Chronic Insomnia

[Sleeprider]

I understand and share your uncertainty about bilevel where centrals are present. If we were suggesting ASV, could you get a script for it? I would guess probably not, unl'ess you demonstrate a predominately central apnea problem. The charts we have seen don't really give that impression. Feel free to post a new chart with the higher rate of CA. Our problem is that you have not been able to trial pressure support in the form of EPR, and the Philips machines seem to give contradictory and confusing information on some individuals. When we looked at the close-up graphs from December 7, we saw a tendency for the variable breathing to be associated with flow limitation. In nearly every chart posted, the rate of OA exceeds CA by a considerable margin. ASV is an amazing therapy and works on all types of events, but it is disruptive to sleep in people that don't need it. I could change my mind, but I don't see anything in this thread that clearly points to ASV as the solution. If you want to take it a bit slower, then try out your wife's machine when it comes using the EPR and we can see what bilevel looks like.

[mawaw1992]

            Here are some charts from last night.

[mawaw1992]

            Here are some charts from this past Friday night Jan. 1. One thing I did noticed that most of the CA's are occurring right before I wake up or either when I am awake. Why would that happen?

[Sleeprider]

Read the Beginner's Guide to Sleepyhead:
http://www.apneaboard.com/wiki/index.php....22_events
http://www.apneaboard.com/wiki/index.php....22_events

Those two links respond directly to your question, in short sleep-wake-junk (SWJ), but this immense wiki has a lot of answers if you want to work through it.

[mawaw1992]

    You had mentioned about trying out my wife's machine when it comes in using the EPR to see what Bilevel looks like. I thought the Airsense 10 Autoset was a Auto Pap machine and not a Bipap. Also please take a look at my chart from last night to check my leak rate. I switched to a Resmed N30i 3 nights ago to see if would leak less than my Dreamwear Nasal. Last night I switched back to Cpap with a pressure of 12 because my AHI has been running higher than normal on APAP. Compare it to the charts just above for Jan. 1 and Jan. 2. To me the N30i did okay on APAP for those 2 nights and then really leaked bad last night on CPAP. 

The other thing I have noticed is that whenever I am on AutoPap the machine shows all those CA's that we decided was mostly SWJ apneas with not as many OA's. But every time I switch back to CPAP my OA's go way up and not as many CA's are shown.

[Sleeprider]

Ah yes Grasshopper...  The Autoset is very much a bilevel PAP therapy, but limited to a pressure support of 3 cm.  By setting EPR to 3, you are receiving bilevel therapy.  For example, your therapy pressure of 11.0 with EPR 3 is 11.0/9.0 (IPAP/EPAP) pressure, and the delivery of that pressure and its transitions are nearly identical to the Vauto. The image below is from my wife's Autoset. Note the mask pressure relationship to flow rate.  Now compare that to the Aircurve 10 Vauto below it.  The only difference is the amount of pressure support.

[mawaw1992]

Very interesting. I did not fully understand at first. I guess since you have shown me that my CA's are not really that big of a problem I will go ahead and get the VAuto since I found a great deal on it. Also let me know what you thought of my Leak Rate. I might have to try some other type of mask.

[Sleeprider]

The leaks make evaluation of the charts very difficult. Everytime the leak rises, the respiratory flow rate falls and evens out, then leaks reduce and your breathing his highly variable and erratic. It drives me nuts because there does not seem to be a respiratory nexus to this. Does your wife ever comment that you are a very active sleeper, moving around at night? The variation in respiratory volume seems real, and there is not an obvious obstructive or even central cause that jumps out. The leaks and variable flow has been a feature of your therapy since you started to post, and it's really confounding.

[mawaw1992]

My wife and I do not sleep together right now because of my sleep problem so I don't know about being a very active sleeper. I do know that during the night when I am partially or fully awake I turn from one side to the other a lot trying to get back to sleep. Back before this problem started in June I mostly slept on my back through the night and my AHI was staying below 1.5 most of the time. That is why I still think a lot of my problem right now is the Trazodone and especially right now with me weaning myself off of it gradually is starting to show because of the way I feel during the day. While I was on 100mg of Trazodone my AHI would not run over 3 most of the time and I did not feel as bad as I do now. In the last week my AHI has been 5.4, 4.7, 4.9, 6.1 and last night was 5.3.  I went a week on 75mg and last night was my third night on 50mg and seems like I am feeling worse but I am determined to get off this stuff and hopefully feel better on the other side. I do not know if that has something to do with what you are seeing on my charts.

[Sleeprider]

There are people on the forum more acquainted than I am with the problems of sleep disruption, leg movement and the use and problems with Trazodone. I really would like you to call your doctor and explain the problems you are having with sleep, movement and the Trazodone. I'll PM Sheepless and see if he has some thoughts. He has usually been very helpful on things like this.