Just don't feel any better

Rubicon · Post by **Rubicon** » Wed Aug 31, 2022 4:10 am

My interpretation of the 95th percentile is that 95% of the people base their decisions on SkyLab View and think they're doing God's work.

An important concept to keep in mind is that obstructive events are heavily influenced by sleep stage and body position (including "chin squashers").

If you note on his NPSG his events are mostly REM and supine.

Pugsy wrote: ↑
Tue Aug 30, 2022 3:01 pm
As I mentioned above...just tossing out ideas that might help reduce the train wreck of your sleep quality and not increase the chances of allowing obstructive stuff to happen.

There may (will?) be some trade off, but perhaps judicious use of some Auto may prove helpful.

Regardless, NPSG showed sleep efficiency of 67%, and his downloads on CPAP look like it's worse than that.

In my experience, people with <70% sleep efficiency often remark that they haven't slept at all.

Meanwhile, there will be blood:

8.27:

8.28

Pugsy · Post by **Pugsy** » Wed Aug 31, 2022 5:09 am

Rubicon wrote: ↑
Wed Aug 31, 2022 4:10 am
Meanwhile, there will be blood:

Well...it's not like there isn't any blood now with things as they are.

We tend to fight battles with the tools and ammo that we have available and my bag of ammo is pretty empty. I am fully aware that the chances of finding a setting or settings that actually helps significantly are pretty slim but I always felt like trying something was better than sitting back and doing nothing and telling people to "give it time" when the chances of giving it enough time to make much of a difference is also extremely slim.
Give it time might help when starting on cpap causes crappy sleep but when the sleep quality was deep in the toilet long before starting cpap I just don't see "giving it time" being all that useful. Especially if sleep apnea isn't the lone cause of the crappy sleep.

Our TiredVet needs some doctors who can think outside the box and are willing to roll up their sleeves and try doing some really hard work figuring out what is going on here and after some recent negative personal experience with our medical professionals I don't hold out a lot of positive thoughts about that ever happening.

I think that there is more going on here than just OSA but it is way above my pay grade to understand it all.
I think that the doctors jumped on the chance to blame all the unwanted symptoms on OSA and expected cpap to fix things but cpap can't fix problems unrelated to OSA or the airway.

I do understand the effects of lack of good quality and quantity when it comes to sleep. A problem I face every night but in my case I know the culprit and it isn't OSA or effective treatment but instead caused from other factors and it's still a bitch to try to fix. I know the source and still fight a war that most of the time I fall short in winning the battles.
I do understand bone crushing fatigue when I don't get enough sleep. I do understand nodding off sitting up because I just can't stay awake anymore. Which is why I am here scrapping the bottom of my bag of tricks trying to come up with something that has a chance in hell of maybe helping and fully realizing how slim the chances are. Try something ...even if it ends up being wrong...in an effort to maybe help because we know that doing nothing isn't particularly useful either.

The Tired Vet · Post by **The Tired Vet** » Wed Aug 31, 2022 8:28 am

Pugsy wrote: ↑
Tue Aug 30, 2022 3:01 pm

The Tired Vet wrote: ↑
Tue Aug 30, 2022 2:43 pm
There were also the three nights of no chin strap from 8/11-8/13 with massive leaks per doctor's orders. I spoke to her again today and she said she believes no matter how high the leak, even the 104 L/min i had one night without the chin strap, could be compensated for by the CPAP machine.
Well I am going to totally disagree on her idea that the machine can compensate for massive leaks like that but how important that 104 L/min leak might be would depend on how much time you spent up there. If you hit 104 for maybe 10 minutes and the rest of the night the leaks were a lot less drastic (like maybe around 30 L/min)...the machine can do a decent job depending on how much less and how long at less.

Edit::: Plus that much leak is very likely going to disturb sleep anyway....the last thing you need to be happening.

