HELP needed for 13-yr CPAP user!

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
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JoyD.
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Re: HELP needed for 13-yr CPAP user!

Post by JoyD. » Thu Nov 17, 2022 8:12 am

PUGSY WROTE:
Are you experiencing any nasal congestion????
No, my nose has been clear. (I do use Flonase at bedtime if I don't have free flow of air through my nose.)

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Re: HELP needed for 13-yr CPAP user!

Post by Pugsy » Thu Nov 17, 2022 8:30 am

So....it's unlikely we can blame nasal congestion for the increase FL activity since you aren't complaining of any nasal congestion.

While your FL graph is a bit "active" we don't know how or even "if" those FLs are impacting your sleep quality and thus impacting how you feel during the day. Your FL graph isn't horribly horrible...below is a screen shot of a really horrible FL graph. Yours could be a lot worse. :lol:

The potty breaks....do you have to go pee often during the day as well??? Trying to tease out a reason as to why so many potty breaks other than "I am awake I might as well go pee"...reason.
JoyD. wrote:
Thu Nov 17, 2022 7:55 am
2. Once I've settled on a Minimum pressure . . . changing the EPR Level to 3 from present 2. I'm wondering if that reduce my FLs further? (I don't want the EPAP too low as to miss treating apneas).
How does that sound??
I would actually try increasing EPR to 3 as the next experiment to try. See if it impacts the FL graph and/or sleep quality and if things don't change THEN start increasing that minimum setting by 0.2 increments and see if anything changes.
Give current settings a few more nights though...it's okay to take things more slowly. I know it's sometimes hard to do but there is a lot of truth to the old adage "give it time".

Now if you were telling us that you were sleeping solidly all night and feeling great during the day I would say don't worry so much about the FL graph. But you aren't saying that and your software reports aren't telling us that either. Are those FLs a culprit???? Maybe but maybe not and it's worth at least looking at trying to kill more of them off.....just in case they are a factor in overall sleep quality.

As for not feeling so great yesterday...being tired...simply not enough good solid sleep would be my best guess. Doesn't surprise me with the number of known wake ups we see.

Ugly FL graph example
Image
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Re: HELP needed for 13-yr CPAP user!

Post by robysue1 » Thu Nov 17, 2022 8:41 am

JoyD. wrote:
Thu Nov 17, 2022 7:55 am
Well, AHI went up a bit, but for NOW I'll take anything under 5.
Most of the increase in your AHI was due to CAs, but the number of CAs is not something to worry about, particularly since you say that you were not asleep for much of the time you were using the machine. It's worth remembering that more pressure isn't going to eliminate CAs, and particularly CAs that are part of sleep-wake-junk (SWJ) breathing.

As I Zoom on my Flow Rate, looking at each breath I am still concerned at ALL THE FLOW LIMITATIONS throughout the night.
Any suggestions here??
The obstructive stuff, including the flow limitations, is about the same on the night when you have an AHI = 1.58 and the night when you have an AHI = 3.97. In my opinion, the question about what to do about the flow limitations is made much more difficult by the amount of SWJ due to you not being asleep for a long time. If many of those "flow limitations" are happening when you are awake, it's probably a wake breathing pattern. Hence Pugsy's question about nasal congestion.

Yesterday I was very tired (no doubt I got inadequate sleep because last night's "usage rate" of 8.5 hours" was probably only 4-5 hours AT BEST of actual sleep since I lay in bed a considerable length of time before falling asleep with each wake up. So . . . LAST night I went to bed early at 7:35pm and got up at 6:46am (11 hrs, 11 min), hopefully getting 8-9 hours sleep. (I was so tired, I seem to remember upon awakening, each time, that I didn't lie awake in bed for a long time waiting to sleep last night.)
In my opinion, at least part of your problem is that you are trying too hard to stay in bed in the hope of getting some sleep. If you only got 4 or 5 hours of sleep while you were in bed for 8.5 hours, that's a sleep efficiency of no more than 58%. Likewise, if you only got 8 or 9 hours of sleep while you were in bed for 11.18 hours, that's a sleep efficiency of no more than 80%. Most people feel better when their sleep efficiency is consistently up around 90% or better because lying in bed not sleeping for long periods of time is, itself, stressful and can make you feel pretty crappy in the morning.

