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[Diagnosis] Thoughts On My Chart Welcome
#11
RE: Thoughts On My Chart Welcome
I like the trend here, and was hoping to get a bit lower on CA before the OA started popping up, but no problem. Give this another night or two then try 8.4. Since the OA events were in close association with other CAs, they may or may not be errors. It looks encouraging.
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#12
RE: Thoughts On My Chart Welcome
Sleeprider and Wallla...I was going to stay at 9.0cm for a few nights but ended up being too impatient and dropping down to 8.6 last night to see what happened. When I looked at my data this morning, I was shocked to see my CAs reduced so much with no increase in OAs!  I'll go to 8.4 tonight and stay there for a while and see if this is a one night wonder or whether this might actually work.

Thanks for your all your help thus far.

[Image: MKV2Av0.png]
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#13
RE: Thoughts On My Chart Welcome
Just an update on how things are progressing. I've continued to lower pressure to get a balance between OA and CAs. I haven't found the spot yet...I'm at 6.4 and it's still primarily CA's. I'll continue to adjust. I'm going to see if I can get my hands on the sleep study from the old doctor. It was done back 10 years ago.

Anyway...here's how things look and my trend...

[Image: eIh7mkh.png]

[Image: KF2NHYA.png]

Don't know why there's no pressure data for those few days...it seems sometimes Sleepyhead overwrites previous days' data.

Still dog tired...
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#14
RE: Thoughts On My Chart Welcome
Wow...it's been a while since I've posted.  I wanted to post here since it has my history in it.

I eventually settled on 7.4 cm of pressure. That level of pressure kept my OAs away while being able to breath well. I was able to go lower with pressure without affecting my OA but i felt like i was suffocating. Unfortunately lowering pressure has not helped my overall AHI at all.  

My numbers continued to climb so I had a follow up sleep study done last December. It showed very few Centrals, a few Obstructive and a boatload of Hypopneas. I've attached the summary of the events as well as my assessment and plan.

My AHI has been very high lately, a lot in the 10+ area.

Right now the doctor is having me document what i'm eating, exercise, sleep hygiene...blah, blah, blah

Anyway, wanted to get thoughts on the summary data...especially on how to interpret those hypopneas.

   
   
[attachment=6987]
[attachment=6988]
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#15
RE: Thoughts On My Chart Welcome
Oh...I should probably add a few screenshots of recent nights...
[attachment=6989]
[attachment=6990]

Thanks!
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#16
RE: Thoughts On My Chart Welcome
Based on your screen shots you need a different machine. The vast majority of your events are CA's, I would guess that eventually you will need an ASV machine. But normally first step is a bilevel machine as a trial before you will be issued with an ASV and possibly further overnight studies.
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#17
RE: Thoughts On My Chart Welcome
Quote:As I continue to struggle a bit with my therapy I wanted to add a private message exchange between Sheepless and me that may benefit others out there battling the dreaded Centrals issue with RLS and PLMD.

He had commented on a user's post:


Quote:Sheepless:
"I often suffer restless legs before falling asleep. it's the need to voluntarily tense leg muscles to relieve agitation or creepy crawlies. people that have restless legs often have periodic limb movement and vice versa but not necessarily both. plm are involuntary and occur during sleep. we are not aware of them. I have never felt any leg pain associated with either rls or plm (agitation with rls but not pain). I had arousals from plm in my at home sleep study but they were not reported to me until I asked a third time for copies of my reports. when I complained repeatedly about fragmented sleep and rls, I was given a prescription for gabapentin. besides the Rx warnings scaring me off it, my subjective sense was that it made the rls worse. at the time I did not know how to recognize my respiratory response to plm in my flow rate so I didn't check that. last night I had an ahi of 0.00 with 9 mask off and dozens of wake/rollover/go back to sleep events. I believe many of these are related to plm arousals. even so, I had an ahi of 0.00 so apparently periodic leg movements aren't related to apnea (although I will say that I struggled and thrashed mightily in the throes of apnea and the fight to breathe before cpap, but that's different than plm). sorry I know nothing about cymbalta. I'm afraid I don't have anything more to offer other than to suggest leg pain could be associated with back pain. and, you're probably aware that it's not uncommon to get leg cramps and that may be eased by eating bananas or other sources of potassium. I have no qualifications to justify this but I doubt waking with leg pain is directly related to rls or apnea."

