New (UARS) -- lots of questions

palerider wrote: ↑

Sat Dec 14, 2019 11:33 am

Pugsy wrote: ↑

Sat Dec 14, 2019 11:09 am

Just a thought...you are self titrating without a lot to go on and 0.2 cm difference here or there isn't going to likely be a deal maker or breaker.

Yeah, 0.2 I inconsequential for almost everyone.

(Ahem!)

palerider wrote: ↑

Sat Dec 14, 2019 11:56 am

Indeed, like with zonker sneaking up the pressure because he was trying to avoid the aerophagia monster.

Well, you preach patience when it's warranted.

(Ahem!) Pt 2

I’m stuck without my gifs or I’d post my meerkat pic.

zonker wrote: ↑

Sat Dec 14, 2019 1:19 pm

palerider wrote: ↑

Sat Dec 14, 2019 11:33 am

Pugsy wrote: ↑

Sat Dec 14, 2019 11:09 am

Just a thought...you are self titrating without a lot to go on and 0.2 cm difference here or there isn't going to likely be a deal maker or breaker.

Yeah, 0.2 I inconsequential for almost everyone.

(Ahem!)

YOU sir, are one of the few that's outside that "almost everyone"... and why I said "almost".

zonker wrote: ↑

Sat Dec 14, 2019 1:23 pm

palerider wrote: ↑

Sat Dec 14, 2019 11:56 am

Indeed, like with zonker sneaking up the pressure because he was trying to avoid the aerophagia monster.

Well, you preach patience when it's warranted.

(Ahem!) Pt 2

I’m stuck without my gifs or I’d post my meerkat pic.

Well, you can come back and edit the post later

palerider wrote: ↑

Sat Dec 14, 2019 3:04 pm

zonker wrote: ↑

Sat Dec 14, 2019 1:23 pm

palerider wrote: ↑

Sat Dec 14, 2019 11:56 am

Indeed, like with zonker sneaking up the pressure because he was trying to avoid the aerophagia monster.

Well, you preach patience when it's warranted.

(Ahem!) Pt 2

I’m stuck without my gifs or I’d post my meerkat pic.

Well, you can come back and edit the post later

I’m WAY too lazy to do that.

Really wanted to share last night because of how well it went!
Bed at ~10:30, woke at 7:30. Took ~75mg Trazodone + 3mg melatonin

Settings: Last night I was feeling confident and upped both Min EPAP (6.0 -> 6.6) and PS (5.0 -> 5.6) -- no baby steps here

Subjectively: last night was great, I didn't ever fully become conscious even when I needed to adjust my mask, I felt like I was really starting to rest, and I slept through the night with no huge issues! Band-aids stayed on for the whole night as well. I still reached semi-consciousness pretty frequently and was aware of ongoing aerophagia, the gross semi-dry taste of my mouth (which mouth taping definitely helped: it was not as bad is it was in the past three nights), and the fact that my mask needed adjustments. But last night was such a good fit that several times, while I was kind of awake, I wasn't sure whether or not I still had the mask on until I put my head against the pillow and heard the exhaust air against the fabric. I'll definitely be using this setting again tonight to see if I get the same positive results.
I'm not sure if this is the setting to help treat my UARS, but I fully believe that I'm getting close with at least the EPR, given how comfortable it is.
Aerophagia was a bigger problem last night than the night before but didn't keep me awake.

OSCAR: Pressure curve still hasn't normalized yet, it's still choppy by the end of the night. Not sure if this is a problem or not. My FL graph could certainly use some work but isn't out of the ordinary for the data I've been logging thus far. I had very few CAs last night, which is a bit surprising, as I'd expected more pressure to influence more CAs.

Good.

How tall are you?

This whole fear of pressure causing centrals is highly over rated.
People can get central apneas even with as little as 5 cm fixed pressure....and a truck load of them at that.
Yes, in SOME people higher pressures can trigger lots of centrals but most of the time it's ANY pressure for those people.
Very few will actually have a fine line where above so and do pressure centrals are numerous and below it they aren't.
Only 10 to 15 % of the people who use cpap will end up with a problem in the number of centrals they are seeing. Most people won't have a problem no matter what pressure they use or if they use exhale relief in some form.

A few centrals here and there during the night is entirely normal. Sleep onset centrals or sleep stage transitions are normal.
Not to mention just the chance of a false positive with an awake breathing pause getting a flag by mistake.

For the aerophagia stuff.....I think you need to back off the increases
It's doing you zero good to swap whatever it is that is messing with your sleep for something else.
You increased both minimum EPAP and PS....so that means IPAP also got increased....more pressure feeds the aerophagia monster every day of the week.

Zan, it's great to hear you've had a better night! Don't be discouraged if there are better and worse nights; sleep is like that. But let's hope you're at the beginning of a new trend. Keep us posted.

