"Dying" To Find ST-A User to Help Me

Notgivingupagain · Post by **Notgivingupagain** » Wed Mar 29, 2023 6:51 am

Rubicon wrote: ↑
Wed Mar 29, 2023 6:46 am
Antidepressant medications.

YES! Actually I am!

I have Bipolar and I am a variety of medications. How does this all play into my situation

Rubicon · Post by **Rubicon** » Wed Mar 29, 2023 7:03 am

Absolutely need initial studies and SleepHQ files.

And undoubtedly a heavy dose of RS1.

ozij · Post by **ozij** » Wed Mar 29, 2023 7:06 am

Rubicon wrote: ↑
Wed Mar 29, 2023 7:03 am
And undoubtedly a heavy dose of RS1.

RS1 ?

Rubicon · Post by **Rubicon** » Wed Mar 29, 2023 7:07 am

And also your weight.

Rubicon · Post by **Rubicon** » Wed Mar 29, 2023 7:08 am

ozij wrote: ↑
Wed Mar 29, 2023 7:06 am

Rubicon wrote: ↑
Wed Mar 29, 2023 7:03 am
And undoubtedly a heavy dose of RS1.
RS1 ?

Seriously?

The Star of Our Show!

ozij · Post by **ozij** » Wed Mar 29, 2023 7:13 am

Sorry, I wan't thinking of her!
(Of people at all...)

Of course.

Notgivingupagain · Post by **Notgivingupagain** » Wed Mar 29, 2023 7:31 am

RS1? What is that?

I am overweight for my height. I am 5 foot 2 and weigh 214-216 pounds. Also, I smoke. I have tried to quit, but am finding it VERY difficult. I stopped once for a year but that was a gazillion years ago. I have usually have 1 -2 drinks of alcohol a day or night, depending.

There is no initial sleep study for this latest treatment. They only did a titration study because of all my other studies over the past years. The current titration study starts off with regular bipap I think. At least that is what they said they were going to do. I think, if I can find it I may have a study w/o therapy from a few years ago if you would like, but I'm not sure how helpful it will be because I wasn't on all these meds at the time.

As for SleepHq, I went to the site but don't see a way to post my study results, just a way to post my charts. Perhaps I am looking at the wrong things on that site?

I know I can find some way to get you guys what you are requesting but I really need to leave for work now. When I get home I will try to get you what you need to help me.

Thanks.

Rubicon · Post by **Rubicon** » Wed Mar 29, 2023 7:33 am

Also I wouldn't assume IPAP EPAP numbers were simply inverted in titration report. Until proven otherwise, I'd assume they're completely wrong.

And that would be the GOOD news.

Nah.

That whole approach was wrong.

Rubicon · Post by **Rubicon** » Wed Mar 29, 2023 7:36 am

Notgivingupagain wrote: ↑
Wed Mar 29, 2023 7:31 am
I think, if I can find it I may have a study w/o therapy from a few years ago if you would like, but I'm not sure how helpful it will be because I wasn't on all these meds at the time.

I think it's going to be VERY helpful.

So we have to put TWA and OHS on the table.

Maybe Overlap.

Did I say there's going to be a lot of stones?

ozij · Post by **ozij** » Wed Mar 29, 2023 8:17 am

Notgivingupagain wrote: ↑
Wed Mar 29, 2023 7:31 am
RS1? What is that?

RobySue1

As for SleepHq, I went to the site but don't see a way to post my study results, just a way to post my charts.

The good thing about SleepHQ's sharing of charts is that anyone can zoom into any place in the chart whenever they think it necessary.

robysue1 · Post by **robysue1** » Wed Mar 29, 2023 8:34 am

Rubicon wrote: ↑
Mon Mar 27, 2023 2:44 pm

robysue1 wrote: ↑
Mon Mar 27, 2023 2:17 pm
why does the inspiratory part of the flow waveform sometimes still have really ragged shapes that would be considered a flow limitation if the machine weren't trying to shove the breath in?
Circle the ones you're referring to.

Here are two examples from the OP's posted data.