The Tired Vet wrote: ↑
Tue Aug 30, 2022 2:43 pm
I can try 10-20 (you had suggested 14-20 and I was a touch worried about moving the top to 20 all at once but I think I can handle it now)
Adding EPR to the minimum of 14 would mean 11 EPAP (if using 3 cm EPR) and if you needed more EPAP then we would expect to see some obstructive in nature events materialize but I have my doubts that we would see them happen.
Then my next idea would be go even lower assuming the reduction during EPAP during cause a lot of obstructive stuff.

As I mentioned above...just tossing out ideas that might help reduce the train wreck of your sleep quality and not increase the chances of allowing obstructive stuff to happen.

I seriously doubt that your pressure will go anywhere near 20 cm even if it could. I might be wrong but I just don't see it happening but if you are more comfortable with a limited max...then just limit the max. If you hit the limitation then we discuss maybe increasing the max. Heck set the max limit to 16 and see if you even hit it. If you do then we talk about the why and what to do about it.

I don't know that there is any magic setting or combination of settings that is going to help your overall crappy sleep but I figured why not at least give it a try....just in case.
If we don't try....we know the answer is always "no".

So, I changed to 10-20 cmH20 last night (I have been on 3 EPR since 8/23). Here's the Sleep HQ from 8/30, and a couple of things:

https://sleephq.com/public/60a0d161-d55 ... 326db45373

-I realized as I started to try to sleep last night why I have been sing higher pressures> I have had trouble since the beginning feeling like I was getting enough air to breathe, and lower pressures are uncomfortable. This doesn't cause me stress, but I do have to consciously breathe harder and that' makes forgetting about my breathing and just falling asleep harder. I'll see if I can try it again tonight but it definitely made falling asleep a lot harder so I may turn the bottom end back up to 12 again.

-I have been using an O2 ring for a couple of weeks (I can attach the file but I can't seem to find a file type that will upload). Here are the details of last night (8/30)
recording time: 7h37m
Drops over 4%: 16
Average O2: 95%
O2 score: 7.6
Average PR: 53
<90% time: 1m
Drops per hour: 2.1
Lowest O2: 88%
-One thing that is notable is that my heart rate is wildly up and down all night, with around a dozen bounces over 90bpm. If I draw a line across the low end of the graph the low end, where it spent the bulk of it's time between the frequent and regularly irregular jumps, in the low 40's. I don't know much about sleep architecture but I don't spike into the 90's when I'm awake unless I am exercising, and then of course certain other activities.

I feel more tired this morning, but it may be two nights in a row of worse than the usual poor sleep in a row.

lynninnj · Post by **lynninnj** » Wed Aug 31, 2022 8:57 am

The Tired Vet wrote: ↑
Wed Aug 31, 2022 8:28 am

Pugsy wrote: ↑
Tue Aug 30, 2022 3:01 pm

The Tired Vet wrote: ↑
Tue Aug 30, 2022 2:43 pm
There were also the three nights of no chin strap from 8/11-8/13 with massive leaks per doctor's orders. I spoke to her again today and she said she believes no matter how high the leak, even the 104 L/min i had one night without the chin strap, could be compensated for by the CPAP machine.
Well I am going to totally disagree on her idea that the machine can compensate for massive leaks like that but how important that 104 L/min leak might be would depend on how much time you spent up there. If you hit 104 for maybe 10 minutes and the rest of the night the leaks were a lot less drastic (like maybe around 30 L/min)...the machine can do a decent job depending on how much less and how long at less.

Edit::: Plus that much leak is very likely going to disturb sleep anyway....the last thing you need to be happening.

The Tired Vet wrote: ↑
Tue Aug 30, 2022 2:43 pm
I can try 10-20 (you had suggested 14-20 and I was a touch worried about moving the top to 20 all at once but I think I can handle it now)
Adding EPR to the minimum of 14 would mean 11 EPAP (if using 3 cm EPR) and if you needed more EPAP then we would expect to see some obstructive in nature events materialize but I have my doubts that we would see them happen.
Then my next idea would be go even lower assuming the reduction during EPAP during cause a lot of obstructive stuff.

As I mentioned above...just tossing out ideas that might help reduce the train wreck of your sleep quality and not increase the chances of allowing obstructive stuff to happen.

