Just don't feel any better

[Pugsy]

DreamWear Nasal pillow mask....are you still using that one?
Have you tried taping your mouth to see if those leaks are mouth opening leaks or mask movement leaks?
When I tried the DreamWear mask I had a lot of leaks but when I taped my mouth shut to rule out mouth opening the leaks were still there so that meant mask movement leaks and come to find out I needed a different size in the frame plus some extra padding to keep it from moving around.

[Rubicon]

Here is a sample of FLs and an apparent arousal. You got some M-FLs in there:



That said, IMO they aren't related. You just have really bad sleep.

Where's the NPSGs?

[Rubicon]

Symptoms: I have been an athlete my whole life and starting around 7-8 years ago I developed more and more intolerance to exercise. I still do it, mind you, but at much less intensity and it tends to exhaust me. I was a marathon runner until 2014 when I had a back injury, so I started powerlifting and Olympic-style weightlifting, and then rowed and swam to supplement. i did that until COVID began and now my daily regimen is 40 minutes on the rowing machine, three days a week of some weights and three days a week of weighted planks. When the sleep is consistent, even if mediocre, I can manage all of this. Sometimes I just can't, though. I am frequently falling asleep when i am seated, and just fogging and feel weary all day.

So let's talk about this. Also IMO there's a more likely explanation that the (or "a") possible cause for this mess is Athletic Burnout.

BTW any "brown-bag" supplements?

Do you have access to CPET?

[The Tired Vet]

Do those leaks bother you? You have a lot of leaking going on and they could be causing arousals that you don't remember.

I forget....what mask are you using?

I don't know what Rubicon might suggest but if it were me I would suggest working on leak management for one thing just in case the leaks are causing arousals and I would give auto mode a try and add in EPR and see what happens to the FL graph.
I wouldn't go increasing the pressure at this point and I would put UARS thinking on the back burner for now and instead work on known documented problems first.

I don't know that you need 14 cm fixed without any EPR to deal with your OSA anyway. The biggest part of your AHI is SWJ flagging anyway.
I don't like making a lot of changes at one time either because with multiple changes at one time if we see a change in something we don't know which change brought about the new result.

I think auto mode instead of fixed....keep the 14 cm pressure as the minimum....set max to 20 cm just to see where the machine wants to go to fight the FLs but add in 3 EPR full time.
At least that is what I would suggest if you were my hubby in this situation.
See what happens and how you feel and go from there.

I have truly spent the last nearly ten months working on leak management. The Deamwear pillow (I have tried all the sizes) in medium seem to be the best so far--truly everything leaks--not a little, A LOT

I changed to 3 EPR last night and kept the 12-15 cmH2O--I had decided to try that and see how it works for a few to five days. I'll post the SleepHQ data tonight.

Working on getting the sleep study posted.

[The Tired Vet]

DreamWear Nasal pillow mask....are you still using that one?
Have you tried taping your mouth to see if those leaks are mouth opening leaks or mask movement leaks?
When I tried the DreamWear mask I had a lot of leaks but when I taped my mouth shut to rule out mouth opening the leaks were still there so that meant mask movement leaks and come to find out I needed a different size in the frame plus some extra padding to keep it from moving around.

I haven't tried taping. TBH, I'm not wild about the idea--it sounds a bit dangerous. I do see the utility of knowing whether it's my mouth causing the problem or the leak is elsewhere. I tend to think it's my mouth. The three days two weeks ago that I slept without a chin strap per doctor's orders I had overall leak rates of 77, 100 and 77 L/min for the night, not to mention godawful sleep.

Padding: are you talking about those pads that come with the headgear and go around the parts that are on my cheek?

[The Tired Vet]

Here is a sample of FLs and an apparent arousal. You got some M-FLs in there:



That said, IMO they aren't related. You just have really bad sleep.

Where's the NPSGs?

What are M-FLs? and NPSGs?

If for the FLs you're referring to the flat tops on the inspiratory portion of the breaths, yeah, they're almost universal in all of my breathing back through April. I figured they were abnormal but wasn't sure why.

