bjhunt01 therapy help thread

[Pugsy]

I am good with 7 to 11.4 ....for now anyway. It's not a lot of room to roam but I have to remember that where the machine might want to go might invite the aerophagia monster in and he is not a house guest.
Yes, I know that you are hitting your max often and a lot of the time staying up there...and some people say since you are going there anyway might as well start out there. I don't necessarily agree with that thinking for a number of reasons.

Your machine is like mine and running in the for Her mode like I am....it can and will respond to SWJ OAs and hyponeas because it doesn't know if you are asleep or not. I have seen it happen on my own reports...it jacks up the pressure and I get a new minimum and I go look at the flagged events and they are so blatantly SWJ events that even a blind man could tell I was awake.
For that reason I am wanting to rule out machine response to SWJ first before I start worrying about where the pressure might need to be for a more optimal setting. There's a chance that you may be seeing some of the same stuff I see on occasion and it gives the initial impression that more minimum is needed but once I look at things really closely....they aren't real asleep events and more pressure really isn't needed.

That's why I keep harping on fixing the sleep issues first...so that we can better trust the data we are seeing and make decisions based on accurate data points and not SWJ data points.

It doesn't hurt anything to use more pressure than you technically might need EXCEPT for that old aerophagia monster wanting to come for a visit. That's why I want you to not have to use any more pressure than you just have to....I don't want to open the door for that unwanted guest.
That's why I am being ultra cautious.
You could use 10 min and 20 max and see what happens....your belly may be cussing you out in the morning if you do though.
You won't be sleeping any better but your belly may hurt like hell. Or you may trade one problem for another bigger problem...and it might even make your sleep quality worse.

You might want to take the time to learn to distinguish awake/arousal breathing from asleep breathing flagged events.
http://freecpapadvice.com/sleepyhead-free-software
While Jason mainly is talking about central flags here...it can actually be any event category that gets flagged and it's arousal breathing and not asleep breathing. Huge learning curve involved with figuring out asleep breathing vs awake breathing.
Remember....anything flagged when you aren't asleep simply doesn't count for anything and we don't base pressure needs evaluation on awake flagged stuff. Gotta be asleep for it to matter at all.

So when you see a high AHI night...and you know you slept like crap....the high AHI is a symptom of the poor sleep and not the cause of the poor sleep. Make sense?

[bjhunt01]

I am good with 7 to 11.4 ....for now anyway. It's not a lot of room to roam but I have to remember that where the machine might want to go might invite the aerophagia monster in and he is not a house guest.
Yes, I know that you are hitting your max often and a lot of the time staying up there...and some people say since you are going there anyway might as well start out there. I don't necessarily agree with that thinking for a number of reasons.

Your machine is like mine and running in the for Her mode like I am....it can and will respond to SWJ OAs and hyponeas because it doesn't know if you are asleep or not. I have seen it happen on my own reports...it jacks up the pressure and I get a new minimum and I go look at the flagged events and they are so blatantly SWJ events that even a blind man could tell I was awake.
For that reason I am wanting to rule out machine response to SWJ first before I start worrying about where the pressure might need to be for a more optimal setting. There's a chance that you may be seeing some of the same stuff I see on occasion and it gives the initial impression that more minimum is needed but once I look at things really closely....they aren't real asleep events and more pressure really isn't needed.

That's why I keep harping on fixing the sleep issues first...so that we can better trust the data we are seeing and make decisions based on accurate data points and not SWJ data points.

It doesn't hurt anything to use more pressure than you technically might need EXCEPT for that old aerophagia monster wanting to come for a visit. That's why I want you to not have to use any more pressure than you just have to....I don't want to open the door for that unwanted guest.
That's why I am being ultra cautious.
You could use 10 min and 20 max and see what happens....your belly may be cussing you out in the morning if you do though.
You won't be sleeping any better but your belly may hurt like hell. Or you may trade one problem for another bigger problem...and it might even make your sleep quality worse.

You might want to take the time to learn to distinguish awake/arousal breathing from asleep breathing flagged events.
http://freecpapadvice.com/sleepyhead-free-software
While Jason mainly is talking about central flags here...it can actually be any event category that gets flagged and it's arousal breathing and not asleep breathing. Huge learning curve involved with figuring out asleep breathing vs awake breathing.
Remember....anything flagged when you aren't asleep simply doesn't count for anything and we don't base pressure needs evaluation on awake flagged stuff. Gotta be asleep for it to matter at all.

