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CAs, RERAs, APAP Machine
#11
RE: CAs, RERAs, APAP Machine
(05-28-2021, 09:05 PM)Geer1 Wrote:
(05-28-2021, 08:46 PM)KingKongBingBong Wrote: Yeah I mean mild is 5 but when they analyse healthy populations they use an AHI < 1. If your AHI is 4 you're gonna tell me you're choking in your sleep more than 30 times per night and it's fine? No way!

My sleep test had more than 25 RERAs/hr. AHI low and no centrals. So this device is giving me centrals. Not sure how to reduce them...

How do you know those were central apneas? How do you even know you were asleep at those times? Put on your CPAP, hold your breath for 10 seconds and OMG you just had a central apnea!!!! There isn't a single person on this planet that you could hook up to a CPAP machine that would not have the odd central apnea. I do not have central apnea but I have them flagged almost every night because these machines are stupid. According to my most recent sleep study I don't even have apnea although my HEALTHY breathing triggers 1+ AHI most nights.


Apnea is only an issue if it is an issue. They don't recommend treating AHI less than 5 unless there is strong reason to believe breathing is an issue (UARS supported by RERA's like your diagnosis). They don't even recommend treating mild apnea (5-15 AHI) unless there are also symptoms present that suggest the apnea is an issue. Many people have apnea that does not need treating and does not influence their health or life significantly (1 in 4 male adults are believed to have apnea). Your recent claim that ancestors had maybe an apnea once a week is utterly ridiculous. Many of our living ancestors are living with heart problems etc because they had no way to treat the apnea when they were younger. Many of these people would be dead if it wasn't for PAP technology now. 

Your untreated RERA count is worth treating. It may already be treated at these settings (or when you were are on ASV). The only way to tell is with EEG so if you are that paranoid about this then get a titration study while using CPAP to confirm if your RERA's are treated. Once you find a treatment that works you need to stick with it for weeks/months while your body heals and adapts.

I used an ASV machine and I had 0 central apneas the entire time. I looked through the breathing graphs and I never had anything that looked remotely like an apnea. I had maybe 1 hypopnea MAX per night.

Yes I might get a test thank you. It's my personal belief that if you have mild apnea you definitely have impaired quality of life whether you realise it or not. There's no way you can choke 40-150 times per night and not be impacted in my opinion. Just because somebody doesn't SEEM to have impacted quality of life doesn't mean they don't. We have a tendency to adapt to the new norm so we fail to recognise that it's possible to feel better, more recovered, more alert. Our ancestors had much better nasal passages and ridiculously stronger jaws. I have a horrible jaw which I am glad I can fix, but when I look at the people in my family who grew up overseas on a different diet, they have completely differently shaped jaws and teeth despite the fact we have similar genes. Considering jaw position, palette size and shape, etc. all are risk factors for OSA and UARS, it's somewhat logical to conclude that our ancestors did not have the kind of suffering we do now. We have all seen weston price's work before I am sure.
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#12
RE: CAs, RERAs, APAP Machine
(05-28-2021, 11:06 PM)SarcasticDave94 Wrote: You're assuming if you have zero Apnea then you'd have zero RERA and the rest. And that you'd also be comfortable. And you're assuming our ancestors had no Apnea at all, but our generation does. Quit assuming. You're setting yourself up for a huge letdown. You can't get a zero AHI and be comfortable.

For myself, a person that has complex Apnea, heavy on the Centrals, and then COPD, BTW my diagnostic in 2017 was 78 or so, when my ASV therapy was doing well, I slept 8 hours BEST when reported OSCAR AHI was about 3. I had some zero event nights and felt worse than the AHI 3.

Chasing AHI ZERO will drive you crazy. Maybe you need to stop looking at any chart and focus on the question "are you sleeping well or not?".

well yes it's just my belief that zero is optimal and zero is where I want to be. attaining zero via PAP alone might not be a good solution. I am of course planning to get both MSE and DJS so yeah.

