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Hopefully with some guidance here you can optimize your CPAP treatment. Once that happens you might want to take a closer look at if your PLM problem merits closer scrutiny or even treatment. I have PLMD and untreated or undertreated it makes my sleep so fitful that the least little thing is aggravating. Made tolerating CPAP much more challenging. As to breathing out of your mouth with a full face mask on - unless the dry mouth is so bad it wakes you up, I wouldn't worry about it too much. The mask accommodates mouth breathing, but nothing wrong with trying to stop if it's an issue for you. I kinda have the same perspective on air in the belly. If it is intolerably painful, it has to be addressed. If it causes belching and farting but does not wake you, then I'd suggest those symptoms have to take a back seat to effective CPAP treatment. Sounds like you've got a few different things to work through, but hopefully soon some of those things will begin to resolve and you can start to feel better.

AFlex doesn't work like Bilevel machine.
AFlex or CFlex are very minor reductions on exhale based on your own breathing flow...think forceful breathing vs shallow breathing.
I liked AFlex...hated CFlex or rather thought it was useless
The 3 different settings pertain to how much of a reduction would be allow with the air flow you are producing...more force and a higher number equals greater reduction.

It's really a more subtle form of exhale relief and hard to describe. AFlex at 3 setting made me feel like I was trying to breathe too fast...almost like hyperventilating..I couldn't keep up with the machine's rhythm.
A setting of 1 seemed too slow of a rhythm...AFlex of 2 made it feel like I was barely exhaling against the pressure which was 10 cm minimum back when I was using the M series.
CFlex...I tried all the settings but none felt better or worse than the other.

Bilevel pressures...2 separate pressures...one for inhale and one for exhale and hugely more comfortable at whatever setting anyone uses.. It's the difference between inhale and exhale that affords the comfort and the more of a difference (call pressure support) the more the breathing is feeling more natural.
Example...EPAP (exhale pressure) of 8 and IPAP (inhale pressure) of say 10cm...offers 2 cm pressure support and feels pretty darn nice but increase the IPAP to say 12 cm there is a 4 cm difference between the 8 and 12 and the perceived comfort difference is amazing...it's so much easier to use 8/12 than 8/10. I know it sounds weird but it's true.

I am using bilevel machine now...long story which I won't bore you with right now. Totally did it on my own and not because I had problems with the APAP pressures or aerophagia. Instead I happened to try one on a lark and within 2 minutes of breathing with it while awake I said to my self...."self, you gotta have one of these machines". It was like I wasn't even using a machine it was so easy to breathe...and that was with 8/12.
So if you can't tolerate the higher pressures that you need to reduce the AHI...we can talk about bilevel options. I may know where we could find a gently used bilevel machine. I know for sure of a new one but it isn't Auto adjusting and it is over $600...so I know it too much for unemployed person to fork out. Send me a PM for further information when / if you think you want to explore bilevel avenues.

Bilevel would enable you to use higher pressures (if needed) and not blow so much air into your stomach. The reduction during exhale seems to markedly reduce air sneaking into the stomach.

BTW while I don't normally have aerophagia issues...I have had it happen a couple of times (way back before bilevel machine) where it was so bad I thought my belly was going to explode..hurt so bad and lasted all day and I was horribly nauseated...So I have an idea how bad it can be.
That bad...unacceptable.

A few farts or belches...annoying but we can live with.
Severe pain...no one should have to deal with that.

Hi Nan, thanks for your kind offer, I think my mask probably needs a new silicone seal.
I sent you a quick private message.

Hi Pugsy, thx for that long post on Bipap etc.

