18 mths of apap: need help optimizing settings to feel better [ASV]

[mper6794]

....in time, do you have a clearcut RLS, or just PLMS?

[mper6794]

Hi, Sheepless
.......
B_ it may happens your PS min : 3.6 is close what you need. To make sure, could you please, see if  you have your normal Respiratory rate from lab studies (with and whithout machine)?,....see attached graph
C_ I strongly suspect you would be on either wrong parameters or wrong machine. How on earth a person with UARS could handle such great variations on pressure gradients, while inspiring and expiring, under PS of 3.6 and loosing at higher values ?...see attache graph

good luck

[sheepless]

"The pressure support line dropping to 0 Is a data issue coming from the Resmed."

thanks jaswilliams. I wonder what causes it; why it occurs when it does. does it tell us anything about what's happening with me or the machine when it happens?

[sheepless]

"...in time, do you have a clearcut RLS, or just PLMS?"

not entirely sure what you mean by this. for clarity, my understanding is that rls is voluntary movements while awake in order to relieve what I refer simply to as tiredness in the legs. plm on the other hand are regular periodic jerks that occur unawares during sleep.

I believe I suffer occasionally from waking rls. making up a number, maybe 10% of nights, shortly before bedtime. no formal diagnosis or acknowledgement of that. I seem to experience rls in batches, meaning I'll have it for a few nights, then go a while without noticing it. it kind of drives me nuts when it happens.

otoh, I'm only 'aware' of plm insofar as I see my respiratory response to plm in my sleeping flow charts. I haven't counted but it's close to every single night since I began cpap nearly 3 years ago. plm is noted, if buried deep, in the report from my at home sleep test: 24/hr, 20/hr were arousals. I've correlated my wife's reports and audio recordings with a distinctive pattern in my flow rate.

my plm tends to occur in episodes from less than a minute to 10's of minutes in duration. although I sleep through most of them, many cause arousals I'm unaware of, judging by my vocal response to movements.

I agree plm isn't just a leg thing. I'm not sure she's tried much to identify the location of my movements but my wife thinks mine are whole body movements. in my mind, necessary characteristics of plm include repetition and near-regular periodicity.

[mper6794]

...Sheepless, sorry!
I mean: diagnosed RLS..... RLS affects you while not sleeping, whereas PLMS, while sleep. There is a vast literature on RLS and PLMS you may want eventually to review. 
I have just reviewed this thread. Like happens the first time I did it, my conclusion is the same: your main sleep drawback would be UARS-driven awakenings/wake-ups, which would be still waiting for proper treatment with a BPAP machine, or BPAP-simulator machine.

good luck.

[sheepless]

thanks for taking a look, mper. you may be right and I might come around to your conclusions eventually. meanwhile, it's my suspicion that much of any problem I have with flow limitations is related to my response to plm. reducing plm has made a significant, if eroding, impact on improving my fragmentation and reducing my sleepiness. also, as I've said before, I don't think cpap of any kind can overcome active (non-passive) flow limitations triggered by plm. overall, I think I'm making slow progress and am feeling better than at any other time in my 3 years on cpap. I discount plm flow limitations as a problem independent of plm and as Sleeprider explains, many of the flagged flow limitations are the asv machine responding with pressure to ca, so I discount much of what I see in the flow limitations graph. even with all those flagged 1.0 magnitude flow limitations (which I assume are ca related), I only occasionally see a value in the 95%tile column. it'll be interesting to see what happens to awakenings after I am able to consistently remove plm from the equation. I know I have some unflagged non-plm-related flow limitations but I'm not sure I can determine if they're contributing to fragmentation until and unless plm associated flow limitation is dealt with by adequately treating the plm.

thanks, btw, for taking the time to enter my data into your ppt charts. I'll have to give some thought to whether and how to use them.

[mper6794]

It was just a curiosity, maybe in your benefit and trying to test my "semi-quantitative approach"....i think I have completed the RR x PS, from what I could get from your posts. It appears you would be almost there with PS:3.6, however, to ultimate this, I would have know your Normal RR from lab.

good luck

[sheepless]

at risk of overkill, here is another example of why I think plm is the source of most of my fragmentation and sleepiness (as opposed to uars, I guess).  this one is notable for it's duration.  after about the first 8 minutes of the first sleep session of the night, the session is dominated by plm, which I slept through for 80 minutes before coming fully awake.  I have no way of knowing but I suspect many of the jerks that occurred every 20-30 seconds for 1h 20m of this session likely triggered sleep disturbances / arousals of which I was unaware.  that's on top of the full awakening that seems likely to have been caused by the plm (it occurred in the presence of plm and no other reason suggests itself).  this is after taking ripinirol for 3 or 4 weeks, whose initial positive effect on plm seems to be diminishing quickly.

[mper6794]

...this would be your PLMS style...https://youtu.be/yF-X7s-bQk4

This is Mine
...https://youtu.be/6RIoRpd-hho

[sheepless]

well, sorry to say neither of those videos show plm as I understand it; lacking in repetition and periodicity. in one, the person is awake so that's demonstrating rls. it's not clear whether the person in the other is awake or asleep but it sure looked familiar to me, like when I'm restless (experiencing rls) before or while falling asleep or during a sleep wake transition period. I don't suppose it matters what we call it if the treatments are the same but understanding the differences will help us identify the activity if/when it shows up in the flow rate, and vice versa.