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Oh...I forgot...the medications questions?

Do you take any meds of any kind? If so, what?

Pugsy wrote: ↑

Tue May 11, 2021 3:41 pm

Oh...I forgot...the medications questions?

Do you take any meds of any kind? If so, what?

Thanks for your previous, more lengthy comment. I need to spend some time going over it and digesting it before replying, but I hope to get to it within the next hour or two.

In the meantime, I can answer the meds question.

I don't take any prescription meds, but I do take supplements, which are:

Morning
Liquid Turmeric
Multi-vitamin
Glucosamine chondroitin
Magnesium
BioAstin
Calcium
Baby Aspirin

After dinner
Magnesium
Calcium
Glucosamine chondroitin

I don't know the dosage of each off the top of my head. I take whatever the dosage is recommended on the bottles. If needed, I can dig out the dosage amount if that helps. Let me know. Thanks!

No need to worry about the dosage of the supplements. None are known to suppress respiration I don't think and that's the one thing I was concerned about. Since you aren't on any heart meds I assume no heart or blood pressure kind of issues going on. I am just trying to rule out common other health issues and meds as a cause for the centrals.

The central apneas (if real asleep central apneas) are a bit of a concern at this point until we rule in or out how much awake breathing might be factoring in.
Plus even if asleep for sure...and having only the one hour long (approx) cluster of centrals that we can't explain away with something logical.....I have seen it before and even talked to a sleep tech about it and the answer was "we don't know why some people have this happen like this"..

I sometimes ask what seems to be irrelevant questions out of the blue but rest assured there is a method to my madness and I have my reasons and since typing out lengthy reasons causes me some rather annoying wrist pain and since my reasons often aren't understood...I wait until I have to explain the "why" I ask so many nosy questions.

Pugsy wrote: ↑

Tue May 11, 2021 4:45 pm

No need to worry about the dosage of the supplements. None are known to suppress respiration I don't think and that's the one thing I was concerned about. Since you aren't on any heart meds I assume no heart or blood pressure kind of issues going on. I am just trying to rule out common other health issues and meds as a cause for the centrals.

The central apneas (if real asleep central apneas) are a bit of a concern at this point until we rule in or out how much awake breathing might be factoring in.
Plus even if asleep for sure...and having only the one hour long (approx) cluster of centrals that we can't explain away with something logical.....I have seen it before and even talked to a sleep tech about it and the answer was "we don't know why some people have this happen like this"..

I sometimes ask what seems to be irrelevant questions out of the blue but rest assured there is a method to my madness and I have my reasons and since typing out lengthy reasons causes me some rather annoying wrist pain and since my reasons often aren't understood...I wait until I have to explain the "why" I ask so many nosy questions.

I have no problem with questions. I just really appreciate your digging into this!

Just an FYI that I've put together a response to your previous comment that I'll be posting shortly. Thanks!

Pugsy wrote: ↑

Tue May 11, 2021 3:40 pm

I was hoping that reducing EPR would help with the central (CA) apneas but doesn't look like it did. Darn.

It's definitely worth a shot and I appreciate that suggestion. A few months ago, I read about reducing EPR to help with CA, so I played around with it. Unfortunately, when sleeping on my back, reducing EPR didn't appear to have much of an effect, if any on the CA's. Because of this, I went back to EPR 3, since that's the most comfortable breathing setting for me. That said, it's certainly worth another look.

As a side note, when sleeping on my side, I have way less CA's than when I sleep on my back.

Pugsy wrote: ↑

Tue May 11, 2021 3:40 pm

What are the chances you were awake from 3:45 to roughly 4:45?

That's an excellent question that I wish I had a definitive answer to. Once I woke up at around 3:15am, I don't feel like I went to sleep again, but it's very possible I dozed off for short periods during that time.

That said, I have lots and lots of past nights with concentrated CA's that I'm pretty confident I was at some level of sleep and not awake.

One point of interest is that my concentrated CA's almost always come in my 2nd block of sleep. The 1st block is when I first go to sleep. It's usually pretty good sleep lasting around 4 hours. I then usually get up to relieve myself. My 2nd block usually last around 2 to 3 hours and is not a great sleep. The 2nd block is where I see the vast majority of my concentrated CA's, just like last night.