There are being who need actual ventilators for sleep--I wonder if I just don't breath normally and the obstructions are a red herring. Or, maybe I have obstructions and I don't breath correctly.

[The Tired Vet]

Symptoms: I have been an athlete my whole life and starting around 7-8 years ago I developed more and more intolerance to exercise. I still do it, mind you, but at much less intensity and it tends to exhaust me. I was a marathon runner until 2014 when I had a back injury, so I started powerlifting and Olympic-style weightlifting, and then rowed and swam to supplement. i did that until COVID began and now my daily regimen is 40 minutes on the rowing machine, three days a week of some weights and three days a week of weighted planks. When the sleep is consistent, even if mediocre, I can manage all of this. Sometimes I just can't, though. I am frequently falling asleep when i am seated, and just fogging and feel weary all day.

So let's talk about this. Also IMO there's a more likely explanation that the (or "a") possible cause for this mess is Athletic Burnout.

BTW any "brown-bag" supplements?

Do you have access to CPET?

Supplements: just the ones I listed. Vitamin D3, Digestive Advantage (probiotic plus lactase), and Omega-3 FAs.

CPET: I did get a workup from a cardiologist around a year ago and he didn't want to perform one. I have essentially none of the risk indicators and am fit, and the CPET has a high false positivity rate, according to him, so they prefer to do them for cause not just as a screening tool.

[Pugsy]

Padding: are you talking about those pads that come with the headgear and go around the parts that are on my cheek?

Yes...those side fleece wraps. In my case I ended up having to wrap everything with some fleece and also use a size small DreamWear frame and it still moved around a bit too much and I just couldn't get it to not leak with the moving.

I understand the hesitancy about taping the lips....I had the same thing when I first started cpap therapy.
To be honest when I first heard about it my first thought was "no way in hell"....but then a bit later I had to re-evaluate that thought.
First thing I did though was apply the tape while awake and test it to see just how much effort it took to break the seal just by opening my mouth. I used the blue painters tape because I had it handy and I am the queen of cheap. It's really easy to break the seal...a nice yawn will do it. Then I decided to try it all night and you know what happened....thunderstorm came up my first night of taping and we lost power. I did wake up when we lost power but I was breathing just fine through the vent holes in the mask. No distress whatever and it was the silence that caused the wake up.
You can move enough air just through the vent holes to not suffocate. It might take a little bit of extra work but it can be done.

And yes...a one night experiment just to see for sure where the leaks are coming from and then decide how to address the problem once you know for sure what the problem is.
I don't know that the leaks (from whatever cause) are a factor in your crappy sleep but they might be and for that reason I would suggest at least trying to reduce them.

I am just tossing out various ideas that could be a factor in your crappy sleep...some may pan out and some won't but if you don't investigate you won't know for sure.

Sleep quality can be very fragile and easily disturbed and not so easy to fix. Been there and done that myself.

Play with taping your mouth while awake and under no stress to go to sleep. Play with breathing through the mask without power by just using the vent holes. See if you can reassure your brain that you won't go killing yourself.
It's just one night or even just a part of the night so you can see that leak line.

[The Tired Vet]

Padding: are you talking about those pads that come with the headgear and go around the parts that are on my cheek?

Yes...those side fleece wraps. In my case I ended up having to wrap everything with some fleece and also use a size small DreamWear frame and it still moved around a bit too much and I just couldn't get it to not leak with the moving.

I understand the hesitancy about taping the lips....I had the same thing when I first started cpap therapy.
To be honest when I first heard about it my first thought was "no way in hell"....but then a bit later I had to re-evaluate that thought.
First thing I did though was apply the tape while awake and test it to see just how much effort it took to break the seal just by opening my mouth. I used the blue painters tape because I had it handy and I am the queen of cheap. It's really easy to break the seal...a nice yawn will do it. Then I decided to try it all night and you know what happened....thunderstorm came up my first night of taping and we lost power. I did wake up when we lost power but I was breathing just fine through the vent holes in the mask. No distress whatever and it was the silence that caused the wake up.
You can move enough air just through the vent holes to not suffocate. It might take a little bit of extra work but it can be done.

