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I've been using my APAP for a week, symptoms wors V2e.
#61
RE: I've been using my APAP for a week, symptoms wors V2e.
I went off the typed heading that you had tried CPAP 13, or straight, or static pressure. But looking at OSCAR again, that's not the case. It says 11-14 pressure. As Gideon mentions, higher pressure support, or in this case EPR, needs to increase to 3.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#62
RE: I've been using my APAP for a week, symptoms wors V2e.
Yeah, I sampled sections from the night with min: 11cmH2O, max 14cmH2O, and EPR 2 and noticed that my flow limits and flat waveforms were significantly worse at 14cmH2O than 13cmH2O. I changed my max to 13cmH2O and while I don't feel amazing, I feel much better than I did after yesterday's sleep with a max of 14cmH2O. I will post last night's results as soon as the SD card gets all the data.
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#63
RE: I've been using my APAP for a week, symptoms wors V2e.
This seems like spam from someone testing the site members...
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#64
RE: I've been using my APAP for a week, symptoms wors V2e.
Amirkas, after finishing a first read of your thread I think you are getting excellent advice from all. If there is anything to my questions or observations, those advisors and your MD should discuss it with and counsel you before ANY change is made in response to what is below. It is likely your thread advisors, as I do now, would recommend staying the course of recommended changes even if they see some merit in my comments. They may already have factored in anything that may be valuable below and I have no credentials or knowledge to advise you on this. I am just probing for more info. 

Two things I noticed which I'd like to see and learn more about, but--again-I would not want your scientific mind to make any changes from guidance above after taking any closer look at these two areas.

-Your WatchPat study shows very little sleep on the right side. The smaller sample may explain what seem to be relatively fewer, less dense or large events/flow-limits, whichever were graphed, per unit time. Does that strike any chord regarding habit, pain, discomfort, etc.?

-Your Tidal Volume(s) often seems low to me and, at the scaling of your FR, it seems incredibly smooth (compared to my spiky FR graphs). Best I could tell from one graph of inhale time it was near 2.5 seconds for a long period. These suggest to me that you could be another instance at AB of someone with high but unusually uniform baseline flow resistance causing you to work hard continuously to breathe--trying to live on a fairly constant survival-volume of air drawn through a tube. That near constant low flow may be episodically and requisitely changed enough to trigger bursts of FL flagging.

If I had your OSCAR setup I'd look at a variety of FR, TV, FL, I, E and MV montages, 2 to 5 minutes duration, expanded to fill but stay inside an OSCAR range window, not less than about a 3/4 inch screen height.

Note that I've been looking at these kinds of flow limitations and am probably afflicted with a persistence of ideation, kind of like persistence of vision. Keep on seeing what, in my case, I think I saw.
I have no particular qualifications or expertise with respect to the apnea/cpap/sleep related content of my posts beyond my own user experiences and what I've learned from others on this site. Each of us bears the burden of evaluating the validity and applicability of what we read here before acting on it.  (Disclaimer use permitted by sheepless)

 
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#65
RE: I've been using my APAP for a week, symptoms wors V2e.
Hi Everyone,

I've finally got all the results from my machine and it looks good. While my AHI may be higher than usual, I'm sure that the majority of my central apneas are false and are rather a result of switching sleeping positions. I have changed my graph layout to show the corresponding graphs to SleepBetta's suggestions. An EPR change to 3 might be due, alongside a slight tweak to my max and min pressures to go with the change. Another potential change is adjusting my APAP to be in CPAP mode with a pressure of 12cmH2O or 13cmH2O.

My doctor is unfortunately out of the office most of the time and hasn't responded to my questions regarding my settings, even after the supposed 48 hour response time, so I'm mostly left with my own initiative to fix my sleep. And due to the time urgency of external responsibilities, I have to try and find the optimal settings to really start alleviating my symptoms by paying my sleep debt off. 

Let me know if I should upload additional screenshots of specific time periods, and please state the y-axis scale so that I don't end up spamming this thread. I really do appreciate the members who have supported me with their advice. Hope I'm giving you guys a good case study to learn from. 