I seriously doubt that your pressure will go anywhere near 20 cm even if it could. I might be wrong but I just don't see it happening but if you are more comfortable with a limited max...then just limit the max. If you hit the limitation then we discuss maybe increasing the max. Heck set the max limit to 16 and see if you even hit it. If you do then we talk about the why and what to do about it.

I don't know that there is any magic setting or combination of settings that is going to help your overall crappy sleep but I figured why not at least give it a try....just in case.
If we don't try....we know the answer is always "no".
So, I changed to 10-20 cmH20 last night (I have been on 3 EPR since 8/23). Here's the Sleep HQ from 8/30, and a couple of things:

https://sleephq.com/public/60a0d161-d55 ... 326db45373

-I realized as I started to try to sleep last night why I have been sing higher pressures> I have had trouble since the beginning feeling like I was getting enough air to breathe, and lower pressures are uncomfortable. This doesn't cause me stress, but I do have to consciously breathe harder and that' makes forgetting about my breathing and just falling asleep harder. I'll see if I can try it again tonight but it definitely made falling asleep a lot harder so I may turn the bottom end back up to 12 again.

-I have been using an O2 ring for a couple of weeks (I can attach the file but I can't seem to find a file type that will upload). Here are the details of last night (8/30)
recording time: 7h37m
Drops over 4%: 16
Average O2: 95%
O2 score: 7.6
Average PR: 53
<90% time: 1m
Drops per hour: 2.1
Lowest O2: 88%
-One thing that is notable is that my heart rate is wildly up and down all night, with around a dozen bounces over 90bpm. If I draw a line across the low end of the graph the low end, where it spent the bulk of it's time between the frequent and regularly irregular jumps, in the low 40's. I don't know much about sleep architecture but I don't spike into the 90's when I'm awake unless I am exercising, and then of course certain other activities.

I feel more tired this morning, but it may be two nights in a row of worse than the usual poor sleep in a row.

I am looking at your chart going wow and wonder how you are feeling?

Less than a minute in apnea. Most of your issues are hypo not full OA. But I *think what happens is that at some point when the o2 levels drop maybe the body tries to get it jumping again and heart rate goes up quickly? I am noticing a general overlap of my 02 drops at the same time as heart rate jumps and events. I don't have a good breakdown of exact times that this happens though I only have hours and ranges.

So maybe that is what is happening with you as far as your data goes? I notice the two early hypos brought about a spike in pressure but also you had a spike in leak there. I still haven't figured out exactly how they coordinate but there must be some tie in. (even if someone here can't tell me specifically, it just seems intuitive). They also seem to correlate with snoring and possibly mouth breathing/flow rate?

Does the ring give precise times that you can match to your chart?

All in all I see 11 events and think that is much better than you had been doing and I wonder other than feeling tired if you don't have more positive symptoms outside of that? ie for me less morning headache but I dont know if you got one of those when you had poor sleep. I mean, some of it could be catching up a bit, I would think? Even when you get a good sleep your body still needs time to heal?

The Tired Vet · Post by **The Tired Vet** » Wed Aug 31, 2022 9:11 am

Pugsy wrote: ↑
Wed Aug 31, 2022 5:09 am

Rubicon wrote: ↑
Wed Aug 31, 2022 4:10 am
Meanwhile, there will be blood:
Well...it's not like there isn't any blood now with things as they are.

We tend to fight battles with the tools and ammo that we have available and my bag of ammo is pretty empty. I am fully aware that the chances of finding a setting or settings that actually helps significantly are pretty slim but I always felt like trying something was better than sitting back and doing nothing and telling people to "give it time" when the chances of giving it enough time to make much of a difference is also extremely slim.
Give it time might help when starting on cpap causes crappy sleep but when the sleep quality was deep in the toilet long before starting cpap I just don't see "giving it time" being all that useful. Especially if sleep apnea isn't the lone cause of the crappy sleep.