And yes...a one night experiment just to see for sure where the leaks are coming from and then decide how to address the problem once you know for sure what the problem is.
I don't know that the leaks (from whatever cause) are a factor in your crappy sleep but they might be and for that reason I would suggest at least trying to reduce them.

I am just tossing out various ideas that could be a factor in your crappy sleep...some may pan out and some won't but if you don't investigate you won't know for sure.

Sleep quality can be very fragile and easily disturbed and not so easy to fix. Been there and done that myself.

Play with taping your mouth while awake and under no stress to go to sleep. Play with breathing through the mask without power by just using the vent holes. See if you can reassure your brain that you won't go killing yourself.
It's just one night or even just a part of the night so you can see that leak line.

Thanks. I'll give playing with all that a shot.

[The Tired Vet]

Here is the last sleep report from Sept. 2021. I had to do it as one image per page.

https://imgur.com/J5tWLKG
https://imgur.com/lnm7FoA
https://imgur.com/tv6gb2T
https://imgur.com/7hq4fBX
https://imgur.com/jDTfNAR
https://imgur.com/vZBEVZR
https://imgur.com/VOvzSP8
https://imgur.com/7LomPKa
https://imgur.com/Sy6aJwu
https://imgur.com/yS4v5Vx

[Rubicon]

What's up with the ECO2 on this one?

https://imgur.com/Sy6aJwu

Your ETCO2 was between 61 and 65 for 90.6% of the time?

[The Tired Vet]

What's up with the ECO2 on this one?

https://imgur.com/Sy6aJwu

Your ETCO2 was between 61 and 65 for 90.6% of the time?

I don't think EtCO2 and ECO2 are the same thing. Target EtCO2 for an anesthetized (ventilated or not) patient is 36-44 mmHg. The low end of the ECO2 on this report is 2 mmHg--to get an EtHg that low would require some extreme hyperventilation. 61-65 is not great either--I guess it would be possible to be there for that long but it would be by definition an indicator that I was hypoventilating for 90.6% of the time I was asleep. I would be concerned if one of my patients ran into the 60's for any period of time at all, even a few seconds--it probably would mean they had stopped breathing and I'd better give them a few breaths, lighten the anesthesia or start the ventilator (lots of anesthetic agents suppress breathing so none of these actions would be very unusual. Usually we try to anticipate it so they don't spike and we have to react). I certainly wouldn't leave them in that range. The fact that I can still feed myself without assistance and can type a sentence makes me think I wasn't hypercapnic for several hours.

Where does one find a key for the terms and abbreviations used on these reports?

[lynninnj]

Hey Tired Vet I must say, I loved this.

The fact that I can still feed myself without assistance and can type a sentence makes me think I wasn't hypercapnic for several hours.

Going back to lurking. Sorry to disturb.

[Rubicon]

CPET: I did get a workup from a cardiologist around a year ago and he didn't want to perform one. I have essentially none of the risk indicators and am fit, and the CPET has a high false positivity rate, according to him, so they prefer to do them for cause not just as a screening tool.

When the sleep is consistent, even if mediocre, I can manage all of this. Sometimes I just can't, though.

OK so you get the data with CPET and then you interpret it. I suppose if he doesn't understand it he might interpret it as a false positive.

You can't simultaneously be "fit" and "can't manage this", so I would hardly consider CPET as a screening tool. It would confirm the presence and extent of of some overtraining syndrome (I don't think that's the only problem you got, but IMO it sure isn't helping).

Ever try to take a month or 2 off?

[Rubicon]

The fact that I can still feed myself without assistance and can type a sentence makes me think I wasn't hypercapnic for several hours.

A sleep ETCO2 wouldn't give you issues that bad and anyway your wake pCO2 would be lower.

I know hundreds of people with elevated pCO2 and they eat and type just fine.

Where does one find a key for the terms and abbreviations used on these reports?

IDK.

Find out and report back.