I tried Afex recently and on any setting ( 1, 2 or 3) it was making the mask bounce up and down on my face. I couldn't even get to sleep. On Cflex it's seamless on the exhale and the mask doesn't "lift" up and down on my face. I wish I could use Aflex.

kteague wrote:Hopefully with some guidance here you can optimize your CPAP treatment. Once that happens you might want to take a closer look at if your PLM problem merits closer scrutiny or even treatment. I have PLMD and untreated or undertreated it makes my sleep so fitful that the least little thing is aggravating. Made tolerating CPAP much more challenging. As to breathing out of your mouth with a full face mask on - unless the dry mouth is so bad it wakes you up, I wouldn't worry about it too much. The mask accommodates mouth breathing, but nothing wrong with trying to stop if it's an issue for you. I kinda have the same perspective on air in the belly. If it is intolerably painful, it has to be addressed. If it causes belching and farting but does not wake you, then I'd suggest those symptoms have to take a back seat to effective CPAP treatment. Sounds like you've got a few different things to work through, but hopefully soon some of those things will begin to resolve and you can start to feel better.

I know the PLM adds to my night horrors, to what degree I'm not sure. I remember 4 years ago the Dr told me they trat it with a Parkinson drug or they use a sleeping med so you don't wake from the PLMs. I use Atavan sometimes and it seems to get me through the night on both fronts...CPAP and PLM.
When I see the Dr again (could be 3 months wait) I will ask which med is best for PLM. Kteague, do you take something for PLM?

Discussion about PLMD can get pretty lengthy. A search of this site will give you more reading than you probably want. While I am not opposed to the meds if they are necessary, I do suggest first finding out if there is anything you can do nutritionally and naturally to help yourself, hopefully before using meds. While this list is by no means all inclusive, having ones ferritin level above 60 and magnesium level normal are usually at the top of the list. I've used several commonly prescribed meds over the past 14 years since diagnosis. For the past couple years I have chosen to use a TENS Unit instead of meds and that is working out well for me. Treating my OSA changed my life. So did treating my limb movements, which were majorly disruptive to my sleep. Some find a warm foot soak before bed to be helpful, and every little bit of relief helps. Best wishes going forward.

Hi again, just wanted to check back in after a couple days.
Not much to report after raising my CPAP pressure a little ( not much has changed on my machine display) and one night I fell asleep w/o putting on the mask. I try to time when I put the mask on ( just as I start to drift off and my PLM starts up)

I have an appointment with the RT on Monday to look at/check my machine and read the card.
I have questions for her, but wonder if anyone here could suggest some good questions for her I could ask??


I am seeing my Family Dr tommorow for other things but will get a referral to UBC Sleep Disorder Clinic.
Except for the follow up after the one night sleep study, I have never been back to see him. He just gave me a prescription of 6-16 ( if I remember right) Lots of questions for him also...

I sure wish I had a card reader and software, then I might be able to figure out why I never sleep well even after 4 years.

LAst night I took an Atavan and slept from approx 11:30 to 5:30 (+-). One thing I noticed in the last few weeks is that if I don't take the Atavan, I sleep way worse and get up to go to the bathroom....and wake up feeling like I have been hit by a steamroller.


Wish me luck Monday, maybe I will know more. Thx all....

ps, if she reads the card Monday, does the info have dates on it? ie I scan ask her what happened Feb 15th etc? Or is just a bunch of data with no dates? Keep in mind my machine is 4 years old and possibly not so sosphsiticated.

vancity wrote: does the info have dates on it? ie I scan ask her what happened Feb 15th etc? Or is just a bunch of data with no dates?

Encore and your machine will only give detailed data for the last 7 nights.
It will give some summary usage data for the past year but the detailed graphs...only the most recent 7 nights. It's a limitation of the machine and the software. After 7 nights the Smart Cards detailed data will be overwritten...oldest by newest.
To have older detailed data available the Smart Card has to be downloaded at least once a week.

But there will be 7 nights of detailed graphs and such available....if she looks.

Look in this old thread of mine to see examples of the detailed data I am talking about.
viewtopic.php?f=1&t=42302&p=372692#p372692

Thx Pugsy, so basically even if I can get a card reader and Encore software, I am limited to 7 days of in depth charts etc, but I can copy the weeks worth of data onto my computer. That would be ok, cause at least I could check on a daily basis what happened the night before. I ask her about the software/reader she is using and if she shows mt the past 7 days...

Does this card / card reader only used with CPAP or are they also used in PC data applications. Could I find a card reader in a PC shop/Best Buy etc??

