Can I have my own thread?

[robysue]

One of the things I'm battling is my tendency toward delayed phase (not sure I merit a diagnosis). My body gravitates toward going to bed later and waking up later, but my life requires me to get up early on some days. I know I should maintain the same wake-sleep schedule, although it's not easy for me to do so. (emphasis added)

Boy do I identify with this this, SU. That "maintain a stable wake/sleep schedule seven days a week" idea was the one piece of sleep hygiene that I'd never been able to maintain for any length of time prior to the PA dictating that I must at the beginning of the year---and my schedule is not really that irregular.

Have to say, though, that the PA was correct: Maintaining the constant wake up time seven days a week is probably the one thing that has lead to the most progress in my fight with the insomnia. Bedtime is still ragged. But because I am forcing myself to get up at 7:30 even on the weekends, it does mean that by the time I am sleepy and it's after "bedtime", I fall asleep pretty quickly: 5 to 10 minutes is usual nowadays instead of my pre-CPAP 20-30 minutes or so and my "last fall CPAP" of anywhere from 15 minutes to an hour or more latency to sleep.

Wishing you the best on your own resolving your own current problems with the CPAP therapy,
robysue

[idamtnboy]

One of the things I'm battling is my tendency toward delayed phase (not sure I merit a diagnosis). My body gravitates toward going to bed later and waking up later, but my life requires me to get up early on some days. I know I should maintain the same wake-sleep schedule, although it's not easy for me to do so. (emphasis added)

Boy do I identify with this this, SU. That "maintain a stable wake/sleep schedule seven days a week" idea was the one piece of sleep hygiene that I'd never been able to maintain for any length of time prior to the PA dictating that I must at the beginning of the year---and my schedule is not really that irregular.

Here's an interesting article about human daily clock cycle. The researcher says our natural cycle is 24 hrs, 11 min. I wonder if CPAP therapy helps to push the body toward the natural cycle time. Earlier studies had indicated the natural cycle was about 25 hrs.

http://news.harvard.edu/gazette/1999/07 ... ock24.html

[SleepingUgly]

I have heard that one's proclivity toward being a night owl or an early bird are fairly genetically determined, and that, while it's possible to shift one's clock so one goes to bed earlier and wakes earlier, one still may not feel great like that. I know that 8 hours of sleep that ends at 9am makes me feel better than 8 hours that ends at 6am (although no amount of sleep makes me feel good...I'm hoping CPAP will help with that). I am going to try to make more of an effort to get up at a regular time, even if it kills me. But my first priority is to get the CPAP going well.

If anyone wants to see what my FLs look like when I'm awake, I have plenty of data from last night!

By the way, I saw myself in a mirror with the Swift LT for Her on with the hose that comes with it attached AND my huge blue-light blocking sunglasses (not to mention my arms splinted) and I must say, I am quite a sight!

[Bright Choice]

And let me also ask, how does one determine whether EPR is useful therapy? Or is it purely a comfort feature and if you can exhale against the pressure, you don't use it, and if you can't, you do? I guess I'm wondering how we'd know if it's helping or hurting me.

I turned EPR on as part of an experiment to get rid of desats. No scientific basis at all but doc said to experiment with pressures to see if desats improved. EPR of 2 really improved desats and the way I feel next day. Never had a problem with exhale against pressure. I am at 7 with EPR 2. As for why that worked I am clueless.

Ahi is not a problem, uars is. Dr. Park has a teleseminar tomorrow pm. I posed the question as to whether or not you can titrate away fl's at home with S9 autoset data analysis or does it take psg titration. I cannot figure out flow graph. There is so much fluctuation min to min and hr to hr. I have been watching posts here but I don't get it. I will be interested to see if he responds.

I think I am much like you SU in terms of symptoms. I just started myself on OTC Prilosc, some gaviscon during the day and a wedge under mattress and I think it really helps my sleep with fewer awakenings. I was hardly aware of my having LPR but upon doing some reading here it began to make sense.

Just food for thought - I am pretty new at this.

Hope you are doing better! Great thread. Thanks!

[-SWS]

If anyone wants to see what my FLs look like when I'm awake, I have plenty of data from last night!

I asked SU for a curiosity peek, and here they are:



The bottom two graphs are when SU took the mask off. So it's a safe bet she was awake for those. I hope SU doesn't mind chiming in later with her best guesses about whether she suspects she was asleep or awake during the other graphs...

[idamtnboy]

I asked SU for a curiosity peek, and here they are:

The bottom two graphs are when SU took the mask off. So it's a safe bet she was awake for those. I hope SU doesn't mind chiming in later with her best guesses about whether she suspects she was asleep or awake during the other graphs...

