zonker therapy thread redux: in the arms of morpheus

[zonker]

Minimum EPAP is what you want to play with. Since the machine won't due halves....I suggest 0.6 more EPAP minimum.
Since you aren't having clusters every night you need to probably keep the setting change for at least a week. Give yourself a chance to have one of those random nights where the clusters happen.

okay, have increased min epap from 11.8 to 12.4. will see how it goes.

it COULD be a slight chin tuck as my collar is reaching the point of break down and i've got a backup to hand. not so sure about position. i LIKE to think i'm side sleeping only but have awakened supine once in awhile.

will start with the min and then start tracking my position. that is, if i wake up on my back, i'll turn the machine off and on.

thank you for the input. we'll see how she goes.

[zonker]

i know i can't get too excited about one night of data, but my cluster of obstructive events yielded a ahi of .91. so there's that.

was an odd night as we didn't get to bed until very late. had an emergency to take care of. still, it wasn't a bad sleep session, just adjusted to a later time.

will hold the course!

[Pugsy]

I don't want to rain on your parade but remember....you had a lot of nights without any clusters of significance before the minor setting change. We need a lot more nights at this new setting to get any idea that we killed the clusters or not.
Good job though.

Back when I first started therapy and had to deal with my own clusters it only took 0.5 cm increase to deal with them.
I was using a Respironics APAP back then so I only has 0.5 cm options. All we want to do is break them up anyway.

[zonker]

I don't want to rain on your parade but remember....you had a lot of nights without any clusters of significance before the minor setting change. We need a lot more nights at this new setting to get any idea that we killed the clusters or not.
Good job though.

killjoy!!


yeah, i get it. i'm basic my cautious optimism on the observation that it's in the same time frame.

not betting the house on it, just being a dewy eyed optimist for a change.

[zonker]

Since you aren't having clusters every night you need to probably keep the setting change for at least a week. Give yourself a chance to have one of those random nights where the clusters happen.

here be some oscar pics. would appreciate your take on them. slept fairly well, all in all. had a slight case of gas the first night from the increase in pressure, but i quickly adapted to that. the one "rough patch" was the ahi of 1.81 which just made me more tired than usual that morning, but it wore off in a few hours.

[zonker]

bump

[Pugsy]

Your witching hour is about the same as mine. Almost always if I am going to see a cluster of anything it's around the 90 minute mark.
I never could figure out the cause with any certainty. Most of the time now all I see is the uptake in the pressure and maybe an occasional flagged event during that time frame.

Up to you if you want to try a little more pressure minimum EPAP to break up those clusters that sometimes come and sometimes don't. Since you say you seem to notice even a slight increase in AHI in terms of how you feel the next day....worth trying a little bit more if you want to.
As we have talked about in the past I just don't ever feel any real difference in AHI numbers that are related to asleep flagged events. Now awake flagged events yeah...I can tell the difference but that's because I didn't sleep so great so I have a greater chance of awake flagged events showing up but it's the poor sleep quality I am feeling and not the events themselves.

Have you confirmed that those flagged events in the cluster are for sure asleep events?

[zonker]

Have you confirmed that those flagged events in the cluster are for sure asleep events?

please remind me of how i can go about confirming? i'm "sure" they are, but have no evidence of such.

meanwhile, i'm going to raise my min epap from 12.4 to 13. and i'll see what happens there.

thanks for taking a look at my charts!

[Pugsy]

please remind me of how i can go about confirming? i'm "sure" they are, but have no evidence of such.

You look at the flow rate/breathing immediately preceding the first flagging and decide if you were asleep or not right before the flagged event.

Asleep breathing is circled in red. Note that the breaths got irregular before the first flagged event.
These were NOT real asleep events

Same time segment but zoomed out a little further...all that mess after the end of the red circle....not asleep...SWJ or arousal related.



Now this one is a real asleep flagging of 2 OAs. Note the regular rhythm before and after....along with small gulp of air which is a recovery breath.

[zonker]

thank you. i will now go do some homework.

[zonker]

as i've never had a need to take a screenshot of a single event graph, i have no idea how to do so. so i took the full blown deal.

here they are-









my problem is, i can't see your example images side by side with mine, so it makes it hard for me to directly compare. am i right in saying these are NOT happening while i'm asleep?

[Pugsy]

You have zoomed in too close on the bottom one (and need a bit more breathing to the left of that first flagged event) and not zoomed in enough on the other 2....at least for evaluation purposes.

And the scale of the flow rate is a bit "off"...but I don't know how to explain why it looks off to me.

Actually looks more like a mixture....with the bulk appearing arousal related to me. Some aren't so easy to put your finger on what they are.
I am wondering if they are indeed arousal related but more from the normal arousal/awakening that we have at the end of REM. You probably don't remember it.

You can try a little more pressure and if that takes care of it and no more clusters then you probably have your answer.
If it doesn't take care of it then maybe do some more homework and learning how to tell the difference between asleep and awake breathing.

When evaluating breathing.....
Think of it this way....when your breathing before the flagged even starts looking squirrelly then you probably aren't fully asleep. We just don't breathe squirrelly that way while asleep.

[zonker]

When evaluating breathing.....
Think of it this way....when your breathing before the flagged even starts looking squirrelly then you probably aren't fully asleep. We just don't breathe squirrelly that way while asleep.

thanks for the feedback! like i said, set at min of 13. will see how the next week goes.

as one forum member has as their sig, who thought sleeping could be so complicated?

[zonker]

shouldn't have kicked the min up to 13. woke in the night with dry mouth again. both granny and pugsy spoke to this in my "thin line" thread-
viewtopic/t183961/a-thin-line-between-d ... =thin+line

specifically-

So, airflow over your oral tissues would not be the cause of dry mouth. Then, it could be pressure from the CPAP that is in the mouth. This pressure could easily prevent the flow of saliva from your salivary glands.

and

...I have read that just having the air enter the mouth from the back airway open door can suppress saliva production and cause a dry mouth even though the air can't exit the mouth via breathing.
I wish I save that document (thought I did but I can't find it) as I thought that could explain a lot of people's dry mouth complaints with no mouth breathing.

so, apparently bumping the min that high was enough to trigger dry mouth. and it being the wee hours when i discovered this, my brain wasn't fully engaged and i started dial wingin' and overcorrected to ALMOST rainout. <sigh>

instead of going from my customary 12.4 to 13, i'll have the min set to 12.6 and see how that goes. i'm still on the path of comfort over numbers now. yet i still want those numbers within reason. that is, i'd like to average an ahi of 1 or less.

anywho, just wanted to post this to keep myself straight on what i'm doing. will collect another week of data to see how it goes.

excelsior!

[zonker]

i'm getting frustrated with this whole process. it seems that i'm not making any headway towards sleeping comfortably. i believe it's time to stop treating my bilevel machine as though it's a souped up apap.

pugsy had made mention of this to me in an earlier post, but i can't seem to find it right now.

so i'm hoping that pugsy or others will come in to comment.

i want to start over. what should my settings be to help alleviate my sleep apnea?

thanks in advance.