Pugsy wrote: ↑

Sun Dec 15, 2019 8:59 am

This whole fear of pressure causing centrals is highly over rated.
People can get central apneas even with as little as 5 cm fixed pressure....and a truck load of them at that.
Yes, in SOME people higher pressures can trigger lots of centrals but most of the time it's ANY pressure for those people.
Very few will actually have a fine line where above so and do pressure centrals are numerous and below it they aren't.
Only 10 to 15 % of the people who use cpap will end up with a problem in the number of centrals they are seeing. Most people won't have a problem no matter what pressure they use or if they use exhale relief in some form.

A few centrals here and there during the night is entirely normal. Sleep onset centrals or sleep stage transitions are normal.
Not to mention just the chance of a false positive with an awake breathing pause getting a flag by mistake.

Sounds like a faq

palerider wrote: ↑

Sun Dec 15, 2019 12:04 pm

Pugsy wrote: ↑

Sun Dec 15, 2019 8:59 am

This whole fear of pressure causing centrals is highly over rated.
People can get central apneas even with as little as 5 cm fixed pressure....and a truck load of them at that.
Yes, in SOME people higher pressures can trigger lots of centrals but most of the time it's ANY pressure for those people.
Very few will actually have a fine line where above so and do pressure centrals are numerous and below it they aren't.
Only 10 to 15 % of the people who use cpap will end up with a problem in the number of centrals they are seeing. Most people won't have a problem no matter what pressure they use or if they use exhale relief in some form.

A few centrals here and there during the night is entirely normal. Sleep onset centrals or sleep stage transitions are normal.
Not to mention just the chance of a false positive with an awake breathing pause getting a flag by mistake.

Sounds like a faq

Yep...the list is growing. We knew it would.

slowriter wrote: ↑

Sun Dec 15, 2019 7:23 am

Good.

How tall are you?

5'1" on a good day (I have scoliosis). Does it matter?

Pugsy wrote: ↑

Sun Dec 15, 2019 8:59 am

For the aerophagia stuff.....I think you need to back off the increases
It's doing you zero good to swap whatever it is that is messing with your sleep for something else.
You increased both minimum EPAP and PS....so that means IPAP also got increased....more pressure feeds the aerophagia monster every day of the week.

Whoops, didn't get a chance to read this thread before I went to bed last night, and increased the PS from 5.6 --> 6.2.... with surprisingly little aerophagia this time.

Bedtime at ~10:45, wake at 7:30. Took 3mg melatonin and 50mg Trazodone.

Settings: Again, only changed PS from 5.6 --> 6.2. Still working with 6.6 Min EPAP and 15 Max IPAP (which I'll go ahead and raise to 20 since I'm hitting the max every now and then)

Subjectively: Dry mouth is still an issue, and today I'll be looking for lozenges and/or better mouth-taping solutions because I didn't find any micropore tape at either the RiteAid by my university or my local grocery store (yesterday I moved back home for winter break). Still slept like crap, and interestingly enough while I was slowly coming to this morning, I noticed what might be flow limitations as I was becoming conscious: I would make a gentle effort to breathe, but it wouldn't be enough to trigger the IPAP (even though the trigger was set to high) and when my brain realized the inhalation wasn't getting enough air in, it'd increase the effort until I had triggered the IPAP. Sounds to me like a textbook FL, and I think that means I have to increase my EPAP at some point (?) because my airway isn't open enough to pull air in with its normal effort (???). Would really appreciate some advice on this front. I am sleeping through the night with the machine, but waking up feeling as I do when I sleep without it, with the new addition of a dry mouth.

OSCAR: Mostly centrals in the last half of the night, which I expected when I raised the PS. My leak rates crossed the critical line multiple times last night, but I'll write that off as part of the adjustment to being back home, since I don't sleep on my bed here much anymore and I'm not used to it. Pressure curves started getting jagged earlier in the night than they had in the past, and I had a lot of flow limitations early in the night as well. Somewhat interestingly, I did have 3 OAs last night, one in the middle of the night and two a couple hours before I woke up. I have never had an OA before according to the machine's data.

zan wrote: ↑

Mon Dec 16, 2019 7:03 am

slowriter wrote: ↑

Sun Dec 15, 2019 7:23 am

Good.

How tall are you?

5'1" on a good day (I have scoliosis). Does it matter?

Just confirming, since your tidal volume is pretty low. But that should be normal for your height, so nothing to worry about.

zan wrote: ↑

Mon Dec 16, 2019 7:03 am

Pugsy wrote: ↑

Sun Dec 15, 2019 8:59 am

For the aerophagia stuff.....I think you need to back off the increases
It's doing you zero good to swap whatever it is that is messing with your sleep for something else.
You increased both minimum EPAP and PS....so that means IPAP also got increased....more pressure feeds the aerophagia monster every day of the week.

