Shallow Breather Oscar Screenshots

[ShallowBreather]

I don't know how to remove all the "transcription."

My 2nd titration was a bust because I only slept for 5 minutes the whole night.
My 3rd titration was a bust because the sleep tech didn't follow any orders and started me off at 5 cmH2O and never got to my treatment levels.

Here's the 4th:

SLEEP ARCHITECTURE:
The study started at 22:44:36 and ended at 05:29:41. Total sleep time (TST)
was 277 minutes resulting in a sleep efficiency of 69.6% (total recording
time (TRT) = 398 m). There were 33 awakenings with a total time awake after
sleep onset of 105.0 minutes. The sleep latency was 16.0 minutes and the REM
latency was 81 minutes. The patient spent 35.1% of sleep time in the supine
position. The sleep stage percentages were 7.9% stage N1, 65.4% stage N2,
6.5% stage N3 and 20.2% REM sleep. There were 109 arousals, resulting in an
arousal index of 23.6. There were 100 stage shifts.

POSITIVE AIRWAY PRESSURE DATA:
Bilevel was initiated at 11/6 cmH2O. Snoring was eliminated at a Bilevel
setting of 12/6 cmH2O. There were 59 respiratory events consisting of 11
apneas [0 obstructive (0%), 0 mixed (0%), and 11 central (100%)] and 48
hypopneas. The mean oxygen saturation during the study was 92%, with a
minimum oxygen saturation of 81%. The patient spent 7.8% (21.6 min) of sleep
time with an oxygen saturation below 90% and 4.7% (13.1 min) of sleep time
with an oxygen saturation at or below 88%. The wake supine transcutaneous
pCO2 (TcpCO2) value was not reliable. The maximum TcpCO2 during sleep was 41
mmHg. Cheyne-Stokes/Periodic Breathing was not present. Supplemental oxygen
was not administered. A back-up rate of 11 breaths/minute was added at the
start of the study. A medium Fisher and Paykel Simplus full face mask without
chin strap was used. The mask leak at the most effective pressure was within
normal limits.

PAP SUMMARY:

PAP BUR TST %Sup SupAHI REM RAHI CAI HI AHI ArIdx Nadr AvgSaO2
11 / 06 11 8.5m 100% 63.5 0.0m -- 0.0 63.5 63.5 35.3 84% 88%
12 / 06 11 38.5m 100% 18.7 0.0m -- 0.0 18.7 18.7 20.3 84% 91%
13 / 06 11 40.0m 84% 5.4 15.0m 12.0 1.5 12.0 13.5 13.5 82% 92%
14 / 06 11 24.0m 0% -- 0.0m -- 15.0 20.0 35.0 30.0 81% 93%
15 / 06 11 30.0m 0% -- 9.0m 0.0 0.0 8.0 8.0 24.0 90% 93%
16 / 06 11 109.5m 15% 14.5 24.5m 0.0 0.5 3.3 3.8 18.6 84% 93%
17 / 07 11 27.0m 2% 120.0 7.5m 0.0 6.7 2.2 8.9 11.1 85% 94%


MOVEMENT DATA:
There was excessive movement during wakefulness in the form of periodic and
aperiodic limb movements. There were 192 periodic limb movements during
sleep, resulting in a PLM-index of 41.5. Of these, 18 movements were
associated with arousals, resulting in a PLM-arousal index of 3.9.

ECG DATA:
The average heart rate during sleep was 71 beats per minute, with a range of
66 to 96. During wake, the heart rate ranged from 69 to 100 beats per minute.
No arrhythmias were noted.

OTHER NOTABLE FINDINGS:
The patient took Lunesta prior to the sleep study.
Experience to PAP therapy as stated by the patient on the morning after sleep
questionnaire: "I did benefit from using PAP therapy, deeper breathing; PAP
therapy was easy to use and comfortable"

ICSD DIAGNOSIS:
Obstructive Sleep Apnea Syndrome [G47.33]
Treatment Emergent Central Sleep Apnea [G47.39]

IMPRESSION:
1. At a PAP setting of 16/6 cmH2O with back up rate of 11 cmH2O, the
apnea-hypopnea and arousal indices were normalized including during
off-supine REM sleep, snoring was eliminated, and the mean oxygen saturation
was 93% with a nadir of 84%.
2. Frequent periodic limb movements not causing arousal from sleep and
periodic and aperiodic limb movements during wakefulness were observed that
is consistent with restless legs syndrome (RLS). The patient also endorses
symptoms suggestive of RLS on the pre-study questionnaire. Clinical
correlation is advised.

RECOMMENDATIONS:
Bilevel 16/6 cmH2O with back up rate of 11 cmH2O and humidification. This
setting may need to be combined with positional sleep therapy. A medium
Fisher and Paykel Simplus full face mask without chin strap was used.

[ShallowBreather]

I really like the Simplus mask, but I was getting this horrible feeling at the start of exhale like I was being dropped or something. The doctor tried changing the Cycle to Low and the Rise Time to .4s, but it never went away until I switched to pillows.

Last night was the first night that I can say I was getting a lot of sleep. It took me an hour to get there, and I woke up a few times, but I was able to get right back to sleep.

[Pugsy]

I don't know how to remove all the "transcription."

You can edit/delete transcription words out and do a little deleting and back spacing and it fixed.
Give me a little bit and I will fix it for you.

I fixed the parts I could fix without losing tab settings.
It's better.

[Rubicon]

So TST on the diagnostic was 183 minutes.

Out of that, 112 minutes was spent titrating, leaving 71 minutes for the actual diagnostic portion (42 events making the AHI 35.5).

A sleep efficiency of <70% is rated poor. And on the titration you can't even hit that with Lunesta.