As to your question - I find it tough to answer. Am I sleeping well? How could I possibly know? I can only measure against myself -> I may think I am sleeping well, but in reailty, I am sleeping atrociously according to a more objective measure. I have certainly not woken up once thinking that the machine has worked significantly better than without, but who knows.
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#13
RE: CAs, RERAs, APAP Machine
(05-28-2021, 11:29 PM)KingKongBingBong Wrote: As to your question - I find it tough to answer. Am I sleeping well? How could I possibly know? I can only measure against myself -> I may think I am sleeping well, but in reailty, I am sleeping atrociously according to a more objective measure. I have certainly not woken up once thinking that the machine has worked significantly better than without, but who knows.

Apologies if this a bit blunt, but I have to ask...

If you aren't noticing a difference, if you don't have any obvious symptoms of disordered breathing, if you're chasing after a hypothetical perfect score? Then I don't think you're doing yourself a favour here. And honestly, your assumptions about our ancestors are not based on any kind of evidence. In many of your posts, you're very focused on the surgery, even though it's no guarantee of treatment, so I feel like you may be expecting too much from that. If that's your goal, regardless of whether PAP going to make any difference (as you've clearly said you don't want to use it full time), then this all feels a little moot, or like you're searching for anything that might justify your decisions/assumptions but discarding everything that goes against it.


See my comparison of Viatom/Wellue and CMS50F oximeters here.

Not a doctor, definitely not your doctor, all advice is given as-is and represents simply my own understanding as a fellow patient and OSCAR user.
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#14
RE: CAs, RERAs, APAP Machine
(05-29-2021, 05:57 AM)Ratchick Wrote:
(05-28-2021, 11:29 PM)KingKongBingBong Wrote: As to your question - I find it tough to answer. Am I sleeping well? How could I possibly know? I can only measure against myself -> I may think I am sleeping well, but in reailty, I am sleeping atrociously according to a more objective measure. I have certainly not woken up once thinking that the machine has worked significantly better than without, but who knows.

Apologies if this a bit blunt, but I have to ask...

If you aren't noticing a difference, if you don't have any obvious symptoms of disordered breathing, if you're chasing after a hypothetical perfect score? Then I don't think you're doing yourself a favour here. And honestly, your assumptions about our ancestors are not based on any kind of evidence. In many of your posts, you're very focused on the surgery, even though it's no guarantee of treatment, so I feel like you may be expecting too much from that. If that's your goal, regardless of whether PAP going to make any difference (as you've clearly said you don't want to use it full time), then this all feels a little moot, or like you're searching for anything that might justify your decisions/assumptions but discarding everything that goes against it.

I literally just listed out the evidence. Not everything has to be backed my a double blind randomised control placebo. I don't really care for whether my theories regarding ancestors are correct or not TBH, I only care about how to fix my own problem. Based on the research double jaw surgery with >1cm advancement as well as expansion of the nasal cavity using MSE have been shown in research AND anecdotally to improve symptoms of UARS. How many people on this forum have gotten better from UARS from PAP treatment? I didn't find a single person reporting major improvement via search, so it's a handful at most.

I do have symptoms ranging from minor to moderate, common to occasional including

morning headaches
fatigue
neuroticism
irritability
unrefreshing sleep


I also fit the build of UARS patients, often described as tall young and thin. I am no longer thin but I was very skinny throughout my teenage years all the way up until 19, and I had to put a lot of effort into gaining mass.

I'm not chasing after a "perfect score", I am chasing after <5 RDI <1 AHI. I have already had 1-2 weeks worth of nights on the ASV with 0 AHI so that is solved. Now I just need to fix RDI.

If my RDI is 30, I don't give a sh*t if I have no perceivable symptoms, having mini suffocations hundreds of times per night is DEFINITELY not good for you. Just because something hasn't been researched doesn't mean there isn't an impact.

Anyway yea. I have all those symptoms. I have UARS. But to define a good night's sleep, I have no idea. I can only compare with myself. There are people out there with 100+ AHI who think they sleep well, but objectively that is atrociously bad sleep. All I know is I can work on minimising my AHI and RDI, see how I feel, and then assess from there.
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#15
RE: CAs, RERAs, APAP Machine
I'm just noting you mention zero Central Apnea while on ASV. That is what ASV does, it's to fight Centrals.
Dave

OSCAR
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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#16
RE: CAs, RERAs, APAP Machine
(05-28-2021, 11:24 PM)KingKongBingBong Wrote: I used an ASV machine and I had 0 central apneas the entire time. I looked through the breathing graphs and I never had anything that looked remotely like an apnea. I had maybe 1 hypopnea MAX per night.

