Tweety: Tweaking Aircurve VAuto settings for aerophagia

palerider wrote: ↑

Wed Nov 13, 2019 8:14 pm

"transition apnea". it's a term, google it for more info.

Thanks, I didn't realize that was a separate thing. From what I can see, it's generally very normal unless it interferes with your sleep. I do have trouble falling asleep if I wake up very early--I keep drifting off but can't stay asleep. I think I had that happen during my sleep study--I took me over an hour to fall asleep after a pee break. The technician did ask me if I knew why it took me so long to fall asleep but I had no idea (other than ALL THOSE WIRES glued to me, duh).

Transitional or sleep onset centrals aren't normally a problem unless they keep a person from progressing into the first sleep stage.
When they keep bouncing a person out of sleep then they become a big problem if for no other reason than preventing good quality sleep and the nice (and much needed for us to feel good) progression into all the sleep stages in the needed percentage of time in each stage.
Too numerous or too prolonged and they can also cause desats.

So they can be a huge problem for some people. I am leaning towards thinking you are one of those people and working on reducing the centrals (whatever the cause) is next on my to do list for you.

oops, don't know how this extra posting got in here--no delete key

Last night's data with VAuto, IPAP 4, PS 3, EPAP 7.

I do have aerophagia this morning, even with the lower pressures, so it almost seems like the difference between PS 3 and PS 4 made the difference. Or the IPAP 3 to 4. It's not the worst it's been, this morning, but uncomfortable. I would be tempted to try IPAP 4, PS 4, EPAP 8 tonight to eliminate PS 3 as a variable--what do you think?

The CAs are still all preceded by an arousal except the early ones. My legs are pretty tight this morning, so the PLMS contributed to some of the wakeups. FWIW I don't remember most of the arousals.

Tweety wrote: ↑

Thu Nov 14, 2019 10:35 am

Last night's data with VAuto, IPAP 4, PS 3, EPAP 7.

Ipap is never lower than epap, (for clarification for others reading along), so your epap was 4 and ipap 7.

Tweety wrote: ↑

Thu Nov 14, 2019 10:35 am

I would be tempted to try IPAP 4, PS 4, EPAP 8 tonight to eliminate PS 3 as a variable--what do you think?

You can try it but I predict the aerophagia will be worse.
We already know that EPAP of 4 is strong factor. No aerophagia with EPAP of 3 and some aerophagia with EPAP at 4. Be thankful that your OSA can be dealt with fairly easily with such a low EPAP.
If EPAP is a strong factor then IPAP is going to also play a significant part.
Might be interesting to see if the centrals increase or not .....your choice as to just how much of a lab rat you want to be. It's always good to get answers to "what if" questions even if the answer isn't what we want. We always learn.

I would like to see what happens with a PS of 2...in auto mode with IPAP max of 7.
Auto mode
Min EPAP 4
PS 2
max IPAP 7
So whenever you feel like trying those settings....before or after the PS of 4 test. Doesn't matter to me.
Trying to see what happens to aerophagia and centrals with this test...and as always watching for OAs and hyponeas starting to appear.

palerider wrote: ↑

Thu Nov 14, 2019 10:45 am

Tweety wrote: ↑

Thu Nov 14, 2019 10:35 am

Last night's data with VAuto, IPAP 4, PS 3, EPAP 7.

Ipap is never lower than epap, (for clarification for others reading along), so your epap was 4 and ipap 7.

Oops, thanks Typing this morning before my brain kicked in.

Pugsy wrote: ↑

Thu Nov 14, 2019 10:51 am

Tweety wrote: ↑

Thu Nov 14, 2019 10:35 am

I would be tempted to try IPAP 4, PS 4, EPAP 8 tonight to eliminate PS 3 as a variable--what do you think?

You can try it but I predict the aerophagia will be worse.
We already know that EPAP of 4 is strong factor. No aerophagia with EPAP of 3 and some aerophagia with EPAP at 4. Be thankful that your OSA can be dealt with fairly easily with such a low EPAP.
If EPAP is a strong factor then IPAP is going to also play a significant part.
Might be interesting to see if the centrals increase or not .....your choice as to just how much of a lab rat you want to be. It's always good to get answers to "what if" questions even if the answer isn't what we want. We always learn.

I would like to see what happens with a PS of 2...in auto mode with IPAP max of 7.
Auto mode
Min EPAP 4
PS 2
max IPAP 7
So whenever you feel like trying those settings....before or after the PS of 4 test. Doesn't matter to me.
Trying to see what happens to aerophagia and centrals with this test...and as always watching for OAs and hyponeas starting to appear.

I'm up for that. I'll try your settings tonight. Still getting my head around how the EPAP/PS/IPAP affects me, thanks for the feedback.

Tweety wrote: ↑

Thu Nov 14, 2019 11:16 am

palerider wrote: ↑

Thu Nov 14, 2019 10:45 am

Tweety wrote: ↑

Thu Nov 14, 2019 10:35 am

Last night's data with VAuto, IPAP 4, PS 3, EPAP 7.

Ipap is never lower than epap, (for clarification for others reading along), so your epap was 4 and ipap 7.

