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

[sheepless]

thank you Molly. magnesium has been on my mind; have to buckle down & sort through the various forms available. thinking about adrenal fatigue as well. apparently not recognized in std western medicine but i have heard & read anecdotal reports of improved sleep when treated for this by naturopaths.

[Walla Walla]

sheepless, Here's a link on Magnesium from the Wiki if your interested. http://www.apneaboard.com/wiki/index.php...=Magnesium

[sheepless]

outstanding. thank you, WW. on quick read I think I learned what to avoid, mostly due to digestive intestinal effects. any suggestions for a variety and dose? (esp variety; wiki might have stated the dose; I'll re-read). sounds like not much harm in higher doses but seems sensible to avoid that. my understanding is supplements are not regulated and so who knows what's really in them (?). are there any preferred brands you know of? alternative to or in conjuction with a supplement, I coincidentally mentioned to my wife last night that I may have to force myself to eat bananas, practically a fate worse than death for me, but I guess we can adapt to almost anything if necessary.

[Walla Walla]

There's some links at the bottom of the wiki.One shows how much magnesium you get from different foods. Almonds and sunflower seeds give you the most.
For supplements probably you want to get one that's time release to avoid overloading your digestive system.

[Sleeprider]

Sheepless, this is why we keep issues on the forum. There is so much more input from all the members, than relying on one. I have no clue about ADHD, Catapress or magnesium, but I'm glad to see you're getting new ideas to fill-in what I can't.

[sheepless]

checking in.

ahi doesn't get any better than last night (see daily chart under #2 below) and yet sleep continues to be exhausting.  not so hungover sick feeling anymore; memory and cognitive ability is improving; but still useless in terms of energy.  inability to sleep more than an hour or so continues to be a problem.  once in a while I get lucky and get longer uninterrupted sessions but 1.5 hours max is still the norm.  three things that are often visible at the end of many of my sleep sessions and which I believe are the causes of my arousals continue to stand out for me but I don't know what to do about them.

1.  periodic leg movements.  last night my wife told me I was having periodic leg movements for more than 15 minutes and which I was able to correlate with the flow rate.  this is the second time we've linked her report to a time and a pattern.  I'm convinced, but I want to be convinced, so in the absence of a camera I'll wait for a 3rd time to declare relative certainty based on circumstantial evidence that this flow rate pattern is indeed plm.  after the awakening for which she reported plm, I had her replicate her interval count aloud, which I timed at ~ 16 - 17 seconds.  the flow pattern is a large breath followed by several smaller breaths followed by a large breath.  the larger breaths are in response to the body movements.  the intervening smaller breaths are often flow limited and the first couple are often saw toothed like a snore but according to my wife they are more likely my moaning mumbling vocalization of my discontent with the sudden disturbance.  this pattern is frequent throughout most nights and often precede an awakening. 

[attachment=8618]


2.  flow limitations.  you can see from the daily chart that I have a lot of magnitude 1.0 flow limitations.  flow limitations very often precede the end of a sleep sessions by roughly a minute or less.

[attachment=8619]

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3.  events and near events. other nights a fair number of awakenings follow flagged events.  an example from last night is an awakening following a series of near events that the machine successfully nipped but which nevertheless resulted in ragged disordered breathing and awakening. 

[attachment=8621]

in sum, I believe these charts suggest the likelihood that periodic limb movement and disordered breathing are the most common causes of my fragmented sleep.  

as always, your reactions and ideas are very much appreciated.

[Walla Walla]

I'm not educated on ASV but was wondering if you had tried using a high minimum pressure support. maybe say 4.6 instead of 3.6? The thinking being it might help reduce the flow limitations. Your leg movements may be caused by your body fighting to breath due to the flow limitations. I don't know I'm just throwing it out there.

[sheepless]

thanks WW. I appreciate your thoughts about this. it's interesting: when I look at the flow that I think represents plm, I also see ps rise and fall which forces me to wonder if increased pressure causes the bump in flow rate or if flow rate increases due to sudden body movements. probably only a camera will tell.

I'd moved up to fixed epap of 11, ps 2.4 which worked great for ~5 nights, then aerophagia became intolerable. I dropped to epap 9 and raised ps to 3.4 because 13.4 was a sweet spot pressure for me on apap. took a day to realize I can't add and 9 + 3.4 does not make 13.4 but one night at lower epap and higher ps returned 0.0 ahi and much less aerophagia. great but too many arousals so I thought I'd move ps to 4.4 to get to ipap of 13.4 tomorrow night because I've already napped today and don't want to mess up the data reported.

gonna keep trying different variations but so far trials with ps up to 6 haven't done much to reduce flow limitations for some reason.

[sheepless]

"You need PS max to be at least 12.0 cm to trigger a breath." - Sleeprider. copied from Broomstick thread.

Sleeprider, can you elaborate on this? don't mean to pin you down but this is confusing to me. I'm doing pretty well at epap 7.6 - 12, ps 3.2 - 9 (last 45 days = 0.24 ahi). maybe you meant ipap 12 or do you think I'm not getting ca or my machine isn't reacting to them?

my c-collars are slowly becoming less effective in staving off lip leaks so I wanted to keep my max ipap relatively low... although I've let it free range up to 25cmw, lately the machine hasn't reached much over 19cmw with these settings.

[jaswilliams]

"You need PS max to be at least 12.0 cm to trigger a breath." - Sleeprider.  copied from Broomstick thread.

Sleeprider, can you elaborate on this?  don't mean to pin you down but this is confusing to me.  I'm doing pretty well at epap 7.6 - 12, ps 3.2 - 9 (last 45 days = 0.24 ahi).  maybe you meant ipap 12 or do you think I'm not getting ca or my machine isn't reacting to them?

my c-collars are slowly becoming less effective in staving off lip leaks so I wanted to keep my max ipap relatively low...  although I've let it free range up to 25cmw, lately the machine hasn't reached much over 19cmw with these settings.

With a max epap of 12 and a max pressure support of 9 it is not possible for your machine to go over 19 CMW it depends how much time your ASV spends at max pressure trying to clear Hypopnoeas and CA’s, I would need to see a recent daily graph with these pressures to comment further but if the Red pressure graph has a flattish top then more room for your machine to move is desired, but it can be a balancing act between pressure needs, comfort and leaks. With an AHI of 0.24 it seems your doing great. But how is your fragmented sleep going (I looked back through this thread to find some current graphs)