What would these graphs look like on a 5 minute scale? I find when looking at my own graphs that the 5 minute scale seems to show an easier-to-see picture. The peaks and valleys are spread far enough apart to be be visible, but close enough to give a good overall view of consistency from minute to minute. With the one minute scale the graph is spread out so that minute-by-minute comparison is visually difficult to do.

[-SWS]

What would these graphs look like on a 5 minute scale? I find when looking at my own graphs that the 5 minute scale seems to show an easier-to-see picture. The peaks and valleys are spread far enough apart to be be visible, but close enough to give a good overall view of consistency from minute to minute. With the one minute scale the graph is spread out so that minute-by-minute comparison is visually difficult to do.

Good points, idamtnboy. I noticed resolution preferences vary quite a bit among our posters... I use multiple resolutions depending on what I'm interested in seeing. But I selected 1-minute resolution above for better comparison against our current FL reference.

Here's that reference of flow-limited wave shapes:

Class 1 is the "normal" flow shape. Class 2 through Class 7 are flow-limited wave shapes. Additionally, it's possible to have hybrid FL shapes. Class 3 and Class 4 sometimes combine, for instance. Class 3 and Class 6 occasionally combine.

[-SWS]

What would these graphs look like on a 5 minute scale?

Here you are, Idamtnboy... I just did that third flow graph from top using a 5-minute scale. Below we can see the same 01:15 period in both 1-minute and 5-minute resolutions for comparison:



I tend to use 1-minute scale when I'm interested in scrutinizing flow-limited waveshape. But I tend to use 5-minute or 10-minute scales when I'm hunting for central periodicity----as in the third post of this thread: viewtopic.php?f=1&t=58711&p=563159&hili ... ll#p552606

I admittedly switch time scales and window-pane orders a LOT.

[idamtnboy]

What would these graphs look like on a 5 minute scale?

Here you are, Idamtnboy... I just did that third flow graph from top using a 5-minute scale. Below we can see the same 01:15 period in both 1-minute and 5-minute resolutions for comparison:



I tend to use 1-minute scale when I'm interested in scrutinizing flow-limited waveshape. But I tend to use 5-minute or 10-minute scales when I'm hunting for central periodicity----as in the third post of this thread: viewtopic.php?f=1&t=58711&p=563159&hili ... ll#p552606

I admittedly switch time scales and window-pane orders a LOT.

To my medically untrained eyes that 5 minute graph shows really great consistency and uniformity in breathing, which based on my experience, indicates she was sleeping soundly. What does a 5 minute section look like when she was awake? Lot more erratic I would guess. On my graphs I can clearly tell wake times from sleep times simply by the spacing of the breaths, and lack of consistency. My awake respiration is only about 2/3 to 1/2 my sleep respiration and flow rates are all over the chart.

But the tremendous number of FL peaks in SU's earlier graphs is, to me, mystifying. Does that possibly point to a physically constricted airway for which there is no treatment short of surgery? Looking back on the graphs it sure looks to me like she needs a higher pressure, maybe on the order of 9 cm. I'm concerned about making changes night to night. Doesn't give time for things to settle down.

SU, you mention dry mouth. From my experience dry mouth definitely indicates mouth leaking, even at low rates. I finally caved in to taping but I think you said earlier that causes you problems, or do I remember wrong?

[SleepingUgly]

The bottom two graphs are when SU took the mask off. So it's a safe bet she was awake for those. I hope SU doesn't mind chiming in later with her best guesses about whether she suspects she was asleep or awake during the other graphs...

I think I was awake for the first two graphs, and some of the others I may have been dozing off and on, but not sustaining any long periods of sleep.

[SleepingUgly]

To my medically untrained eyes that 5 minute graph shows really great consistency and uniformity in breathing, which based on my experience, indicates she was sleeping soundly.

I don't really know. I think -SWS said that I tend not to have FLs when I am awake, so if the shape of the flow suggests I was having FLs, I'm guessing I was asleep.

But the tremendous number of FL peaks in SU's earlier graphs is, to me, mystifying. Does that possibly point to a physically constricted airway for which there is no treatment short of surgery?

I'm not sure what you mean by "physically constricted". That almost sounds constant or fixed, in which case I'd have trouble breathing when I'm awake, too! As far as no treatment short of surgery, I think the fact that my FLs seem to improve with increasing pressure suggests that CPAP can round out my flow (or however you say it). I've already had all the surgeries I intend to undergo for this, so it better!

Looking back on the graphs it sure looks to me like she needs a higher pressure, maybe on the order of 9 cm. I'm concerned about making changes night to night. Doesn't give time for things to settle down.

That's true. Maybe I'll try 7 again tonight and then hang out there for a few days, barring anything unforeseen occurring.

SU, you mention dry mouth. From my experience dry mouth definitely indicates mouth leaking, even at low rates. I finally caved in to taping but I think you said earlier that causes you problems, or do I remember wrong?