Our TiredVet needs some doctors who can think outside the box and are willing to roll up their sleeves and try doing some really hard work figuring out what is going on here and after some recent negative personal experience with our medical professionals I don't hold out a lot of positive thoughts about that ever happening.

I think that there is more going on here than just OSA but it is way above my pay grade to understand it all.
I think that the doctors jumped on the chance to blame all the unwanted symptoms on OSA and expected cpap to fix things but cpap can't fix problems unrelated to OSA or the airway.

I do understand the effects of lack of good quality and quantity when it comes to sleep. A problem I face every night but in my case I know the culprit and it isn't OSA or effective treatment but instead caused from other factors and it's still a bitch to try to fix. I know the source and still fight a war that most of the time I fall short in winning the battles.
I do understand bone crushing fatigue when I don't get enough sleep. I do understand nodding off sitting up because I just can't stay awake anymore. Which is why I am here scrapping the bottom of my bag of tricks trying to come up with something that has a chance in hell of maybe helping and fully realizing how slim the chances are. Try something ...even if it ends up being wrong...in an effort to maybe help because we know that doing nothing isn't particularly useful either.

THANK YOU FOR SAYING THIS

I have been a broken record with friends saying I need someone who will do exactly that. It's nice to hear someone validate that. Knowing the culprit is of course only half the battle so I hope you find ways to make progress in your own war.

Pugsy · Post by **Pugsy** » Wed Aug 31, 2022 9:12 am

The Tired Vet wrote: ↑
Wed Aug 31, 2022 8:28 am
-I realized as I started to try to sleep last night why I have been sing higher pressures> I have had trouble since the beginning feeling like I was getting enough air to breathe, and lower pressures are uncomfortable. This doesn't cause me stress, but I do have to consciously breathe harder and that' makes forgetting about my breathing and just falling asleep harder. I'll see if I can try it again tonight but it definitely made falling asleep a lot harder so I may turn the bottom end back up to 12 again.

You've been using 14 cm for a long time and your body/brain is used to that and the reason why I suggested just adding in EPR all by itself to the 14 cm starting point and just changing from fixed to auto adjusting.
I was afraid that to set it much lower that you would be uncomfortable using a lower starting minimum.
So that is why I initially suggest 14 minimum with EPR at 3....one change only and didn't want to try a lower minimum at first.
I suspected you would have some uncomfortable sensations with lower. You won't suffocate by any means but it can sure be uncomfortable and you can sure feel air starved. I had this happen to me some years back when I did an experiment where I increased my minimum pressure from 10 cm to 13 cm...going up 0.5 cm at a time and allowing a week at each change.
It took me a few weeks to work up to 13 minimum and after a week I decided that since nothing changed anywhere (AHI, hours slept, sleep quality, energy levels) that I would abort the "more pressure" experiment and when I went back down to 10 cm I found it quite uncomfortable. Now I knew what it was and sort of expected it so I just decided to bull my way through it and I had only been at the higher pressures a really short time.

So by all means...don't try 10 cm minimum again tonight. Instead try the 14 or maybe 13 and lets get you more comfortable to start with. If you aren't comfortable you aren't going to fall asleep or stay asleep easily and sleep quality is what we are trying to fix here. If we are going to maybe reduce the pressure minimum....lets go slow and with small baby steps.

So I scrolled through the flow rate and there was one flagged event that I thought might have been a real asleep flagged event and that was a central later in the night. It might have been a sleep onset central as it got flagged after a period of irregular breathing where I don't think you were sound asleep and then it appears that you transitioned to sleep which would be a normal thing for a sleep onset central. The rest of the flagged events were pretty much arousal related.

Now there was some "cycling" looking or waxing and waning of some of the flow rate. Not CSR because no events got flagged during it and really looked more SWJish looking than anything. I am not sure of the significance of this type of breathing one way or the other so that goes on the back burner for now. I really couldn't tell if the amount of "cycling" was changed one way or the other and with the overall crappy sleep it makes it hard to evaluate.

