The more I try, the worse it gets.

Prednisone. I finally remembered.<g>

Last night was discouraging.

No rainout, hose cozy doing its job. No doxepin (took 5mg on Wed and try to keep it to every other day to get the effects for the itching but try to keep the side effects of the sleepiness controlled)

Wore my Zest. Its more comfortable than the Wisp for me, less headgear feeling. Warmed my humidifier and I actually liked it. So did my sinuses. Fell asleep. When I sleep on my side, its most comfortable, altho eventually the hips starts yapping.

That the good stuff. The bad stuff is the aerohagia is wrecking havoc with my ability to stay asleep. Without tape or chinstrap, where I used to be somewhat able to keep my mouth shut, that seems to have gone out the window. (this has all been since I have tried the full face mask which I will permanently retire, I think) I seem to be dropping my lower jaw. Getting dry mouth and that with the sound of an open mouth on a nasal mask kept waking me up. The only ok thing about the aerophagia is it is still in the mobile stage. meaning it hasn't landed like a brick in my stomach. I can still eliminate the gas throughout the day. But its not my favorite thing.

At 5-530 I applied tape to my mouth. I still kept getting chipmunk cheeks and awoken. I wonder if I forgot how to breathe right?

As you can see by my graphs, I had. over 10 ahi with 8.5 being centrals. I am beginning to wonder, like RS mentioned, if most of my numbers are arousal created. That its not my throat closing everything down, but outside factors being the things that disrupts my sleep. Cats? Removed them at night. Itching. Doxepin helps. Even gives me a small freebie sleep help. Using my mask. Pressures seem logical. I know I woke up often last night and I know each time its was because my jaw dropped, I could hear the leak and my mouth was bone dry. I know I reached REM because I dreamed of puppies.(we may be considering a boston terrier and spoke about that yesterday so it was in my dream). I know I switch sides several times a night because my hips hurt after awhile. I know I have restless legs and even worse I have a really bad habit of flexing my toes. I have to really work hard to stop doing that, its become so natural.

So you all know just about everything about my sleep thing. I know I could improve some things but I am not thinking those are the things causing the problems. I kept the mask on for at least 2 extra hours but the leaks and the wakefulness really starting to be disrupting toward the end.

I think I still have some things to learn and try and correct, but if I understood both RobySue and Pugsy, there is only so far we can go with the sleep apnea solutions and then its outside issues. Am I understanding that correctly? What do you think of my reasoning and my graphs from last night. Last night should have been a good night and it wasn't.


ResMed
S9 VPAP Auto
Mode: Bi-Level
EPAP: 9.0 IPAP: 15.0 cmH2O
PS: 4.0
Date Sleep Wake Hours
5/2/14 00:24 06:28 06:04:02
AHIApnea / Hypopnea Index 10.05
HypopneaHypopnea 0.49
ApneaUnspecified Apnea 0.00
ObstructiveObstructive Apnea 0.99
Clear AirwayClear Airway Apnea 8.57

Event Breakdown


Statistics
Channel Min Med 95% Max
EPAPExpiratory Pressure (cmH20)
W-Avg: 9.81 4.72 9.76 10.90 11.00
IPAPInspiratory Pressure (cmH20)
W-Avg: 13.81 8.72 13.76 14.90 15.00
Minute Vent.Minute Ventilation (L/min)
W-Avg: 5.05 1.00 5.25 7.62 10.38
Resp. RateRespiratory Rate (breaths/min)
W-Avg: 14.58 4.60 14.60 19.00 26.40
Resp EventsRespiratory Events
W-Avg: 0.00 0.00 0.00 0.00 0.00
Flow LimitFlow Limit Graph (0-1)
W-Avg: 0.01 0.00 0.00 0.05 0.37
LeaksLeak Rate (L/min)
W-Avg: 7.62 0.00 1.20 27.60 33.60
SnoreSnore (unknown)
W-Avg: 0.05 0.00 0.06 0.08 0.12
I:EInspiratory:Expiratory (ratio)
W-Avg: 41.51 7.00 42.00 58.00 88.00
Insp TimeInspiratory Time (seconds)
W-Avg: 1.20 0.44 1.20 1.50 1.76
Exp TimeExpiratory Time (seconds)
W-Avg: 3.04 0.68 2.84 4.56 7.70
Tidal VolumeTidal Volume (ml)
W-Avg: 353.28 60.00 360.00 580.00 720.00

