Recently diagnosed, looking to make sense of my data.

[camo]

The part about setting it to cpap at your 90/95 % pressure number is BS though.
That's old school and not necessarily what needs to be done in your case even if we weren't facing all these central apneas.

I kinda got the feeling that my doc was sort of going through the motions during my diagnosis (it was all over the phone after the initial lab study). Going forward It's likely they'll just look at pressure and AHI and go from there without even examining the detailed data. (unlike the wonderful people of this forum )

Now since we are looking at an unwanted number of centrals....we might need to restrict the pressures a bit depending on what happens with EPR off and the starting pressure but lets cross that bridge if/when we come to it. It might be that cpap mode or a more restrictive apap mode is better for you but there are ways to get around that problem. It all depends on if those centrals are asleep centrals or not and if they reduce with just turning EPR off or not. I have seen people have treatment emergent centrals at 5 cm pressure and EPR not being on. We get to have a whole different discussion should that happen in your situation.

I really do hope that with EPR off it will have some favourable results. Specifically since this is being covered by OHIP and the DME told me under no circumstances to change the pressure settings unless my doc advises me otherwise (it's got the Airview modem so they can see the results too) and to only adjust the comfort settings outside of the clinical menu (he was actually kind of irritated I asked how to get into the clinical menu after watching him do it). So worst case I'll have to endure 4 weeks of their "program" (I believe they're testing me for compliance during this time). And if that doesn't seem to turn up positive results, I'm going to take things into my own hands with the advice of people who actually have to live with this.

We need you to be for sure asleep though....and don't use alcohol to help out if at all possible. It's actually bad for the sleep stages we need. It messes with the central nervous system and messes with normal sleep stage architecture.
I would rather see you take some sort of OTC sleep aid if you can safely do it than use alcohol at bedtime.

Yeah, I figured alcohol can't be too good during treatment which is why I'm tapering off. Although after 10 years of having a few during/after dinner time, it's been more or less the norm for me. Just need to re-adjust to my new reality.

[camo]

I requested a copy of my Sleep Study and was provided with it for $5.00

Awesome! I'll email the lab and ask for my copy!

If the machine you have is you permanent machine, you got the for Her model because it is the best device that qualifies under ADP as a CPAP machine.

I'm fairly sure that this is my permanent machine.

I don't know about availability in Canada but here in the US about 20 bucks.
https://www.cpap.com/productpage/resmed ... -faceplate

Wow. Didn't even realize they had stuff like this! I'll have to check that out.

Thank you everyone for helping me out with this! It's incredibly encouraging to know that I'm not alone in this and good people like yourselves are willing to lend a hand to help out a fellow apneatic? (sp.) lol

[Pugsy]

A glass of wine or whatever at dinner time...not that big of a deal as long as bedtime is a lot later.

4 glasses of wine right at bedtime....totally different discussion....

You know where I am heading with this discussion.
https://www.sleepfoundation.org/article ... tity-sleep

We can have all things in moderation but we have to use some common sense.
We can't be using alcohol as a sleeping pill and there's more than one reason for not doing that. We all know that fact.

Now I do occasionally still like a bit of a toddy. I am 68 years old and can't party like I used to and when I do I know that those calories go directly to my butt or belly which is obviously unwanted.....so I don't imbibe much and never within 2 hours of bedtime and I am a cheap drunk so can't drink much at all anymore without just wanting to curl up on the couch and go to sleep.

[camo]

A glass of wine or whatever at dinner time...not that big of a deal as long as bedtime is a lot later.

4 glasses of wine right at bedtime....totally different discussion....

You know where I am heading with this discussion.
https://www.sleepfoundation.org/article ... tity-sleep

We can have all things in moderation but we have to use some common sense.
We can't be using alcohol as a sleeping pill and there's more than one reason for not doing that. We all know that fact.

Now I do occasionally still like a bit of a toddy. I am 68 years old and can't party like I used to and when I do I know that those calories go directly to my butt or belly which is obviously unwanted.....so I don't imbibe much and never within 2 hours of bedtime and I am a cheap drunk so can't drink much at all anymore without just wanting to curl up on the couch and go to sleep.

Haha yeah I definitely have to remind myself that I'm in my mid thirties now and things aren't like they used to be when I was younger.

I will def be more observant about anything near bed time (although I don't tend to use it as a sleeping aid, it's more of a habit and stress reliever from the work day).

My eventual goal is to just not drink anymore.. But old habits die hard ... Those unwanted calories have definitely started making their way to my belly

Thanks for all the insight, friend.

