Another sleep apnea "victim"

SuperDave · Post by **SuperDave** » Sat Jan 19, 2019 10:15 am

I think I only had 2 brief arousals last night, which is much less than normal. Awake time with mask on seemd like only a few minutes. (Usual awake time requires 30-45 minutes to fall back asleep.) Last night the sleep latency after each awakening seemed like only a minute or two. I awoke feeling like it was better than an average night's sleep. I alternated sides, and consciously tried to avoid time on my back.

Will increase min EPAP from 12 to 15 and raise ramp from 7 to 12, incase I need it again. (last night I did not start with ramp on, so I had no problem falling asleep at 12. When I woke up and hit ramp, it seemed too low.)

Pugsy · Post by **Pugsy** » Sat Jan 19, 2019 10:29 am

Ramp is optional...available only if needed and yes...once we are used to the higher pressures the lower pressures of ramp can feel a bit stifling.

Darn I was hoping to blame SWJ for a lot of the ugly but if you weren't awake half the night...that excuse won't fly.
Darn I was hoping to blame the ugly on you sleeping on your back all night long...that excuse won't fly either.
Fast running out of excuses.

Do you take any meds of any kind? I forget if I asked that already....bear with me and answer again.

How much time went by from when you stopped using the S8 and then started up with it again and spotted the big difference in AHI?

SuperDave · Post by **SuperDave** » Sat Jan 19, 2019 11:06 am

I do have a "cold" with coughing and nasal congestion. The PAP keeps the nasal passages open, but I probably had a number of short duration coughing fits last night (less than 5 seconds + time to fall back asleep), so lets blame some of the SWJ on that.

I have been taking the same meds for years to treat high blood pressure (valsartan/HCTZ and amlodipine), depression (celexa), thyroid (levothyroxine) and gerd (aciphex). Also flonase and zyrtec for sinus allergies.

I used the S8 daily in 2011 and 2012, but with no analysis of data or knowledge of AHI at the time. Stopped treatment from 2012 until Nov 2018, when I learned how to access ResScan data. In Nov 2018, I learned for the first time that historically, the AHI had ranged from 40+ to 70+ in 2011-2012 (and auto CPAP pressure never increased above 15 and usually stayed around 11.) Sleep study in Dec 2018 showed AHI 86.

SuperDave · Post by **SuperDave** » Sat Jan 19, 2019 11:21 am

Note the Periodic Breathing between 3:45 and 5:45, where pressure was below 15 and there were only a few events. Is that relevent? BTW the machine clock is off by 1 hour, so actual time of day would have been 2:45am - 4:45am.

Pugsy · Post by **Pugsy** » Sat Jan 19, 2019 11:24 am

Okay...you were never even well treated when using the S8 back when you first got it.
So it's not like something really changed between now and back then.
Somebody dropped the ball in terms of your therapy and you didn't even realize it. Sad but it happens.

Okay...so we can blame some of the ugly on maybe being ill....are you winding down in terms of the illness symptoms or staying pretty much the same with the congestion issues?
Just wondering if any of your symptoms were brought on by adding in the cpap use with the S8....the old cpap rhinitis thing or if you really do have some sort of bug that we have to wait out. Being ill with anything can impact the accuracy of the data.
I seriously doubt that we can put much blame on being ill though...I assume you weren't ill the entire time you used the S8 back when you first started cpap.

Are you feeling that the illness symptoms are starting to abate a little?????

Normally cpap rhinitis though...only causes the nasal issues...won't cause sore throat, cough, fever or general upper respiratory illness symptoms.

I am hoping that if we can get the OAs and hyponeas reduced to an acceptable level that the centrals will also reduce to an acceptable level. This machine won't/can't do anything about the centrals anyway....real or SWJ. I am hoping that the centrals are a byproduct of the OAs happening....OA happens..disturbs sleep...causes arousal...and with the arousal you pause your breathing and the central gets flagged. Hoping that if we stop the OA from happening...and that stops the arousal...then that stops the post arousal central flag.
It's not impossible...I have seen it happen.

So for right now...working on what we can fix with regular xpap...the obstructive stuff and see what's left once the obstructive stuff is better dealt with.

Pugsy · Post by **Pugsy** » Sat Jan 19, 2019 11:33 am

I don't know what to make of that big chunk of PB. I really need to look at it up close and using my own SH.
Want to email me the SD card contents? I was going to suggest it eventually but really wanted to wait a few days until we got closer in pressure needs adjustments first. I was wanting more than a couple nights worth of data to look at....was wanting to look once we got the OAs reduce to a more acceptable level.

With just a few nights data on the SD card...it would be easy to zip it and attach it to email...and then I unzip it and run it through SH.
Harder to do with months of data on the card...makes it too big even zipped for some email systems.

