First OSCAR Post here - mild OSA/UARS-type SDB. First night with Bi-Level.

Nocibur wrote: ↑

Mon Feb 24, 2025 11:01 am

-sws used to say

that said

a lot.

I thought it sounded cool.

So if it looks like too much blame him.

I miss him.

I thought I just posted a response but it looks to have gone away. So first things first: OSCAR issue is fixed and it has the correct ventilator model showing. So that is good.

Nocibur - yeah. I agree and that was the plan. I thought I was buying a Vauto. The person said it was a Vauto and I got a quick picture and then it was shipped. I was clueless on the other end and that is my fault for not being informed. That being said, flow limit numbers didn't LOOK bad on my old CPAP, but I've heard from the apnea board that you could still be heavily flow-limited despite the machine saying your flow limits are well-controlled - thus I was told to try to help manage to the flow-rate shape first and foremost. Not sure if that is incorrect. It doesn't sound like too much (and I am a fan of that said clearly).

Pugsy. I do have the old machine still. An AirSense 11.

To answer your other question, I am in pretty good health but do have some issues.

I have severe PLMD, although per the recent sleep study that seems to be very well-controlled. Don't think that is the issue.

I do have pretty bad anxiety and take 60 mg Cymbalta for it. For some reason, the day after I use PAP, my physical anxiety intensifies majorly. No idea why and I hate it because I know my anxiety gets worse, but I also know my breathing is bad and I need to use it. I am not anxious or psyched out about using the machine - I actually enjoy the feeling of breathing with it on. I don't know if I am having some weird "reaction" considering it's just pressurized air. But maybe. I also go to therapy so I am doing all I can on this front. I really want PAP to work!

bruins2006 wrote: ↑

Mon Feb 24, 2025 11:29 am

I have severe PLMD, although per the recent sleep study that seems to be very well-controlled. Don't think that is the issue.

Well, not necessarily:

bruins2006 wrote: ↑

Mon Feb 24, 2025 11:29 am

Pugsy. I do have the old machine still. An AirSense 11.

Which model AirSense 11?

CPAP?
AutoSet?

I assume AutoSet (based on what I saw on the old report's pressure response) but I don't like guessing....I like to work with known facts whenever possible.

bruins2006 wrote: ↑

Mon Feb 24, 2025 11:29 am

That being said, flow limit numbers didn't LOOK bad on my old CPAP, but I've heard from the apnea board that you could still be heavily flow-limited despite the machine saying your flow limits are well-controlled - thus I was told to try to help manage to the flow-rate shape first and foremost. Not sure if that is incorrect.

Well.....I don't know if what you were told is incorrect or not but I do know that not every sleep problem in the world is caused by flow limitations and/or "better" settings or a "better" machine.

I don't go by "numbers" when it comes to FLs....I look at the graph and activity first and if very active at all I then ask the "are you having any nasal congestion" question because nasal congestion can manifest itself on the FL graph showing increased activity but we don't treat nasal congestion FLs in the same way we treat regular OSA airway FLs. So you gotta know the cause of ANY FLs FIRST and then we worry about settings or what to do.

Curious though....you said the first machine didn't help and so you decided to try bilevel.
Exactly what was it that "didn't improve" that you wanted to improve?
What symptoms are you or were you having that prompted this whole journey?

Please answer the meds and other issues questions I asked.

Nocibur - so you think those actually could be PLMD? To be fair, I should've said the PLMD AROUSALS are being treated well, not necessarily the PLMD. PLMD arousals were .2 per hour while the PLMD index was still around 25 (down from 65 per hour but still high). So thanks for correcting that.

Pugsy - AirSense 11 AutoSet, yep. I take 60 mg of Cymbalta for the anxiety as well as 6 mg silenor for the PLMD arousals.