Pugsy wrote: ↑

Tue May 11, 2021 3:40 pm

I do not know what to make of the complaint of headache that started early in the night and last all night. Nothing showing at the beginning of the night that we could maybe blame the headache on. Now the 3:45 to 4:45 time frame is a maybe in terms of blame.

Since the headache started shortly after I connected to APAP and I was having breathing difficulties, my best guess is that the headache cause was related to the EPR of 0, but that's certainly just a guess.

Pugsy wrote: ↑

Tue May 11, 2021 3:40 pm

It does sound like you had a lot of time awake with the chipmunk cheek thing. What are the chances it might have been going on for that hour between 3:45 and 4:45?

I'm pretty confident that the chipmunk thing woke me up at 3:15. It's possible that it also occurred between 3:45 and 4:45. I was definitely experiencing air filling my mouth during the times I was awake and my best guess is that I was awake at that time.

Prior to taping my mouth, I had constant mouth leaks throughout the night, constantly waking me up. After taping my mouth, I would still get woken up by the chipmunk thing, but not as much as before I taped my mouth.

I very rarely get the chipmunk thing, or sleep arousal from air filling my mouth when I sleep on my side.

When I do a mix of side and back sleeping, if I'm on my back and I'm awoken by air filling my mouth, I just turn to my side and it goes away and I usually just go right back to sleep.

It seems the chipmunk thing is only a problem when I'm sleeping on my back. Probably more exact, it's when my head is facing up.

Pugsy wrote: ↑

Tue May 11, 2021 3:40 pm

What I am trying to figure out if those centrals flagged are real asleep centrals in which case there are a potential problem or if they are simply awake breathing irregularities getting flagged by mistake.

That's the tough question isn't it! I have lots and lots of nights with these concentrated CA's when sleeping on my back, in fact, almost every night that I sleep on my back.

I did have a Sleep Lab study done about a month ago. I slept on my back with my Bleep mask with only around 2 hours of actual sleep. Here's a pertinent snippet from the data summary:

"The patient slept in the supine position and had difficulty achieving persistent sleep due to central apneas or periods of breath holding at the onset of the study."

The following is from the Respiratory section of the Sleep Study:

"The patient experienced 10 apneas in total. Of these, 0 were identified as obstructive apneas, 0 were mixed apneas, and 10 were central apneas...The patient experienced 14 hypopneas in total...The overall apnea-hypopnea index (AHI) was 9.0 events/hr."

The report is consistent with my experience in that I have very few to no Obstructive Apneas, but lots of events that are flagged as CA's when sleeping on my back.

Pugsy wrote: ↑

Tue May 11, 2021 3:40 pm

Guess you need to take a crash course in flow rate evaluation.
Watch the videos here with special attention to the bottom one.
http://freecpapadvice.com/sleepyhead-free-software

Thanks for the advice and link. I hope to check this out later today.

Pugsy wrote: ↑

Tue May 11, 2021 3:40 pm

If the bulk of the central flags are real asleep centrals then you need to be having a chat with your doctor.

About a month ago after I did the Sleep Lab study, I did have what was supposed to be a follow-up talk with my doctor about this possible CA problem via a TeleMedicine meeting, but he didn't appear to have the Sleep Lab Report with him when I spoke with him, nor did he seem to be aware of it. He basically hemmed and hawed when I asked about the CA problem. He said he'd look into it and would try to have an answer in a month.

I only have the Sleep Lab report because I later called his office and asked for it. The report does not read anything like what he was telling me during the TeleMedicine meeting.

This is why I'm trying to get to the bottom of my problem with outside help, such as yourself and this great forum. I'm currently looking into another doctor.

Pugsy wrote: ↑

Tue May 11, 2021 3:40 pm

But if they are a symptom of poor sleep quality and most are awake breathing related then we need to figure out what is causing the awakenings and try to reduce that from happening.

That would be great!

Pugsy wrote: ↑

Tue May 11, 2021 3:40 pm

In terms of OSA and back sleeping though....in your case it doesn't appear to markedly make it worse or make you need more minimum pressure or anything like that. That's what I wanted to see...the worse case scenario and your OA/hyponea count didn't seem to be worse for it.
Sleep in whatever position you want to sleep in. In your situation I don't see it really being a problem in terms of worsening your OSA.
While it is common for some people...not everyone will have a much worse OSA problem when supine. Mine isn't...but REM sure is.

