ejbpesca wrote: ↑Sat Oct 15, 2022 8:18 am
I have an adjustable bed. I raise the head section to replicate having the entire bed on an incline, as prescribed for acid reflux, when my spine will tolerate it.
How often are you able to raise the head section of your bed?
I sleep mostly on my left side. At times I will wake to find myself on my back. Lately I have placed pillows to my back hoping to prevent a roll to my back while sleeping.
Is the acid reflux and/or aerophagia better when you manage to stay on your left side?
I see the pressure is on the move all night. My machine is reaching the end of its service life. I wonder if the APAP is working okay.
The pressure is "on the move all night" because that's what Resmed APAPs do: They are constantly increasing/decreasing the pressure based on an algorithm.
Pressure goes
up when the machine detects flow limitations and snores. The machine also goes up after the machine detects obstructive events that are close together. Note, however, that it
waits until after the event is over before increasing the pressure: Even at maximum pressure, a PAP machine can't force your collapsed airway to open; so it waits until your body responds, arouses, and opens the airway. Then the machine increases the pressure in an effort to make it more difficult for the airway to collapse again. And the machine keeps
increasing the pressure until the machine thinks the flow limitations have been smoothed out, the snoring has stopped, there are no obstructive events being detected, and the machine is certain that your breathing has stabilized into nice regular sleep breathing OR the max pressure setting is reached. Then the machine is programmed to start
decreasing the pressure until either the minimum pressure is reached or more flow limitations, more snoring, or more obstructive events are detected and the next pressure increase starts.
It's important to note that Resmed's Auto algorithm is pretty aggressive in terms of responding to flow limitations, snoring, and events. In other words, once a Resmed Auto decides to increase the pressure, it can increase the pressure by quite a bit over a fairly short period of time. That's why the front (increasing) sides of "waves" in the pressure curve are so steep.
And while the Resmed Auto algorithm is aggressive in its pressure increases, it's also important to note that just as soon as the machine is "happy" with your breathing, it immediately starts to reduce the pressure. That's what causes the characteristic sharp "peaks" in the pressure curve graph for a Resmed Auto.
Finally, it's also worth noting that the Resmed Auto algorithm is much slower (and more cautious) about lowering the pressure than it is about increasing the pressure. That's why the back sides of the "waves" in the pressure curve are so much more "gentle" than the front sides are.
In other words, there's nothing fishy about how your pressure curve looks given that you are using a Resmed APAP.
Breathing through the APAP mask is easier with the EPR set to 3. I cannot tell if the 3 setting is negatively effecting the therapy.
It will take several days of using EPR = 3 to tell whether there is any serious effect on your therapy.
But if the data you posted at
https://sleephq.com/public/2a3ea170-359 ... a9223aacd7 turns out to be typical, then I'd say EPR is not really affecting your therapy all that much.
Yes, there is one cluster of events that starts around 2:50 AM (EDT since I'm in Buffalo, NY) that has 6 OAs scored in a 6-7 minute period. It would be really useful if someone like Rubicon or Pugsy looked at those OAs. To my eyes, it's not clear whether there was an arousal before the cluster started. It is clear that just before the cluster starts, your pressure was at 8.3cm. And it's clear that the machine increases the pressure from 8.3 to 11cm in a 1-minute long period between 2:50 and 2:51 EDT. The pressure increase is in response to the first two apneas being scored along with a flow limitation being scored. But the machine can't go any higher in response to the 3rd, 4th, 5th, and 6th OAs nor the continuing flow limitations that occur between 2:51 and 2:57 EDT.
Regular sleep breathing is established by around 2:57 EDT and continues 3:22:30 EDT. During this time the machine goes through a long pressure decrease specifically because there is nothing to "respond" to and your minimum pressure setting of 7.6 is not reached.
I don't think EPR = 3 is connected to that one cluster of events.
Aerophagia is not detectable upon waking on 10/15.
Not rested, fatigued.
No aerophagia is good. But waking up not rested and feeling fatigued is not good.
How many days have you been using a pressure range of 7.6--11? And was this the first night with EPR = 3?
Have you woken up feeling rested or not fatigued on any day that you've used 7.6--11?
Finally, your
median pressure for this night is about 8.6. In the long run, you might need to increase your min pressure up to something in the 8.4-8.8 range, as well as bumping your max pressure up to something in the 11.4--11.6 range. But it's important to change only
one variable at a time when you're trying to figure out what does and what does not trigger the aerophagia.
My advice would be to use the
current settings (Min = 7.6, Max = 11, EPR =3) for at least a couple more nights. And then post three days worth of data at the same settings so we can figure out what to recommend as the next step.