Obviously from the 10 cm minimum and subsequent 12.1 95% pressure number....and the lack of real asleep obstructive events of any real worrisome numbers....14 cm doesn't appear to be technically needed...at least last night. It is but one night though.

Eventually I would like to work downward with the minimum pressure but don't go making big bold changes....it's perfectly fine to take small baby steps and let your body/brain get accustomed to lower pressures.
The last thing we want to do is put your brain on high alert because of the reduction in air flow and the brain thinking "OMG my human is trying to suffocate me so I had better stay alert and make sure he doesn't"....Your sleep is already fragile enough without adding in more potential arousals from the brain being on high alert.

Is/was the higher pressures a potential factor in the cycling of the flow rate making things looks CSRish???
Dunno but we can evaluate that aspect once you are comfortable with and using a lower pressure in general.

At some point I might ask you to send me your SD card contents so I can really look way back or even more recent stuff to compare the cycling stuff....I don't think it is EPR related though since you report you had it pre adding EPR.
I don't have the time to do that work right now and I will want more nights at lower minimums to evaluate anyway.
So that is down the road.

Your brain and body needs time to adjust to any change....this isn't going to be a quick fix thing. Hell, I don't even know it will fix anything but we sure don't want to make sleep quality worse with a change.
Don't try any setting change that is the least little bit uncomfortable for you because if you aren't comfortable you won't/can't sleep so great and your sleep quality is already seriously fragile.

Your choice as to your own personal comfort limits and how quickly you proceed. It is okay to go slow though.

Pugsy · Post by **Pugsy** » Wed Aug 31, 2022 9:24 am

lynninnj wrote: ↑
Wed Aug 31, 2022 8:57 am
All in all I see 11 events and think that is much better than you had been doing and I wonder other than feeling tired if you don't have more positive symptoms outside of that? ie for me less morning headache but I dont know if you got one of those when you had poor sleep. I mean, some of it could be catching up a bit, I would think? Even when you get a good sleep your body still needs time to heal?

Pretty much all his flagged events except maybe one central are arousal related and he wasn't asleep. SWJ and in terms of evaluating the OSA side of his therapy we toss them out the window.
Now from evaluating overall sleep quality itself we pay great attention to them.

His overall sleep quality is in the toilet...and I suspect given the prolonged flow rate that I saw where he wasn't asleep....he's going to feel like dog crap today. His sleep quality is a train wreck...takes a long time to fall asleep and then he can't stay asleep despite his not remembering a lot of arousals. He's not sleeping soundly...it's highly fragmented for some unknown reason (and I don't think it is necessarily related to airway issues) and he's probably not getting the percentage of each sleep stage that we need for the restorative powers of sleep to work their magic.

There's a lot with him that we don't know and not much that we do know.
We don't know if the CSRish looking breathing is significant or not.
We don't know what is causing the arousals.
We don't know how to fix whatever is causing the arousals.

We do know that his sleep quality is deep down in the toilet and when someone is that deep...they are going to feel like total crap no matter what the AHI is or how many hours of "sleep" they get.

I do think that his OSA stuff...is probably fairly well managed and we need to look elsewhere for the cause of the bad sleep.

The Tired Vet · Post by **The Tired Vet** » Wed Aug 31, 2022 9:27 am

[/quote]

So, I changed to 10-20 cmH20 last night (I have been on 3 EPR since 8/23). Here's the Sleep HQ from 8/30, and a couple of things:

https://sleephq.com/public/60a0d161-d55 ... 326db45373

-I realized as I started to try to sleep last night why I have been using higher pressures> I have had trouble since the beginning feeling like I was getting enough air to breathe, and lower pressures are uncomfortable. This doesn't cause me stress, but I do have to consciously breathe harder and that' makes forgetting about my breathing and just falling asleep harder. I'll see if I can try it again tonight but it definitely made falling asleep a lot harder so I may turn the bottom end back up to 12 again.