So when you see a high AHI night...and you know you slept like crap....the high AHI is a symptom of the poor sleep and not the cause of the poor sleep. Make sense?

I am good with 7 to 11.4 ....for now anyway. It's not a lot of room to roam but I have to remember that where the machine might want to go might invite the aerophagia monster in and he is not a house guest.
Yes, I know that you are hitting your max often and a lot of the time staying up there...and some people say since you are going there anyway might as well start out there. I don't necessarily agree with that thinking for a number of reasons.

Your machine is like mine and running in the for Her mode like I am....it can and will respond to SWJ OAs and hyponeas because it doesn't know if you are asleep or not. I have seen it happen on my own reports...it jacks up the pressure and I get a new minimum and I go look at the flagged events and they are so blatantly SWJ events that even a blind man could tell I was awake.
For that reason I am wanting to rule out machine response to SWJ first before I start worrying about where the pressure might need to be for a more optimal setting. There's a chance that you may be seeing some of the same stuff I see on occasion and it gives the initial impression that more minimum is needed but once I look at things really closely....they aren't real asleep events and more pressure really isn't needed.

That's why I keep harping on fixing the sleep issues first...so that we can better trust the data we are seeing and make decisions based on accurate data points and not SWJ data points.

It doesn't hurt anything to use more pressure than you technically might need EXCEPT for that old aerophagia monster wanting to come for a visit. That's why I want you to not have to use any more pressure than you just have to....I don't want to open the door for that unwanted guest.
That's why I am being ultra cautious.
You could use 10 min and 20 max and see what happens....your belly may be cussing you out in the morning if you do though.
You won't be sleeping any better but your belly may hurt like hell. Or you may trade one problem for another bigger problem...and it might even make your sleep quality worse.

You might want to take the time to learn to distinguish awake/arousal breathing from asleep breathing flagged events.
http://freecpapadvice.com/sleepyhead-free-software
While Jason mainly is talking about central flags here...it can actually be any event category that gets flagged and it's arousal breathing and not asleep breathing. Huge learning curve involved with figuring out asleep breathing vs awake breathing.
Remember....anything flagged when you aren't asleep simply doesn't count for anything and we don't base pressure needs evaluation on awake flagged stuff. Gotta be asleep for it to matter at all.

So when you see a high AHI night...and you know you slept like crap....the high AHI is a symptom of the poor sleep and not the cause of the poor sleep. Make sense?

Yes - little by little things are sinking in and falling into place to my brain dead brain. Jason's videos were extremely helpful and showing how to single out an OS or Hypopnea and how to determine if they really were that. Here is the July 3 screen I mentioned that I thought was so amazing at 6.8 and 10.2. (Except for flow limitations). And using Jason's technique, the Hypopneas weren't really Hypopneas.

[bjhunt01]

Hi Pugsy: I started at 7 and 12 as you suggested and I turned the EPR off.
About 6:15 or so, I turned the max down to 11.8. Was getting Bubble cheeks.
About 8:30 or so, still having Bubble cheeks, so I turned the max down to 11 and turned the EPR on to 3.
A bit of aerophagia with lots of burping and my stomach is the size of a woman three months along but it's going down.
Still spending an awful lot of time in bed, but today I kept the mask on until I got up instead of
taking if off and snoring for another 1 to 2 hours.

Here is my main screen and then an expansion of two OS areas when I went down to 11.

[Pugsy]

When you turned EPR back on...that drop during exhale allowed some OAs to happen.
You still are having a lot of wake ups and time spent awake with the machine on.
You are still having a lot of aerophagia issues when using anywhere near the pressures that you need to prevent the OAs.
I still don't know what to make of the CAs/centrals. Were you asleep or not when the bulk of those got flagged.

I think you need to be having a chat with your doctor about all these problems. You may need a bilevel machine so that you can use the pressures you need to hold the airway open and not have the aerophagia issues be such a problem.
If you need to use EPR of 3...you will need to have a starting minimum pressure higher.
Notice how the OAs really didn't start up until you turned EPR on???
And obviously...still not sleeping so great.

[bjhunt01]

When you turned EPR back on...that drop during exhale allowed some OAs to happen.
You still are having a lot of wake ups and time spent awake with the machine on.
You are still having a lot of aerophagia issues when using anywhere near the pressures that you need to prevent the OAs.
I still don't know what to make of the CAs/centrals. Were you asleep or not when the bulk of those got flagged.