Whoops, didn't get a chance to read this thread before I went to bed last night, and increased the PS from 5.6 --> 6.2.... with surprisingly little aerophagia this time.

Didn't we all agree you should stick with a setting for maybe a week?

You're unlikely to magically sleep better by changing these settings. It will take your body time to adjust to the therapy. We're talking weeks and months.

We probably need to add more homework for you.
Learning how to figure out awake vs asleep breathing and are the events flagged real asleep events or just SWJ sleep/wake/junk events being flagged by mistake.
http://freecpapadvice.com/sleepyhead-free-software

Arousal breathing or awake breathing is much more irregular than asleep breathing. Remember the machine only knows how to measure air flow. It doesn't have a clue if you are awake or not and it can and will flagged irregularities in breathing during an arousal or awake time as some sort of apnea event and maybe even respond to it as such. Flagged events immediately preceded by evidence of arousal/awake breathing are called post arousal events and they don't count either.

Did you know that dry mouth is a common side effect of Trazadone?

You might want to google the side effects of both the melatonin and trazadone.
https://en.wikipedia.org/wiki/List_of_a ... _trazodone
https://www.mayoclinic.org/drugs-supple ... t-20363071
Are but a couple...google and read up from several resources

Read up on the half life of trazadone
https://www.drugs.com/medical-answers/l ... m-3365771/
The more often you take it the more that will be in your system during the day to potentially cause some unwanted side effects.

I am sleeping through the night with the machine, but waking up feeling as I do when I sleep without it, with the new addition of a dry mouth.

And what does that part about wake up feeling as you do without it mean?

slowriter wrote: ↑

Mon Dec 16, 2019 7:14 am

Just confirming, since your tidal volume is pretty low. But that should be normal for your height, so nothing to worry about.

I have much to learn

slowriter wrote: ↑

Mon Dec 16, 2019 7:14 am

Didn't we all agree you should stick with a setting for maybe a week?

You're unlikely to magically sleep better by changing these settings. It will take your body time to adjust to the therapy. We're talking weeks and months.

I blame the ADHD... the past few days I've been much more impulsive than normal. Last night I had changed the PS when I was half asleep, thinking, I can handle it! without regarding the principle of "slow and steady progress"... I'll move back to my previous PS setting (5.6) and keep it for a few days, although I'm sticking with my decision to raise the Max IPAP since I don't see much harm in that.
I apologize for mucking up last night by bouncing the pressures around. I'm not immune to overeagerness.

Pugsy wrote: ↑

Mon Dec 16, 2019 9:05 am

(1) Learning how to figure out awake vs asleep breathing and are the events flagged real asleep events or just SWJ sleep/wake/junk events being flagged by mistake.
http://freecpapadvice.com/sleepyhead-free-software
...
(2) Did you know that dry mouth is a common side effect of Trazadone?
...

I am sleeping through the night with the machine, but waking up feeling as I do when I sleep without it, with the new addition of a dry mouth.

(3) And what does that part about wake up feeling as you do without it mean?

(1) I just watched the second video (how to review and evaluate your data) and went over my data to the best of my ability.

Last night was dominated by high leaks, much of which was barely below 26L/min. I've noticed that for the nights that I felt I'd slept pretty well (Thursday and especially Saturday night), my flow rate graph was flatter and more contained and the pressure curves were smoother / had fewer "mountains".
I'm most interested in how shallow my breaths are. You can see in these examples from last night, especially in the second graph, how close I am to basically not taking in any air at all. I've always been aware of how shallowly I breathe even while awake, but for all of the periods in which there were no leaks and my breathing was steady, my flow rate never exceeded ±30L/min. I really feel that there's a connection between my shallow breathing and UARS, maybe a matter of airway shape and/or strength?

(2) I've been taking Trazodone since roughly April and hadn't noticed any dry mouth, ever, until I started PAP therapy. Maybe this is a side effect of the Trazodone I hadn't noticed before because I'd kept my mouth firmly shut the whole night, and now that it's opening just a bit due to air pushing it open, I'm getting an exacerbated response. Melatonin is pretty tame as far as sleep aids go, but I'll suspend them both until Thursday night at the least.

(3) Just feeling unrested and strung-out, like I spent the night tossing and turning instead of recovering. My therapist described it as "laying in bed unconscious, but not sleeping."

---------

I really want to do something about the leaks, they're consistently pretty high and I feel are mucking up my data. Many of you have given me good reason to look into the Bleep, so I'll ask my parents whether they'd be willing to cover me as a Christmas gift. I like the N20 so far but it would be nice to have other options, especially ones that don't protrude out of my face.