Need a new plan for BiPAP / CSA

[Rubicon]

If the sleep study does include staging, Lexapro effects could be reviewed: REM suppression, as well as additional sleep disruption.

[Rubicon]

irrelevancy.

Please don't use your vendetta against Rubicon to derail other people's threads.

If all the kid got is

nowhere near bioequivalents

"irrelevancy" is exactly the right description.

That said, his rant does leave a meatball hanging in the air which I'd like to address. One of my disciplines landed me working in detox for a couple years. So when I say

Yeah I know what MF meth does.

I can say that with the utmost of confidence.

AAMOF, there's a mildly interesting backstory which we might run through (and if we get through the 532.4 pages of data submitted thus far) and it becomes necessary to go down that rabbit hole.

[SwirlySauce]

Never took Adderall.

Oh yes that was me. 60mg IR Adderall is a huge dose, I'm nowhere near that lol.

Can you clarify this? Are you on or off (that) meth?

I've been on 40mg Vyvanse a day since I got prescribed.

2016 - 2022: took it as needed, only a few times a week (3 - 4 times). I also took week long breaks from it quite frequently.

January 2023 to now: Bumped it up to 50mg starting January and started taking it daily as per doctor for more consistent treatment of ADHD - including some weekends. I'll most likely reduced it again to 40mg though due to side effects and last couple of weekends I haven't taken it.

60mg IR Adderall is a huge dose

Yeah I know what MF meth does.

If my sleep issues are causing my concentration / ADHD symptoms that would be a blessing. I'd much rather tackle the root cause with PAP therapy then have to take amphetamine for the rest of my life to cope.

[SwirlySauce]

These are probablies:

Two isolated FLs F/B pressure attacks (OK, only a few 0.0 cmH2O, but there appears to be disturbances in sleep continuity that immediately follow).

So I believe where we're going here (still need 39.5K breaths reviewed) is

1. Your sleep inherently sucks.
2. Taking crazymeds makes it worse.
3. Poking it with a stick doesn't help.
4. Is attack mode helping or hindering, especially if the events are isolated?

Consider the Jason Premise.

1. Yep, always has.

2. Very possible. I started taking Vyvanse before I ever got on PAP therapy so I don't have a "clean" reference point in OSCAR. I do take med breaks (generally weekends, and used to take whole weeks off) but AMP has a long half life anyway so weekend data may still be influenced.

No idea what sort of impact Lexapro would have on sleep. I've been slowly weaning myself off the stuff over the last two years. Down to 2.5mg now from 10mg.

3. / 4. I do wonder if VB is only an issue when I'm on PAP or if it happens without as well. Would the at-home sleep study have caught that? Is that something respiratory therapists look for / care about?

Jason Premise - So back to capping my pressure again?

[SwirlySauce]

Anyway I appreciate you all looking through pages of my data! Rubicon I owe you some beers after all this

Our province has been on fire (Alberta wildfires!) this week and my sinuses are royally messed up from all the smoke. I wasn't able to sleep with the Resmed the last two nights at all so no new data unfortunately. Thankfully we got the air purifier set up today so that should help things.

[Rubicon]

3. / 4. I do wonder if VB is only an issue when I'm on PAP or if it happens without as well. Would the at-home sleep study have caught that? Is that something respiratory therapists look for / care about?

Depends on the sleep study, and depends on the RRT/RPSGT.

Jason Premise - So back to capping my pressure again?

See what this latest batch of D/Ls does. Then we'll look at each pressure increase to see if it was justified and try to determine lowest effective pressure. Any luck in getting the sleep study?

[Rubicon]

If my sleep issues are causing my concentration / ADHD symptoms that would be a blessing. I'd much rather tackle the root cause with PAP therapy then have to take amphetamine for the rest of my life to cope.

I think we need to see what you look like w/o CPAP. Hopefully the PSG will shed some light.

[SwirlySauce]

If my sleep issues are causing my concentration / ADHD symptoms that would be a blessing. I'd much rather tackle the root cause with PAP therapy then have to take amphetamine for the rest of my life to cope.

I think we need to see what you look like w/o CPAP. Hopefully the PSG will shed some light.

I'm not even sure how to get a PSG in this country or how long it would take. I'll have to do some research

I found another guy on TOF whos having the same issue with VB: https://www.apneaboard.com/forums/Threa ... rts?page=3

He also takes ADHD meds which is interesting and he's trying ASV now which seems to be working better for him than Autoset. Also less EPR = better

[SwirlySauce]

In this screenshot you posted earlier what is the event that kicks off the waxing and waning? It just looks like a mess of random breathing.

[palerider]

In this screenshot you posted earlier what is the event that kicks off the waxing and waning? It just looks like a mess of random breathing.

Quite possibly an external event, and yes, it probably did.

Have you left your settings alone for a few days? if you have, how's things been?

[Rubicon]

I'm not even sure how to get a PSG in this country or how long it would take. I'll have to do some research

Are you able to get the results on the one you already had?

I found another guy on TOF whos having the same issue with VB: https://www.apneaboard.com/forums/Threa ... rts?page=3

He also takes ADHD meds which is interesting and he's trying ASV now which seems to be working better for him than Autoset. Also less EPR = better

He hasn't posted any data yet, and as you're starting to see, looking at SkyLab View only suggests sleep disruption, you need to go breath-by-breath.

If he's trying to fix waxing and waning, well, waxing and waning was probably caused by over-aggressive settings on CPAP. You'd have to see how much, and question the treatment approach (fixing a problem that wasn't there initially but generated by improper settings so let's fix the new problem instead of the original problem).

ASV is The Big Lie. I'll bet your life if he were to post SleepHQ of CPAP and ASV his sleep (and again, we would need surrogates and lot of leeway) would be no better on ASV. He pretty much concedes this when he says

the ASV has to work hard constantly to keep my flow rate in check

But that's him not us.

[Rubicon]

In this screenshot you posted earlier what is the event that kicks off the waxing and waning? It just looks like a mess of random breathing.

Yup. Looks like you went to the refrigerator to get a drink of water and Oh Look! Waxing and waning!

Big pressure attack for nothing. The Jason Premise.

[Rubicon]

...Vyvanse ... I do take med breaks (generally weekends, and used to take whole weeks off) but AMP has a long half life anyway so weekend data may still be influenced.

... I've been slowly weaning myself off the stuff over the last two years. Down to 2.5mg now from 10mg.

5 things:

1. So far, there is no evidence that you even have OSA in any form.
2. It is clear you have a sleep continuity issue.
3. I cannot think of any sleep continuity issue that would not benefit, indeed, absolutely require, strict military sleep hygiene.
4. From what you have presented thus far, your choice of settings, your compliance and your medication adherence is off the wall.
5. There are more than likely more unknowns (a sleep history is about 7 pages long) including (and please don't take this personally) possibly "untruths". For example, a third of your age group abuse drugs, meth is highly addictive, you got one or two bottles of candy in your medicine cabinet and methheads are notorious liars. You're probably right up there with St. Thomas of Assini, but I'm just telling you how the assessment works. There's objective data, and there's stuff that is documented as "patient states".

[Rubicon]

So the little stumble with Adderall raised a red flag. Not that I care how many of those things you shove in, I'm never going going to meet you, go fishing with you, have those beers with you (actually I'm an abstainer) and in about 3 days I'm never going to talk to you again. I just need to know if 50 arousals or 250 arousals need explanation.

[Rubicon]

I just need to know if 50 arousals or 250 arousals need explanation.

Or alternatively, 50 arousals and 50% of the night SWJ.