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EPR Settings and Flow limits
RE: EPR Settings and Flow limits
Hi Stuart,

Thanks for sharing your experience. It is helpful to hear what other people are going through, especially when it relates to such a confounding condition. I know you are right about everything going haywire in REM. I dream a lot and I remember them because I am always waking up--micro arousals through the night. In the early morning hours, I was dreaming I was taking the lid off of something and I awoke with my hand raised. I have always had experiences like that and I think that is not supposed to happen. My sleep study was flawed because I had a terrible doctor and he told me to sleep on my back, which I cannot do without CPAP. I only slept 4hrs though it felt like 30 minutes. My REM sleep was 28 minutes and my AHI in REM was 53, but my overall test was only 4. So I had to fight for a machine. The CPAP has helped with lots of things. No more waking up every hour going to the bathroom, not more waking up with a racing heart and headaches, etc. But I wake up so much through the night and I think I may spend too much time in REM. Before seeing a sleep doctor, I was sleepwalking into walls at night, so it was extreme.
I appreciate you explaining about tidal volume, etc, because I have always thought the tidal volume was more important to look at than the AHI in my case. I tried to get my sleep doctor to look at that but all she said was it fluctuates during the night. Now I do not have a sleep specialist, so I am struggling on my own. 
I don't understand a lot about minute vent, tidal volume, etc. I do wear an oxygen monitor and as long as I use my cpap, my blood oxygen has only gone as low as 91, so I am grateful for that. 
I worry about all of this because my lifetime of sleep disordered breathing has cause diastolic dysfunction, which is not helped by breathing issues in REM.

Anyway, here are last night's charts. I had many arousals.


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RE: EPR Settings and Flow limits
Also, Stuart, was there a big enough difference with bipap? Did you sleep better?
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RE: EPR Settings and Flow limits
I have found my REM sleep as being way different, with minimal pauses in breath. The tidal volume goes down, but resp rate increases and the minute vent stays pretty constant, very wide variance in respiration (if I'm 16 normal respiration, the respiration during REM is fluctuating from 12 to 28), sometimes wildly.

I was pretty sure that all NREM sleep breathing was only diaphragm breathing, and that functioning during REM sleep was way more like awake breathing only shallower. In my mind, during REM sleep you might have more than just diaphragm involved. I would have to do another search for whether that is true (in general).

But, as you may have a REM sleep disorder, allowing for lack of paralysis (REM only), there may be more at play.

On sleep walking, Johns Hopkins medical site says: "Sleepwalking usually occurs during the deeper states of non-REM sleep."

Our daughter had quite a few sleep-walk and sleep-active tendencies when younger. When we noticed her sitting in bed, moving imaginary thing around with her hands, she even responded to our questions about the imaginary things.

Hope you find some comfort and answers that make micro awakenings less prominent, or at least less disruptive.

QAL
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RE: EPR Settings and Flow limits
I am in two minds about the usefulness of the BiPAP trial.  On one hand, I did not like the machine, was not clear about what the settings changes were doing and could not access the data to see what was really going on.  I got to the point where I did have two really good nights, then I saw the consultant and a change might have been made by them (I asked them to change the setting and thought they did it but, two days later it seemed not to be the same as before)  but I did not continue as well as the two good nights that I had before I saw them.

I also seemed to get aerophasia from the BiPAP, which is apparently unusual, but it might not be that or anything from the machine.

But the machine definitely did have an impact on my tidal volume and eliminated my oxygen desaturations.  What is perhaps more telling is that I have had some odd nights on my fixed CPAP since giving the machine back.  I have had about 5 nights in a row with brilliant SpO2 but high AHIs and some really weird breathing patterns that I have never seen before.  

Overall conclusion is that I am chasing a prescription for the BiPAP and intend to purchase one.  I will simply hold back on the settings and work up to where I am supposed to be.  I have decided that PAP machines are like running shoes.  You don't buy them, put them on and run a marathon.  you need to do some training and build up your capacity before you can do that.
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RE: EPR Settings and Flow limits
Thanks, QAL and Stuart.

My sleepwalking stopped after about a month on CPAP, so I think all the years of sleep deprivation caused it. I wonder if whatever happens to me in REM is due to apnea or some kinds of breathing issue. My flow curves do really get strange, as you can see here. 
I am wondering if some of the awakenings are related to the silent reflux. It would explain how the aerophagia is hard to treat. 

Stuart, I hope you find someone to prescribe the right machine for you and that you begin to sleep better without swallowing air. Then you can give me a full report and I can follow right behind you! I will be lucky if I find a new sleep doc worth anything.


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RE: EPR Settings and Flow limits
Hello. Has anyone one seen this kind of break in data with an OA without a flow curve? I did not have my machine off at this time.


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RE: EPR Settings and Flow limits
By chance, are you using the Smart Start option? This usually occurs on the AS10 with this option turned on.
Crimson Nape
Apnea Board Moderator
www.ApneaBoard.com
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Useful Links -or- When All Else Fails:
The Guide to Understanding OSCAR
OSCAR Chart Organization
Attaching Images and Files on Apnea Board
Apnea Helpful Tips

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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RE: EPR Settings and Flow limits
No, Smart Start is off.
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RE: EPR Settings and Flow limits
OK. Try purging that day's data then reimport it.
Crimson Nape
Apnea Board Moderator
www.ApneaBoard.com
___________________________________
Useful Links -or- When All Else Fails:
The Guide to Understanding OSCAR
OSCAR Chart Organization
Attaching Images and Files on Apnea Board
Apnea Helpful Tips

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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RE: EPR Settings and Flow limits
So just delete that day in Oscar and try again?
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