Part 1:

   

Part 2:

   


Thanks again!
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#66
RE: I've been using my APAP for a week, symptoms wors V2e.
(07-02-2021, 12:59 AM)AmirKas Wrote: Even with improved breathing, my symptoms have barely subsided. I'm still feeling terrible and I really don't know how much longer I can take this. I have too many loans taken out to drop out of college without a degree, and can't get health insurance to treat myself without being enrolled. But my grades are taking a hit which is making the situation seem even worse. I feel stuck and really need some way to get out of this hole, which is why I'm on this forum, posting every, single, day. I have my food allergy test attached if you want to take a look. I have lactose intolerance, but my intolerance is barely above the threshold. 

What kind of allergy test was that? Please answer then read the rest of this post.

You need to calm yourself. I guarantee that at least some if not a significant amount your physical symptoms right now are due to anxiety, you probably have other underlying health issues as well but chronic stress and anxiety literally destroys the physical function of your body and you will not be able to improve or determine cause of health issues until you gain control of your anxiety. You don't have to first fix your health issues to improve anxiety, you can improve anxiety first and then change focus to health issues. Myself and many others have done it. 

Stress and anxiety trigger your sympathetic nervous, this is your bodies preprogrammed fight or flight mode. The sympathetic nervous system affects every single physical aspect of your body. It shuts down important functions such as digestion, kidneys, balanced neurotransmitter synthesis and more all to try and survive this moment of stress. This nervous system has adapted over 1000s of years of evolution and it is meant to trigger in acute cases of danger/stress such as being chased by a tiger. The problem is that the anxiety related to our stressful lives these days triggers the exact same response, your current stress and anxiety is literally triggering the exact same response as if you were being chased by a tiger, except it is doing it almost every minute of almost every day, day after day after day... You would never sleep well when being chased by a tiger, nor will you ever sleep well if you don't gain control of your anxiety and stress. You MUST improve your mental health now, the health will improve with it and then we will figure out other health issues.

One of the easiest ways to trick your preprogrammed nervous systems is to take deep slow belly breaths. This will switch off the sympathetic nervous system and turn on the parasympathetic nervous system which is responsible for the rest and digestion. This is a built in response again built in after 1000s of years of evolution, your ancestors used to run for their lives then once safe would slow down and take deep slow breaths as the adrenalin high wears off. Whenever you feel you are getting worked up take deep breaths to get yourself back under control. 

Next you need to stop telling yourself you can't go on longer like this, you can't do this anymore etc. You need to be positive and start telling yourself that you have got this and that it is just a bump in the road on your path to recovery. This is called cognitive behavioural therapy (CBT). When you are having trouble sleeping do not get frustrated and tell yourself your life is going to crap because of poor sleep, tell yourself that sleep is nice but you can function without it if needed. Go for a walk and take deep breaths to gain control and switch on sympathetic nervous system and then try to go back to sleep. 

Research sleep hygeine and CBT for insomnia. They will make a significant impact on your sleep and life. Believe me, I was once in your shoes... I was ready to quit my job and give up on life, I couldn't sleep, I couldn't eat right, I wasn't digesting food properly and I was getting to the point of being borderline suicidal. I ended up having to take about a month off work and I improved my mental health with research on the matter, counselling and medications. Once I had my anxiety under control I was finally able to realize what was causing some of my symptoms and was able to improve sleep issues, digestive issues etc.

The best part about being stuck in a hole is that there is tons of room improvement and as you work on these things life will get better. 



Careful what conclusions you draw about pressure and flow limitations. The pressure is high because the flow limitations are present. You do need to spend time to try to determine if increasing pressure improves or worsens flow limitations but that is a slow process because there are so many variables involved. For example if you see an example where flow limitations got worse as pressure increased does that mean that pressure made the flow limitations worse or that whatever was causing the restriction continued to get worse even though pressure was increasing? You can't determine this after one example, you need to draw the conclusion after multiple examples. We all have good nights and bad nights, you don't titrate PAP settings based on these nights you titrate them based on the average nights.