-I have been using an O2 ring for a couple of weeks (I can attach the file but I can't seem to find a file type that will upload). Here are the details of last night (8/30)
recording time: 7h37m
Drops over 4%: 16
Average O2: 95%
O2 score: 7.6
Average PR: 53
<90% time: 1m
Drops per hour: 2.1
Lowest O2: 88%
-One thing that is notable is that my heart rate is wildly up and down all night, with around a dozen bounces over 90bpm. If I draw a line across the low end of the graph the low end, where it spent the bulk of it's time between the frequent and regularly irregular jumps, in the low 40's. I don't know much about sleep architecture but I don't spike into the 90's when I'm awake unless I am exercising, and then of course certain other activities.

I feel more tired this morning, but it may be two nights in a row of worse than the usual poor sleep in a row.
[/quote]

I am looking at your chart going wow and wonder how you are feeling?

Less than a minute in apnea. Most of your issues are hypo not full OA. But I *think what happens is that at some point when the o2 levels drop maybe the body tries to get it jumping again and heart rate goes up quickly? I am noticing a general overlap of my 02 drops at the same time as heart rate jumps and events. I don't have a good breakdown of exact times that this happens though I only have hours and ranges.

So maybe that is what is happening with you as far as your data goes? I notice the two early hypos brought about a spike in pressure but also you had a spike in leak there. I still haven't figured out exactly how they coordinate but there must be some tie in. (even if someone here can't tell me specifically, it just seems intuitive). They also seem to correlate with snoring and possibly mouth breathing/flow rate?

Does the ring give precise times that you can match to your chart?

All in all I see 11 events and think that is much better than you had been doing and I wonder other than feeling tired if you don't have more positive symptoms outside of that? ie for me less morning headache but I don't know if you got one of those when you had poor sleep. I mean, some of it could be catching up a bit, I would think? Even when you get a good sleep your body still needs time to heal?
[/quote]

I feel pretty tired this morning--my go to is heavy/weary eyelids in the morning and then hard to control sleepiness in the afternoon, and general weariness that is hard to describe. My head is full feeling, like I haven't slept much but probably much like many other people it's hard to describe my symptoms because it's not the same feeling I would have many years ago if I had to cut my sleep short for one night. Oh, and unfortunately for these purposes (fortunately in general) I just never get headaches--I have had maybe just a few in my life and the last one I can remember was in my early teens.

The ring: it's an app on my phone--I can get close to the time things happened by scrolling in but it's a bit less precise than SleepHQ (I think the Ring link for SleepHQ is coming soon--i believe it is already available for Apple users).

The Tired Vet · Post by **The Tired Vet** » Wed Aug 31, 2022 9:48 am

Pugsy wrote: ↑
Wed Aug 31, 2022 9:12 am

The Tired Vet wrote: ↑
Wed Aug 31, 2022 8:28 am
-I realized as I started to try to sleep last night why I have been sing higher pressures> I have had trouble since the beginning feeling like I was getting enough air to breathe, and lower pressures are uncomfortable. This doesn't cause me stress, but I do have to consciously breathe harder and that' makes forgetting about my breathing and just falling asleep harder. I'll see if I can try it again tonight but it definitely made falling asleep a lot harder so I may turn the bottom end back up to 12 again.
You've been using 14 cm for a long time and your body/brain is used to that and the reason why I suggested just adding in EPR all by itself to the 14 cm starting point and just changing from fixed to auto adjusting.
I was afraid that to set it much lower that you would be uncomfortable using a lower starting minimum.
So that is why I initially suggest 14 minimum with EPR at 3....one change only and didn't want to try a lower minimum at first.
I suspected you would have some uncomfortable sensations with lower. You won't suffocate by any means but it can sure be uncomfortable and you can sure feel air starved. I had this happen to me some years back when I did an experiment where I increased my minimum pressure from 10 cm to 13 cm...going up 0.5 cm at a time and allowing a week at each change.
It took me a few weeks to work up to 13 minimum and after a week I decided that since nothing changed anywhere (AHI, hours slept, sleep quality, energy levels) that I would abort the "more pressure" experiment and when I went back down to 10 cm I found it quite uncomfortable. Now I knew what it was and sort of expected it so I just decided to bull my way through it and I had only been at the higher pressures a really short time.

