More than two years with CPAP/APAP and no progress

For what it's worth, I didn't see any relevant possible side-effects for vortioxetine (Trintellix), but I did see both insomnia and drowsiness as possible side-effects of alimemazine (Theralen).

Also, I saw lots of cautions about checking for drug interactions, including interactions with supplements and over-the-counter drugs.

So you might talk with your doctor about reducing or stopping the Theralen, and you should try to make an office visit in which you bring a bag including the bottles for every drug or supplement you take.

Pugsy wrote: ↑

Wed Sep 07, 2022 11:54 am

Do you have much nasal congestion going on???

What did the adding in of the EPR to 3 cm do to the past FL graphs....any change one way or the other?

Did you notice any change when you weren't using the EPR?

Have you ever tried a fixed pressure setting and not used the auto adjusting mode?

No nasal congestion going on but a deviated nasal septum.

Adding EPR from 2 to 3 improved flow limits a bit but CA are more frequent.

I tried fix pressure at 10 EPR 1 and 2 but results are always inconsistent, whatever the pressure.
I had sometimes good result at around 7-16 EPR 2.
Without EPR a lot of flow limits.
At EPR 1 too but sleep can be ok.

In fact I tried many things but I cannot find any correlation between my CPAP setting and sleep quality.
It's like hazard.

Miss Emerita wrote: ↑

Wed Sep 07, 2022 12:03 pm

For what it's worth, I didn't see any relevant possible side-effects for vortioxetine (Trintellix), but I did see both insomnia and drowsiness as possible side-effects of alimemazine (Theralen).

Also, I saw lots of cautions about checking for drug interactions, including interactions with supplements and over-the-counter drugs.

So you might talk with your doctor about reducing or stopping the Theralen, and you should try to make an office visit in which you bring a bag including the bottles for every drug or supplement you take.

Yes i am going to try to stop supplements and theralen.

What do you think of this Oscar charts which is the best night I recorded this year (in March) with 3 hours of deep sleep (Apple Watch) versus 1 hour last night for example.
It was at 9 fixed with EPR 2.

Oops I cannot post a new picture here I don't know why, but it said AHI 2.6, 95% FL 0.09

I don't remember exactly why I changed later my settings.

otterley wrote: ↑

Wed Sep 07, 2022 12:49 pm

Oops I cannot post a new picture here I don't know why, but it said AHI 2.6, 95% FL 0.09

Probably because the forum attachment storage is full
See this
viewtopic/t183806/EVERYONE-PLEASE-READ- ... MENTS.html

either that or you image was too large and needs to be resized. There is a 1 MB limit to attachment's file size.

With the AHI of 2ish...and you report sleeping better that probably does mean less chance of the false positives inflating the AHI.
You slept better so less arousal/awakening segments of sleep that increase the chances of those false positives.

Pugsy wrote: ↑

Wed Sep 07, 2022 12:59 pm

otterley wrote: ↑

Wed Sep 07, 2022 12:49 pm

Oops I cannot post a new picture here I don't know why, but it said AHI 2.6, 95% FL 0.09

Probably because the forum attachment storage is full
See this
viewtopic/t183806/EVERYONE-PLEASE-READ- ... MENTS.html

either that or you image was too large and needs to be resized. There is a 1 MB limit to attachment's file size.

With the AHI of 2ish...and you report sleeping better that probably does mean less chance of the false positives inflating the AHI.
You slept better so less arousal/awakening segments of sleep that increase the chances of those false positives.

So indirectly you mean that AHI is not only an apnea index but also a kind of sleep quality index ?

I have never seen a flow rate so high. How is that even possible?

lynninnj wrote: ↑

Wed Sep 07, 2022 1:05 pm

I have never seen a flow rate so high. How is that even possible?

I compared with other days and you are right last night was unsual from this point of view.

But I cannot post a new image anymore here.

otterley wrote: ↑

Wed Sep 07, 2022 1:11 pm

lynninnj wrote: ↑

Wed Sep 07, 2022 1:05 pm

I have never seen a flow rate so high. How is that even possible?

I compared with other days and you are right last night was unsual from this point of view.

But I cannot post a new image anymore here.

Sleephq.com is your friend. I saw you figured out how to post and share it.

FYI I am a newbie that doesnt much know what they are looking at but I just thought that looked high compared to every other one I have looked at while trying to learn.

otterley wrote: ↑

Wed Sep 07, 2022 1:03 pm

So indirectly you mean that AHI is not only an apnea index but also a kind of sleep quality index ?

Well...yeah, sort of in a back door way.

Your AHI from last night on your first image above was in the 5 plus range and probably 90 % of it was arousal false positive.
I would wager that a night with AHI of 2 ish stands a good chance of having a similar ratio of arousal related false positive flagging. That would seemingly indicate better sleep quality...less flagged events...real or false positives....and you report feeling better.

Obviously there could be other factors and it's not something written in stone but we look more for patterns and trends in general than we look at one night's worth of numbers.

I have some sleep problems unrelated to my OSA which is well treated. Whatever AHI I might see is almost always about 75% arousal related and I have seen a few nights where the AHI is 95% false positive arousal related flags.

And you can still use Sleephq for image sharing and you can also use any other image sharing website.

https://postimg.cc/dhzs5SYf

Here you can check my best night of the year ...

And Sleephq is still in import state.

One thing I want to add and I noticed : You said (Pugsy) that my CA are probably false positive and junk sleep. But when I increase EPR, these CA are more numerous (and flow limits lower). So it seems to follow logic of usual CA either way as I red in cpaptalk discussions.

Anyway EPR or not my sleep is uncertain. But higher pressure with lower EPR means lower AHI overall.
Maybe that's a clue, and it follows Palerider last year recommandations.

