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18 mths of apap: need help optimizing settings to feel better [ASV]
RE: 18 mths of apap: need help optimizing settings to feel better
thanks again ajack, for your time and interest.

I agree, there's no way to infer plm from just the flow rate. yes, it's pb and of course plm is periodic. for a long time while on apap I assumed it was rampant pb but began to notice a difference between one manifestation of it that looked more like the classic csr type and this pattern that doesn't. some time ago I posted a couple of comparison charts somewhere around here.

that it's plm is supported by my wife's observations and audio recordings correlated with the time of the flow rate. in audio you can hear the kick against the sheets and a moan. not sure I need another night in the lab and I surely would like to avoid it. I was never told, even when I complained of restless legs, but after I pressed for more of my file from the sleep doc I found my last sleep test reported (iirc) 24plm/hr of which 20/hr caused arousals. the only way to be any more certain (confirm or deny) is to pick up a night camera but inertia is my MO and I'm amazon-averse to boot. to me, this all adds up to plm being a simple and logical explanation for my fragmented sleep and residual tiredness, now that my apnea is controlled.

sorry if I wasn't clear. aerophagia occurred with high minimum epap and/or high min and/or max ps. none at current settings.
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RE: 18 mths of apap: need help optimizing settings to feel better
ajack (and everyone else that's interested), here are the charts with the substitutions you mentioned for the same flow rate segment I posted earlier.
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RE: 18 mths of apap: need help optimizing settings to feel better
forgot the pressure graph in the chart in previous post.  try this one.  

not clear to me if you can tell if spikes are pushed by pressure support or pressure support follows the sharp inhale. again, I don't think plm can be inferred directly from the data without external confirmation, in this case: spousal observations and audio recordings.
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RE: 18 mths of apap: need help optimizing settings to feel better
This appears to be mitigated periodic breathing. Pressure (in this case mask pressure might be better) is inverse to the flow rate, so that spikes in flow are during pressure minimums, and low flow rates correspond to higher pressure. The machine is working exactly as intended to maintain a more steady volume.
Sleeprider
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RE: 18 mths of apap: need help optimizing settings to feel better
but what is the source of the pb? yes the machine is acting as expected. my contention, with external confirmation, is the source is the leg movements and my respiratory response to them. but I'm not trying to convince anyone. the spousal observations and recordings which only I have are are integral to my conclusion.
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RE: 18 mths of apap: need help optimizing settings to feel better
What sleeprider said. it isn't to make every breath perfect. It's to make every breath part of achieving the target minute vent.

re the aerophagia, do you have GERD? If you do, there are some suggestions I could offer.
It isn't unusual for aerophagia to settle over time, Leave the epap where it is and increase the max PS a bit at a time. The machine will only use what it needs. There will be good and hopefully just a few bad nights, I guess it's just balancing it with effective treatment.

The PLM arousal of 20 per hour may be your current issue. It is impacting on your sleep states and shouldn't be ignored. It will be finding the most effective medication.
mask fit http://www.apneaboard.com/wiki/index.php...ask_Primer
For auto-cpap, from machine data or software. You can set the min pressure 1 or 2cm below 95%. Or clinicians commonly use the maximum or 95% pressure for fixed pressure CPAP, this can also be used for min pressure.
https://aasm.org/resources/practiceparam...rating.pdf
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RE: 18 mths of apap: need help optimizing settings to feel better
(05-30-2019, 06:36 PM)sheepless Wrote: forgot the pressure graph in the chart in previous post.  try this one.  

not clear to me if you can tell if spikes are pushed by pressure support or pressure support follows the sharp inhale. again, I don't think plm can be inferred directly from the data without external confirmation, in this case: spousal observations and audio recordings.

Can you replace the pressure graph with mask pressure that is a high resolution graph which shows what the pressure is doing at the mask rather than the machines target pressure.
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RE: 18 mths of apap: need help optimizing settings to feel better
ajack, sorry if I haven't been clear. I'm quite happy with my settings (50 days: 0.23 ahi) and I only had aerophagia at much higher settings. I have reflux but it has diminished so much after moving from apap to asv, I no longer take anything for it. and yes, I agree, I believe that 20 plm arousals per hour is precisely the source of much of my fragmentation.

jaswilliams, I'll post a chart as you suggest in a bit.

no matter though if you all are responding to my plm waveform because you can't tell it's source with data alone. yes, it's pb and I have identified the source of the pb in my charts that look like what I've posted. I've confirmed to my satisfaction based on independent observations and audio recordings associated by time with the data.

I'll be back with the updated screenshot shortly. thanks all!
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RE: 18 mths of apap: need help optimizing settings to feel better
mask pressure as requested.

edit: to add end of session screenshot.
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RE: 18 mths of apap: need help optimizing settings to feel better
too late to edit the previous post again... I want to clarify that I don't expect cpap settings to mitigate plm or resolve this pattern. it's been prevalent in my charts for my full 2.5+ year history with apap and asv and at dozens of different machine settings. moreover, asv is supposed to address periodic breathing and clearly it hasn't resolved this pattern; and that, I am convinced, is because the periodicity in the pattern in question stems from physical jolts to the body in the form of periodic leg movements rather than some inherent heart or respiratory problem.
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