YouTakeMyBreathAway's Therapy Thread

[Miss Emerita]

I'm not seeing any reason to change your settings. Your O2 levels are just fine throughout the night. I'm not sure why you're as focused as you are on the occasional drop to a level that remains comfortably above 90%.

The obvious culprit for remaining daytime sleepiness is the frequency of your wake-ups and mask removals. In your place, I'd focus my efforts there.

[YouTakeMyBreathAway]

Would love any advice on how to treat my remaining hypopneas. Here's an example from last night with mask on, side-sleeping:

[YouTakeMyBreathAway]

Still having issues and feeling tired in the morning now ~1 year after beginning treatment.

Here's my latest OSCAR:



And here's a zoomed in section:







Something must still be arousing me throughout the night.

1. I'm still having ~15 pulse changes per hour.
2. I still sometimes get a tickly nose, but I am tired even on nights when I don't (e.g. when I just got a new mask I usually don't get tickly)
3. It seems like I continue to have these sections of hypopneas throughout my nights (picture above). My breathing sometimes will wax and wane and sometimes it's just 2-3 breaths that are slower or w/ less tidal volume. I set a custom user flag at 70% for 10s to detect these hypopneas and I am having between 5-8 of them per hour.
4. I continue to have to take a nap once every weekend ever since starting treatment.

I wonder if those 5+/h mini-hypopneas are what is making me tired. If yes, how could I fix them?

[Miss Emerita]

I'm so sorry, but even using palerider's trick, I can't view your chart at a resolution that allows me to read the numbers. It'd be great if you could take a screenshot that follows these suggestions from my earlier post:

Close the calendar. (Click on the triangle next to today's date.)

Include these graphs only:

Events
Flow rate
Pressure
Leaks
Flow limitations
Snores.

You might also include O2, since that concerns you.

But I'm not sure how useful it will be to see the information. The zoomed in views do show a slight periodic waxing/waning pattern, and they also show some arousal breathing and/or awake breathing. If you see something before an arousal that might explain it (e.g., a pressure change or a sudden leak), then good, but otherwise looking at your charts and tweaking your settings will be unlikely to help you figure out why you experience arousals.

I don't know whether it's correct to refer to your wanings as hypopneas; others may be able to weigh in on that. But waning is common after deeper breathing. The deeper breathing washes out some CO2 from the blood, which reduces the "breathe" signal to the brain, resulting in shallower breaths or pauses in breathing. When CO2 builds up again, deeper breathing resumes. But if it's quite deep, then the cycle repeats itself until breathing stabilizes again.

The obvious thing I *can* see is that you have multiple breaks in therapy throughout the night. You may already have explained why that is, but could you remind us? That seems like something you really need to focus on -- more than short arousals.

[YouTakeMyBreathAway]

The breaks are because of my nose/face tickling that I need to scratch.

Interestingly: When I take a nap in the afternoon, I end up sleeping for just 30-50 minutes, but I am significantly more well rested after that than the 9 hours I sleep at night.

Here is a view of just the charts you requested for yesterday night:




Putting these together I actually just realized that my User Flag ("Mini Hypopneas") and PC (Pulse Change) overlap a lot. Here's the plot for the past 7 days. It seems like many of my HR spikes are preceded by a Mini Hypopnea. See the gray markers (mini hyponpeas) at the top of the pulse rate charts for my last 7 nights here:

[Miss Emerita]

You may sometimes be experiencing a higher heart-rate during REM sleep. (The timing of some of the episodes suggests this.) The respiration rate during REM sleep can be elevated too, and sometimes depressed.

In your place, what I'd be focusing on are the itch problems you're experiencing. Those frequent breaks in therapy are probably a more serious problem for sound sleep than the variations in data that you're focusing on.

Can you consult a dermatologist to see what might be able to calm your skin?

[YouTakeMyBreathAway]

I have an appointment with an allergist coming up, will ask there. I guess given AHI below 5 is considered normal, it feels surprising that waking up 5 times in a whole night from itching would cause major fatigue, no?

Also just got my Vitamin D labs back and my Vitamin D is now actually above the normal range after supplementation, so that was probably not the issue. (113ng/ml)

[Miss Emerita]

Something is causing you to feel unrested during the day. Waking all the way up multiple times per night may well be at least part of the problem. I'm glad you'll be seeing a doctor who might have some thoughts about the itchiness. Keep us posted, would you?

[YouTakeMyBreathAway]

I did a lung function test and it looks like most results were normal except for ERV and FRC. Any thoughts?

[Rubicon]

What's your height and weight?

[Miss Emerita]

Did your doctor not discuss these results with you?

[YouTakeMyBreathAway]

Rubicon: 170cm, 86kg, male

Miss Emerita: Not yet, they are super busy so I got an appointment to discuss results only pretty far into the future. Trying to see if I can make anything of the results in the meantime.

[Rubicon]

Rubicon: 170cm, 86kg, male

Decreased ERV is most often associated with obesity.

Your BMI calculates out to be 29.8. Obesity starts at 30.

The study you quoted on AB

In a multiple regression analysis, ERV was an independent predictor of nocturnal apnea (R2=0.13; p=0.001) and desaturation frequency (R2=0.11; p<0.01).
http://www.diva-portal.org/smash/record....dswid=9034

Those guys were BMI > 30.

Just sayin'...

[Rubicon]

In addition, once you're supine, everything gets worse. This was noted in your reference:

A further reduction (down to 17% of average normal value) was noted when the patients were studied in the supine position. The authors concluded that the reduction in lung volume may contribute to the frequent desaturations and that obesity was the primary factor in this syndrome.

[Rubicon]

When ERV is low, it means the lungs are not able to exhale as much air as they should, which can result in incomplete expiration and air trapping in the lungs.

Not always, but when that happens, RV is increased (the "trapped air"). Your RV/TLC% is right on the money.