I seem to have very few to no Obstructive Apnea no matter if I sleep on my back or side. My sleep is by far better sleeping on my side (much fewer CA's), but side sleeping causes body aches and pains for me. That's why I'd like to be able to sleep on my back. That said, if back sleeping causes greater sleep problems, then I need to just suck it up and sleep on my side. I hope not though!

Pugsy wrote: ↑

Tue May 11, 2021 3:40 pm

Do you happen to have one of those overnight recording pulse oximeters to see what your oxygen levels might be doing during the night?

Unfortunately, no. Would it be useful for me to get one? If so, I will.

Pugsy wrote: ↑

Tue May 11, 2021 3:40 pm

If the starting pressure of 6 feels too stifling...consider maybe trying 7 cm just from a comfort and air moving aspect...or add back in EPR but use it during ramp period .....at least until a few more nights with EPR being off gets documented.
I was hoping we could blame the centrals on EPR and could reduce them that way but it doesn't look like that's your culprit and after maybe a week with no EPR but still seeing these centrals in high numbers....I see no harm in adding EPR back in because it doesn't look like EPR was the cause of the centrals.

6 feels just right when I set EPR at 3. For tonight, I'll turn the ramp back on with EPR 3 for the ramp time only. EPR will otherwise be off.

Pugsy wrote: ↑

Tue May 11, 2021 3:40 pm

Next time/tonight....when you find yourself awake because of chipmunk cheeks or anything...reach over and push the on/off button. This will give a break in therapy line that is easily seen and we can know for sure that you were awake at that time and can disregard any events that might be flagged around that break in therapy time frame.

Great advice. Will do. This is what I happened to do at 3:17 last night as seen in the Oscar data. I'm guessing the 2 Hypopneas seen at around 3:14 and 3:15 are the 2 Chipmunk events that woke me up. Anyway, I'll try to make sure and push the on/off button the next time I'm awake and experience the Chipmunk thing.

Thanks VERY much Pugsy for all your help! I really appreciate it!

So you had a few centrals during an in lab sleep study and your were using the Bleep? Do I understand that correctly?

You didn't sleep much though...is that correct? 2 hours of sleep???

Hyponeas but no full grown OAs...hyponeas are just OAs that haven't quite met criteria to earn the OA flag but enough to earn a diagnosis of OSA if you have enough of them and 9 per hour is enough.

OA...reduction in air flow that amounts to 80 to 100 percent reduction that lasts at least 10 seconds.
Hyponea....reduction in air flow that amounts from 40 to 79 % that last for at least 10 seconds. If you hit 80% you earn the OA flag.
In reality there's not a lot of difference between a 70% reduction and an 80% reduction other than the label. So hyponeas are very important and not to be pooh poohed off.

If supine sleeping had caused worsening OSA for you....we would expect more hyponeas to be flagged but that didn't seem to happen.
Now could more minor air flow reductions associated with air flow reduction while supine (and don't meet criteria for hyponea either) actually be a disturbing factor to your sleep quality....very possible. So it wouldn't be impossible for the airway to be compromised enough to impact sleep and yet not meet criteria for some sort of apnea/hyponea flag. Sometimes very minor appearing stuff can make a bigger impact on sleep quality than we might think.
And for some reason chipmunk cheeks happen more when you are supine. This actually doesn't surprise me.
Chipmunk cheeks happen when air goes up the nose and tries to exit the airway prematurely though the oral cavity instead of proceeding down the airway where we want it to go (behind and below the oral cavity). Lips are closed or taped in your situation and that air entering the mouth with lips closed causes the cheeks to inflate which eventually disturbs sleep because it is difficult to equalize the pressure with the tape on.

Supine position is more likely to open the back door and let the air try to enter the mouth for some reason....chipmunk cheeks happen.
Need to keep that back door closed but that's easier said than done. I know it's weird but I have learned to keep the back door closed no matter what I do but it's a reflex action and I can't explain how I do it. Sure wish I could. I can open my mouth and stick out my tongue (with mask and machine on) and not have any air enter my mouth to try to exit. I can even talk without air entering my mouth.
Took me about 6 months of cpap therapy to realize this could be done.