You can try increasing EPR to 3 but if it causes more centrals and increased AHI decrease it back to 2.
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#67
RE: I've been using my APAP for a week, symptoms wors V2e.
I'll say this, what Geer1 mentioned is quite true. I'm doing this same stuff now, and it's not positive thinking, but controlling what I'm worried about. I've got currently untreated very complex Apnea along with COPD. I am 52 and use a walker as my left leg won't reliably support me but I've also got a $29k 345 pound wheelchair if I feel I need it, I've broken 7 or so vertebrae in 2018-19, spinal stenosis, have a spinal cord stimulator implant for severe back pain, a scripted hospital bed and air mattress, high insomnia, fairly frequent headaches for Apnea, GERD issues that I sometimes eat 8 Tums at a time, bariatric sleeve weight loss surgery, medications for inhalers, a nebulizer, GERD and BP, heart palpitations with heart PVCs. I think that's it. And despite not having a job as I get Disability (go figure), I get up every day smiling. And I must give God credit, because He makes this possible.

It Is Doable. If I never can advise you on anything else but this, it is NEVER QUIT.

No this isn't venting or dumping on you. Attitude makes or breaks it.
And no this isn't sarcasm but very real. Ask others here if you want.

Keep smiling son and take it one day at a time.

Coffee
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#68
RE: I've been using my APAP for a week, symptoms wors V2e.
Hi Geer,

I'm aware that some of my symptoms are a result of anxiety, however, I'd like to give some context. Yesterday was a pretty bad day in terms of symptoms, and as a result of my overwhelming fatigue and stress response, I felt awful and got worried about the future due to my symptoms. It's been difficult to keep on hoping that things will get better since I feel absolutely awful and incapable to deal with even basic tasks. I didn't have any anxiety issues during my childhood and adolescence, not even a single panic attack. It was the brain fog and the associated feeling of brain damage that started my anxiety. I've already done some CBT to deal with anxiety and it didn't do much. I was compliant during therapy and followed my therapist's advice, but with the symptoms, I've experienced it was hard to get out of the anxious feedback loop I got caught in. Today, I had a decent night of sleep, and my anxiety drastically improved, being almost non-existent. 

I appreciate you trying to look out for me and help me figure out a way back to health, but I personally don't think anxiety is the underlying issue behind my symptoms. Rather, I consider it a reaction to an extreme amount of stress that I've been dealing with, alongside my apparent inability to have the mental nor physical energy to deal with those stresses. I'm sure I'm not in denial regarding my anxiety, since I'm aware of its existence and the impact it's having on me, but I am even more sure that it's not the main issue I'm dealing with. Most likely years of SDB and sleep debt have culminated in my symptoms. I'm sorry to say that I don't believe that I should deal with my anxiety first. My insomnia is not a result of overthinking a night, but rather a result of feeling significantly more functional and having around 50% of my brain fog lifted so that I can complete the tasks that I need to do. 

My results may not show significant AHI numbers or even major flow limits, but my symptoms clearly have a correlation with the quality of my sleep. My apparent OCD has improved by 70-80% from yesterday and my physical stress response which I normally experience every day around 8-10 pm, has been much easier to deal with. I know I can do it, but when my sleep-related daytime symptoms are severe, things get tough, and it's much tougher to have the clarity to understand that things will get better and that my Mom and I will be fine. 

Thank you again for your help. I'll be fine, I just need to firstly get my CPAP settings right before I move onto the next issue, my circadian rhythm disorder. Trust me.
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#69
RE: I've been using my APAP for a week, symptoms wors V2e.
Your CPAP settings are pretty close to being dialed in, that is why I am saying you need to focus on the rest of these issues now and let CPAP work as it is working at these settings. I would say your data looks as good if not better than my own.

Lets break down your last data.

