ejbpesca wrote: ↑Wed Oct 05, 2022 10:36 am
Here we go. Now I'm taking meds to help sleep, as expected, OA's are up. 18.8 AHI today. I was on a campaign to stop meds, I lost, meds won.
Don't beat yourself up for needing meds to help your sleep and pain: You've got some real significant health issues and there's nothing wrong with needing some medication to help you get the rest you need.
I have no blinking anything that will give an indication of a power outage that could have caused the off/on of my machine.
Does this mean you don't own anything that blinks if the power goes out? Or does it mean that the things that blink when the power goes out are not blinking?
When our power goes out we have blinking things all over the house: The bedroom alarm clock (yes, we still use one), the clock on the stove, the clock on the microwave are all blinking and screaming at us RESET RESET RESET. I seem to be the only member of the house that ever bothers to reset them though.
Yes, there is a possibility that I could have removed the mask then put it back on while asleep. I have sleepwalked, so I could have sleep mask removed then put back on, with no recollection of doing so. Mask off = auto shut down, mask on = auto start.
Since you can't verify or rule out a power failure, it could be that the power failure woke you up and disturbed you enough to keep you from getting soundly back to sleep for 2 hours I suppose.
Please remark on the following:
Reading your questions, should I answer them in a reply or just ask them to myself and ponder the answer?
I raised Min Pressure to 5.6 I am tempted to take it on up to 6.5... More power Scotty.
Given your aerophagia, I'd be really reluctant to make a jump from min pressure = 5.6 to min pressure = 6.5. Particularly since you say this about the acid reflux today:
Waking: No detection of aerophagia, acid symptoms down but rising,
You also write:
My current concept of therapy: (please check for accuracy)
Min pressure is to maintain a steady flow to prevent apneas. If an event occurs during Min pressure, pressure will rise in attempt to prevent more events, but immediate rise in pressure does not jump up fast to stop an event in progress.
While the gist of this is more-or-less correct, there are some misconceptions that we need to clear up.
1) Your machine can and will raise the pressure even if it is detecting no apneas and no hypopneas. Most of the time a Resmed APAP raises the pressure when it detects flow limitations and snoring. These can be
precursors to the airway becoming blocked enough to cause a real hypopnea or a real obstructive apnea. So if the machine is not happy with the shape of your inhalations (i.e. it thinks there is a flow limitation), it will increase the pressure. Likewise, if the breathing pattern is characteristic of a snoring breathing. patter, the machine will assume you're snoring and raise the pressure.
2) The machine does
not raise the pressure during the middle of an OA in an effort to "stop the event". Even at maximum pressure, our machines can't force an obstructed airway to open up. The machine will likely raise the pressure
after the event is over, particularly if there have been two events in a short period of time or if the machine is detecting flow limited breathing patterns or snoring breathing patterns in the aftermath of the event. The idea is that the current pressure is not enough to keep the airway open and stable, but more pressure should help keep the airway open and stable. So by increasing the pressure, the machine hopes to prevent further events from happening. Once the machine is satisfied that your breathing has become steady, good quality sleep breathing and that your upper airway is now stable, the machine will start lowering the pressure back down until it detects flow limitations, snoring, or another event or two happens.
3) CPAP pressure is designed to make it
harder for the airway to collapse in the first place. That's how it prevents events from happening. You eventually want your minimum pressure to be high enough to do a decent job of preventing
most of your events. Ideally you also want little or no action in the Flow Limitation graph, and for most people that means setting the minimum pressure high enough to smooth out the flow limitations. But, and this is a BIG BUT, some people's airways react to higher pressures by becoming
less stable. In other words, for some people, additional pressure never really smooths out the Flow Limitations and the machine can keep on increasing the pressure unnecessarily. And those unnecessary pressure increases do not usually result in better AHI numbers. And sometimes the AHI goes up, even though the pressure is high, specifically because the airway has somehow become unstable as a result of the pressure and that has then triggered really raggedy breathing patterns that the machine interprets as hypopneas and apneas.
With more events pressure keeps rising until it hits Max setting. If Max is not high enough, events will continue to occur until, for some reason, events stop anyway. Is that correct?
Again the gist of this is more-or-less right, but it's more subtle than whether the the max pressure setting high enough allow the machine to keep increasing the pressure until the last of the events stop.