Just I need to accommodate higher pressure ?

Damn it. My nice detailed reply got lost when the damn cat knocked my mouse off and it hit the floor and flew into pieces...and closed out my browser window when it did.

The short version may have to be sufficient....give me some time to get more coffee.

Pugsy wrote: ↑

Thu Sep 08, 2022 3:14 am

Damn it. My nice detailed reply got lost when the damn cat knocked my mouse off and it hit the floor and flew into pieces...and closed out my browser window when it did.

The short version may have to be sufficient....give me some time to get more coffee.

Sorry

Okay...let me try this again.

Flow limitations....they can be a sign that the airway is trying to collapse and they can potentially disrupt sleep...these are maybes. The auto adjusting algorithm will try to increase the pressure in an effort to reduce the number of FLs it is sensing.
Now sometimes FL increased activity could be coming from nasal issues like congestion and/or the deviated septum which is why I always ask the "is there any nasal congestion going on" because the machine won't know where the increased FL is coming from and if it is in the nasal cavity more pressure or really doing anything isn't going to help with the FLs that originate in the nasal cavity. FLs don't always have to be killed off or attacked and what we do about them really depends on if they are a problem or not...and if we do try to kill them off we have to be careful that the attacking we do just for FL reduction doesn't end up causing a bigger problem than the FLs are causing a problem. Sometimes the cure is worse than the disease kind of thing ends up being a not so great choice we have to make.

Adding EPR will sometimes help reduce FLs and sometimes it helps and we don't always have to compensate for the reduction during exhale with more baseline pressure either. It doesn't totally compute that something that normally needs more pressure to reduce will reduce by adding EPR without a pressure adjustment upwards. Sometimes adding in EPR causes the baseline pressure to reduce to the point that more OAs/hyponeas end up happening and when we see that then we know we also need to increase the baseline pressure.

Baseline pressure is either the minimum pressure setting when using auto adjusting mode or fixed pressure mode.

So there are 2 ways to try to reduce FL activity on the graphs and we are assuming that the FL activity is in the airway below the nasal cavity and not from the nasal cavity which more pressure won't deal with FLs originating in the nasal cavity.

Either adding in EPR with or without a baseline pressure adjustment will sometimes help reduce FLs.
Also simply increasing the baseline pressure can reduce the FL activity.
We often suggest adding in EPR because it also adds in a more comfortable exhaling situation especially when someone is starting to see pressures that are trending higher. More comfort will usually mean more sleep and sleep is our ultimate goal here. Without sleep none of this stuff really matters.

Now there are a few people that EPR ends up creating a problem with triggering central apneas in numbers where they are a problem. It's actually a very, very small percentage of people that will have this happen. When/if it does happen and we just HAVE to try to reduce the FL activity then we back off using EPR and simply go with more baseline pressure.

The bulk of the centrals I saw on the above Sleephq report when I zoomed in were obviously SWJ centrals but there may have been a handful of sleep onset centrals in there as well. There was at times some breathing that looked a bit waxing and waning which may or may not mean much.
Remember this is one night and we don't sleep the same every night.
In general we don't worry about awake/arousal related breathing stuff because we have to be asleep for it to matter.
Now when we see lots of episodes of arousal/awake breathing we do worry about the fact that the sleep quality is in the toilet but it's not the AHI that is the problem but instead it's just the wake ups or arousals that is the problem
People can have lots of arousal/awake breathing episodes and not have false positive flagging going on and they still have a problem with sleep quality.

So the junky sleep quality matters because it means fragmented sleep but it isn't the AHI that is the problem.
You can have AHI 0.0 but still have sleep quality that is totally in the toilet and you are still going to feel like total crap.

You had lots of segments of arousal/awake breathing without any flagging going on.
You had lots of segments of arousal/awake breathing with flagging of events going on...false positives so to speak.
A substantial number of those false positives were flagged as central apneas which is very common but you had some of the other categories thrown in there as well.

Did adding in EPR create some sort of breathing imbalance situation where you tended to have some unstable breathing which in turn caused you to have some centrals increase? I don't know because you weren't asleep for the bulk of the centrals shown and if you weren't asleep they don't matter except to highlight that fact of you weren't asleep.
Could just simply adding EPR cause you to not sleep so great???? I dunno but there's always a maybe when it comes to cpap therapy. Many people say they don't like EPR and sleep better without it. I don't think it would be impossible at all.
The same can be said of auto adjusting mode...some people do better with fixed mode.

I really don't worry so much about the AHI as I do how a person is sleeping and feeling.
I once had a day (many years ago) where I felt like superwoman...it was after a night with the AHI of 9.4.
Go figure that one. It was before we could evaluate flow rate stuff so I don't know what happened but I will tell you right now that if I had a choice of AHI 0.0 and feeling so so during the day or an AHI of 9.4 and feeling like superwoman...I would choose having AHI 9.4 every day of the week. I don't care so much about numbers....I care about how I sleep and feel.

Without decent solid sleep the best numbers in the world don't mean squat.

Do you need more baseline pressure? I dunno because I don't know what is causing your poor sleep quality but it might be a worthwhile experiment to try.

I once did such an experiment to see if anything changed. At the time I was using auto adjusting mode with a minimum of 10 cm and max of 20. I decided to increase the minimum to see if anything changed so I did a 0.5 cm increase once a week until I had worked up to 13 cm minimum. I kept the change for one week each so it took me 6 weeks to get to 13 cm.
After the week at 13 cm I sat back and evaluated my experiment both from the numbers and how I slept and felt.
Nothing changed...AHI never changed and ran in the low 2.0ish range....hours of sleep never changed...how I felt I slept never changed...how I felt during the day never changed either.
At that point I aborted the experiment since nothing really changed.