So by all means...don't try 10 cm minimum again tonight. Instead try the 14 or maybe 13 and lets get you more comfortable to start with. If you aren't comfortable you aren't going to fall asleep or stay asleep easily and sleep quality is what we are trying to fix here. If we are going to maybe reduce the pressure minimum....lets go slow and with small baby steps.

So I scrolled through the flow rate and there was one flagged event that I thought might have been a real asleep flagged event and that was a central later in the night. It might have been a sleep onset central as it got flagged after a period of irregular breathing where I don't think you were sound asleep and then it appears that you transitioned to sleep which would be a normal thing for a sleep onset central. The rest of the flagged events were pretty much arousal related.

Now there was some "cycling" looking or waxing and waning of some of the flow rate. Not CSR because no events got flagged during it and really looked more SWJish looking than anything. I am not sure of the significance of this type of breathing one way or the other so that goes on the back burner for now. I really couldn't tell if the amount of "cycling" was changed one way or the other and with the overall crappy sleep it makes it hard to evaluate.

Obviously from the 10 cm minimum and subsequent 12.1 95% pressure number....and the lack of real asleep obstructive events of any real worrisome numbers....14 cm doesn't appear to be technically needed...at least last night. It is but one night though.

Eventually I would like to work downward with the minimum pressure but don't go making big bold changes....it's perfectly fine to take small baby steps and let your body/brain get accustomed to lower pressures.
The last thing we want to do is put your brain on high alert because of the reduction in air flow and the brain thinking "OMG my human is trying to suffocate me so I had better stay alert and make sure he doesn't"....Your sleep is already fragile enough without adding in more potential arousals from the brain being on high alert.

Is/was the higher pressures a potential factor in the cycling of the flow rate making things looks CSRish???
Dunno but we can evaluate that aspect once you are comfortable with and using a lower pressure in general.

At some point I might ask you to send me your SD card contents so I can really look way back or even more recent stuff to compare the cycling stuff....I don't think it is EPR related though since you report you had it pre adding EPR.
I don't have the time to do that work right now and I will want more nights at lower minimums to evaluate anyway.
So that is down the road.

Your brain and body needs time to adjust to any change....this isn't going to be a quick fix thing. Hell, I don't even know it will fix anything but we sure don't want to make sleep quality worse with a change.
Don't try any setting change that is the least little bit uncomfortable for you because if you aren't comfortable you won't/can't sleep so great and your sleep quality is already seriously fragile.

Your choice as to your own personal comfort limits and how quickly you proceed. It is okay to go slow though.

Thanks, and roger that. FYI, I was only on 14 for eight days. Here's the timeline on that:

-12-15 APAP since April 2022 (I believe 12-16 before that but I would have to search back in my notes)
-14 CPAP from 8/11 to 8/19 per doctor's orders
-12-15 from 8/20 to 8/27
-Turned on EPR set to 3 on 8/23
-Changed to 14-18 on 8/28 and 8/29
-Changed to 10-20 on 8/30

I'm going to go back to 12-15 for a few days to get my bearings back. It sounds like the higher end wasn't needed and a VERY slow move downwards might be the next move in a few days?

Happy to send my SD card contents

The Tired Vet · Post by **The Tired Vet** » Wed Aug 31, 2022 9:49 am

Pugsy wrote: ↑
Wed Aug 31, 2022 9:24 am

lynninnj wrote: ↑
Wed Aug 31, 2022 8:57 am
All in all I see 11 events and think that is much better than you had been doing and I wonder other than feeling tired if you don't have more positive symptoms outside of that? ie for me less morning headache but I dont know if you got one of those when you had poor sleep. I mean, some of it could be catching up a bit, I would think? Even when you get a good sleep your body still needs time to heal?
Pretty much all his flagged events except maybe one central are arousal related and he wasn't asleep. SWJ and in terms of evaluating the OSA side of his therapy we toss them out the window.
Now from evaluating overall sleep quality itself we pay great attention to them.