---
My question:

Hi Sheepless,

I didn't want to hijack the thread you posted on but wanted to ask you a question. Your experience with RLS and PLMD sounds just like mine. Did the ASV help you to get your AHI down? I have a boatload of centrals but it is really related to constantly waking up. My AHI is 10+ with 95% being Centrals. I'm thinking of going the ASV route but not sure if it will make a difference. How do you feel on a daily basis? I'm not open, at the moment, to taking any medication for this.

Thanks for any insight you have.

---

Sheepless' response:

Quote:Hi fings1.  I've commented with parts of my story in a lot of threads; I hope this isn't too much duplication.  
briefly, I was diagnosed 30 years ago with central apnea.  no treatment available.  late 2016 was tested with severe obstructive apnea despite near equal numbers of ca and oa.  I had good results on paper with apap but never got the long term average ahi under 5.  doc was pleased.  I felt awful.  picked up a used asv and after experimenting for the better part of a year have gotten ahi down under 0.5.  hard to tell if it resolved my ca because the resmed asv is said to be so good with ca and periodic breathing it only reports unclassified apnea.  still I believe the asv better at resolving all types of my apnea, given my low ahi.  I almost immediately felt much less sick (if still tired) after moving to asv.  

now my problem is fragmentation, brought on, I believe, by arousals from periodic limb movements.  I've learned to identify my respiratory response to them in my flow rate graph (I've posted examples in several threads).  I don't think asv has had any effect on plm but for some reason my sleep sessions have lengthened considerably over my year on asv.  never used to sleep more than an hour at a time.  now usually getting at least one 3-5 hour session a night.  

one problem I think I'm starting to see is that pressure support rises in response to either my sharp inhale during plm or the reduced and often flow limited breaths that follow the big inhale.  I surmise the machine thinks it's addressing ca or pb or flow limitations, leading to unnecessarily rising ps and ipap.  that causes more leaks and aerophagia than I'd like.  guess I'm going to have to seek out a chemical solution to plm.  

I'm rambling on.  don't know if I've addressed your interests.  feel free to ask.  I have barely enough knowledge to be dangerous but lots of thoughts and opinions.  

I think you're asking if asv can reduce sleep wake junk ca brought on by plm?  I'm not sure of the answer but I'm inclined to think yes, it'll nudge you to breath during a pause whether you are awake or asleep.  it'll stop ca but it won't stop arousals from plm.  

I took a quick look at your "thoughts on my charts" thread.  IMO, you'd do better on asv as long as you don't have a particular kind of heart condition they warn against.  the system seems very resistant to prescribing asv.  it doesn't seem to happen often without a lot of patient advocacy.  or as in my case, going around the system.  when I was on the fence, a member suggested I get a used asv and if it didn't improve things it would be very easy to resell.  I was desperate for relief and that was all I needed to take the gamble.  turned out to be the right choice.

I'm happy to discuss anywhere, but it can help others if we put all but really personal stuff in the main forum. it's up to you.  

I wish you the best.
sheepless

Many thanks to Sheepless for his thorough response!  And for those of you scoring at home I do have an ASV machine on the way  Dancing
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#18
RE: Thoughts On My Chart Welcome
I have seen many members in your situation that converted to ASV with great success. Hope you found a good deal, and will be rewarded for your investment with great sleep.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


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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#19
RE: Thoughts On My Chart Welcome
(07-22-2019, 08:46 AM)Sleeprider Wrote: I have seen many members in your situation that converted to ASV with great success.  Hope you found a good deal, and will be rewarded for your investment with great sleep.

Thanks Sleeprider.

Idlewire provided me with a lead to a great deal so even if it doesn't work out, I'm not out a ton of money. Anyone looking for a very affordable S9 VPAP should direct message him.
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#20
RE: Thoughts On My Chart Welcome
The ASV is in the house! I've used it for several days now and my AHI is under 1. Ha, take that Event Flags chart!  Banana

It takes a little getting used to, but I felt pretty comfortable with it last night. I've started off with the ASVAuto mode to get a bit of a baseline. What I've noticed is that everything seems to look good except the Flow Limitations.

I just need a little guidance in reducing them as much as possible. Am I correct in thinking that I need to raise EPAP Min from 4? Or do I raise PS from 4 to something higher? Or is there something else I should be looking at?

I've read so much that I have confused myself.

Thanks for any help you can provide.

fings1


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