Good questions for you to be asking when you're scrolling through the flow rate data are:
  • Are a lot of events, including the OAs and Hs, being flagged during times you are pretty sure you were awake? Or dozing very lightly? If so, those events are not likely "real".
  • Is there a lot of activity in the flow limitation graph (and funky looking inspirations) during the times you think you were awake? If so, those flow limitations are not likely part of sleep disordered breathing.
  • Are you overestimating or underestimating how much sleep you got? In other words, look for long stretches of what you're pretty sure is sleep breathing and try to figure out if your sleep efficiency really is in the 50-60% range on a lot of nights.
As for how to get that sleep efficiency higher, that's a good question. The usual suggestions are:
  • Go to bed only when you are actually sleepy, as opposed to just tired
  • Don't lie in bed for more than 15-20 minutes if you can't get to sleep. Go ahead and get up and do something quiet and relaxing rather than continuing to lie in bed fighting to get to sleep.
Good luck!

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Re: HELP needed for 13-yr CPAP user!

Post by JoyD. » Thu Nov 17, 2022 9:36 am

PUGSY WROTE:
The potty breaks....do you have to go pee often during the day as well??? Trying to tease out a reason as to why so many potty breaks other than "I am awake I might as well go pee"...reason.
YES, I have had a "frequency" problem for many years. I think it's gotten worse as a "Senior" (over twice a night, mostly 3-4x).
I would actually try increasing EPR to 3 as the next experiment to try. See if it impacts the FL graph and/or sleep quality and if things don't change THEN start increasing that minimum setting by 0.2 increments and see if anything changes.
Give current settings a few more nights though.
Will do.
Are those FLs a culprit???? Maybe but maybe not and it's worth at least looking at trying to kill more of them off.....just in case they are a factor in overall sleep quality.
I agree!
As for not feeling so great yesterday...being tired...simply not enough good solid sleep would be my best guess. Doesn't surprise me with the number of known wake ups we see.
Well, I can't do anything with my "frequency problem" . . . but I CAN stay in bed longer to at least get more hours of "real sleep" (even if it is interrupted). It did feel good to get back in bed, and, as I said before: last night I remembered falling asleep more quickly each time (rather than lying in bed awake for a long period).

~ Thanks for your input, Pugsy.

JoyD.

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Re: HELP needed for 13-yr CPAP user!

Post by JoyD. » Thu Nov 17, 2022 10:45 am

ROBYSUE1 WROTE:
Most of the increase in your AHI was due to CAs, but the number of CAs is not something to worry about, particularly since you say that you were not asleep for much of the time you were using the machine. It's worth remembering that more pressure isn't going to eliminate CAs, and particularly CAs that are part of sleep-wake-junk (SWJ) breathing.
Yes, I know that raising the pressure will not address the CAs since there is already an open airway. It actually was the night of the 16th that I was not asleep a lot of the time. Last night, the 16th, I believe that I did NOT lie awake for long. -- I also know not to worry about CAs that are part of SWJ (which I have a lot of SWJ since I'm up & down at least 4 times a night). But the CAs I see as I look at them on the 16th are not near the SWJ times. So I am a bit concerned, except that I wonder WHY I'm not seeing a lot of CAs EVERY night if I, in fact, did have Complex Apnea or a CA problem.
The obstructive stuff, including the flow limitations, is about the same on the night when you have an AHI = 1.58 and the night when you have an AHI = 3.97. In my opinion, the question about what to do about the flow limitations is made much more difficult by the amount of SWJ due to you not being asleep for a long time. If many of those "flow limitations" are happening when you are awake, it's probably a wake breathing pattern. Hence Pugsy's question about nasal congestion.
Yes, I DID notice that the FLs looked about the same on the 15th and 16th. I'll start paying attention to WHEN the FLs are mostly occurring (ie, SW periods or not).
If you only got 4 or 5 hours of sleep while you were in bed for 8.5 hours, that's a sleep efficiency of no more than 58%. Likewise, if you only got 8 or 9 hours of sleep while you were in bed for 11.18 hours, that's a sleep efficiency of no more than 80%. Most people feel better when their sleep efficiency is consistently up around 90% or better because lying in bed not sleeping for long periods of time is, itself, stressful and can make you feel pretty crappy in the morning . . . Most people feel better when their sleep efficiency is consistently up around 90% or better because lying in bed not sleeping for long periods of time is, itself, stressful and can make you feel pretty crappy in the morning.
Since your FIRST post to me, robysue, I have relaxed about getting stressed out over all this, since it's like shooting myself in the foot. The past few nights, whether lying awake for long or not, thankfully I have NOT felt stressed. THIS morning I felt so much better already after my 11+ hours of CPAP usage (perhaps 8+ hours of actual sleep, even if interrupted). And, so far, at almost noon I don't feel tired. So, I'll continue going to bed very early and staying there beyond 8 hours of "usage time" for a while . . . and see if that continues to help.
Good questions for you to be asking when you're scrolling through the flow rate data are:
Are a lot of events, including the OAs and Hs, being flagged during times you are pretty sure you were awake? Or dozing very lightly? If so, those events are not likely "real".
Is there a lot of activity in the flow limitation graph (and funky looking inspirations) during the times you think you were awake? If so, those flow limitations are not likely part of sleep disordered breathing.
Are you overestimating or underestimating how much sleep you got? In other words, look for long stretches of what you're pretty sure is sleep breathing and try to figure out if your sleep efficiency really is in the 50-60% range on a lot of nights.
Thank you for these excellent suggestions for observing my OSCAR results. Actually, I have made an attempt to figure these things out, but so far have not made any eye-opening discoveries. Will continue to try!