I think you need to be having a chat with your doctor about all these problems. You may need a bilevel machine so that you can use the pressures you need to hold the airway open and not have the aerophagia issues be such a problem.
If you need to use EPR of 3...you will need to have a starting minimum pressure higher.
Notice how the OAs really didn't start up until you turned EPR on???
And obviously...still not sleeping so great.

So I will need to find and make an appointment with a good doctor. I believe I have found one. We'll see how long it takes to get in.

Yes I think I was in and out of being awake during all the centrals at the end. Yes I did notice the OA's at EPR 3 which surprised me because the last time at EPR 3, minimum was at 8 and I thought screen was good - Below.

I have an idea while I'm looking for a doctor and a new sleep study, etc. There were 2 nights when I didn't have bad insomnia, had begun to make some minor changes to pressures, to 8 and 11. The first night EPR was 2 and the second night EPR was 3. Except for falling asleep time and getting up to use restroom and having to fall asleep again, I thought the second night especially looked really good -EPR 3 - and I got very excited. Can you take a look at the 2 and tell me if you think the second one looked good? If you do, why don't I back up and set the machine where it was, double the melatonin tonight. I can't explain this bout of insomnia other than I had run out of Melatonin during that time. Tomorrow I'll see about getting in to see new Dr. but need a plan in the meantime. Thanks for your help as always!

[bjhunt01]

Also thought July 2 and 3 looked pretty good except no one liked the flow rate. I was at 6.80 and 10.20 and no EPR

[Pugsy]

To hell with the flow limitations right now....
Your efforts to kill them caused you more problems with your sleep than the FLs caused.

July 5 and 6....pretty sure the bulk of that AHI is SWJ centrals.
Minimum was 8 and max was 11 and the FL graph was slightly less ugly with the increase from 7 to 8 minimum....but that was really more because of the increase in the maximum than it was the increase in the minimum.

It doesn't really matter if you use 7 or 8 minimum....those FLs are going to drive the pressure up probably to the max setting and it's going to pretty much stay there all night (or at least while you are asleep).

11 maximum is better for FL control than 10.2 maximum
BUT....you have to be able to sleep first....so do whatever you need to do to fall asleep and increase your chances of staying asleep.
If it involves meds...take them.

[djams]

For melatonin - I take REMFresh. It works better for me than the stuff I was picking up at the drugstore. I've been taking it for about 4 months every night.

Time released, and they claim it lasts nearly all night long. All night meaning 6-8 hours. They put melatonin in the "skin" of the pill so there's a boost at the beginning of the night.

They make some pretty incredible purity claims. No way to know if this is true. Maybe they'll be the next one sued for false advertising, I dunno.

On nights when I forget to take it, my sleeptracker shows that my deep sleep is affected. REM stays within normal variations. I guess DEEPFresh isn't as catchy.
But like I said- works great for me. YMMV

[bjhunt01]

For melatonin - I take REMFresh. It works better for me than the stuff I was picking up at the drugstore. I've been taking it for about 4 months every night.

Time released, and they claim it lasts nearly all night long. All night meaning 6-8 hours. They put melatonin in the "skin" of the pill so there's a boost at the beginning of the night.

They make some pretty incredible purity claims. No way to know if this is true. Maybe they'll be the next one sued for false advertising, I dunno.

On nights when I forget to take it, my sleeptracker shows that my deep sleep is affected. REM stays within normal variations. I guess DEEPFresh isn't as catchy.
But like I said- works great for me. YMMV

Do you get it on amazon? How many mg. do you use?

[bjhunt01]

To hell with the flow limitations right now....
Your efforts to kill them caused you more problems with your sleep than the FLs caused.

July 5 and 6....pretty sure the bulk of that AHI is SWJ centrals.
Minimum was 8 and max was 11 and the FL graph was slightly less ugly with the increase from 7 to 8 minimum....but that was really more because of the increase in the maximum than it was the increase in the minimum.

It doesn't really matter if you use 7 or 8 minimum....those FLs are going to drive the pressure up probably to the max setting and it's going to pretty much stay there all night (or at least while you are asleep).

11 maximum is better for FL control than 10.2 maximum
BUT....you have to be able to sleep first....so do whatever you need to do to fall asleep and increase your chances of staying asleep.
If it involves meds...take them.

ok.....