And fantastic point about nasal congestion/nasal breathing. I am sometimes congested, but even when I am not, I mouth breathe. I recently got a laryngoscopy (and will go for a CBCT scan next month) and have a deviated septum according to the ENT. Find myself mouth breathing while on the couch, when I walk, when I lift weights, etc. Exertion doesn't matter. I do use nasal pillows so maybe that isn't the best option.

The laryngoscopy also showed "mild pharygeal collapse on Mueller's maneuver, near-complete anteroposterior palatal collapse and near-complete anteroposterior palatal flutter on simulated snoring. There was moderate anteroposterior narrowing of the redropalatal and retrolingual airways.

So in short, it seems to be that there is flow limitation probably occurring both nasally and further into the airway. But I can't be 100% there.

I originally got a sleep study because I had immense brain fog, fatigue and sleepiness (aware there is a difference) and worsening anxiety. That is the quadfecta right there and is why I started on a machine as well, when MAD and positional therapy didn't help. But none of those had improved. Still could be sleep 15 hours a day if I didn't have a job.

Apologies as I thought I answered the other issues - my bad. In my mind, the other issues are the PLMD and anxiety. These are really the only 2 other notable health effects, either mental or physical, that I have. I'm a 26 year old male, tall and skinny.

When you get a chance please add your equipment to your profile like I have mine (see below my comments here)?

That way I won't have to ask "what mask are you using"....
and "what machine are you using".
So what mask are you trying to use????

I will respond in a little bit about meds, PLMD, etc. When do you take them? Both are well known to cause excessive sleepiness/drowsiness. I understand the need what with the anxiety and all but they both come with some side effect baggage that isn't/aren't doing you any favors.

How long have you been taking the Cymbalta and Silenor?

Did you actually ever have a sleep study done that met the criteria for a diagnosis of OSA or obstructive sleep apnea or actual airway problem besides arousals?

So....tell me about why you bailed on the AutoSet and opted to try bilevel?

Your original post subject line mentions mild OSA ....what was the diagnostic AHI?

Read up on the side effects for your meds
https://www.google.com/search?client=fi ... de+effects
https://www.google.com/search?client=fi ... de+effects

Look at multiple results....don't rely on what one website says as the entire gospel.

haha! yeah, ill fix my profile up after I post this. I definitely understand that my Cymbalta and Silenor can both cause drowsiness - particularly the silenor. I am talking to my doctor about possibly changing to dayvigo, which he likes for sleep maintenance (arousals). I have taken the Cymbalta for about 12 years now and 6 mg silenor for 6 months or so. I take my Cymbalta at 7:30 and my silenor at 10:30 (45 minutes before bed). I have had had fatigue for about 15 years, although even before that, my parents said I'd sleep quite a lot. My doc says it is possible my orthodontics (got braces at 6.5 years old) messed up the growth of my maxilla/nasal aperture as both are very small which has allowed SDB to manifest.

I have used pillows 95% of the nights I use CPAP. I have tried FFM but leak rate was way too high. Pillows feel less intrusive to me and I like the way breathing feels with them.

Yes - I've had 2 in-lab sleep studies. First one I had an AHI of 9 and an RDI of 11 with severe PLMD. Arousal index of 36 an hour. I had a second one with the doxepin to see how the dox is treating the PLMD arousals - it did a good job, but breathing got worse - with the MAD, I had an AHI of 4.5 but an RDI of 30. Arousal Index of 31/h or so. First one was majority PLMD arousals while 2nd was majority SDB arousals. My doctor said that these two conditions essentially "jockey" for supremacy, and as I treated one thing, SDB essentially filled the power vacuum. I liked the analogy. Again, these are respiratory arousals (not spontaneous) so I know that sleep should theoretically improve by trying to treat this.

Happy to provide either/both studies.

My reasoning for Bi-Level was that UARS seemed to be better treated by using Bi-Level, and figured I'd give it a go since my symptoms were not getting better. May have been a bit hasty by me, but willing to go back to AS11 if you guys think that's necessary.

Nocibur - your question is answered somewhere here but in short, 6 mg doxepin is used to treat my PLMs and PLM arousals.