JoyD.

PS - Do you -- or anyone -- know of a good Tutorial or Video online for interpreting PSG graphs?? (I have read the Wiki articles from Apnea Board.)

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Re: HELP needed for 13-yr CPAP user!

Post by Pugsy » Thu Nov 17, 2022 10:53 am

JoyD. wrote:
Thu Nov 17, 2022 10:45 am
So I am a bit concerned, except that I wonder WHY I'm not seeing a lot of CAs EVERY night if I, in fact, did have Complex Apnea or a CA problem.
You aren't seeing a lot of CAs/centrals every night because you simply don't have Complex or central apnea issues.

Remember it is quite normal to have a handful of centrals throughout the night anyway.
Also remember sleep onset centrals which are also normal to see.
When we have multiple wake ups during the night and that means multiple "going back to sleep" then the chances of a sleep onset central happening are also increased for no other reason than multiple "going back to sleep" episodes.
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Re: HELP needed for 13-yr CPAP user!

Post by JoyD. » Thu Nov 17, 2022 2:01 pm

PUGSY WROTE:
You aren't seeing a lot of CAs/centrals every night because you simply don't have Complex or central apnea issues.
Remember it is quite normal to have a handful of centrals throughout the night anyway.
Also remember sleep onset centrals which are also normal to see.
When we have multiple wake ups during the night and that means multiple "going back to sleep" then the chances of a sleep onset central happening are also increased for no other reason than multiple "going back to sleep" episodes.
Well, that's what I was assuming . . . but VERY good to have confirmed!! :D Thank you.

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Re: HELP needed for 13-yr CPAP user!

Post by JoyD. » Thu Nov 17, 2022 2:16 pm

Is ANYONE having any success with something that KEEPS YOU OFF YOUR BACK AT NIGHT???

I rigged up an old T-shirt sewing a sock on the back containing 2 tennis balls. I tried it out for two minutes . . . the dang thing would cripple me if I wore it at night! :lol:

And I ordered an inexpensive 2"-height Cervical Collar to keep my neck from falling to my chest (chin-tucking), but it's difficult to sleep on my side with it on!

My original sleep study in 2009 showed 120 events/hr on my back & 30/hr on my side. Even lately, I note that when I wake up on my back once or twice during the night, that I have more problems with obstructive events & increased FLs.

Would love to hear some ideas to AVOID --or, at lease discourage-- the supine/back sleeping position. Thanks.

JoyD.

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Re: HELP needed for 13-yr CPAP user!

Post by Pugsy » Thu Nov 17, 2022 3:02 pm

Buckwheat hull pillow shoved up against the back/spine when on your side to help you stay off your back.
That's what I had the best success with.
Needs to be heavy whatever because otherwise it slides around too much or off the bed kind of thing.

Plus if you do end up halfway laying on that pillow the support offered is quite comfy on the back.
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Re: HELP needed for 13-yr CPAP user!

Post by JoyD. » Thu Nov 17, 2022 3:56 pm

PUGSY WROTE:
Buckwheat hull pillow shoved up against the back/spine when on your side to help you stay off your back. That's what I had the best success with. Needs to be heavy whatever because otherwise it slides around too much or off the bed kind of thing.
Thanks. I just bought a Pur-sleep Buckwheat pillow (has some foam pieces which you can add or subtract). I REALLY love it under my neck/head . . . it definitely keeps my nasal mask from leaking. I don't want to use THAT one for my back since it works so well for my head. But they sent extra buckwheat hulls, so maybe I could try them in a zippered pillow I might have around. Actually my favorite sofa pillow is just right for it, and my extra hulls fit perfectly. Tried it out, and feels great so I'm good to go tonight!! We'll see how well it works for me . . . tossing from one side to the other (good thing it only measures 16"x20").