FWIW...remember the sleep tech I told you about who said that sometimes we just see a cluster of real asleep centrals in some people maybe once during a night.....almost always in the latter part of the night when it happens. We don't know why.

An overnight pulse oximeter that records through the night would tell us if when you have those centrals (assuming real asleep) if they actually caused a drop in O2 levels or not. Not sure if it is that critical at this point. Let's first try to figure out if you were really asleep or not before worrying about getting one of those devices.

There is one experiment I would also like to see the results of...sleeping on your side with EPR off (or in ramp only) in hopes to remove chipmunk cheeks from the equation and see what the centrals do if we can get a decent block of sound sleep.
I understand the discomfort associated with side sleeping. I deal with that myself but in my case the aches and pains it causes with my shoulders is still less than the back pain I get when I sleep on my back....but I know it hurts.
This experiment is just to see what happens in terms of sleep quality and what it looks like with EPR off...see if you still get a central cluster.

At some point another chat with the doctor might be needed (after making sure he has all the pertinent records this time) and you can tell him the various experiments you have made in an effort to figure out the centrals...but if you had centrals in a sleep lab...you were asleep or they wouldn't have bothered mentioning them. They don't count awake false positives in the AHI or events recorded.

barney999 wrote: ↑

Tue May 11, 2021 6:52 pm

My sleep is by far better sleeping on my side (much fewer CA's), but side sleeping causes body aches and pains for me. That's why I'd like to be able to sleep on my back. That said, if back sleeping causes greater sleep problems, then I need to just suck it up and sleep on my side. I hope not though!

Might a body pillow provide enough support for you to side sleep comfortably?

https://nymag.com/strategist/article/be ... llows.html

These look massive but comfy.

There is also the expensive MedCline ($250) with "Patented Arm Pocket" which is actually 3 pieces.

Pugsy wrote: ↑

Tue May 11, 2021 7:29 pm

So you had a few centrals during an in lab sleep study and your were using the Bleep? Do I understand that correctly?

That's correct.

As a side note, the sleep techs had never seen Bleep. I kinda raved about the fact that it doesn't leak, and they seem pretty interested. I think they were even more interested after the study when they saw for themselves that, in fact, it didn't leak.

Pugsy wrote: ↑

Tue May 11, 2021 7:29 pm

You didn't sleep much though...is that correct? 2 hours of sleep???

That's correct. I believe I tried to sleep starting at around 10pm. I just laid awake on my back not moving until around 12:30am, when I apparently fell asleep until around 2:30. I was then awake until 3:30, when they came in and told me they had enough data for me to go home.

Pugsy wrote: ↑

Tue May 11, 2021 7:29 pm

There is one experiment I would also like to see the results of...sleeping on your side with EPR off (or in ramp only) in hopes to remove chipmunk cheeks from the equation and see what the centrals do if we can get a decent block of sound sleep...
This experiment is just to see what happens in terms of sleep quality and what it looks like with EPR off...see if you still get a central cluster.

I can do that tonight with the EPR off. My guess is I'll get a better night sleep than sleeping on my back, even without EPR. Right now, I'll take a better night's sleep, even at the expense of some aches and pains.

Are you interested in seeing my Oscar data from the last 2 nights that I slept on my side (note: I just edited this. I originally mistakenly wrote "back"), which were a couple of nights ago? The settings were 6-20 with EPR 3. The OSCAR data is really good with very few CA's. Both nights had AHI's under 1. They might be my best AHI's for two consecutive nights.

GrumpyHere wrote: ↑

Tue May 11, 2021 9:16 pm

There is also the expensive MedCline ($250) with "Patented Arm Pocket" which is actually 3 pieces.

Hey GrumpyHere. Thanks for this and the body pillow info! I'll check them out. Sometimes the best answer is the simplest one!

Yes, I would like to see a nice low AHI night.
Proves it can be done and makes us wonder what changed with the not so nice AHI nights.

When you get time take that crash course in figuring out awake/arousal flagged centrals vs asleep centrals.

