So glad I found you

abeardneglected wrote: ↑

Wed Sep 23, 2020 10:21 am

Last night was encouraging.

Sep 22 chart.png

Hi,
_yes, indeed kind encourageous...
_ if I may, I would suspect your Centrals would be false positive events, associated with arousal-awakening/back-to-sleep transitions...and, also, you may have been facing detrimental flow reductions during REM stages (ex: just after 1;40, and 4;45);

_ to be more confident, would mind post some 10min-duration strecthes just prior your concentrations of CA's and during them?

_ have you been using soft collar?

all the best

mper!? wrote: ↑

Wed Sep 23, 2020 11:12 am

_ to be more confident, would mind post some 10min-duration strecthes just prior your concentrations of CA's and during them?

Sure - here's 1:30-1:40 (normal breathing just prior to a bunch of CAs): And here's 1:40-1:50 when the CAs start happening:

mper!? wrote: ↑

Wed Sep 23, 2020 11:12 am

_ have you been using soft collar?

I haven't yet, but am willing to try.

The zoomed in section with the centrals....looks like awake/arousal breathing to me. False positives.
There is an obvious arousal prior to the first flagged central and it doesn't look like at any time there was asleep breathing at least in this segment above.

For right now I would concentrate on just adjusting to cpap therapy and getting good solid sleep. It's not an easy adjustment and getting good solid blocks of sleep to evaluate isn't easy for a lot of people.

You might want to review the videos here and evaluate the other central clusters to see if they look like awake vs asleep breathing.
http://freecpapadvice.com/sleepyhead-free-software

Hi,
_ Pugsy: good point: "For right now I would concentrate on just adjusting to cpap therapy and getting good solid sleep. It's not an easy adjustment and getting good solid blocks of sleep to evaluate isn't easy for a lot of people".

_Pugsy, others: I was wondering if would worth and help these thoughts, if I may, anyway:

…….abeard, it looks you are a luck guy. Your centrals would be false events (associated with post arousal-awakenings, and tossing and turn moves), in accordance with your sleep study (Zero CA);

…….maybe at this time we could hypothesize you would be eventually facing flow restrictions (RERA, either flagged or not; hypopneas) while entering/during REM stages, or just positional sleep drawbacks, due to ?chin-tucking or ?tongue collapse. Maybe you would want to compare your curves with your sleep results;

…….I would suspect that flow limitation would account for your main awakenings, that is, your main drawbacks during this posted night (for instance at 00;39, 1;40, and 4;43);

……then, eventually, it would worth trying the soft collar, as well as increase your minimum pressure, as soon as you feel comfortable to do so. Maybe your EPAP are still too low, while using EPR=3 (If were me I would not trust that much on this automatic pressure recordings; they don’t differentiate true events from artifcats, and, in addition, you may need more pressure to overcome FLs during REM).

……For such an eventual titration, I could suggest you take a look at this Resmed guide (this was amazingly useful for me to get proper pressures, after struggling with them in VAUTO for some 8 months): https://www.resmed.com/us/dam/documents ... er_eng.pdf

good luck

Thanks for all your help so far. I'm still (at Day 20) treading water in about the same spot I was a week ago - an hour or more cycling through Drift Off / Gasp Awake, followed (sometimes) by a few minutes of sleep. Rinse and repeat.

I visited the doctor last week and he changed the settings to a static 10cm, which worked horribly. It didn't improve the CAs I get every time I fall asleep and it added a new problem of not being able to keep my mouth closed (even tried mouth tape for 3 nights) and feeling like the air wants to get into my stomach and out my ears more than through my airway. After his office ignored my calls for a week I changed it myself back to a range of 7-12, which at least gets me back to where I was before.

Here's a couple of hours from last night - looks like I got a little sleep from 00:35-00:48 and maybe another 10-minute stretch after that. I've tried to wear it more during the day to keep getting used to it. Any other thoughts would be appreciated - do I just need to stick it out and give it more time or should I try adjusting something?