Some people really cannot tolerate high pressures. Pressures over 10cm can
sometimes trigger central apneas in some CPAPers. How many? I've seen estimates that maybe 15% of PAPers can have some problems with pressure-induced central apneas. For many of those affected, the problem more or less resolves itself after a while, but a few unlucky ones continue to have real problems with central apneas. Way back when (as in during the era of the Resmed S8 and PR M-Series machines), APAPs could not distinguish OAs from CAs, and the Resmed APAPs were programmed to
not increase the pressure for apneas occurring when the pressure got above 10cm specifically because there was a chance those apneas were centrals rather than obstructives. And increasing the pressure in the presence of central apneas can increase the breathing instability and increase the number of centrals that get scored.
As for why the events can just "stop anyway": If a string of
real events is triggered by REM sleep or supine sleep, the events will likely stop just as soon as the REM cycle is over or the person turns onto their side or their stomach. Sometimes a nasty cluster of events will just end because the person has finally aroused themselves enough to open the airway and as they go back to sleep, the airway simply remains stable. Sometimes the nasty cluster of events is
sleep-wake-junk breathing and the machine is scoring a lot of events that would not actually be scored on a real sleep test because you're not actually fully asleep when they happen, and the cluster of events ends when you finally get into a real, honest sleep state and your breathing simply settles down into a real, steady sleep breathing pattern instead of the ragged SWJ pattern that has some characteristics of wake breathing, some characteristics of sleep breathing, and lots of weird transitions between the two that can make the machine score things as "events" when they're not real.
So the goal is to have a Min pressure setting that prevents apnea all night but does not cause aerophagia.
You don't need the min pressure to be so high that it prevents
all the apneas from happening. You do need the minimum pressure to be high enough that the machine is not going to have to "chase" the events. By that I mean, you want the min pressure to be high enough that when events start to happen, the machine doesn't need to increase the pressure by 5 or 6 cm in 10 minutes in an effort to stabilize your airway and keep it open. By setting the min pressure a bit higher, you minimize the chance that a nasty cluster can get started. And you also make it easier for the machine to increase the pressure to an appropriate level to stabilize your airway if/when a small cluster of events occurs, and this can prevent a 3 or 4 event cluster from turning into a 20-30 event cluster.
Now factor in the aerophagia: You also need the minimum pressure to be low enough to not trigger the aerophagia. The more aerophagia you are dealing with, the worse your sleep becomes. The more restless you are because of the aerophagia, the more SWJ breathing creeps into your data. And the more likely you are to have breathing patterns that get (mis)-interpreted as flow limitations, which trigger pressure increases, which trigger more aerophagia and more arousals/mini-wakes and more SWJ breathing, all of which then has the potential to create a situation where a whole string of events gets scored that may not be real events.
So you've got to find a balance between aerophagia and the pressure needed to smooth out your flow limitation curve and prevent
most of your events from happening. That means finding the highest
Min Pressure setting your stomach can tolerate, particularly with the meds.
And finding the highest level you can set the
Min Pressure setting means
cautiously increasing your Min Pressure so that your stomach is not inundated with a significant pressure increase all at once.
So go slow. And accept that this is a process. Increase the Min Pressure in steps of 0.2 cm at a time instead of 1cm or more at a time. And after each increase in Min Pressure, leave the setting along for at least 3 days to see if the aerophagia really doesn't happen at that pressure. It if doesn't, then raise the pressure by 0.2 again and repeat.
That Min is now challenged by me resuming medications. Meds, I've taken for 30 years may be a major factor of OA events. I believe OA's are up due to meds resumed.
Why do you think the meds are increasing the OAs? If the meds were increasing the apnea in general, it seems to me we'd see a night-long increase in apneas rather than one bad cluster each night.
I think I could bump up that min to 8 as was the original one pressure setting from my first sleep test and bring AHI down. That may trigger aerophagia, maybe not. The culprit that causes the aerophagia may be the Max setting.
Yes, it could be the culprit that causes the aerophagia is the time you spend at pressures close above 10 or 11 or 12 cm. But you won't be able to tease that out if you keep switching both the Max and Min pressures at the same time. In order to figure out what's driving the aerophagia, you need to only change
one variable at a time.
And you have reported that you had bad aerophagia when you had the machine set at 6-11 and no aerophagia at 4-9 and 5-9.
So, yes, you might be able to bump the min pressure up to 8 without triggering the aerophagia. But why risk it?
I'll look at your sleep data later tonight.
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