Last night I slept on my back again, with EPR off except for auto ramp EPR 3.

I had an AHI of 1.69, which looks good, however, the reality is that my overall sleep quality was pretty bad, for a couple of reasons.

1) I had difficulty breathing without EPR. I don't like this feeling at all. When I was awake during the night, I had headaches that I think were caused by this difficulty in breathing.
2) My sleep was very disrupted. I slept in 2 main blocks of around 2+ hours each. Block one was from around midnight to 2:20. And then again, not until around 6:20 until around 8:35.
3) In between my sleeping blocks, I was awake for around 4 hours from around 2:20 until around 6:20. I was trying to sleep most of this entire time, but I was constantly disrupted by air filling my mouth. As advised, I hit on/off on my APAP machine to mark the times of the air/chipmunk disruptions. Also no EPR really added difficulty to breathing which didn't help when trying to go to sleep.

After 4 hours of trying to sleep from 2:20 until 6:20, I couldn't take it anymore trying to sleep on my back, so I moved to a side sleep position. I still left EPR off, except for auto ramp EPR 3. I feel like I fell asleep right away on my side and slept for 2+ hours of I believe quality sleep from around 6:20 until around 8:35.

I woke up headachy, kind of dizzy and foggy, and not well-rested. But at least my AHI looks good!

I only have around 7 months of APAP experience, but I really wonder if sleeping on my back is not realistic for me, even with APAP. I can't seem to prevent the air/chipmunk thing and/or clusters of what look like CA's, despite trying numerous things over the months.

That said, I'm still willing to try things while sleeping on my back. I'm also willing to try things while sleeping on my side if that would provide clues to help allow me to sleep on my back.

I'll be checking out the recommended videos later today.

Anyway, here's the OSCAR data from last night. Surprisingly, there were relatively few CA's flagged, most occurring when I was awake. There were no CA's flagged in my 1st block of sleep on my back and only 2 CA's flagged in my 2nd block of sleep while sleeping on my side. That's pretty unusual when I sleep on my back, but not when I sleep on my side.

Just thinking out loud...

I've had 2 sleep studies in the last 7 months. The first was a home study, the last almost a month ago was in a sleep lab. Both were done while sleeping on my back.

After months of trying different things with APAP, I can't seem to get quality sleep while sleeping on my back.

However, I get relatively good quality sleep of at least 4 hours while sleeping on my side with APAP, with my last 2 sessions of sleeping on my side showing AHI's under 1.

Before APAP, I generally would sleep 4 hours, get up to relieve myself, then pretty much go right back to sleep for another 3 hours or so. I very rarely would ever be awoken by snoring or any kind of breathing problem. Basically, my sleep was not disrupted except for getting up to relieve myself. That said, I was feeling fairly bad when I woke up for a few months. That's why I did the initial home sleep study which showed severe sleep apnea. I think the score was 31.

Since APAP over the past 7 months, I feel like I get a good 4 hours of sleep when I first go to sleep, then afterwards it's a real crap shoot. I have difficulty going back to sleep and even if I get 2 or 3 hours more sleep, it doesn't feel like its restful sleep. I'm basically disrupted every night by things I believe are related to APAP, but often I just don't know why I woke up. This did not happen before APAP. I guess the positive is that even if I wake up in the morning with some combo of dizzy, headachy, foggy, tired, and/or not rested, there's still a part of me that feels better than before APAP. I believe its related to my energy level, which seems better than before APAP.

Another positive thing about APAP all these months is that I feel like I breathe much better in general that I did before APAP.

Anyway, I was never tested for sleep apnea while sleeping on my side, so I'm now wondering if I even need APAP if I sleep on my side. My guess is that I would have much less sleep disruption. However, and its a big however, what I don't know is how I would feel upon waking up. If I felt good on waking up, why even use APAP.

So, I'm just thinking about it at this point in time, but I'm now thinking more about it, likely because of my frustration trying to get good sleep while sleeping on my back.

Here's something else to think about.
If the back sleeping is preferred but you are having poor sleep quality because of the chipmunk cheeks thing mainly...how about not taping the mouth and see just how bad leaks or sleep is if the thing causing the chipmunk cheeks isn't there?

