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CAs and I are tighter than I'd like :)
#21
RE: CAs and I are tighter than I'd like :)
Here is the additional info I mentioned above.

Close up of a CA. This one happened after seemingly non-waxing/waning flowrate, but after it I was waxing/waning:

   

Other later CAs seemed to be in the middle of the waxing/waning:

   

Also, on the hypops, do these really disrupt sleep as much as an apnea awaking?:

   

Thanks, scottgbp
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#22
RE: CAs and I are tighter than I'd like :)
Thank you for your patience with all my questions, I really want to learn and understand the ins and outs of how everything is related Smile
I'm very grateful for your valuable input as I am definitely feeling better!

I noticed these trends, can you make any comments on whether this is what you would expect for the changes we've made and how it relates to results? May 25th is the first day of our pressure changes and the first day I started improving my mask fit via the mask primer. I see the following trends with our pressure and PS reductions: respiratory rate increased; minute vent. decreased; and tidal volume decreased:

       

Thx again, scottgbp
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#23
RE: CAs and I are tighter than I'd like :)
The closeups of the CA’s seem to be arousal related you see how there is a spike in the flow then no breath and a CA then scored that is an intake of breath likely to be followed by a rollover or similar nothing at all to worry about
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#24
RE: CAs and I are tighter than I'd like :)
(06-06-2020, 12:40 PM)jaswilliams Wrote: The closeups of the CA’s seem to be arousal related you see how there is a spike in the flow then no breath and a CA then scored that is an intake of breath likely to be followed by a rollover or similar nothing at all to worry about

Thanks for your comment, jasw. So there is a difference between CAs with this initial spike and those that are CO2-driven and correlated to the waxing/waning I guess? Before bonjour helpfully guided me to decrease my pressure and PS I was having A LOT more CAs. Thx!
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#25
RE: CAs and I are tighter than I'd like :)
Exactly the waxing and waning is CO2 related those are arousal related
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#26
RE: CAs and I are tighter than I'd like :)
The lower pressures are working better for you and this looks like nicely optimized therapy. I agree the centrals now appear arousal related and are not something you can address anyway. Excellent results and good job documenting the progress. Bonjour stepped away from the internet this weekend, and I'm sure he will comment when he gets back.
Sleeprider
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#27
RE: CAs and I are tighter than I'd like :)
sleeprider and jaswilliams - thanks a ton for the feedback! I'll look forward to bonjour returning.

bonjour, others - I am indeed seeing many of my CAs resembling the arousal and non-CO2 trigger you describe. However I do often have pockets of the other behavior like in the screenshot from last night, where the CAs are associated with the waxing and waning. I'm wondering though, does this indicate an opportunity to continue to decrease PS or make further E/I adjustments?

   

Thanks! scottgbp
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#28
RE: CAs and I are tighter than I'd like :)
Our best guess is that as you approach your apneic threshold, CO2 fluctuates and changes your respiratory drive. As the respiratory volume drops, CO2 increases and causes respiratory volume to increase which drives down CO2 suppressing respiration. The cycle repeats as your internal autonomic respiratory rate rises and falls in an effort to equalize the CO2 balance. The actual mechanism and chemistry involved in respiratory drive is more complex, but that is the fundamentals. A CA event is often just a condition where CO2 has gone so low, there is a temporary loss of respiratory drive, and that is what we refer to as the central apneic threshold. Some people are simply more sensitive to this balance than others. It does not mean there is any disease or problem. The body continuously rebalances and the problem is idiopathic. As your pressure support and pressure dropped, this effect became less noticeable, so that is the tool we use to minimize the problem of CA events.
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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#29
RE: CAs and I are tighter than I'd like :)
(06-06-2020, 11:46 AM)scottgbp Wrote:
(05-29-2020, 10:37 AM)bonjour Wrote: First of your numbers are good, and as such, there is no reason to change them.  How you feel is very important.  Please let us know that and how you perceive any changes.

That said I'd like you to try a lower pressure. Reducing by one
EPAP = 11
IPAP = 13
PS = 2

Let us know which you feel is better.

Hi bonjour, it has been several days and I wanted to be sure and touch base. I've racked up 8 days with the last change down to E/I 11/13 and it seems to be an improvement. Since I'm an engineer I made a summary table lol, maybe only interesting to me haha:



For the last 8 days, FWIW there seems to be a correlation between the higher AHIs seen and poorer choices for food/drink. Overall I feel better, I am able to get moving (i.e., wake up) easier in the morning it seems. I still have a strong nap urge in the afternoon, but sometimes now I don't actually fall asleep. I know my numbers are pretty good now compared with before, but of course I'd take better numbers if I might feel better and welcome all input.


And here are the overview shots of last night. I'll add some zoomed-in shots of the CAs and a couple questions next:



Thanks! scottgbp

I have a low AHI too of usually around 3.  I'm very fatigued even with a low AHI.  I think mine is diet related too.  I thought I had UARS but I guess not.  Did have nasal surgery a few months ago.  I have weened down my caffeine consumption to less than 50mg a day but still getting bad sleep.  Low amounts of deep sleep according to tracker.  When I get lots of deep sleep I feel much better but doesn't happen very often.  As my caffeine consumption is going down I am actually getting less deep sleep and getting more tired.  Hopefully after a couple weeks of no caffeine my sleep will start to improve.  I think dairy affects my sleep too.
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#30
RE: CAs and I are tighter than I'd like :)
As before, your numbers are great and do not require adjustment.  Changes should generally be based on how you feel.

I suspect that you can handle a much lower pressure, but you are not in a hurry, again because your numbers are good.
Let's drop another 1 cmw so EPAP =10, IPAP =12, maintaining that PS = 2.
Looking for some signs of an increasing obstructive events or you having some possible difficulty on inhaling, in other words how you feel.
A standard titration is from low pressure to high pressure, we are going down looking for where you feel best.  So keep notes, critical notes on how you feel.
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
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