First Example:

Those are pretty distorted inhalations anyway you look at them. Of course, the PS is not very large on this snippet. So I guess the machine is not trying to shove the breath in? Any insight into why the machine isn't responding to the flow limitations? Is it because the sizes of the inhalations are "ok" so the iVAPS is happy enough with the its calculation of the approximate alveolar ventilation?

Second example:

Here the PS is greater. Does that mean the machine has started to shove the breath in? The breaths are still pretty ragged and this is the snippet that still looks like SWJ to me, particularly with the large inhalation at the very left edge of the snippet.

robysue1 · Post by **robysue1** » Wed Mar 29, 2023 9:00 am

Notgivingupagain wrote: ↑
Tue Mar 28, 2023 4:22 am
Good Morning.

(I tried to resize the image smaller from the original, but had difficulty. This image might be too small, please let me know).
....

Please don't shrink the image. The size of your original images was much better. I can't read the text for this one at all, even when I click on the link and "enlarge" over at imgur.

Last night I decreased the EPAP from 15 to 12 to see what would happen.

You said you had your reasons. Can you enlighten us? In other words, was the decrease in pressure solely out of curiosity or were you trying to fix a specific problem? If so, what problem?

I only awoke one time that I am aware of and I believe it was due to leaks. My machine has a leak alarm, I think I will turn it on tonight. I just hope it won't annoy my husband My AHI is a tiny bit higher, could be from lowering my EPAP from 15 to 12. I had two hypopnea during the second portion of my sleep and one unclassified apnea.

If I recall correctly, your machine doesn't try to classify apneas as OAs or CAs. They are just labeled as "apneas", and Oscar marks anything that is just labeled as an "apnea" in the machine's data as an unclassified apnea in the table of events.

(I did watch suggested video on mask fitting. At first it felt more comfortable, except for the silicone area almost being in my eyes. But I thought I could live with that. I had learned that the top of the mask should be placed just near to below the eyebrow area and the bottom in the crease of the chin. (Chin crease I knew). The video also mentioned tightening the straps so you take out the slack. Unfortunately, these steps resulted in quite a bit of air leak. I stopped the machine and tightened my straps. After starting the machine again I seemed to sleep straight through until about 5am with three episodes of unnoticed air leakage. This morning I do feel residual discomfort from the mask, but not as bad as last night. I am using a small mask because I do have a small face and this is what the fit guide and tech said I should use. The medium just seemed too big during titration. I might take another gander at this though.)

The leaks are noticeably better during the second half of the night.

I feel tired but not devastatingly so. If I could just get MORE sleep it sure would help I think, but unsure of how much because of the issues with my breathing patterns/waves? If zoom shots are requested I will be happy to oblige).

In your first post you wrote:

Notgivingupagain wrote: ↑
Mon Mar 27, 2023 6:47 am
5) Unfortunately, I normally have to go to bed for the night pretty late and my body naturally wants to get up for the day quite early. I have been getting four to five hours of "sleep".

And your usage numbers seem to confirm this: You are only getting four to five hours of sleep. Even if the sleep were exceptionally high quality, you would still likely be sleep deprived and feel tired during the day. So the question remains: What is stopping you from trying to get more sleep? Why can't you go to bed a bit earlier? Or sleep later in the morning? Those are exceptionally important questions for you to deal with if you want to feel better.

Rubicon · Post by **Rubicon** » Wed Mar 29, 2023 9:40 am

I wish we had EEG and a Respironics machine (it marks machine breaths), but I also wish I had a Lambo and that ain't happening either.

In your images, boxes 1 and 4 are machine breaths, boxes 2 and 3 are spontaneous breaths.

There is no indication of FL.

Again, I agree this is all SWJ, hence rattiness. Look at box 1, even though they are machine breaths, try to exhale based on the expiratory waveform. IDK what's happening there, but it ain't sleep.