There may be a little leak or maybe a lot of leak but much better sleep quality?????

I don't tape my mouth. I know I sometimes do some mouth breathing but it is never prolonged and rarely deep into large leak territory but more importantly it doesn't cause me wake ups. I could tape and get real pretty leak graphs but I know that the taping would very likely be a disturbing factor to my sleep quality (I have taped in the past). So I choose sleep quality over perfect leak graphs. I got enough stuff (like back pain) causing sleep quality problems so I just don't want more stuff waking me up unless I just have to.

Pugsy wrote: ↑

Wed May 12, 2021 4:59 pm

Here's something else to think about.
If the back sleeping is preferred but you are having poor sleep quality because of the chipmunk cheeks thing mainly...how about not taping the mouth and see just how bad leaks or sleep is if the thing causing the chipmunk cheeks isn't there?

There may be a little leak or maybe a lot of leak but much better sleep quality?????

I don't tape my mouth. I know I sometimes do some mouth breathing but it is never prolonged and rarely deep into large leak territory but more importantly it doesn't cause me wake ups. I could tape and get real pretty leak graphs but I know that the taping would very likely be a disturbing factor to my sleep quality (I have taped in the past). So I choose sleep quality over perfect leak graphs. I got enough stuff (like back pain) causing sleep quality problems so I just don't want more stuff waking me up unless I just have to.

Thanks for sharing and the suggestion. Sorry to hear about the back pain problem. I'm sure that makes sleeping well very challenging.

My main issues with back sleeping are the air in the mouth/chipmunk thing, but also the high number of clustered possible CA's.

Anyway, related to the air in the mouth issue, when I first started APAP, I didn't know about either mask nor mouth leaks. I quickly learned the hard way as I experienced both.

I was able to somewhat correct the DreamWear Nasal mask leaks, but the mouth leaks continued. Basically, every night I was being awoken thru the night with air escaping out of my mouth.

Since my mask was a nasal mask, I decided to try a full face mask which I thought would handle the escaping air out of my mouth. It didn't work at all. I couldn't get the mask not to leak, so it was constantly waking me up. Additionally, my mouth was extremely dry after the full face mask. I think my worst nights of sleep on APAP were when I used the full face mask. Maybe it's possible a full face mask would work somehow, but I couldn't get it to work for me. The full face mask I used is the Phillips DreamWear Full Face mask.

I continued to look for solutions. I think I learned from various sources, but I learned the most from Jason's (LankyLefty) videos. It seemed my options were the chin strap, mouth guard, and/or tape. To me, it seemed taping was the best solution, so that's what I tried and still do today. I think taping does a great job of keeping air in with no mouth leaks. Also, over time, the air in the mouth events started lessening, especially when I started mixing side sleeping with the back sleeping for some reason.

I used to re-use the tape over multiple nights, but after the third night or so, air would start leaking out of the side of the tape, so I don't re-use tape anymore. It's now a one time use only.

Just based on my past experience of not taping over a period of a couple of months, I can't imagine not taping would not cause lots of mouth leaks that would wake me up. But, maybe it's worth another try. If I get mouth leaks that wake me up, I can just put on the tape.

All the above applied to sleeping on my back.

During the time I was working on the air in the mouth leaks, I was also trying to find a way to stop the nasal mask leaks. A few months ago, I discovered and soon thereafter started using Bleep, which corrected my mask leaks. A very big improvement!

After a couple of weeks of using Bleep while sleeping exclusively on my back, I experimented and discovered that I could sleep on my side without mask leaks, which I couldn't do with a nasal mask, so I started to incorporate side sleep into my night's sleep. What I found is that when sleeping on my side, I don't get air filling my mouth so no chipmunk cheeks and no sleep disturbance from air in the mouth. That was a HUGE improvement that I wouldn't have discovered without Bleep!

Anyway, your suggestion of not taping, which I appreciate, is actually what I've been thinking about, but only for my side sleeping and not back sleeping. I actually think I might not need tape for side sleeping. I'll likely try that within the next few nights. First though, I'd like to get in a pretty good night's sleep before I give it a try on the following night. At some point, I'll also try your suggestion of no taping while supine sleeping.

Thanks for your continued help!