The diagnostic centrals were likely post-arousal.

IMO you got Hiroshima Sleep.

And then some AGGRESSIVE titrating.

[Pugsy]

IMO you got Hiroshima Sleep

While I probably get the idea you are attempting to transmit here...I am thinking the OP won't and will frantically be googling Hirsohima Sleep.
You might want to spell it out for him.

[palerider]

I ALREADY said that I would just post everything in this thread, but PaleRider seems intent on coming back for another pound of flesh over and over again.

You whined

Seems to be an inconsistency here. I’ve been looking at other threads, and this message of “only post in one thread” appears to be only for me.

Ok, fine. I’ll never post in any thread but this one, but you need to go talk to a lot of other people.

I was simply responding to your allegation.

I'll happily ignore any further requests for help you issue, since you've got such an attitude of being picked on by anybody that DARES to say please to you (and you'd ignored at least one prior request).

*PLEASE* stop posting in multiple threads,

[ShallowBreather]

IMO you got Hiroshima Sleep

While I probably get the idea you are attempting to transmit here...I am thinking the OP won't and will frantically be googling Hirsohima Sleep.
You might want to spell it out for him.

Right. I don’t understand either part.

“IMO you got Hiroshima Sleep.

And then some AGGRESSIVE titrating.”

The Lunesta was only on the last study in March 2022. Studies 1 and 2 were very screwy nights. I was in and out of sleep a lot. That’s my usual. Study 3 was on the Lunesta and I feel like I had large portions of good sleep but the middle 2 hours of the night were spent with horrific restless legs episodes which I think the Lunesta caused.

Thank you

[DaveC]

Shallow Breather, to be completely fair, this isn't the only apnea group out there and some of us are members of more than one. This isn't the only place you've asked about the same thing and had someone tell you to keep your stuff in one thread.
As others have said, it just makes it easier when people are trying to see your information and offer you help.

[Rubicon]

"Hiroshima Sleep" looks like this:



It's one step worse than "Train Wreck".

Do you have the graphs from the sleep study? Specifically at least the histogram and oximetry.

With 33 awakenings and 126 arousals those "events" could have simply been a part of incredible sleep disruption (sleep onset and post arousal crap).

How MANY desaturations were there?

By "aggressive" titration, I mean all you got is a few hypopneas and you're on BiPAP S/T @15/9 f=10. Were they titrating OSA or bad sleep?

[Pugsy]

It's one step worse than "Train Wreck".

Thanks. I figured as much.
Here we go again trying to fix bad sleep with some sort of cpap/whatever pap machine and maybe the bad sleep can't be fixed by the machine.
Then stick someone on a machine with a PS that is pretty much guaranteed to make the bad sleep worse and/or for sure trigger real centrals.

Anyhow...way above my pay grade. Though if we can't trust the guys doing the in lab diagnostic study....who can we trust?

[ShallowBreather]

Shallow Breather, to be completely fair, this isn't the only apnea group out there and some of us are members of more than one. This isn't the only place you've asked about the same thing and had someone tell you to keep your stuff in one thread.
As others have said, it just makes it easier when people are trying to see your information and offer you help.

I. Get. It.

[ShallowBreather]

"Hiroshima Sleep" looks like this:
It's one step worse than "Train Wreck".

Do you have the graphs from the sleep study? Specifically at least the histogram and oximetry.

With 33 awakenings and 126 arousals those "events" could have simply been a part of incredible sleep disruption (sleep onset and post arousal crap).

How MANY desaturations were there?

By "aggressive" titration, I mean all you got is a few hypopneas and you're on BiPAP S/T @15/9 f=10. Were they titrating OSA or bad sleep?

Thanks. And you’re right, of course. It’s rare that I sleep through the night. Train wreck is normal for me. Sadly.

I don’t have access to any of the data you’re asking for. I know that I get a huge morning headache every other day prior to the Cpap. My wife says I stop breathing. But, no, I can’t prove that I’m asleep during my actual events.

From the waveforms on the ST machine I’ve been studying in the morning, most of the hypopneas are when I’m still awake or just relaxed prior to sleep. As are the UA’s. Once I’m out, the waveforms seem to become very regular.

Now I’m lost again.

[Pugsy]

You don't happen to have an overnight recording pulse oximeter do you or did you?

[Rubicon]

I know that I get a huge morning headache every other day prior to the Cpap. My wife says I stop breathing.

That's solid data.

But do you need to kill it with BiPAP S/T @15/9 f=10. IOWs, is that your lowest effective pressure, or can some improvements be made to make this thing as tolerable as possible.

[Rubicon]

Specifically, you need to identify what the role of the central component is. IMO on the diagnostic they were probably sleep onset or post-arousal, so don't need treatment (AAMOF trouble starts when you try to treat them). This will hold true during the titrations as well.

The 2 other possibilities are:

Underlying medical condition (neurological or cardiac).

Emergent when therapy begins. Despite what some people claim (especially in the other place where it's "OMIGOD THERE'S ONE CENTRAL APNEA THEY'RE SO STUPID THEY DIDN'T GIVE YOU AN ASV!!!)) this only happens about 15% of the time and most of the time resolves by itself in about a month or so.

That said, when people do need ASV it's often quite dramatic when it works.

That said2, plenty of vanilla OSA people end up on BiPAP or ASV as a comfort measure, they say it's good for them, it works, and I ain't the xPAP police so if they're happy, so be it.

Anyway, I think you really have to figure out what you need to control OSA and don't chase stuff that is bad sleep. That's just going to need some Dial Wingin' (and maybe you're actually there already), but more important, what are you doing about your bad sleep?