Need a new plan for BiPAP / CSA

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
Callen
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Re: Need a new plan for BiPAP / CSA

Post by Callen » Wed May 24, 2023 12:05 am

Rubicon wrote:
Mon May 22, 2023 3:05 am

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.
From 85'-96'?

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Rubicon
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Re: Need a new plan for BiPAP / CSA

Post by Rubicon » Wed May 24, 2023 4:00 am

Rubicon wrote:
Tue May 23, 2023 3:26 am
So far, there is no evidence that you even have OSA in any form.
Rubicon wrote:
Fri May 19, 2023 3:58 am
In one of your images there is some funny stuff going on during expiration:
Now to review the above thoughts. The screens need to be reviewed at 12 - 20 breaths/window. And scrolled instead of paged. Which REALLY takes an LFT.

OSA is an entity of impeded inspiration. That said, if we expand to sleep-disordered breathing (SBD), now the whole spectrum can be examined. There's a lot of possibilities, but specifically here, is there a disturbance in expiration. Most often, this would be due to palatal interference. 14 May being reviewed. Spoiler Alert: Might not be worth pursuing.

Image

In this case there's little to no expiration. An obstructive apnea is scored, but being a suspicious person, nay, a downright cynic, IMO it's probably a central. One would look at this and say "Aha! Palatal prolapse!" except for the appearance of some leaks. ResMed leaks are signal-averaged, so it takes a few breaths for leaks to start to be registered-- at this level they are not in real time. It is noted that you are on nasal mask (but again, question everything-- trust nothing!) so this is most likely mouth puffs.
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Rubicon
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Re: Need a new plan for BiPAP / CSA

Post by Rubicon » Wed May 24, 2023 4:19 am

That said, there's number of areas where one could make a case for palatal interference. This could very be one (and again, obstruction to exhalation, not inhalation):

Image

A number of lesser disturbances to follow.

Who did your initial assessment? Was he an EENT guy? Did (s)he even know what (s)he was doing (really, being a cynic is the only way you're going to find a solution)?

I'd consider seeing an EENT guy but IDK if that's the Aha! Moment.
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Rubicon
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Re: Need a new plan for BiPAP / CSA

Post by Rubicon » Wed May 24, 2023 4:28 am

Meanwhile, back to the do you even have OSA, waiting on the sleep study, you really oughta look at down titration. In reviewing you history, your starting pressure was lower than where you are now, and you apparently jacked it up for comfort. We need evidence-based practice. Data. Assume nothing, trust no one, challenge everything.

And yes, that includes me. No skin off my butt.
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Rubicon
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Re: Need a new plan for BiPAP / CSA

Post by Rubicon » Wed May 24, 2023 4:39 am

As your "Changes to Device Settings" is cropped, do you have any data with like straight 5.0 - 7.0 w/o pressure support? What do the settings look like prior to February 5?
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Re: Need a new plan for BiPAP / CSA

Post by Rubicon » Wed May 24, 2023 5:29 am

Not all stuff on the expiratory limb is palate-related tho. In this case, with no active exhalation (where it's stable on the -0- line) those tiny waves are probably cardioballistic artifact-- heart pulsations picked up by the transducer. The PB 420E used to make a living looking for those.

Image
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palerider
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Re: Need a new plan for BiPAP / CSA

Post by palerider » Wed May 24, 2023 1:17 pm

Rubicon wrote:
Wed May 24, 2023 4:00 am
Which REALLY takes an LFT.
As an aside, in the next version of Oscar, the zero redline will always be on, and (iirc) when you zoom in, it'll autoscale to avoid the barely squiggled line syndrome that's so common.

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Re: Need a new plan for BiPAP / CSA

Post by SwirlySauce » Wed May 24, 2023 3:03 pm

Quick update, I'm out and about at the moment but I have the level 3 sleep study (the at-home test) from a few years ago. I'll PM that to you palerider and rubicon later this evening.

Also got 6 hours of sleep with my machine last night, will upload that to SleepHQ as well when I get back.

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Re: Need a Yesnew plan for BiPAP / CSA

Post by SwirlySauce » Wed May 24, 2023 6:14 pm

Rubicon wrote:
Tue May 23, 2023 3:26 am


5 things:

1. So far, there is no evidence that you even have OSA in any form.

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".
1. Wouldn't the CPAP be treating the OSA at least to some degree?