Flow rate was a little rough when you were obviously awake then at 9:50 you fall asleep and sleep perfectly until 10:28, not so much as even a twitch let alone any breathing issues or arousals. 10:28 there is a blip, probably a micro arousal, and then 10:30 to 10:58 you have what appears to be some periodic breathing. Then from 10:58 to to 11:55 (almost an hour) you have almost perfect sleep again with only one minor blip (micro arousal, twitch etc) at 11:33. At 11:55 you appear to have an arousal and then you have some periodic breathing again from 11:55 to 12:30. At 12:30 your breathing stabilizes again and looks pretty good until 13:20 (one apnea but no idea if it was real or not). 13:20 to 14:30 your breathing looks a little periodic again and then smooths out again until around 15:20 when you wake up. 

The only instances that don't look ideal are the moments of what appears to be periodic breathing (can tell there is a periodic nature by the flow rate chart and the periodic tidal volume chart). This is either related to extra restriction in rem sleep (breathing is almost always worse in rem) or it is central in nature. If it is rem sleep and obstructive in nature then raising EPR to 3 might help but if it is central in nature raising EPR to 3 will make it worse. If it is obstructive then increasing pressure slightly may help but increasing pressure may worsen periods of good sleep and will make your aerophagia worse. Your data doesn't show any obvious obstructive issues other than the very odd period of flow limitations but that could easily be sleeping on edge of pillow with neck kinked etc.

If this is central in nature there is a chance it will improve as you continue to adapt to CPAP. If it is obstructive in nature then as mentioned trying EPR of 3 or higher pressure may help but both may also make things worse. If you feel the need to change settings feel free to try EPR of 3 to see if it makes things better or worse. I would be more hesitant to try higher pressure because you don't have any obvious obstructions but do have issues with aerophagia. Right now you are talking very minor changes (EPR or pressure by 1 maybe at most 2 cm) which will have minimal effect overall. 

CPAP is a game of averages and finding the best setting means finding the settings that treat the majority of your breathing but not all of it. If you chase perfection you will never find it. Imo your biggest improvement in sleep quality will come from getting more of it as that is something that is obviously an issue.
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#70
RE: I've been using my APAP for a week, symptoms wors V2e.
@SarcasticDave

Glad to hear you're going through all of that and can still stay positive, it's an inspiration. My attitude towards this overall been pretty good, but when my symptoms get really bad cognitively it's hard, especially with little support from lack of family and fairly judgemental friends. 

I do have the drive to get better and to once again reach my full potential, which is why I'm here posting every day on this forum. My classes have started getting fairly difficult and my brain fog is making my future possibilities seem bleak, which is part of the reason why I'm so anxious. Letting go should seem easy when life takes away a lot from you, but it only makes it more difficult. I can't take a break from my university since they provide my health insurance so that I can finally heal. As well as that, I have no home anymore to return to so that I can rest a little. My situation is even more exceptional than I made it seem to be, and all I want is to have my mental energy back so that I can do what I need to do to take care of my Mom, who's sacrificed so much for me to succeed and be the person I want to be. I'm not that same person anymore. The fog has stolen my passion, my curiosity, my drive to learn, and my determination to reach my own goals. 

I ask you to understand that I haven't given up, nor will I. This disease has led me to the lowest of lows and at those times, and while those times are difficult and I don't feel like I'm gonna make it, the brain fog and physical agitation eventually subside and I can feel somewhat positive about the future. Do not worry about me. I'll be fine and will come out a much, much stronger person after I've dealt with this.

To Geer's comment:

I got a new CPAP pillow to support side sleeping without having the mask affect me so I'm hoping that goes well. My sleep study recorded no central apneas, so besides treatment-emergent CA's, I believe my apneas are more obstructive in nature. I do get at least 7 - 8 hours of sleep a night (or morning -- eekh) so it's definitely not the quantity of sleep, but rather the quality that's been messing me up. I will try an EPR of 3 tonight and hope it improves my breathing.

I am planning to deal with my circadian rhythm issues after I complete an exam in a week's time, by using both melatonin, cbt tips from online (can't afford a therapist), and possibly bright light therapy in the morning. I'm sure that as I'm more functional, my anxiety will drastically drop to the point of non-existence.



Thank you for the support.
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