His overall sleep quality is in the toilet...and I suspect given the prolonged flow rate that I saw where he wasn't asleep....he's going to feel like dog crap today. His sleep quality is a train wreck...takes a long time to fall asleep and then he can't stay asleep despite his not remembering a lot of arousals. He's not sleeping soundly...it's highly fragmented for some unknown reason (and I don't think it is necessarily related to airway issues) and he's probably not getting the percentage of each sleep stage that we need for the restorative powers of sleep to work their magic.

There's a lot with him that we don't know and not much that we do know.
We don't know if the CSRish looking breathing is significant or not.
We don't know what is causing the arousals.
We don't know how to fix whatever is causing the arousals.

We do know that his sleep quality is deep down in the toilet and when someone is that deep...they are going to feel like total crap no matter what the AHI is or how many hours of "sleep" they get.

I do think that his OSA stuff...is probably fairly well managed and we need to look elsewhere for the cause of the bad sleep.

Amen

Pugsy · Post by **Pugsy** » Wed Aug 31, 2022 10:07 am

The Tired Vet wrote: ↑
Wed Aug 31, 2022 9:48 am
I'm going to go back to 12-15 for a few days to get my bearings back. It sounds like the higher end wasn't needed and a VERY slow move downwards might be the next move in a few days?

Happy to send my SD card contents

FWIW...when I was using the 13 cm it was only for a week and when I went down to 10 in one fell swoop the uncomfortable feeling was pretty significant. You had been using 12 minimum for quite some time before you tried the 14 cm so I am not in the least surprised that you had some trouble with going down to 10 cm.

Let your body be your guide in terms of whatever you are comfortable doing.

The maximum or high end...I am not nearly as worried about it because if you never go there then it becomes a moot point.
Since we don't sleep the same each night though...we just don't know for sure that something won't happen that might cause the machine to want to go higher AND remember that since the machine doesn't know awake breathing from asleep breathing it can want to increase the pressure based on awake event flagging and it isn't limited to just centrals. I have seen those false positive flags on OAs and hyponeas as well. The machine just responds per what it senses but what it senses isn't always spot on. It does the best it can given what it has to go on though. My ideal machine would be one that could toss out awake breathing totally from the equation and ignore it. We would need a machine that could determine sleep status though and that's a difficult challenge for sure. Wouldn't surprise me to find out that the machine manufacturers are right now working on such a machine in some form but it's not an easy job.

I don't have the time right now that I would need to dig deep into your SD card plus I want this current experiment available as well. Sleephq gets us close for right now though.

When you do share your reports here....always include how you think you slept as well as how you feel.
Subjective feelings are critical.

cayenne · Post by **cayenne** » Sun Sep 04, 2022 11:10 am

How is the experimentation coming along? Thanks for hanging in there with this.

I haven't tried taping. TBH, I'm not wild about the idea--it sounds a bit dangerous.

Ditto, you could try somnifix or poking a similar vent hole in tape. btw not all tapes are equal, some good discussions here and youtube about different tapes. I found the tape didn't hold for me and I wound up mouth wide open anyhow (but I also have bruxism, which likely put xtra stress on the tape).

Agree w/ Pugsy you should get the leaks under control - similar leaks were wrecking my sleep - I get it that most of the FFMs don't fit well (I have facial hair and most of the FFMs leaked) have you tried mask liners or cpap gel / lanolin (or anything that wouldn't degrade the mask cushion)?

14 cmH20 constant was the recommendation from the sleep doctor on 8/11--she picked this because I think she misunderstood what 95% pressure means.

My 95% pressure was around 10 but sleep Dr started me on the median pressure (which was 7) because my centrals were high during the titration phase (but these were apparently real events and not SWJ). Wound up dropping that to 5 given centrals persisted, but then the obstructive events were not settled, so I wound up on ASV and it dropped events to < 1 most nights and I feel a lot better. But keep in mind I've identified and dealt with the other causes of daytime fatigue (depression, allergies [w/ false negative test results], and so on).

Best of luck on your journey!

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