Yes I might get a test thank you. It's my personal belief that if you have mild apnea you definitely have impaired quality of life whether you realise it or not. There's no way you can choke 40-150 times per night and not be impacted in my opinion. Just because somebody doesn't SEEM to have impacted quality of life doesn't mean they don't. We have a tendency to adapt to the new norm so we fail to recognise that it's possible to feel better, more recovered, more alert. Our ancestors had much better nasal passages and ridiculously stronger jaws. I have a horrible jaw which I am glad I can fix, but when I look at the people in my family who grew up overseas on a different diet, they have completely differently shaped jaws and teeth despite the fact we have similar genes. Considering jaw position, palette size and shape, etc. all are risk factors for OSA and UARS, it's somewhat logical to conclude that our ancestors did not have the kind of suffering we do now. We have all seen weston price's work before I am sure.

ASV has a backup rate and variable PS that forces you to breath when your body doesn't want to. You don't even have apnea and were using a machine capable of treating far worse obstructive and central apnea. Of course your AHI is going to be 0 or close to it on ASV as it would be with almost anyone that is healthy to even moderate apnea. 

Saying you never have apnea on ASV is similar to saying you never have apnea on a ventilator. Of course because the machine is doing its job. The question isn't whether your apnea or UARS is treated it is whether the treatment you are using is actually ideal or if its level of invasiveness is too high. If basic CPAP treats your UARS but leaves 1 AHI or even 3-5 RDI you could very well have better treatment and better results then using ASV and having 0 RDI. 

Your argument that people with mild untreated apnea might be having mild not noticeable symptoms is valid. What you continue to not believe me on is that PAP is an invasive treatment and using PAP in these mild cases has not proven to be effective or beneficial and that is why medical guidelines are to only treat mild apnea if symptomatic and the patient will notice and continue to use PAP as a treatment. Most don't because the benefits are not substantial enough to warrant its use or cost. 

Frankly I think your RDI was likely treated by ASV and it may be on this machine too. If your body had fully adapted to ASV or if the benefits outweigh the negatives is the main question imo. My next question would be if you have any other underlying health issues that are at play as well, for example something making your nervous system over sensitized causing RERA's even though your breathing isn't really the underlying issue.

Edit: Feel free to get jaw surgery etc if you prefer. No guarantees that will work either though and just be careful and think out every surgery you get done as they are permanent and sometimes can make things worse instead of better.
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#17
RE: CAs, RERAs, APAP Machine
Oh and just to be very clear surgeries are considered more invasive and less successful. That is why PAP is the first treatment of choice in almost all cases even though it isn't a perfect treatment itself.
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#18
RE: CAs, RERAs, APAP Machine
(05-29-2021, 09:12 AM)Geer1 Wrote:
(05-28-2021, 11:24 PM)KingKongBingBong Wrote: I used an ASV machine and I had 0 central apneas the entire time. I looked through the breathing graphs and I never had anything that looked remotely like an apnea. I had maybe 1 hypopnea MAX per night.

Yes I might get a test thank you. It's my personal belief that if you have mild apnea you definitely have impaired quality of life whether you realise it or not. There's no way you can choke 40-150 times per night and not be impacted in my opinion. Just because somebody doesn't SEEM to have impacted quality of life doesn't mean they don't. We have a tendency to adapt to the new norm so we fail to recognise that it's possible to feel better, more recovered, more alert. Our ancestors had much better nasal passages and ridiculously stronger jaws. I have a horrible jaw which I am glad I can fix, but when I look at the people in my family who grew up overseas on a different diet, they have completely differently shaped jaws and teeth despite the fact we have similar genes. Considering jaw position, palette size and shape, etc. all are risk factors for OSA and UARS, it's somewhat logical to conclude that our ancestors did not have the kind of suffering we do now. We have all seen weston price's work before I am sure.

ASV has a backup rate and variable PS that forces you to breath when your body doesn't want to. You don't even have apnea and were using a machine capable of treating far worse obstructive and central apnea. Of course your AHI is going to be 0 or close to it on ASV as it would be with almost anyone that is healthy to even moderate apnea. 