Oops, thanks Typing this morning before my brain kicked in.

Yup, been there, done that.. it doesn't go that the acronyms are a so close and a bit confusing... Lol

Oof! Definitely aerophagia last night with the PS 2. I was very uncomfortable at 5:20am so I took the Dreamport off to get a little relief. At 6:20am I put it back on (after waking up with a nightmare) and figured WTH, I'll try the PS 4 (EPAP 4, IPAP 8 ) since I'm uncomfortable anyway. The PS 4 is nice for breathing, but I was feeling that bubbling/aerophagia indicator, (I think at the bottom of my breath if that makes any difference), and I slept off-and-on 'til I got up for the morning. I marked this on the chart for clarity. The 4:50am-5:20am section was me lying awake, feeling sorry for myself

One thing I noted was longer sleep periods, but my breathing Flow Rate had a lower amplitude than normal. It usually roughly touches the +20 and -20 marks. Also my corrective deep inhales were deeper (higher amplitude). I don't think I was clenching my teeth, but there are some squiggles in the Flow Rate which might say otherwise.

Did you ever really fall asleep after the 6:20 change to PS of 4?

Did you know you can turn off each session where you started and stopped the machine and changed things?
This enables you to evaluate the results individually without the other sessions messing with the results.
Look on the left side and scroll all the way down to the bottom where it shows the sleep sessions.
You can click on a session and change it from green to red and when red it is omitted from the detailed data.

It might be interesting to see the detailed results of only the first and much longer sleep session.

It's looking more and more like EPAP of 3 might work better for you in terms of not causing so much aerophagia issues.
That would mean fixed mode obviously but there are worse things in life than not having auto mode....like bad belly pain.
I would like to see if reducing PS from 4 to 3 in fixed bilevel mode reduces the centrals any...
So at some point I would like to see S mode ....minimum EPAP 3 and IPAP 6 and see how you do with the central numbers.
I know we won't get the FL graph but it's not real exciting anyway so at this point it doesn't matter. It's not horrible at these lower pressures but the aerophagia is still annoyingly there.

Pugsy wrote: ↑

Fri Nov 15, 2019 12:46 pm

Did you ever really fall asleep after the 6:20 change to PS of 4?

Not really, mostly just dozed-off for three 10-15 minute chunks. It did help clear my head after falling asleep without PAP--bleah.

Pugsy wrote: ↑

Fri Nov 15, 2019 12:46 pm

It might be interesting to see the detailed results of only the first and much longer sleep session.

It's looking more and more like EPAP of 3 might work better for you in terms of not causing so much aerophagia issues.
That would mean fixed mode obviously but there are worse things in life than not having auto mode....like bad belly pain.
I would like to see if reducing PS from 4 to 3 in fixed bilevel mode reduces the centrals any...
So at some point I would like to see S mode ....minimum EPAP 3 and IPAP 6 and see how you do with the central numbers.
I know we won't get the FL graph but it's not real exciting anyway so at this point it doesn't matter. It's not horrible at these lower pressures but the aerophagia is still annoyingly there.

Revised chart is below. Happy to try the S mode again tonight--it was a nice aero-break That's going to be my new catch-phrase, it sounds like Aero Bar-- a really good chocolate bar in England.

...And now I'm hungry...

Thanks for redoing that session.

I am assuming some of those centrals are related to arousals or awake time...do you know how to zoom in and figure out awake breathing from asleep breathing?

Pugsy wrote: ↑

Fri Nov 15, 2019 2:30 pm

Thanks for redoing that session.

I am assuming some of those centrals are related to arousals or awake time...do you know how to zoom in and figure out awake breathing from asleep breathing?

Yes. The first cluster is typical for me falling asleep,



and the rest are all arousal-related or in the middle of SWJ. I don't remember lying awake for any significant length of time before I got up for a break. I was conscious of the shallowness of the PS and the aerophagia last night, so I might have been shifting around a lot.

Okay, looks like mainly arousal related centrals for the most part. I won't worry about them so much now and will just put them on the back burner for now.
Concentrate on improving sleep quality and keeping the aerophagia monster at bay....see if the centrals fade with better sleep.
Main thing...keep the aerophagia away so that it isn't a factor in any arousals.

Alrighty, here's this morning with S-mode, EPAP 3, IPAP 6. No aerophagia, as expected (and very appreciated!). I slept solidly, aided by lack of sleep from the last couple of nights, although I woke up with a very tight jaw and at times during the night felt like it wasn't quite enough pressure. Still no events flagged, but I'm kinda headachy/foggy this morning. I would be tempted to increase the IPAP to 7 again, like a few nights ago.

That first break at about 00:15 isn't real, and PS 4 is incorrect, but I think I've read elsewhere that that's a bug in the Sleepyhead/Oscar software?




Since there are no FL or meaningful Pressure readings, I moved up the Respiration Rate chart. When I was videoing, I found RR helpful to see the changes in my sleep phases. I found a loose correlation between really rough RR + rough Flow Rate graphs and REM (I'm assuming it was REM because I could see my eyes moving during those periods). So, just for grins , here's an example of what I think that looks like for me--no idea if it's typical.