I definitely recognize that the medications may cause some drowsiness, but with 31 arousals/hr (mostly being respiratory in my 2nd study), I know there is still a lot of room for improvement and I think if I were to get rid of SDB, I'd be much less tired. Someone at my age should be at around 10 an hour, with less than 5 of them being respiratory in nature. Was a smart guy. Went to college and got good grades. But my brain - concentration, memory (all part of brain fog) has deteriorated so bad that I can't reach the goals I've set for myself and that makes me sad.

Have you checked on the cost for dayvigo?
It's similar in function to a med I have on hand called Belsomra and it's extremely pricey even with insurance helping with the cost.

Something to think about.

About the PLMD thing.....have you had your ferritin (iron) levels checked with blood work? Special test for iron levels and don't assume that a CBC with normal hemaglobin or hematacrit means iron levels are normal....because it doesn't.

Appreciate you looking out for me here. American healthcare

Yeah, I've talked it through with my doctor and he said that with my private insurance and the savings card, I could get a pretty good price. How do you like it (Belsomra)?

Yeah, I've had the full iron panel. Specifically got the ferritin checked twice and both times they were figures were actually quite good.

Nocibur - your question is answered somewhere here but in short, 6 mg doxepin is used to treat my PLMs and PLM arousals.

Yes I saw and deleted my comment.

bruins2006 wrote: ↑

Mon Feb 24, 2025 2:13 pm

Happy to provide either/both studies.

Can't hurt.

I don't really buy the "jockeying for supremacy" concept, but I tend to be cynical (way beyond skeptical) so what the hey.

How did you arrive at doxepin? The new clinical practice guidelines just came out 2 months ago and doxepin isn't even on the list. Previous studies showed it didn't really help.

Is your sleep guy a real sleep guy?

Were the studies done at the same facility with the same scorers?

Because the scoring rules for PLMs are mildly involved and somewhat tedious, and sometimes shortcuts are taken...

...but again, cynical.

How do I like the Belsomra???? Well....it's hit or miss with it and not a magic bullet but it does help somewhat.
I have a lot of arousals myself but my arousals are from pain (I am old woman with bad arthritis) and it's mainly to help me "sleep through the pain" a bit so I can get a little more hours of sleep as well as reduce arousals a bit.
It is considered a Tier 3 drug by my insurance so I can get 30 days worth for $47 or else I couldn't afford it.
It does work better than the other sleep aids though and it doesn't come with any unwanted next day symptoms (unlike the other sleep meds).
If you read deep in the literature it's not expected to take away all the arousals and let a person get 8 hours of non arousal sleep. It's really maybe going to give me an extra hour or so of sleep but sometimes that hour is pretty important as to how I feel the next day.

Would it (or a med like it) help you "sleep through" the PLMD arousals???? I have no idea but might be worth a try.
I doubt seriously if the Silenor (doxepin) is going to be doing much for PLMD stuff though.

I do think you need to address the PLMD first ....if possible. I have a sneaky gut feeling that those PLMD arousals are doing more harm to your sleep quality than you realize.

...2 in-lab sleep studies. First one I had an AHI of 9 and an RDI of 11 with severe PLMD. Arousal index of 36 an hour. I had a second one with the doxepin to see how the dox is treating the PLMD arousals - it did a good job, but breathing got worse - with the MAD, I had an AHI of 4.5 but an RDI of 30. Arousal Index of 31/h or so.

And IIWM, I'd get the raw data and rescore the studies myself, because IMO the most likely explanation is scoring discrepancy.

Anyway, why not load up a couple nights into SleepHQ and see what shakes out.

I was also going to suggest using SleepHQ but I wanted the OSCAR bugs gone by fixing the SD card first.
Using SleepHQ would let us zoom in on whatever we want to see rather than you doing a gazillion screen shots.

I am unsure just how reliable OSCAR is when it can't tell what machine you are using or settings used. That's why I wanted that bug fixed before I spend much time zooming in on the data.