You can zoom in on it yourself though for now.
Look to see if it looks like this

or like this minus the flags.. It would be unusual for it to look like this minus the flags

SuperDave · Post by **SuperDave** » Sat Jan 19, 2019 11:44 am

current illness is a viral cold, which has been going around. eveyone in my family has had it. family doctor advised its viral and symptoms could last 3 weeks. Mine is abating after 2 weeks of coughs and sniffles/sneezing.

After learning apneas were not responding to S8 (CPAP), I began to suspect most of my apneas would be centrals that needed ventilation treatment (ASV). But now, thanks to the PRS1 and SH, I can see there are a considerable number of stubborn OA's, which should eventually respond to pressure. I agree that OA's should be eliminated first, and then see if the CA's and hypopneas decrease.

SuperDave · Post by **SuperDave** » Sat Jan 19, 2019 12:01 pm

here's some snapshots in the large PB time

Pugsy · Post by **Pugsy** » Sat Jan 19, 2019 12:13 pm

Periodic Breathing is nothing more than a waxing and waning of the air flow that lasts at least 2 minutes. Yours obviously lasted a lot longer for some reason.

CSR or Cheyne Stokes Respiration is a form of Periodic Breathing but it isn't the only form of Periodic Breathing. It does get the bad press because when it is real and we see large number of centrals in association with it ...it can mean some potential cardiac issues going on so it scares the devil out of people. It's not a given though...people can have CSR and have no cardiac issues at all.

The 2 segments you show...actually look more SWJ irregular breathing to me than anything and for sure not even remotely looking like CSR. I tend to maybe blame it on the illness for now and put it on the back burner for now.
Once the illness has run its course and we can hopefully dial in the therapy a little better...then worry about PB should we continue to see very much of it. A little bit here and there...no big deal.
At this point...we really can't do anything about it anyway.

I don't totally ignore stuff we can't do anything about but I do put it on the back burner and target stuff we can do something about first that for sure needs to have something done about it...then worry about the other stuff later if we need to.

SuperDave · Post by **SuperDave** » Sun Jan 20, 2019 8:57 am

According to SH, last night was "horrible, call your doctor immediately." I wouldn't classify the night as horrible, but it was worse than the prior nights. I remember waking up twice, struggling to exhale. Felt like I was fully inflated and only able to make very shallow inhales and exhales, no doubt due to the high pressures. With higher pressures came noiser mask leaks, which caused frequent arousals to readjust the nasal pillows. Twice I had to press the ramp button, where the ramp pressure of 12 seemed like a relief. The chart shows a higher AHI, with both OA and CA increasing over the prior night. The PB was evenly distributed over the entire night in smaller sessions.

Comments and recommendations are welcome.

Pugsy · Post by **Pugsy** » Sun Jan 20, 2019 9:10 am

Well crap. No more big changes so fast. We've invited the aerophagia monster for a visit and he's not pleasant.
Let me think on this a bit.

I guess I need to see your SD card now. I will send you my private email address in just a bit.
I want you to zip the SD Card in one fell swoop...don't send me bits and pieces...I can't reconstruct the card from bits and pieces and have it work.

Right click your mouse when over the drive letter where the SD card sits....if you get a choice to send it to...compress or zip...use it and compress the entire SD card.
If you don't get a choice to compress then copy it and paste it to your desktop and then you will get a choice to zip it when right clicking the mouse.

I don't think Flex or PS is causing your centrals...so let's add it back in to help keep the aerophagia monster away.

SuperDave · Post by **SuperDave** » Sun Jan 20, 2019 9:14 am

three nights in a row for easier comparison

SuperDave · Post by **SuperDave** » Sun Jan 20, 2019 6:02 pm

tonite I will use the sttings from the 2nd night, which had the best results for the last 3 nights. just add back the ps of 2.5-4.0.
Min Epap 12.0
Max EPAP 25.0
Min IPAP 14.5
Max IPAP 25.0
PS Min 2.5
PE max 4.0
ramp time 30 min
ramp pressure 12.0

will post charts tomorrow.

Pugsy · Post by **Pugsy** » Sun Jan 20, 2019 7:09 pm

Sounds like a plan.
Back up and regroup and I need to think a bit about possible options. Let's see what tonight brings.

I don't suppose you happen to have a copy of that old sleep study from years ago do you?

And in case anyone wants to say "see your doctor".....the appointment has been made but it is the end of April.

palerider · Post by **palerider** » Sun Jan 20, 2019 8:02 pm

SuperDave wrote: ↑
Sun Jan 20, 2019 6:02 pm
tonite I will use the sttings from the 2nd night, which had the best results for the last 3 nights. just add back the ps of 2.5-4.0.
Min Epap 12.0
Max EPAP 25.0
Min IPAP 14.5
Max IPAP 25.0
PS Min 2.5
PE max 4.0
ramp time 30 min
ramp pressure 12.0

will post charts tomorrow.

According to what I saw, the second night was pretty good, but you had zero PS.

I think you should stick with the settings from the *third* night.

Have you been to a cardiologist lately?

What kind of mask are you using?

Another sleep apnea "victim"

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