[zonker]

Unfortunately, I have not received a copy of the actual sleep study. I'm not sure if I'm entitled to a copy by Canadian law. But I do remember them telling me it was mostly obstructive.

excuse me a minute, camo, i'm going to alert dog slobber to this-

hey, dog? can camo get a copy of his/her sleep study?

Medical practices fall under provincial jurisdiction. But, they are pretty consistent between provinces.

<sigh> why can't you ever come in here with facts instead of making things up?

[camo]

Let's see what tomorrow's report shows with EPR off.

Alright.. I turned off EPR fully. It took more than I thought to adjust to exhaling and actually gave me a bit of anxiety, but I powered through it.

Also turned off the ramp, which I had set the previous two nights, and used the stop and start method whenever I was aware that I woke up.

Here's last nights results:

[Dog Slobber]

Given that a lot of those clusters of CAs are occurring while you are power cycling you device, then they can't be happening while you're sleeping.

Not sure why you turned off ramp though.

If it were me, I would:

• Turn ramp back on and set to Auto. For many, ResMed does a pretty good job of determining if you're asleep.
• Turn EPR on, but set to Ramp Only. This way you don't have to struggle against the pressure while you're still awake.

[Pugsy]

You didn't sleep well. That's obvious and likely a considerable amount of awake flagged events there. Pretty much impossible to know if the centrals seen are real asleep centrals or false positives.

If you need EPR to be comfortable and fall asleep....you can indeed set it to be used during ramp only and then make use of the ramp feature so you don't have to fight to exhale or be uncomfortable.

When ramp is used the machine won't flag anything but at this point I would take that over not sleeping.
The auto ramp thing....I don't have as much faith in it as DS does but it wouldn't hurt to give it a try. Auto ramp....30 minutes or whenever the machine thinks you have fallen asleep based on your breathing pattern...whichever comes first. If it takes you more than 30 minutes to fall asleep it ends while you are awake.

EPR can be set to "ramp only" meaning you get the benefit but it ends when ramp ends.

[camo]

Given that a lot of those clusters of CAs are occurring while you are power cycling you device, then they can't be happening while you're sleeping.

So safe to say those aren't actual central events?

Not sure why you turned off ramp though.

Honestly, I'm not sure why I decided to turn it off.

I guess I just figured that with me power cycling the machine the ramp would be more disruptive than helpful.. I had it set on auto before.

You didn't sleep well. That's obvious and likely a considerable amount of awake flagged events there. Pretty much impossible to know if the centrals seen are real asleep centrals or false positives.

Yeah, I don't feel like I got great sleep last night.. Still better than pre-treatment, but not as good as the previous nights.

If it were me, I would:

• Turn ramp back on and set to Auto. For many, ResMed does a pretty good job of determining if you're asleep.
• Turn EPR on, but set to Ramp Only. This way you don't have to struggle against the pressure while you're still awake.

If you need EPR to be comfortable and fall asleep....you can indeed set it to be used during ramp only and then make use of the ramp feature so you don't have to fight to exhale or be uncomfortable.

When ramp is used the machine won't flag anything but at this point I would take that over not sleeping.
The auto ramp thing....I don't have as much faith in it as DS does but it wouldn't hurt to give it a try. Auto ramp....30 minutes or whenever the machine thinks you have fallen asleep based on your breathing pattern...whichever comes first. If it takes you more than 30 minutes to fall asleep it ends while you are awake.

EPR can be set to "ramp only" meaning you get the benefit but it ends when ramp ends.

Alrighty. I'll turn the ramp back to auto tonight, and set EPR to ramp. Should I keep EPR level at 3? or lower it to 2 or 1.

[Pugsy]

Use EPR at whatever level you need to be comfortable with and fall asleep. Since you had been using 3 EPR and probably liked it...that's what I would use during ramp. Nothing gets flagged during ramp anyway. Use what you have be accustomed to using.
I should have told you about that option but you seemed so sure that you wouldn't have a problem with EPR just being totally off I didn't think about it.

Bear in mind that if you wake during the night and do the off/on button pushing then ramp also resets again which is both good and bad.
During ramp the machine won't flag anything so the absence of any flags during ramp doesn't mean much.

We gotta get good solid blocks of sleep first and foremost for any expectation of evaluating your results.

[camo]

you seemed so sure that you wouldn't have a problem with EPR just being totally off I didn't think about it.

Yeah I really didn't realize what a difference it made for a newbie. I didn't think it would be that bad. I got used to it after a bit, but at first it was pretty daunting.