If you had the card reader and downloaded data at least once every 7 days...you have access to unlimited detailed data in the past.
The Software only shows 7 nights detailed at a time but you can select from older dates as long as it has been downloaded in the past. Your doctor can't do that because this will be the first download.

No, you can't go to just any PC shop and get just any card reader.
It has to be a DT 3500 Infineer Smart Card...I have no idea what other uses it could be used for.
It very well could have other smart card uses but how often do we use smart cards now...everything is SD card.

This is what is needed. I know of another source for $46.50 but don't have it handy at the moment.
https://www.cpap.com/productpage/Respir ... r-USB.html

Back when I was using the M series machine...I did it for 2 years...I could access the reports from the very first night of download because it was stored in the software and I downloaded at least weekly.
Anytime I wanted to see older reports I just selected a date range with only 7 dates and I could see the detailed graphs even if they were a year old. The software does allow for date selection...it just defaults to most recent unless you tell it different.

OK thx, after I see her on Monday maybe I will decide to get the card reader and software. Maybe I can borrow some money somewhere. I can't see any other way of trying to understand whats going on. I can't go to the RT every day thats for sure and it takes months to see the Doctor.

I will get back to you on the reader/software buy.
Do they ship to Canada?? Also, We have a mac, but also an older pc laptop with Windows XP and a Netbook with windows 7 starter. Will Encore and the reader work on one of these 3 computers?

The source I know of will ship to Canada but the 6.50 shipping is US shipping price...it will be more to Canada. I don't know how much more.
Cpap.com will ship to Canada and match online prices of other vendors. They ship to Canada also. Again I am unsure of price.

EncoreBasic software is Windows based software and won't work on a Mac unless you have a virtual Windows environment for it to run in.

It will work on Windows XP PC...not sure about the Netbook because I don't know if it has a plug on it for the USB port connection on the card reader. I have never seen a Netbook. Windows 7 is no problem but I don't know about the Netbook itself.

See if the RT will give you printed copies of the detailed reports. Scan them and post them here for review...if they aren't real exciting then maybe seeing the detailed reports won't offer many clues. We can help you evaluate them but we have to be able to see them.

ok thx so much Pugsy, I will ask her to print them out for me...hopefully she will do it. I'll try to take notes too.

Movement disorders such as PLMD and RLS are treated similarly and dopamine agonists are popular meds to treat the symptoms these days. Current thinking is that iron lackings could be a contributor to the symptoms. One problem with the dopamine agonists is that augmentation is not uncommon. It has been suggested that a low ferritin level (below 50) could make one more prone to experiencing augmentation.

Because these meds have the potential to have some nasty side effects, I suggest FIRST getting iron studies to include ferritin level just in case correcting a low level could resolve the symptoms and avoid the pharmaceutical route. But if meds are still needed, having the ferritin level higher could lessen the chance of augmentation. Just makes sense to not go on these meds until you are sure you are providing the environment most conducive to their success.

A little light reading if you are so inclined...
http://www.ncbi.nlm.nih.gov/pubmed/19200780
http://www.ncbi.nlm.nih.gov/pubmed/17921065
http://www.ncbi.nlm.nih.gov/pubmed/14592347
http://www.ncbi.nlm.nih.gov/pubmed/14572128

And while you're at it, have your magnesium levels checked.
http://www.ncbi.nlm.nih.gov/pubmed/15310483
http://www.ncbi.nlm.nih.gov/pubmed/9703590

Disclaimer: I did not select these links because I support the studies or have looked closely at their trustworthiness etc. Quoting them only to point out that my thinking on the subject did not originate in my head.

Hi again, saw the RT today. She read my card and printed out about 10 pages incl. past 7 days.

This is my first attempt to place image in the post. Hope it works. If not, I may need a couple of pointers.
I scanned the printouts and used Photobucket.
Hope image is not too big.
Any input appreiciated. I actually had the pressure set from 8-10 last week (thought it was 11). Reguardless I need a higher setting...I guess.
We takled about PLM, but she wasn't too familiar with taht...