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18 mths of apap: need help optimizing settings to feel better [ASV]
#41
RE: 18 mths of apap: need help optimizing settings to feel better
yes, you are right to rib me about the collar, Sleeprider. I believe most of my leaks have been from a very slight parting of lips and not from jaw-drop so I had doubts the collar would be effective. I'm thrilled with the result. 13.4cm all last night and leaks very well managed. just goes to show: keep an open mind and try everything.

now with the collar and minimal leaks my machine doesn't understand me. great ahi of 0.98 last night but that doesn't include 4.90 rera index. 35 rera events. I know I must sound like a broken record but from an uninformed common sense point of view, it seems logical that rera with associated flow limitations, a whole lot of ragged breathing, frequent periodic breathing and a bunch of short (under 10 second) flat lines, have to be traumatic and could explain many of my frequent unflagged awakenings.

I don't want to beat this drum more than I already have, particularly since more-knowledgeable folks seem doubtful about it, so I haven't added images from last night, but will do so if there's an interest.

I expect you-all must be pretty tired of hearing from me. I know I'm tired of speculating and the uncertainty that drives it.

time will tell? I will have an asv to try out very soon. I don't know much of anything about asv yet so I don't know if it will even out all the stuff listed above, but it sounds like it might and if it does, that should determine one way or another whether these rera etc. explain my awakenings. I hope so.

until then, I plan to incrementally push fixed pressure up to see if the collar will still control leaks and if higher pressure will push through the rera and anomalous breathing.

thanks everyone for bearing with me.
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#42
RE: 18 mths of apap: need help optimizing settings to feel better
I hate to call you a borderline patient, but I've learned a lot from following thread, in particular about periodic breathing, and you are borderline because the numbers don't agree with what's really going on with you, and would be next to impossible to prove that you would need a different mode of therapy just looking at the face of one of your sleep data charts.

I look forward to seeing what your charts will look like on ASV, as I'm sure you will post them.
Jesse


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#43
RE: 18 mths of apap: need help optimizing settings to feel better
thanks Jesse. you make a good point. apparently it's not clear just what ails me so I have to continue beating the bushes if I have any hope of returning to a productive life. I keep alluding to the possiblility that breathing difficulties break up my sleep. in a way, it's what I hope, assuming the right machinery can deal with it. that's partly because I don't think I have the kind of issues cognitive behavioral therapy - the only alternative I've heard about - address. and it sounds like a long, less than pleasant process; among other things, being ADD, I struggle with structure and routine. but I didn't think the collar would work for me either so I might have to follow my own advice, to keep an open mind and try everything. meanwhile, you can call me whatever you want, I don't mind, as long as you-all help me see this through. <smile>
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#44
RE: 18 mths of apap: need help optimizing settings to feel better
(06-01-2018, 01:39 PM)Sleeprider Wrote: Mainly I wanted to see what your tolerance is for lower EPAP pressures.  The same patterns as always are present here, and the AHI is frankly no worse or better. There is still a lot of periodic variation in flow rate.  I looked at a lot more of those patterns last night, and they are a constant feature of your breathing. You have tried pressures from this low of 9/6 to variable pressures that went to 20 cm, all without much change from the big clusters of CA and OA and the fragmented therapy. I can't think of much else to do with CPAP.

Given your original diagnosis in sleep study of central sleep apnea, and your follow up sleep study showing complex or mixed apnea, I think you should try ASV is the opportunity presents itself.  My suggestion is an EPAP of 6 to 12, PS 3 to 12.   We can hope that you can change your habit of breaking therapy every hour, or that the therapy works well enough that you won't feel a need to. I tend to think this is going to be a difficult habit to break and the only help we can offer is to make the sleep you get as good as possible by evening out periodic respiration and breaking the cycle that leads to the clusters of OA.  I think a good soft cervical collar will continue to be your friend..

Sleeprider, et.al.: setting up aircurve 10 asv.  no manuals. have seen basic setup info (same as autoset) and have requested setup manual from board. some questions:

okay to insert sd card I've been using with autoset?  I erased all data on asv machine, once by mistake without card that came with it and once with that card in.  pros and cons, if any, of one using one card or the other?

will resscan and sleepyhead recognize different machine or do I need to do something like set up a different profile?

you've suggested epap 6-12, ps 3-12.  last few days I've been raising pressure on autoset.  have attached last 2 days daily screen, 14.4/14.4cm and 15.0/15.0cm both epr 3.  results look like improvement to me but flow rate waveforms just as ugly including ragged breathing and periodic breathing.  collar doing great job minimizing leaks and some clusters. do you see anything that would lead you to change your suggested settings?