In a machine breath, the system pressurizes for x seconds, and flow actively passes into patient lung. Patient does nothing so flow is constant (actually it should be decelerating as lung fills, as in box 4, but we'll get into that further when SleepHQ shows up). Since the patient is not inspiring you cannot say there's IFL. If there is flow reduction, then there could be airway obstruction, but more likely it's simply insufficient PS or needing to overcome resistance (as in obesity). But that's academic as the answer is more PS regardless.

At any rate we need to overturn more stones. The whole idea of iVAPS for CompSAS is stupid. Unless it's really OHS in which case it's brilliant (morning headaches important clue. We need ABG and PFT).

Yeah I have NFI what's going on either...

...but I do think she's got bad TWA, perhaps mostly because of the ADMs.

I'm questioning the overall validity of the submitted NPSG. Long uninterrupted N2 despite dozens of arousals? A product of lazy scoring.

robysue1 · Post by **robysue1** » Wed Mar 29, 2023 10:37 am

Rubicon wrote: ↑
Wed Mar 29, 2023 9:40 am
I wish we had EEG and a Respironics machine (it marks machine breaths), but I also wish I had a Lambo and that ain't happening either.

In your images, boxes 1 and 4 are machine breaths, boxes 2 and 3 are spontaneous breaths.

There is no indication of FL.

Just wanting to make sure I understand what you are saying.

Box 1 refers to the breaths in this image:

And because those are machine breaths, the flat tops are expected. At least that's what you seem to say a bit later in your post when you explain what's going on with a machine breath:

In a machine breath, the system pressurizes for x seconds, and flow actively passes into patient lung. Patient does nothing so flow is constant (actually it should be decelerating as lung fills, as in box 4, but we'll get into that further when SleepHQ shows up). Since the patient is not inspiring you cannot say there's IFL. If there is flow reduction, then there could be airway obstruction, but more likely it's simply insufficient PS or needing to overcome resistance (as in obesity). But that's academic as the answer is more PS regardless.

I really have learned something. Thanks for this explanation. This explanation does explain the shape of those inhalations. It also explains a lot about what you've said in the past about certain machines manufacturing flow rate graphs.

And boxes 2 and 3 refer to the left and middle boxes of this image:

And these are spontaneous breaths that look the way they do because they're most likely sleep-wake-junk breathing? Or the infamous "I have NFI what's going on, but it's not sleep" breathing?

Box 4 is the right most box in that last image. And again, those flattish tops are because they're machine breaths, but they do show the decelerating air flow into the lungs as the lungs fill up.

If I've got all that correct, then I've learned something today.

Again, I agree this is all SWJ, hence rattiness. Look at box 1, even though they are machine breaths, try to exhale based on the expiratory waveform. IDK what's happening there, but it ain't sleep.

So the ratty looking exhalations are an issue?

More to the point of the OP's real problem: Since that ain't sleep, then she's getting even less sleep than she thinks she's getting, particularly if her much of her flow wave data looks like these snippets. And that's a real problem on multiple levels.

At any rate we need to overturn more stones. The whole idea of iVAPS for CompSAS is stupid. Unless it's really OHS in which case it's brilliant (morning headaches important clue. We need ABG and PFT).

Yeah I have NFI what's going on either...

...but I do think she's got bad TWA, perhaps mostly because of the ADMs.

Time for an acronym check: Are these correct?

OHS = obesity hypoventilation syndrome
ABG = arterial blood gas
PFT = pulmonary function tests
ADM = anti-depressant medications

And the ABG & PFT are needed to sort out whether the diagnosis ought to be OHS instead of (or in addition to) CompSAS.

But TWA? That one is stumping me right now. Care to give me a hint?

I'm questioning the overall validity of the submitted NPSG. Long uninterrupted N2 despite dozens of arousals? A product of lazy scoring.

Yep. That stuff does look more than a bit weird.

Rubicon · Post by **Rubicon** » Wed Mar 29, 2023 11:44 am

Train Wreck (Sleep) Architecture.

See all the arousals in the hypnogram above in the long N2 runs? Well, Da Rules say:

After an arousal change to stage N1 until a K complex unassociated with an arousal or a sleep spindle occurs.

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