FYI, Pugsy, last night removing my painter's tape left irritation and a tiny blood spot, even though I remove it with one finger holding my skin down as I remove the tape sideways close to the skin. That tape has seemed equally gentle to the blue Nexcare tape I also have, but I'll use the Nexcare tape tonight. ALSO, today I ordered a hybrid FF mask, EVORA, to use as a break from tape, or when I have a URI. I read that FFM's often require higher pressure, and I don't welcome throwing one more variable into my plan in lowering AHI & FLs! But I thought I need to have a FFM on hand.

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Last edited by JoyD. on Fri Nov 18, 2022 12:34 pm, edited 1 time in total.
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Re: HELP needed for 13-yr CPAP user!

Post by ozij » Thu Nov 17, 2022 8:36 pm

JoyD. wrote:
Thu Nov 17, 2022 3:56 pm
FYI, Pugsy, last night removing my painter's tape left irritation and a tiny blood spot, even though I remove it with one finger holding my skin down as I remove the tape sideways close to the skin. That tape has seemed equally gentle to the blue Nextape I also have, but I'll use the Nextape tonight. ALSO, today I ordered a hybrid FF mask, EVORA, to use as a break from tape, or when I have a URI. I read that FFM's often require higher pressure, and I don't welcome throwing one more variable into my plan in lowering AHI & FLs! But I thought I need to have a FFM on hand.
Good thinking about the buying the FFM. After things have settled down with the pillow masks and tape, take some time - a week or so - to see what you have to do to sleep well with the FFM. You don't want to struggle with setting up a new FFM when you're in the emergency that made you need it. And I'm very glad you have the Nexcare blue at hand - tearing skin off around our lips (been there, done that with Micropore paper) is no fun. Especially when you have to re-apply the tape once again the following night. That's why these new silicone medical tapes that can even be applied directly on wounds really shine. They're worth the price!

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Re: HELP needed for 13-yr CPAP user!

Post by JoyD. » Fri Nov 18, 2022 12:46 pm

I have some "HOW TO..." questions that I haven't been able to find the answers for:

1. When I use "quotes" to post on my reply . . . HOW DO YOU get it to say "[person's name] wrote" before the quote?? I always have to type the words myself instead of the person's name appearing automatically before the quote.

2. Rather than using the "Standard" or "Advanced" setting for graph order . . . how to I "drag & drop" a graph to put it the order I choose? (I use an Apple Mac Laptop, so I don't have a mouse). If dragging & dropping is possible, where to I place/hold the cursor to do so?

Thanks!
JoyD.

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Re: HELP needed for 13-yr CPAP user!

Post by ozij » Fri Nov 18, 2022 12:55 pm

JoyD. wrote:
Fri Nov 18, 2022 12:46 pm
I have some "HOW TO..." questions that I haven't been able to find the answers for:

1. When I use "quotes" to post on my reply . . . HOW DO YOU get it to say "[person's name] wrote" before the quote?? I always have to type the words myself instead of the person's name appearing automatically before the quote.
First you click reply
When the reply screen opens, scroll down - the posted messages are there. Note the large quote button on the upper right of each message.
Highlight the text you like to quote
Clock on the quote button/symbol
The text highlighted appears if the "Reply" frame, with all the message detail.
JoyD. wrote:
Fri Nov 18, 2022 12:46 pm
2. Rather than using the "Standard" or "Advanced" setting for graph order . . . how to I "drag & drop" a graph to put it the order I choose? (I use an Apple Mac Laptop, so I don't have a mouse). If dragging & dropping is possible, where to I place/hold the cursor to do so?
In the PC, when you place your mouse cursor on the graph's name it changes into a hand and you can drag and drop the graph to wherever you want.

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Re: HELP needed for 13-yr CPAP user!

Post by robysue1 » Fri Nov 18, 2022 1:17 pm

JoyD. wrote:
Fri Nov 18, 2022 12:46 pm
2. Rather than using the "Standard" or "Advanced" setting for graph order . . . how to I "drag & drop" a graph to put it the order I choose? (I use an Apple Mac Laptop, so I don't have a mouse). If dragging & dropping is possible, where to I place/hold the cursor to do so?
Since you are using a Mac, it may depend on how you have your track pad set up.

On my MacBook Pro laptop, this is what I do:

Step 1) Put the cursor over the name of the graph you want to move and wait for it to turn into a hand.

Step 2) Click and hold the "mouse cursor" with one finger and drag the graph with a second finger to where you want it to go. (You can use fingers on different hands to do the "click and hold" part of this combo and the "drag to where you want it to go" part.)

If that doesn't do the trick, you'll need to let me know how you've got your trackpad set up in terms of clicks and drags and swipes.

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Post by JoyD. » Fri Nov 18, 2022 1:45 pm

DELETE

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Last edited by JoyD. on Sat Nov 19, 2022 9:24 am, edited 9 times in total.
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