5. Oh no offense taken. I lead a pretty boring life otherwise to be honest. I like a few drinks on a Friday to unwind and relax but even that ritual I've cut back on in recent years. Too many calories and alcohol messes up sleep as well, plus all the other negative health effects.

My Vyvanse habits over the years are exactly how I described them. I'd rather not have to rely on it if at all possible since it already increases my blood pressure and hear rate at the 40/50mg dosage.

I'm trying to think of other health conditions / medications / habits that could be causing my sleep issues but nothing obvious comes to mind. I've always had issues with anxiety , low moods, unrestful sleep, low energy, ADHD symptoms. Hence the SSRIs, Vyvanse, and sleep apnea treatments over the years. Whether one of those conditions is the true underlying root cause of all those issues, or if they all exist separately I have yet to figure out. I was hopeful that treating sleep apnea would explain a lot of that and lead to an AHA moment. Bad sleep can definitely cause all those issues, but so can those conditions...and everything else under the sun!
Rubicon wrote:
Tue May 23, 2023 2:36 am
SwirlySauce wrote:
Mon May 22, 2023 5:59 pm

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.
I hope its not all placebo but you're probably right. I do wish him the best, but it doesn't look like hes gotten much help from TOF so far...just trying to figure it out by himself :/

palerider wrote:
Mon May 22, 2023 11:15 pm
Have you left your settings alone for a few days? if you have, how's things been?
I haven't touched the settings at all this week. We finally got some rain in our province yesterday which cleared up the wildfire smoke quite a bit. My sinuses are much better as a result so I was able to use the Resmed for 6 hours last night. I slept pretty good last night! I also haven't taken Vyvanse since Friday since I'm off work until tomorrow for vacation, so I'm sure that helped.

Rubicon wrote:
Wed May 24, 2023 4:19 am
That said, there's number of areas where one could make a case for palatal interference. This could very be one (and again, obstruction to exhalation, not inhalation):

Image

A number of lesser disturbances to follow.

Who did your initial assessment? Was he an EENT guy? Did (s)he even know what (s)he was doing (really, being a cynic is the only way you're going to find a solution)?

I'd consider seeing an EENT guy but IDK if that's the Aha! Moment.
Is an EENT the same as ENT? In any case, my doctor referred me to a sleep clinic -> They did a level 3 at home sleep study -> Diagnosed mild/moderate sleep apnea -> They recommended a DreamStation -> I've been trying to make that work ever since + Resmed as of January this year.

I'm still miffed that the sleep clinic recommended and sold me a DreamStation over a Resmed when I had asked about which is better in 2019. I think their margins are higher on DreamStations. Well not anymore now that Philips screwed the pooch :lol:

Rubicon wrote:
Wed May 24, 2023 4:28 am
Meanwhile, back to the do you even have OSA, waiting on the sleep study, you really oughta look at down titration. In reviewing you history, your starting pressure was lower than where you are now, and you apparently jacked it up for comfort. We need evidence-based practice. Data. Assume nothing, trust no one, challenge everything.

And yes, that includes me. No skin off my butt.
I think this might be an old habit of mine from the DreamStation days. My sleep clinic started me out on the "classic" 4.0 - 20.0 pressure range. This caused me a huge amount of problems at first since I felt like I was suffocating. It was terrible. I found that my breathing didn't start feeling 'normal' until I got to a pressure of around 9.0. Anything below that and it felt like I was breathing through a straw. Keep in mind that I was using an AirFit P10 Medium pillow size during these years (see below).

Incidentally, about two months ago I switched to a Large pillow mask full time after I found my perfect mask. Large pillow fits better, makes breathing easier for me and seems less likely to leak. Up until the switch I had been using Medium for years with my DS1.

However - the Large pillow is more comfortable and provides better airflow BUT it also increases my Central Apneas at the same pressure settings. I documented this as well in TOF.

I used the AirFit P10 Medium with DS1 and the Resmed, and no/minimal central apneas. Also used a F&P Brevida briefly with my Resmed a few months ago, which is smaller compared to P10 Large. Very minimal CA with that as well, but I hated the mask.

I switched to AirFit P10 Large eventually and saw an increase in CA immediately...at the same pressure settings. I'm not sure if this info really matters now but its interesting that there could be such a huge difference in efficacy between different mask sizes alone.