Saying you never have apnea on ASV is similar to saying you never have apnea on a ventilator. Of course because the machine is doing its job. The question isn't whether your apnea or UARS is treated it is whether the treatment you are using is actually ideal or if its level of invasiveness is too high. If basic CPAP treats your UARS but leaves 1 AHI or even 3-5 RDI you could very well have better treatment and better results then using ASV and having 0 RDI. 

Your argument that people with mild untreated apnea might be having mild not noticeable symptoms is valid. What you continue to not believe me on is that PAP is an invasive treatment and using PAP in these mild cases has not proven to be effective or beneficial and that is why medical guidelines are to only treat mild apnea if symptomatic and the patient will notice and continue to use PAP as a treatment. Most don't because the benefits are not substantial enough to warrant its use or cost. 

Frankly I think your RDI was likely treated by ASV and it may be on this machine too. If your body had fully adapted to ASV or if the benefits outweigh the negatives is the main question imo. My next question would be if you have any other underlying health issues that are at play as well, for example something making your nervous system over sensitized causing RERA's even though your breathing isn't really the underlying issue.

Edit: Feel free to get jaw surgery etc if you prefer. No guarantees that will work either though and just be careful and think out every surgery you get done as they are permanent and sometimes can make things worse instead of better.

Yeah I get you. I don't think I have other underlying health issues. I had one psychologist suggest that I have a high sympathetic nervous drive, but he failed to explain why my RDI would not be impacting my sleep negatively. It's also possible in my opinion that having UARS may lead to an overactive sympathetic tone, given that you are essentially experiencing mini-suffocations all night long. I have also read a paper that suggests that insomnia can be mediated by respiratory events. I already see a psychologist fortnightly despite not having any major mental issues, and she has stated that she highly doubts I experience anxiety to the level of which my sleep would be impacted. I strongly believe my breathing is impacted; I can't even breathe through my nose during the day effectively, and I have many pictures of myself as a teenager where you can see I am likely mouth breathing slightly. 

Fair enough if PAP isn't warranted. But mildly impacting your cognitive function and general wellbeing doesn't sound like something I want to live with from a young age. Moreover, research implies that these conditions get worse over time; they do not stabilise. So I would do my best to ensure optimal treatment, even if that means surgery. 

Sorry if this is all a jumble. GF is at me to get off the computer lmao. So I'll try to clarify my points better later on.
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#19
RE: CAs, RERAs, APAP Machine
Yes these things can be caused by respiratory issues but they can also be caused by other issues. An overactive sympathetic nervous system could be a symptom of UARS or imo it can also be the cause of UARS. It doesn't have to be stress/anxiety (although those are killers for sympathetic nervous system), there are a lot of other causes.

The sympathetic nervous system acts to keep our body on alert and ready to run or fight. During sleep that means you are in lighter stages of sleep more and any trigger causes you to wake up more readily. RERA's are activation of this system and if your body is already on alert then I believe your body reacts earlier. How do you sleep in a strange area with strange people etc? Probably poorly like I do and for the same reason, activated nervous system. I am pretty sure this is one of main sleep issues although I now don't believe breathing issues are the trigger (took a while to figure it out).

If you struggle to breath through your nose that could be part of the issue and you should see and ENT about septoplasty, turbinate reduction etc as he recommends for whatever is causing your restriction. There is little risk with those surgeries and I had it done myself although it didn't solve much. The majority of my nasal congestion was caused by dairy which I figured out when I changed path from treating apnea to treating digestive symptoms which has had the biggest change by far on health including sleep quality. I still think digestive issues are my problem but solving them is difficult.

My only argument against yours is that you have assumed this is 100% the issue and that you are not already successfully treating it. As I mentioned look at the breathing before spikes, if there is no obvious obstruction, no obvious flow limitation, no obvious RERA then it is likely this device is already treating your restricted breathing and either your body needs time to adapt and heal or there is more to this problem.