Hi,
_ yes, Pmin : 10cm is already not that easy to copy....aerophagia quite often comes in, like happened to me. Solution came moving to BPAP;

_ We would still need further observations on OSCAR new charts to better diagnostic on your case, nonetheless, at this point in time:

.....maybe you would want experience Full Face Masks or hybrid (this is so tailored.....however, anyway, to myself, after trying many types, in this order: nasal, FFM, pillows, back to different kinds of FFM and hybrid ones, finally getting at the FFM AirFit f20, likely forever...I needed Clonazepam to adapt at the beginning). Airfit f20 starts leaking too much on pressures > 12.4, in my case. Airfit f20 + soft collar had a plus for me: educated me to better-quality-not mouth-breathing;

.... this night chart and previous one suggests to me you go to detrimental flow restrictions (hypopneas likely)/arousals while moving to REM stages. Still did not see OSA as per your Lab study;

_ so, you could eventually try this for the moment, focus on running smoother through REM stages;

(a) experience FFM masks, if you are willing to;
(b) are you able to sleep on your sides, rather than backs ?;
b) try to use the soft collar, if not already;
(b) keep pressures as this last night, and change EPR to 2.0;

let us see what happens!

and, of course, other opinions are always wellcoming;

all the best and good luck

Thanks again mper!?

1. Full Face Mask - I have been thinking about trying this and may call the supplier tomorrow. I know I'm at least partially a mouth-breather and I sometimes wake up when my mouth pops open. I'd really like to make a nasal mask work, but maybe I'm trying to adjust too many habits at once.
2. Side sleeping - fortunately, this is one area I already do well. I have never been able to sleep on my back without snorting awake. My sleep study showed I only spent 30 seconds on my back, so probably just during a rotation to the other side.
3. Soft collar - I have one on order and will let you know how it goes.
4. EPR - I was initially at 3.0. I tried 1.0 for part of a night, but it was too much fighting to breathe out. I think you're right that 2.0 might be the right setting.

So far I've been using a nasal cushion and I find I have to adjust it quite often during the night to keep the seal. Last night I tried a nasal pillow and I found it comfortable enough and a lot easier to keep a seal. Late at night I was bothered by the whistling sound it made when I breathed but this morning I slept almost an hour straight with it on.
And then this afternoon I took a 20-minute nap with it on and it went much better than usual - hardly any fighting before I fell asleep: So, maybe I'll give the nasal pillow a try for a few nights before moving to a full-face mask.

_ hi,

_looks promising your mask experiences, then;

_good you already able on your sides; and less likely the detrimental tongue collapse;

_ on chin tucking (it may happens also while sleeping on your sides, by pushing soft tissues backward), please don’t underate the soft collar. Simple thing, but potential to make a great differential, as per my experience and many anedoctic cases;

_aiming better interpretations on your charts, I was wondering if you could also add TV, Inspiration Time, and MV. And, also, always put your full day-night chart (context may turn out to be very important for interpretations).

Nonetheless, for while, with some risks, maybe I could say:
…..15:20/15;24hs: you would have sleep under very high drive (sleep deprivation, I could suppose), and faced some minor flow restrictions (FL and ?quasi-hypopneas);
….5;05: you would have gone through a period of toss/turning/sleep/awake up to some 5;26…..slept sound, then (NREM, likely), and maybe had entering REM at 6;00, likely waked up at 6;07 and back started up problems for the remaing. Centrals appears to be false positive ones;

….. therefore, main drawbacks keep the same as previously suggested.

P.S: as usual, on APAP machines, you also have been facing problem with a respiration on exertion (that is, Expiratory/Inspiratory ration < = 1.0; it should be around 2.0, rather), as usually (always?) happens with APAP machines. However, we would may leave this apart for while, eventually. I am afraid I am negatively biased toward APAP machines. This anomalous E:I and eventual consequences? has been intriguing me for a quite long while. Your case is going to be one more for us to learn more on this.

All the best and good luck.

About the whistling with the pillows mask: if you got a fit pack, try the other sizes to see if any of them are better. And sometimes pulling the pillows away from your nose and then re-seating them will help. Also, do you see any moisture in the pillows in the morning? If so, maybe reduce humidity a notch or two.

I'm baffled why your doctor raised your pressure when your AHI is mostly due to CAs. At any rate, obstructive events seem to be well treated with pretty low pressures. If you're looking for yet another experiment, you could try max = min = 6 or 7 with EPR off. I have two reasons for making this suggestion. One is that for some people, pressure changes cause sleep to be shallow and interrupted. The other is that with EPR off, you might have CAs less frequently after your arousals. The arousals would still be a problem, but possibly less of a problem without the CAs. (It's hard to be sure, but it looks as though many of the CAs are followed by recovery/arousal breathing, which in turn sets off another CA, making for a lot of choppiness.)