[djams]

Do you get it on amazon? How many mg. do you use?

Yes Amazon, it's available pretty much everywhere(drugstores, walmart, etc).I take 5mg dose, one per night. 30 minutes before bed. Going to switch to 2mg next time I buy.

Kinda pricey at a dollar a night for 5mg. Same price everywhere I look.

I didn't like the company's marketing gimmicks - put me off using it regularly for a long time. Then I found reference to a study on side of the box and this showed up when I googled it.

http://www.sleepreviewmag.com/2017/06/r ... 6-7-hours/

[bjhunt01]

Do you get it on amazon? How many mg. do you use?

Yes Amazon, it's available pretty much everywhere(drugstores, walmart, etc).I take 5mg dose, one per night. 30 minutes before bed. Going to switch to 2mg next time I buy.

Kinda pricey at a dollar a night for 5mg. Same price everywhere I look.

I didn't like the company's marketing gimmicks - put me off using it regularly for a long time. Then I found reference to a study on side of the box and this showed up when I googled it.

http://www.sleepreviewmag.com/2017/06/r ... 6-7-hours/

djams: Thanks for sending the study. I continually wake up about 5 am and can stay awake until 7 or 8. It's so annoying! Last night I took two 3 mg. of sustained release that I got at Cooper Clinic and STILL woke up at 5 am. This looks like it might get me through that time period. I'm out of blue tape so will be at the drug store today and will look for this. Thanks so much for telling me about it! I still have on my to do list to look at the tech info you sent me and I will.

[bjhunt01]

To hell with the flow limitations right now....
Your efforts to kill them caused you more problems with your sleep than the FLs caused.

July 5 and 6....pretty sure the bulk of that AHI is SWJ centrals.
Minimum was 8 and max was 11 and the FL graph was slightly less ugly with the increase from 7 to 8 minimum....but that was really more because of the increase in the maximum than it was the increase in the minimum.

It doesn't really matter if you use 7 or 8 minimum....those FLs are going to drive the pressure up probably to the max setting and it's going to pretty much stay there all night (or at least while you are asleep).

11 maximum is better for FL control than 10.2 maximum
BUT....you have to be able to sleep first....so do whatever you need to do to fall asleep and increase your chances of staying asleep.
If it involves meds...take them.

ok.....

So I went backwards to 6.60/10.20 and EPR off. I think the two periods where I was asleep look pretty good. Do you? Still waking up around 5 am - those are the centrals. This has been happening for years. Then later a little after 8, I took off the Bleep, went to the restroom and when I came back I was experimenting with a nasal mask and was awake all, if not all, the rest of the time. So I've highlighted the two areas where I was sleeping. I didn't get a lot of sleep but it appears to at least be quality sleep. In order to not make you crazy, I'll (maybe) not post for a few days while I get the insomnia back under control! A really significant change since I came here about mid June has been reducing the horrible leaks I was having with the help with all the things to do to stop so much leaking. Raising my minimum from 4 was another important change. I had no idea that was too low. Tons of education and humor have been enormously helpful. Now onto the insomnia. Maybe I'll take up wine. Just kidding!! I know that makes it worse - also gives me migraines )-:

[djams]

djams: Thanks for sending the study. I continually wake up about 5 am and can stay awake until 7 or 8. It's so annoying! Last night I took two 3 mg. of sustained release that I got at Cooper Clinic and STILL woke up at 5 am. This looks like it might get me through that time period. I'm out of blue tape so will be at the drug store today and will look for this. Thanks so much for telling me about it! I still have on my to do list to look at the tech info you sent me and I will.

You're welcome, I hope it works for you.

I also have a cup of sleepy time tea almost every night with a bit of raw honey. It doesn't make me sleepy, but it sure does help me relax.

[bjhunt01]

djams: Thanks for sending the study. I continually wake up about 5 am and can stay awake until 7 or 8. It's so annoying! Last night I took two 3 mg. of sustained release that I got at Cooper Clinic and STILL woke up at 5 am. This looks like it might get me through that time period. I'm out of blue tape so will be at the drug store today and will look for this. Thanks so much for telling me about it! I still have on my to do list to look at the tech info you sent me and I will.

You're welcome, I hope it works for you.

I also have a cup of sleepy time tea almost every night with a bit of raw honey. It doesn't make me sleepy, but it sure does help me relax.

Couldn't find 5 mg. just 2 but that's OK. I can take it and take another later if it's not working.