The reason we are being blunt and trying to persuade you of this stuff is that you fit a group candidates that spends months/years and money trying to fix something they don't even have proof is still an issue/not being treated and rarely does it seem to be fixed by PAP, surgeries etc. Maybe you are that exception but maybe not. Imo the main way to tell is based on onset, if this is something you think you have dealt with for a long time then might be breathing issue due to airway structure etc but if it seems to have gotten significantly worse at some point with no known reason as to why probably less so imo.
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#20
RE: CAs, RERAs, APAP Machine
(05-29-2021, 10:49 AM)Geer1 Wrote: Yes these things can be caused by respiratory issues but they can also be caused by other issues. An overactive sympathetic nervous system could be a symptom of UARS or imo it can also be the cause of UARS. It doesn't have to be stress/anxiety (although those are killers for sympathetic nervous system), there are a lot of other causes.

The sympathetic nervous system acts to keep our body on alert and ready to run or fight. During sleep that means you are in lighter stages of sleep more and any trigger causes you to wake up more readily. RERA's are activation of this system and if your body is already on alert then I believe your body reacts earlier. How do you sleep in a strange area with strange people etc? Probably poorly like I do and for the same reason, activated nervous system. I am pretty sure this is one of main sleep issues although I now don't believe breathing issues are the trigger (took a while to figure it out).

If you struggle to breath through your nose that could be part of the issue and you should see and ENT about septoplasty, turbinate reduction etc as he recommends for whatever is causing your restriction. There is little risk with those surgeries and I had it done myself although it didn't solve much. The majority of my nasal congestion was caused by dairy which I figured out when I changed path from treating apnea to treating digestive symptoms which has had the biggest change by far on health including sleep quality. I still think digestive issues are my problem but solving them is difficult.

My only argument against yours is that you have assumed this is 100% the issue and that you are not already successfully treating it. As I mentioned look at the breathing before spikes, if there is no obvious obstruction, no obvious flow limitation, no obvious RERA then it is likely this device is already treating your restricted breathing and either your body needs time to adapt and heal or there is more to this problem.

The reason we are being blunt and trying to persuade you of this stuff is that you fit a group candidates that spends months/years and money trying to fix something they don't even have proof is still an issue/not being treated and rarely does it seem to be fixed by PAP, surgeries etc. Maybe you are that exception but maybe not. Imo the main way to tell is based on onset, if this is something you think you have dealt with for a long time then might be breathing issue due to airway structure etc but if it seems to have gotten significantly worse at some point with no known reason as to why probably less so imo.

Well, I have tried literally every intervention under the sun for improving sleep to no avail. This includes blackout curtains, low/high dose timed/instant release melatonin, no light before bed, no eating before bed, tons of supplements (magnesium, l-theanine, ashwagandha etc...), healthy diet, meditation, gratitude, blah blah blah. I have never noticed a single difference in my sleep no matter how relaxed I feel. The ONLY thing I have ever noticed to have an effect upon my sleep is high levels of stress/anxiety, which cause me to constantly wake up (consciously) and leave me feeling majorly unrefreshed in the morning. But naturally this is a pretty rare occurrence and part of life.

If it's truly a psychological issue as this particular sleep physician suggests, I am truly unreceptive to all forms of intervention. The last thing to try would be a beta-blocker to blunt the effects of the sympathetic nervous system. I am not sure about this however given that my diastolic blood pressure is very low and my heart rate also sits very low too (maybe this is purely due to how much exercise I do, who knows).

I have had sleep issues for over a decade, my parents certainly agree that my inability to rise in the morning since perhaps the age of 10-12 is peculiar. I also remember getting up to go to the bathroom often during my teenagehood, as well as to drink water. I remember waking up with a wet pillow because I had been drooling sometimes. I have many, many experiences like these which are indicative of sleep-disordered breathing, and I am confident that surgery and MSE can fix my issues. After all, I have almost every physical manifestation of mouth breathing except weak cheekbones. Maybe I am wrong, but I think it is no coincidence that I was able to accurately predict that I had UARS before I even had a sleep lab. I know things will get better for me, but at the moment, I need to focus upon PAP therapy as that's the only thing I have access to for now.

By the way, I have attached some of my breathing spikes. These don't look like RERAs to me, they look more like mini centrals. Almost all the spikes on this machine look like this; how do you guys interpret them? What can I do about them?


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