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Brazen Therapy Thread
RE: Brazen Therapy Thread
That is a very important statement.
You have used a CPAP for. Xx months and have not received relief for your symptoms (have a list of symptoms, how often you have each and what you perceive the severity to be.) from before CPAP. I want to try BiLevel with its higher PS to see if that helps to relieve my symptoms. While my AHI is under 5 I still see significant flow limitations and arousals ( show your stack of examples) that should be better managed via a higher PS.
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RE: Brazen Therapy Thread
Thank you Gideon!

We'll see what the sleep doc has to contribute in a few weeks.

I'm also meeting my new primary doc tomorrow. Maybe she will offer some insight or at least be willing to dig a little for other possible reasons for the fatigue. 

Not denying the need for apap/bi-level, I can see in the charts now there's definitely some disordered sleep, just thinking there is potentially a secondary issue going on.
Former primary docs haven't looked past OA.
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RE: Brazen Therapy Thread
I'm pretty sure the lower the pressures the better, all around.  In the beginning I used higher pressures because I liked them, but I've paid the price with a high ratio of CSA now.  I taught my brain that I didn't need to breathe much!
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RE: Brazen Therapy Thread
@Gideon (& other experts if they want to weigh-in)

A while back you asked if I had a copy of my sleep study.
I requested the full report and all they sent me was the summary 
I have again asked for the full report but here is the summary information:

Date of sleep study: 3/23/2022 
Total recorded time: 486.6 minutes  

1. SLEEP ARCHITECTURE: sleep architecture was impaired, including increased N1 sleep, increased N2 sleep, normal N3 slow wave sleep and decreased REM sleep. Decreased sleep efficiency of 83.3% (normal 85%), normal sleep onset latency of 17 minutes (normal <65yo is 15-20 minute and >65yo is 15-30 minutes), and prolonged REM latency of 356 minutes (normal 90-120 minutes). 
2. SNORING: Technician reported snoring was observed during study. 
3. RESPIRATORY: Mild obstructive sleep apnea with an Apnea/Hypopnea Index (AHI) of 7.7 events per hour, supine position with AHI 10/hr. The sleep-disordered breathing in REM sleep with AHI 24.5/hr. The lowest 02 desaturation of 85%, Mean SpO2 91.8%. Patient spent 2.5 minutes with SpO2 at and below 88%. Cheyne-Stokes breathing pattern was absent. 
4. ECG ANALYSIS: The average heart rate/min was 81 bpm. Normal sinus rhythm was noted throughout the night. 
5. LEG MOVEMENTS ANALYSIS: No significant leg activity was seen. The periodic limb movement (PLM) index was 5/hour. 
6. The patient was not observed to move and/or speak during REM sleep. Other parasomnias were not present.

Does the mild OSA explain the prolonged REM latency?  Or something else (like being in an uncomfortable bed in a lab)?
Or is it likely even with the APAP I have the prolonged REM latency issue which would mean there's no way in my average 6-7hrs sleep a night I'm getting anywhere near enough REM?

It also looks significant for REM induced apnea - any different treatment strategies with that?

Thank you!
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RE: Brazen Therapy Thread
Oooh... just look at that beautifully peaceful breathing from 0100-0213!

After that all heck broke loose and I gave up early. But dang, that is the prettiest bit of chart I've had so far!  I want more of that.
I also FINALLY had a dream (first since starting APAP)!

What was different...  I had one glass of wine a few hours before bed. (rarely drink) I doubt that's a factor but it's the only thing that was different.

Everything else was the same... APAP settings, mask, sleep hygiene, blankets, pillow, sweet pup by my side...

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RE: Lower pressure = lower AHI??
(09-07-2022, 10:56 AM)Brazen Wrote: I'm not trying to be difficult.  Just trying to find the benefit.

I have looked for studies showing the benefits of treating mild OSA -- all the while wondering if that's really even my issue or if the sleep specialist just rubber stamped that.  Not having much luck finding the data.  Severe OSA... absolutely! I can grasp the long-term benefits.

When my only symptom of OSA was fatigue and the prescribed treatment isn't resolving that it's incredibly difficult to see the benefit. I don't want to give up on cpap if it can help me long-term, just trying to find that evidence.

I have learned a lot from this thread. I am new to this therapy and cannot provide much input. However, I can pass on what a professor of oral medicine at Seoul National University Dental Hospital told me. She said there is a lot of new research being done that's showing even mild apnea causes low grade inflammation throughout the body; which, in turn, disrupts homeostasis and normal functionality in pretty much every system given the time. Her subsequent advice was to use CPAP and not a MAD (even though her job is designing them) for these reasons. Her comments help keep me motivated. I hope you feel better soon.
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RE: Brazen Therapy Thread
Interesting info from that professor. 
I'll keep looking for those studies.

I feel like reading through this thread shows a time-line to my eventual acceptance of APAP treatment. Let's hope someday it even shows EFFECTIVE treatment!

I keep trying even though so far it feels more disruptive than beneficial.
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RE: Brazen Therapy Thread
@Mitreal if you can share any of those studies it would be really interesting, thanks!
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RE: Brazen Therapy Thread
(09-28-2022, 12:57 PM)EddyDee Wrote: @Mitreal if you can share any of those studies it would be really interesting, thanks!

I'd like to. I have only seen her for a brief moment to inquire about an appointment for the MAD since. At the time in question, I was getting enhanced CT and blood test results. The CT was clean. Yet my glucose was a bit high. When we transitioned to speaking about grinding and clenching marks and facial muscle tension, she recommended that I get a sleep study. Of course I mentioned that it would be a relief to grind and clench less. That was when she made the comments I mentioned above, eluding to the high glucose result. At the time, I didn't think to ask her where I can find the studies. I will ask her, but I don't think that will be anytime soon. The facial pain has subsided since I started CPAP.
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RE: Brazen Therapy Thread
For Centrals machines other then bilevel may be recommended. Some of these machines have medical contradictions.

Some reasons for a Bilevel

Consider using bilevel when:
• Patient is not tolerating high pressure settings
- Pulling at mask
- Experiencing arousals or microarousals
- Can’t progress to REM sleep cycle
- Feels bloated or has a sensation of swallowing air
- Saying pressure is too high
- States it’s difficult to exhale despite EPR feature
• Events persist at 15 cm H2O2
• Women may need to be switched at a lower pressure due
to their increased pressure sensitivity
• Patient has history of ventilatory insufficiency such as
chronic obstructive pulmonary disease (COPD), restrictive
lung disease, or obesity hypoventilation syndrome (OHS)
• More than 3 cm H2O is required between IPAP and EPAP.
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