will dme and resmed continue to automatically receive data from new machine and should I care?

thanks.
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#45
RE: 18 mths of apap: need help optimizing settings to feel better
I just read Horrux's question about blood pressure. it reminded me that I believe my pressure has been going up ever since starting cpap. have taken atenolol for many many years. Horrux's question prompted me to check mine just now: 178/100, pulse 59. the last windows 10 update cruelly wiped my c drive including my bp history spreadsheet so I can't verify but believe this is the highest ever. will measure again another time to see if an anomoly. yes, it's time to check in with a doctor. meanwhile: does high bp have any bearing on whether I should try the asv?
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#46
RE: 18 mths of apap: need help optimizing settings to feel better
Your sleep data is tracked by machine serial number and model in both softwares. You can put a clean SD card into the new ASV and it should work seamlessly. The session you download will have very different looking pressure, flow, mask pressure and other graphs, but the software won't be confused, just import the new information into your existing profile. Use the initial settings I suggested before. They are intentionally broad, but recognize you won't tolerate the lowest EPAP pressures. We will fine-tune as soon as we see a pattern, and I suspect the minimum EPAP will be higher.

There is no way to predict how you will react on the ASV or if the pressures you needed on CPAP will be required to control apnea. It's a different animal and will treat the precursors to your central and possibly obstructive apnea. Remember if you feel the machine is running the show, blow! Don't expect to use this the first night and wake up feeling the best-ever. This will be a journey. Stick with it and don't break therapy. Continue using the C-collar for now.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#47
RE: 18 mths of apap: need help optimizing settings to feel better
okay. just had a 30 minute trial nap at suggested settings. not sure I slept. it's different but so far no problem. feel it a little more in my ears than I'm used to. maybe some minor aerophagia. for some reason I had less at 15cm with autoset.

about breaking therapy. are you suggesting I leave the mask and machine on when I'm awake?

I've mentioned before that I have used the autoset nearly every sleeping moment. I can't imagine sleeping without it. non-use during sleep has been infrequent and unintentional. this may be semantics, but I don't think I'm breaking therapy. I don't tear the mask off in sleep or anything like that. as you've seen, I become fully awake 6, 9, 15 ish times per night. sometimes in response to runaway pressure, sometimes clearly in response to flagged events. I have my own suspicion about what's causing the other awakenings, but nothing else. regardless, I beome so awake and I think physically stressed that I know I'm not relaxed enough to immediately fall back to sleep.

besides feeling the need to do something like read or get up and "walk it off" during these gaps in therapy (honestly I usually feel compelled to sit up, get out of bed, walk around, sit quietly in another room, etc), my thought is that it's better to stop therapy under these conditions so it's obvious I'm awake. these awakenings are my biggest problem. leaving the mask and machine on while awake would gloss over that fact. more importantly, I figure leaving it on while awake for what adds up to a significant amount of time will seriously skew or misrepresent actual therapy results.

but if you want me to try lying awake without 'breaking therapy' following these awakenings, leaving mask on and machine running, please confirm that.

thanks.
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#48
RE: 18 mths of apap: need help optimizing settings to feel better
Your therapy is fractured beyond anything else in my experience. It's a habit, or anxiety, I don't know.  Somehow you get in almost 8-hours of total therapy, but the many sessions it takes to get there is beyond my comprehension. You should do some research on sleep hygiene and see if there is anything there you can learn. You be the judge.

[Image: attachment.php?aid=6440]
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#49
RE: 18 mths of apap: need help optimizing settings to feel better
Just for fairness this is mine for comparison.

[Image: attachment.php?aid=6442]
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#50
RE: 18 mths of apap: need help optimizing settings to feel better
Sleeprider, I wrote a more detailed reply but ditched it because it's all been said before. I think we understand each other.

You said, "Stick with it and don't break therapy." semantics probably, but it's not like I have a choice.

Meanwhile, I don't think you'd want me to 'not break therapy' by lying awake with mask on and machine running during the gaps but have not had a direct answer to that and I'm really bad at reading between the lines. I don't know what else you mean by that statement, at least in the short term. I will try to identify and implement additional sleep hygience measures but that and cognitive behavioral therapy don't sound like short term strategies.

To save you yet another reply, I'll assume continuing therapy while awake is not what you mean. I'd ask you to reply only if that's an incorrect assumption.

It can't be said enough: your efforts and those of so many on this board are awesome and inspiring. I am grateful for the substantial education and assistance I've received here.
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