Machine Settings
Pr. ReliefPressure Relief Easy-Breathe x1

Session Information
SessionID On Date Start End
CPAP Sessions
1399004687ResMed CPAP 6h, 4m, 2s 5/2/14 00:24 06:28

lliann,

Observations about last nights data:

1) Leaks were in the large leak zone between 3:40 and 4:40 and the machine was having trouble tracking the breathing---you can see that with the severely reduced wave flow data during that period.

2) The number of centrals between 4:40 and 6:40 is excessively high, but you also report that you were restless during those last two hours. So many (most?) of them are probably sleep/wake/junk (SWJ) that are not necessarily real. Leaks are also problematic off and on during this time frame, but you knew that.

3) The obstructive events remain well under control at this Auto Bipap range.

In light of those observations, we're still tangling with the big question of how to get less fragmented sleep and reduce the number of arousals? And that's not always an easy problem to solve. Sometimes it just takes time: Time for the body to actually adjust to this way of sleeping. And in your case, time to adjust to kicking the cats out and sleeping without them (but that's needed for your health). And time for the mouth to learn to stay closed (or mostly closed). And time to sort out the delicate balance between enough pressure to take care of things and not enough pressure to trigger severe problems with aerophagia.

You also write:

When I sleep on my side, its most comfortable, altho eventually the hips starts yapping.

and

I know I switch sides several times a night because my hips hurt after awhile. I know I have restless legs and even worse I have a really bad habit of flexing my toes. I have to really work hard to stop doing that, its become so natural.

Pain can play havoc with the quality of sleep and perhaps some of your arousals are pain related. Could even be that the hip pain triggers an arousal which in turn triggers the mouth to open which in turn triggers the leak which is what you remember as the cause for the wake ...

Is the hip pain confined to sleep? Or do you have it in the daytime as well? Ever been evaluated for it? Something that sometimes works to help nighttime hip pain is to use a thin, firm pillow between the knees when you're sleeping on your side.

When you say you know you have restless legs, do you mean you exhibit symptoms or do you mean you've had a formal diagnosis? I know you're reluctant to take additional meds (and I share that reluctance), but if the restless legs are really bothersome, you might want to ask about what kinds of things can be prescribed. My father has fought RLS for decades. He finally agreed to take something for it about 5 years ago (I don't know what right off the top of my head), but it's made a big difference in his sleep and he's had no serious side effects from whatever it is his doc prescribed.

The toe flexing may or may not be a problem. If you're doing it as a way of stretching out the restless parts of the legs, then "fixing" the restless legs will eliminate the toe flexing. If you're doing just to relax, I wouldn't worry too much about it.

Last night was nuts. Had an itch flare up so took a whole doxepin. So I am groggy and tired and will be all day. I tried the aitfit full face with a resmedzzzzz liner and I got those funny under the lip u tape things.

There were moments of okness. But I also had a double whack of doxepin. (this is why I don't like it. It just makes me too tired but it took care of the itching (feet. Neurological or something. We just can't figure it out.) But I kept waking up. The u tape thing kept the aerophagia out (but wearing a tape mouth in a full face is odd. Its like being in a gigantic nasal mask.

Also that u tape thing felt like it gave me an u exfoliation thing. Yikes. Wonder if that painters tape is more forgiving? Anyway I kept waking up and I guess I took it off for awhile. The events were, as usual, mostly centrals and I believe they are all the times I lifted the mask to reseat it. Oh I remember. I did not take it off. But the machine turned off and it took me a while to notice.

So I think last night was too atypical to bother showing the charts.