SwirlySauce
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Re: Need a new plan for BiPAP / CSA

Post by SwirlySauce » Wed May 24, 2023 6:31 pm

Last night's SleepHQ

https://sleephq.com/public/ae937b86-19d ... 8fc340c952

My Level 3 Sleep results

Rubicon, Palerider - I'll PM you links to download the PDF file

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Rubicon
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Re: Need a new plan for BiPAP / CSA

Post by Rubicon » Thu May 25, 2023 2:19 am

SwirlySauce wrote:
Wed May 24, 2023 6:31 pm
My Level 3 Sleep results

Rubicon, Palerider - I'll PM you links to download the PDF file
OK thanks, very helpful.

Your next task is to contact Hanly and/or DSR and get a hold of the raw data and sleep analysis software. May need to contact Sagatech (https://www.sagatech.ca/promo/index.php?func=page&id=7). Conceivably, the raw data file might be able to be read with existing available software, but do not know this. Could certainly give it a shot if they won't share the software.
Freeze this moment a little bit longer.
Make each sensation a little bit stronger.
Experience slips away.

Callen
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Re: Need a new plan for BiPAP / CSA

Post by Callen » Thu May 25, 2023 6:56 pm

Rubicon wrote:
Thu May 25, 2023 2:19 am
SwirlySauce wrote:
Wed May 24, 2023 6:31 pm
My Level 3 Sleep results

Rubicon, Palerider - I'll PM you links to download the PDF file
OK thanks, very helpful.

Your next task is to contact Hanly and/or DSR and get a hold of the raw data and sleep analysis software. May need to contact Sagatech (https://www.sagatech.ca/promo/index.php?func=page&id=7). Conceivably, the raw data file might be able to be read with existing available software, but do not know this. Could certainly give it a shot if they won't share the software.
The raw data can be imported to most software programs. The file format is what's important. You'll want to make sure the raw data is in the EDF file format. There should be an option to import EDF files to whichever software Rubicon has access to.

"The European data format (EDF) is a widely accepted standard for exchange of electroencephalogram and polysomnogram data between different equipment and labs." https://pubmed.ncbi.nlm.nih.gov/12948806/

SwirlySauce
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Re: Need a new plan for BiPAP / CSA

Post by SwirlySauce » Thu May 25, 2023 8:11 pm

Rubicon wrote:
Thu May 25, 2023 2:19 am
SwirlySauce wrote:
Wed May 24, 2023 6:31 pm
My Level 3 Sleep results

Rubicon, Palerider - I'll PM you links to download the PDF file
OK thanks, very helpful.

Your next task is to contact Hanly and/or DSR and get a hold of the raw data and sleep analysis software. May need to contact Sagatech (https://www.sagatech.ca/promo/index.php?func=page&id=7). Conceivably, the raw data file might be able to be read with existing available software, but do not know this. Could certainly give it a shot if they won't share the software.
I did email the person at DreamSleep that sent me the L3 study report for further info on the raw data but haven't heard back yet. I'm not sure if they would have access to that data but hopefully they can point me in the right direction.

SwirlySauce
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Re: Need a new plan for BiPAP / CSA

Post by SwirlySauce » Thu May 25, 2023 9:43 pm

Rubicon wrote:
Wed May 24, 2023 4:39 am
As your "Changes to Device Settings" is cropped, do you have any data with like straight 5.0 - 7.0 w/o pressure support? What do the settings look like prior to February 5?
Sorry, missed this. The last couple of months with the Nightmare station I went hard on high pressures (up to 13) to try and smooth out flow limitations to see if that would make a difference after talking with TOF. It didn't

I never used the Resmed without PS since I got it.

Early days with the DS were between 8.0 - 10.0 min pressure - some periods with and w/o FLEX. Let me see if I can upload my DS charts to SleepHQ.

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Rubicon
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Re: Need a new plan for BiPAP / CSA

Post by Rubicon » Fri May 26, 2023 2:19 am

SwirlySauce wrote:
Thu May 25, 2023 8:11 pm
I did email the person at DreamSleep that sent me the L3 study report ...
What means L3? If you got more stuff like this

Image

by all means slap it up here.

Meanwhile, we'll run whatchu brung.

Image
Freeze this moment a little bit longer.
Make each sensation a little bit stronger.
Experience slips away.