say before. in my own case, i got a low AHI of 0.23 friday night! yay, me!! but then, last night, i got an AHI of 1.68. but i'll just wait and see what tonight or even tomorrow night brings.

good luck!

[tyrone747]

Very long sleep last night. CPAP 7, EPR 2, Dreamwear Nasal Cushion, Mouth taped. I don't feel great this morning but I don't feel terrible either. Still getting some flags for centrals. Some are obviously fake with a big spike before I stop breathing. Others I'm not so sure. I'll post some examples I'm not sure of and perhaps you guys can tell me what you think. I'm thinking they're likely fake.

I'm not sure how to get rid of these if they are real. Two ideas I have are, lower EPR to 1, or do nothing and see if they go away on their own.

[Jas_williams]

There is not enough centrals to worry about they will likely diminish further over time but you could try reducing EPR to 1 to see if it helps

[Pugsy]

I agree with Jas..
Not enough centrals to worry about even if every single one of them was the real deal.
Hold your breath for 10 seconds....did it cause you any discomfort or stress? That is essentially a 10 second central.
If they are real you can't do anything to get rid of them. They are normal and not a problem unless present in very large numbers all night long. Yours are far from being anything remotely close to "large numbers".
It's entirely normal to have an occasional real central....sleep stage transition or sleep onset central....entirely normal to have them happen.

The ones that aren't real...they mainly point to arousals or poor sleep quality for whatever reason might be causing either arousals you remember or even don't remember. So more of a symptom of poor sleep than a cause of the poor sleep. To fix it....you have to fix the poor sleep and that's always easier said than done because we don't always know why our sleep quality isn't optimal.

I seriously doubt that your centrals are related to EPR at all but you can try reducing EPR just to see what happens.

[tyrone747]

Another great night on paper last night. Today I'm feeling totally exhausted. I had to cancel my plans today and take a nap. I never napped before starting CPAP. It seems to me the longer I sleep in a night on CPAP the more tired I feel the next day. But now if I sleep more than 8 hours I really feel like taking a nap the next day.

Some theories I have are:
1. Sleep inertia
2. Body healing from years of untreated apnea

Anyone have some other ideas on why this might be the case?

[Jay Aitchsee]

I've mentioned this before as has Pugsy. I really think you need to examine other aspects of your life which could be negatively affecting your sleep. This comes under the broad heading of Sleep Hygiene - things like meds, alcohol, caffeine, lifestyle, depression, limiting naps, regular exercise and so on. Fixing SDB is relatively easy with CPAP. Fixing poor sleep from other causes can be much more difficult, requiring discipline and a process of elimination through detective work.

And yes, I think it does take some time to become accustomed to sleeping well - in reference to your theory above about the body healing.

Sleep Hygiene

[tyrone747]

I've mentioned this before as has Pugsy. I really think you need to examine other aspects of your life which could be negatively affecting your sleep. This comes under the broad heading of Sleep Hygiene - things like meds, alcohol, caffeine, lifestyle, depression, limiting naps, regular exercise and so on. Fixing SDB is relatively easy with CPAP. Fixing poor sleep from other causes can be much more difficult, requiring discipline and a process of elimination through detective work.

And yes, I think it does take some time to become accustomed to sleeping well - in reference to your theory above about the body healing.

Sleep Hygiene

Thanks Jay. Yes, I've addressed the things you mentioned. The only reason I had a nap today was because I was so sleepy I could barely keep my eyes open. It's rare that I experience fatigue on that level in the past. I don't take medications, alcohol, or caffeine. I get regular exercise, before this current wave of fatigue hit me. I've reached out to my sleep doctor to get help on this issue. His assistant seems to agree this fatigue is happening while my body is adjusting to the therapy and responding to the changes. That actually excites me. I don't feel any resentment towards this fatigue. For the first time in a long time I'm actually looking forward to sleeping. I can't wait to do my nightly routine that ends in me getting into bed.

I'll see if the doctor has any other advice. Kind regards.

[Jay Aitchsee]

I don't feel any resentment towards this fatigue. For the first time in a long time I'm actually looking forward to sleeping. I can't wait to do my nightly routine that ends in me getting into bed.

I think this is a good and proper attitude. One has to be careful not to obsess over sleep, but continually work toward conditions that foster better rest while not expecting immediate results.

Anecdotally, in my case, it took considerable time to obtain truly restorative sleep after my thereapy was optimized. Progress was slow, but looking back, it was steady. I do credit the progress to strict adherence to sleep hygiene principles which is why I often recommend the same to others.

I think, with your attitude, you'll find that your sleep will begin to improve, too.

[tlohse]

Anything is possible when it comes to CPAP. I’ve been a user for about 5 years now and sometimes I still don’t always feel the greatest all though my Ahi Is 1.1 now and was at my March 29 2019 check.

[Jay Aitchsee]

Tyrone, did you wake with an alarm from the last sleep you posted? The reason I ask is sometimes waking from the wrong sleep stage, particularly deep sleep (SWS), can leave one feeling groggy for a long time afterwards, sometimes referred to as Sleep Inertia. Looking at the chart you posted, the flow rate just before waking has some characteristics of deep sleep - smooth, with less amplitude.

Typically, one wakes naturally in the morning during light sleep or at the end of a REM stage. Some "smart' alarms are being sold now which try to wake one during an "optimal" sleep stage.

Snooze alarms may be troublesome and can result in grogginess since they tend to start the sleep cycle over, which begins with deep sleep, and then one is awakened at the end of the snooze period from deep sleep.

Just something to consider.

Bad Snooze
Sleep Inertia
Tassi P, Muzet A.

One of the most critical factors is the sleep stage prior to awakening. Abrupt awakening during a slow wave sleep (SWS) episode produces more sleep inertia than awakening in stage 1 or 2, REM sleep being intermediate.

[tyrone747]

Well my treatment definitely seems to be improving. Here's the last three nights. I'm sleeping looong. Centrals are still a bit of a concern since it looks like I'm not breathing for up to 15 seconds. But like many have said those will go away with time. I managed to get up to 9 cmH20 last night with no aerophagia I believe this is due to upping EPR to 3. I'll continue at this setting for now since it feels good and eliminates all apneas but the centrals. I imagine I'm now paying off sleep debt that's why I'm sleeping so long. Though some experts no say that's not a thing. Hopefully my sleep becomes more efficient with time. It's nicer to be over sleeping than under sleeping like I was in the beginning. Kind regards.