Above all, keep in mind that it's still early days. This will get better.

Thanks Miss Emerita!

Pillows whistling - I switched from a medium to a large and the whistling went away.

Baffling doctor - yes, this is not the only thing I've been baffled by, which is why I have an appointment soon with a different doctor.

Another experiment - tonight I'll set it at 6 with EPR off and see how it goes.

Miss Emerita wrote: ↑

Mon Oct 05, 2020 9:52 am

Above all, keep in mind that it's still early days. This will get better.

I do try to keep this in mind - it's easier to remember it during the day than at 2:30am. I definitely had the wrong expectations going into this - I had asked a couple of acquaintances on CPAPs how long it took them and they either misremembered or were trying not to scare me. I was thinking it would take a few nights to get used to it. Here I am 3 weeks later with worse sleep than ever (and that's saying something!)

mper!? wrote: ↑

Mon Oct 05, 2020 6:46 am

_aiming better interpretations on your charts, I was wondering if you could also add TV, Inspiration Time, and MV. And, also, always put your full day-night chart (context may turn out to be very important for interpretations).

Here you go -

Hi, guys

"Another experiment - tonight I'll set it at 6 with EPR off and see how it goes".

_ seconding this. I like the idea start all over again, as if we were going through a Resmed guided titration (I painfully realized this after some two years changing pressures, yet with some target each moment. At the very beggining of this year started all over again, and, within some 15 days I had my tailored EPAPmin: 7.2, PS: 4.4, IPAPmax: 11.6 ). Then, if you are willing to, I would go for even lower CPAP mode ; Pmin = Pmax = 5.0; EPR off, kind of at-least-good-for-a-diagnostic style.https://www.resmed.com/epn/dam/document ... er_eng.pdf

_ what a context you have! I know, I know, sleep hygiene is a tough thing! However, would not you willing to try something, eventually? For me, rigorous sleep hygiene was very worth doing so. At the beggining, rigorous same time to bed - rigorous same time to get up. And, from since some three months ago, even better: rigorous same time to bed - whatever time to get up.

all the best

mper!? wrote: ↑

Mon Oct 05, 2020 10:57 am

_ what a context you have!

I should have noted that most of the day was just me trying to get used to wearing the mask (which is why I removed them in the earlier screenshot). I had it on while watching tv, etc. I am pretty consistent with a 10:30pm bedtime and 8am wake-up. I used to fall asleep really quickly - like, within 15 minutes. The CPAP has changed that. I generally do a 1-hour nap in the afternoon to (partially) compensate for lack of sleep at night.

I slept 2 hours last night with the mask on! This smashes my previous record of 20 minutes. Since we last spoke I tried a couple of nights at a static 6cm with 0 EPR, which didn't seem to help - so I switched it back to the range. I picked up a full-face mask (Resmed F20), which I've used the past 3 nights and quite like it. I'm trying to interpret the charts this morning - it looks like I woke up a bit at 1am and moved the mask enough to create a leak that lasted the rest of the session.

hi,

_Looks promising! Airfit f20 is my mask as well; very good, educated me to not mouth breath, brought me comfort. More comfort and sleep hygiene may move you to even larger chuncks and less interruptions, eventually;

_ and the collar? FFM works very well in combination with this tool;

_ looks interesting you were be able to sleep through the very high leaks and flagged flow limitations, without significant arousals/awakenings;

_ However, leaks are detremental at those levels. Are you confident your mask is fitting well? Tailored size? You always could tight it up a little more (not kidding; it worked for me. I would no trust on masks fit by themselves, with pressures from within);

We could try this interpretations, to begin with:
…likely ?sleeping till 00:200, then wake up, likely to respiratory effort at this time….then, bouncing on false centrals and false flow limitations during some 10 minutes, and drifting to sleep at some 00:20hrs, at the moment your pressures started to increase. Deep sleep til 1:00, likely moving into REM (much higher respiratory rate variability) or into disctint stage, you would have experienced muscle relax, your mask started shifting and leaking stronger; maybe on REM till some 1:17hs……you had been sleeping through leaks, otherwise you would have taken off the mask…….1:40 you moved, mask rearranjed on your face, cut off leaks for a little while……1:50 keep going in REM?, facing more FL, yet with no significant arousal/awakenings;

_ priority: it would be fix your leaks, maybe.

_please change your scales: MV, maximum 12….Leaks, maximum, say, 48…TV: 1,200….

All the best and good luck