Bear in mind that if you wake during the night and do the off/on button pushing then ramp also resets again which is both good and bad.
During ramp the machine won't flag anything so the absence of any flags during ramp doesn't mean much.

I guess that's why I turned it off last night, since I thought it might skew the data a bit.

We gotta get good solid blocks of sleep first and foremost for any expectation of evaluating your results.

Hopefully tonight it will go a bit better!

[Dog Slobber]

Given that a lot of those clusters of CAs are occurring while you are power cycling you device, then they can't be happening while you're sleeping.

So safe to say those aren't actual central events?

Not yet.

I think we should see a few nights sleep. The machine is flagging them as centrals, it appears you're getting some flagged while awake, but that doesn't mean you're not getting them while asleep.

The auto ramp thing....I don't have as much faith in it as DS does but it wouldn't hurt to give it a try. Auto ramp....30 minutes or whenever the machine thinks you have fallen asleep based on your breathing pattern...whichever comes first. If it takes you more than 30 minutes to fall asleep it ends while you are awake.

This is worth repeating. ResMed's Auto-Ramp feature (attempt to turn ramp off when it believes one has fallen asleep) is not a guarantee you are asleep. It attempts to *guess* based on breathing pattern and time. But we all have very different breathing patterns. It worked well *for me*, but not for everyone. Definitely a YMMV.

If we see Auto-Ramp has lasted for 30 minutes, there's a pretty good chance It exited on time and not presumption of sleeping.

[Pugsy]

That's okay about the skewed data. I would rather have the data a bit skewed during ramp than essentially no useful data because of no sleep. Sometimes we just have to take the lessor of 2 evils.

[Pugsy]

This is worth repeating. ResMed's Auto-Ramp feature (attempt to turn ramp off when it believes one has fallen asleep) is not a guarantee you are asleep. It attempts to *guess* based on breathing pattern and time. But we all have very different breathing patterns. It worked well *for me*, but not for everyone. Definitely a YMMV.

If we see Auto-Ramp has lasted for 30 minutes, there's a pretty good chance It exited on time and not presumption of sleeping.

You know this is probably an experiment I need to schedule to try...the auto ramp thing but my problem is my current settings are really no different than what ramp might offer me.
And lately my usual "go to sleep in 5 minutes" has taken me a lot longer due to some insomnia issues from life stresses.
I have never really challenged the auto ramp feature to test it out. I am just a natural skeptic when it comes to anything assuming I am asleep just because of my breathing. I learned long ago how easy it was to fool the machine. Which makes me a natural skeptic.
I can fool the machine or the FitBit or whatever which of course makes me question any data I get from anything.

Maybe I can figure out some minor setting changes that will let me see auto ramp in action. I will think on it a bit and see if I can come up with something.

[Dog Slobber]

This is worth repeating. ResMed's Auto-Ramp feature (attempt to turn ramp off when it believes one has fallen asleep) is not a guarantee you are asleep. It attempts to *guess* based on breathing pattern and time. But we all have very different breathing patterns. It worked well *for me*, but not for everyone. Definitely a YMMV.

If we see Auto-Ramp has lasted for 30 minutes, there's a pretty good chance It exited on time and not presumption of sleeping.

You know this is probably an experiment I need to schedule to try...the auto ramp thing but my problem is my current settings are really no different than what ramp might offer me.
And lately my usual "go to sleep in 5 minutes" has taken me a lot longer due to some insomnia issues from life stresses.
I have never really challenged the auto ramp feature to test it out. I am just a natural skeptic when it comes to anything assuming I am asleep just because of my breathing. I learned long ago how easy it was to fool the machine. Which makes me a natural skeptic.
I can fool the machine or the FitBit or whatever which of course makes me question any data I get from anything.

Maybe I can figure out some minor setting changes that will let me see auto ramp in action. I will think on it a bit and see if I can come up with something.

Except you would have to go back to your AirSense, AirCurve doesn't support Auto-Ramp. That is the one thing I missed about moving to the Curve.

What I used to do, when lower ramp pressures were no longer important to me, (but I wanted to use Auto-Ramp to see my fall asleep time) was set my Auto-Ramp pressure to 0.2 less than therapy pressures.

Auto-Ramp pressures also work differently than Timed-Ramp. With Timed-Ramp the pressure is gradually increased for the known ramp time. Auto-Ramp keeps the pressure flat at ramp pressure, then upon exit, more abruptly moves from ramp-pressure to therapy-pressure.