nearenough - Therapy Thread

[nearenough]

The machine seems to agree with you.  I set it min/max 13/16 and it never reached 14cm.

[nearenough]

Here's an example of what I'm trying to learn but not understanding.  The sleep tech evaluated this segment of my best night (0 AHI) and found what were described as "back to back RERAs" and is recommending higher pressure still.  

Where are they, and are they worth changing pressures over?  Apparently there are hypopneas (unflagged by the machine) on the next night at the same pressure, 15cm.  Are whatever these charts show able to cause sleep quality issues or health-related issues, or are they inconsequential?

Zoomed - 24 minutes
   

Zoomed - 12 minutes
   

[Gideon]

I can see at most only 1 arousal. As far as having too many, the flow limitations 95% chart is not supporting that.

And the best solution would be to increase PS or EPR, which is an argument for a BiLevel, not to raise pressure.

What you do should be based on how you feel more than numbers.

Look at a 2-3 minute segment of the flow rate at a time looking for these RERAS, they should stand out on the basis of the arousal which is fundamental to a RERA.

[nearenough]

I'll go through everything at that window.  I've looked at the guide here on the board wiki, but what are the typical patterns took look for to identify RERAs?  I'm still learning how to interpret various patterns.

[Gideon]

Look for AROUSALS. a spike in pressure then evaluate what happened before it. The signature is a series of flow limitations ending in arousal. So as series of misshaped tops followed by a spike or gap in breathing as you tossed to break up your labored (flow limited) breathing.

[RainbowFish]

 I am so glad you started this thread!  My graphs basically look the same as yours, and I have been unsure what, if anything, to do about the centrals, which make up by far the majority of my apneas.  (I live at 7000 ft so I think we are exhibiting the same issue with periodic breathing.) 

I was diagnosed with mild-moderate OSA (no centrals on the initial test) and feel worlds better with APAP, but after almost a year on therapy they obviously aren't emergent. I have experimented with adjusting pressure and changing masks with and without O2 supplementation (needed when I travel to 9000 ft) and nothing consistently alters the pattern.  I have a Wellue ring, and the centrals do not cause any decrease in O2 sat unless they are quite dense.  I briefly tried lowering the EPR (which is set to 3 full-time) but felt I could not breathe as freely, and so increased it again. For me, narrowing the pressure range and using the Soft setting is most comfortable, even though the AHI is a bit higher on Soft.  I am curious to hear what your doc says (mine left, so I can't see anyone until January)!

[nearenough]

Let's see if I'm at all close.  These moments stood out as having some measured flow rate decrease, curves that aren't sinusoidal, and what seems like a spike, or increase in flow rate.

Am I in the ballpark?

   

   

   

[nearenough]

Hi everyone,

First, I want thank you all again for your ongoing help.  Having only been on therapy for 2 months, your advice has been incredibly beneficial.  Many thanks to you all, particularly Gideon and SleepRider  

I've posted previously that I spent a few weeks working with a polysom tech to do what I would describe as an "at home titration."  We tested pressures from 9 to 16 with and without EPR turned on.  At higher pressures my OA and HA events virtually disappear, and I'm left with just CA events.  However I've never been more tired, even bordering on exhaustion.  I wake up feeling like I need to go right back to bed, and then I'm tired for much of the day.  

The tech reviewed each day's data and found that even at 16cm I still have subtle SDB events that look to be fragmenting sleep.  

So I'm at a crossroads.  At lower pressures I tend to have more events per hour, particularly centrals, but I generally felt better.  My question is this - would you personally solve for quality of sleep or for quantity of events?

Given how I feel at the higher pressures, and as long as my AHI and related metrics stay in good therapeutic ranges, I wonder if it make more sense to aim for feeling better than for 'ideal' therapy.

Secondly, would you expect there to be any long term physiological pitfalls to choosing better sleep at the expense of increased AHI? 

As a side note, I started wearing a sleep tracker a few days ago.  While I realize they are not entirely accurate, it's showing what I already suspected.  I have very little time spent in N3 (6% or so).  I don't yet have enough data to add it to my decision making, but it's still a metric pointing towards poor sleep quality issues.

What would your approach be?  I'm guessing you would encourage therapy that leaves you feeling better since several of you have hinted at that previously.  I figured I'd ask anyway because I'm willing to acclimate if the fatigue will eventually go away.

Again, thank you all for the ongoing support you bring to the community.  I can't imagine trying to go it alone.

An example of an average night @ 16cm, EPR=3
   

An example of an above average night @ 13cm, EPR=3 (typically 13cm shows more CAs, a few more obstructive events).
   

[nearenough]

I should add a small postscript.  

Part of why I think my CAs diminish at higher pressures is that I'm fighting to exhale.  It's notably uncomfortable, and expiration feels short.  As such, I likely expel less CO2 thereby preventing CA onset.  I also suspect that 7 hours of increased expiratory effort plays a large part of my overall fatigue.

[Gideon]

At least for now, comfort rules.
Set up for your best sleep subjectively at the sacrifice of numbers. Run that for at least a week then repost before and after charts and your critical opinion.
Of course if something looks like it's going south/bad post then and we will be more than happy to help.