Well, I tried taping, but the problem with taping is you can't burp! And sometimes I need to burp. I'm hoping I can train myself to keep my mouth shut. If I can't, I'll have to consider a chin strap (which I found very uncomfortable) or taping.

[SleepingUgly]

BTW, this is my overall picture of my sleepless night last night. I started at 7cm with no EPR and switched to EPR of 1. Here I am at best dozing off and on (my FLs look so much better when I'm awake!):

[-SWS]

To my medically untrained eyes that 5 minute graph shows really great consistency and uniformity in breathing, which based on my experience, indicates she was sleeping soundly.

Gottcha. Rhetorically: what might the colloquial phrase "sleeping soundly" mean relative to: 1) brief arousals, versus 2) frank awakenings, versus 3) sleep-stage shifts resulting in deteriorated sleep architecture? Unfortunately I don't think the spacing of sleeping breaths can differentiate those unique sets of sleep problems.

But the tremendous number of FL peaks in SU's earlier graphs is, to me, mystifying. Does that possibly point to a physically constricted airway for which there is no treatment short of surgery?

My understanding is that constant high airway resistance can cause FL---but that variable or transient occlusion can also contribute to FL. So it can be primarily one or the other---but usually a combination of those two...

BTW, since the syndrome called UARS is comprised of FL-based arousals, UARS medical literature is a great place to read about physiologic characteristics contributing to flow limitations. But bear in mind UARS---as a complete syndrome---requires not only the FL, but also the daytime symptomology. Still, UARS literature is a great place to understand FL etiology IMO. But craniofascial characteristics usually contribute...

Most UARS researchers attribute UARS daytime symptomology to sleep-related RERAs that result from FL----but specifically in patients who are SUSCEPTIBLE to those sleep-deteriorating RERAs. Interestingly some UARS researchers now suspect daytime UARS symptomology MIGHT be related to yet other stressors besides/in-addition-to RERAs.

Looking back on the graphs it sure looks to me like she needs a higher pressure, maybe on the order of 9 cm.

Right. That's the basic premise behind treating UARS: eliminate the FLs that cause RERAs with CPAP pressure. And if that second UARS thought-school is right, then the same treatment premise just might hold true: eliminate the FLs that cause all UARS-related "stressors" with CPAP pressure. Unfortunatley many patients with daytime UARS symptomolgy are ALSO sensitive to pressures beyond 6cm to 8cm according to UARS researchers and practitioners. Some UARS researchers suspect UARS sleep-related symptomology and CPAP pressure intolerance might BOTH be related to airway or blood-gas hypersensitivity.

I'm concerned about making changes night to night. Doesn't give time for things to settle down.

Well, if we accept that premise as a rule rather than exception, then PSG titrations are a bankrupt proposition as a rule rather than exception. I agree that multiple nights at one setting can help with data interpretation amidst variability.

[idamtnboy]

I'm not sure what you mean by "physically constricted". That almost sounds constant or fixed, in which case I'd have trouble breathing when I'm awake, too!

I wonder, because I know very little about physiology, if we don't unconsciously and unnoticeably exert greater effort to breathe when we are awake. A constriction that would impede the gentle flow of air caused by a systematic low effort breathing cycle while asleep would not be a factor when we are awake.

I'm hoping I can train myself to keep my mouth shut. If I can't, I'll have to consider a chin strap (which I found very uncomfortable) or taping.

Some folks here say they've done it, so you very well may do so also. Since I'm not awake to see how I act when I'm sleeping I can't be certain, but I'm sure my mouth leak occurred at the corners of my mouth with my lips pretty much closed. In that case I don't think a chin strap would help. I guess I should see if I can't do what I've been thinking about and that is to come up with some sort of pliable and kind of sticky mask held over the mouth with an elastic strap around the back of the head.

P.S. After seeing your FL charts I can appreciate your adamant comments a few weeks ago about the need and value of interpreting the FL graph. You know, that thread where I ended up sucking on my big toe!

[SleepingUgly]

Interestingly some UARS researchers now suspect daytime UARS symptomology MIGHT be related to yet other stressors besides/in-addition-to RERAs.

What are you referring to here?

Unfortunatley many patients with daytime UARS symptomolgy are ALSO sensitive to pressures beyond 6cm to 8cm according to UARS researchers and practitioners.

Really? Have you seen those numbers cited?

Some UARS researchers suspect UARS sleep-related symptomology and CPAP pressure intolerance might BOTH be related to airway or blood-gas hypersensitivity.

What do you mean by this?

I'm concerned about making changes night to night. Doesn't give time for things to settle down.

Well, if we accept that premise as a rule rather than exception, then PSG titrations are a bankrupt proposition as a rule rather than exception. I agree that multiple nights at one setting can help with data interpretation amidst variability.

Ha! True, and true. And boy does "variability" seem to characterize my symptoms, at least.