I knew I was having rls and I was going to mention it to my pcp when I saw him next. But my last sleep study did define I had severs rls (something like 199 events?) I do have the complete study. It actually looks decent and supports that 13/8 took care of things for at least half the night. But something just isn't jiving. Not sure what yet. I suspect its those non obstructive arousals, whatever they are and I think they may be more than one thing. Sigh.

About the mask. I am going to try it one more time. The liners helped in some way, but don't know if its enough.

Ok, I gave Airfit F10 a good try. I give up. Full face is just not for me. I spend all night chasing the leaks

checking in. Still alive.<g> It appears the Wisp is my most consistent mask so far. A little more stuff on my face than I would like (I feel like a hockey goalee) but mostly it presents the least issues. It still does move around on my head and lift off my nose, but thats because I move around so much. OMG! I just bought THE best pillow for side sleepers. Expensive tho. Its the biggest bullseye I have hit in a long time.

Meanwhile, back at the ranch (I have travels and trips in May and June so I will be a little inconsistent), here are the latest readings. Next on my agenda is to be able to interpret what each graphs mean. (I have to take the time to read and apply) I still wonder how the ahi's translate (2.04, 2.04 to 34 events?) And I still suspect my centrals are when the masks is lifted for a reseat or when it moves. I have noticed 2 morning straight, at the end of my tolerance, I waken by air noise. The nose mask has shifted, and yet I don't think it goes above the 25 leak number. B ut the sound still wakes me.

Hope all are well and enjoying some kind of good weather.

Mode: Bi-Level
EPAP: 9.0 IPAP: 15.0 cmH2O
PS: 4.0
Date Sleep Wake Hours
5/18/14 23:33 07:30 07:50:01
AHIApnea / Hypopnea Index 4.34
HypopneaHypopnea 0.26
ApneaUnspecified Apnea 0.00
ObstructiveObstructive Apnea 2.04
Clear AirwayClear Airway Apnea 2.04

Event Breakdown


Statistics
Channel Min Med 95% Max
EPAPExpiratory Pressure (cmH20)
W-Avg: 10.02 4.74 10.08 10.84 10.98
IPAPInspiratory Pressure (cmH20)
W-Avg: 14.02 8.74 14.08 14.84 14.98
Minute Vent.Minute Ventilation (L/min)
W-Avg: 5.34 1.62 5.38 7.38 9.88
Resp. RateRespiratory Rate (breaths/min)
W-Avg: 14.63 4.00 14.60 18.80 28.60
Resp EventsRespiratory Events
W-Avg: 0.00 0.00 0.00 0.00 0.00
Flow LimitFlow Limit Graph (0-1)
W-Avg: 0.00 0.00 0.00 0.00 0.22
LeaksLeak Rate (L/min)
W-Avg: 1.97 0.00 0.00 10.80 16.80
SnoreSnore (unknown)
W-Avg: 0.04 0.00 0.04 0.08 0.26
I:EInspiratory:Expiratory (ratio)
W-Avg: 45.55 6.00 46.00 61.00 79.00
Insp TimeInspiratory Time (seconds)
W-Avg: 1.28 0.36 1.28 1.52 1.70
Exp TimeExpiratory Time (seconds)
W-Avg: 2.93 0.64 2.78 4.36 7.32
Tidal VolumeTidal Volume (ml)
W-Avg: 368.24 40.00 380.00 540.00 700.00

Machine Settings
Pr. ReliefPressure Relief Easy-Breathe x1

Session Information
SessionID On Date Start End
CPAP Sessions
1400470388ResMed CPAP 3h, 4m, 1s 5/18/14 23:33 02:37
1400481844ResMed CPAP 4h, 46m, 0s 5/19/14 02:44 07:30

lliann wrote:I still wonder how the ahi's translate (2.04, 2.04 to 34 events?)

Multiply the index number, which is hourly average, by number of hours the machine is on and you get total number of events in each event category.

2.04 sounds so small and 34 sounds so big.