In anticipation of my BIPAP Re: New Thread

[Plmnb]

 Good Morning all.

Sleeprider, Yes, a deep breath and we shall see what we shall see. A special call out to you, ApneaQuestions, slowriter, Osiris357, and others, for getting me to this point.  


This morning I think I feel a tiny bit more rested.  I am chalking this up to actually getting in a longer "sleep" period.  I was so exhausted last night, that even though I really wanted to be awake for my husband for when he got home from work, I did settle in for sleep at approximately 11:13PM. I didn't put my mask on right away though because I needed to hear if my phone was going to ring with a call from my husband. (His car isn't in the greatest shape and he has a long drive from work to our home, so in case he were to breakdown, I need to be on call to rescue him). I did not put the mask on until around midnight.  I did not finally wake up and get out of bed until approximately 6:42AM.

(Even though I believe I got longer sleep, there were periods without the mask that I was asleep. I also shut the machine off twice last night).

Before I post my OSCAR charts, I have a couple of questions?:  (Yes ApneaQuestions, I am going to post yesterday's as well    )

If you have an event, but the video shows you moving around, repositioning ones self, etc. does that mean the event doesn't really count as whatever it may be classified as?  I think I have read here in this forum that when you do those things that means you really aren't having a problem?  The event only really counts if it happens when you are laying still?  I'm sorry if this is a dumb question, but I would like to be clear in my brain about this. EDIT: These are POSITIONAL events and don't count?  Even if they occur prior to the event recording?

EDIT: Oh, and also... If you have an event and/or poor wave forms when you have a leak (if counted under the threshold), do those events count in the scheme of things?

Plmnb

[Plmnb]

Here are the OVERVIEWS for yesterday morning and last night.  ZOOMS will follow at some point.

YESTERDAY 1-21-20

[attachment=19321]



THIS MORNING 1-22-20

[attachment=19322]


God I hope I have the right charts and dates today 


Plmnb

[Sleeprider]

Good morning Phoebe. Last night looks good, and FL is reasonable (no smashed cars). If this was every night, we'd call it good to go. There are events around therapy breaks, and we can discount that and ones where you are moving. I think at this point a lot of analysis is unnecessary, the 6.8 PS has apparently had some benefits. It will be interesting to see how ASV goes, however it is still up to you to dedicate enough hours to sleep to derive the benefits.

[ApneaQuestions]

Life is full of irony isn't it?

The data from 1/21 has so many leaks that I don't trust what I'm looking at and would tend to discard it and wait for the next night.

When we look at 1/22, things start to look impressive. However, is this another one of your teasing nights which is followed the next night by worsening data? We'll find out.

This raises some interesting financial questions for you.  If we could maintain last night's results consistently then you'd need to ask the question "Do I NEED the ASV?"
Especially since we know that we could bump the VAuto even further if we needed to.

The cost to obtain the ASV is going to include..
1) Yesterday's office visit
2) The upcoming ASV titration study
3) An echocardiogram to check for left ventricle ejection fraction (if you haven't already had one). The doctor should be covering his bases by ordering one.
4) The cost of a follow up visit to discuss all the above
5) The cost of the machine itself.

When I reached a similar point in December, I had already maxed out my out of pocket maximums/maxima for 2019 and so everything was free.  In your case it won't be free.
So it raises an interesting question of how much you want to spend to get an ASV and is it now actually NECESSARY for you.

Ironic!

I'd suggest that we keep on titrating and checking the VAuto so that you can make an informed decision in terms of what you want to do next.
I'd also suggest that you keep on extending the sleeping period and getting to bed earlier to see if that gives some significant improvements on how you feel.
We will be in a much better position to answer these questions in about a week.
If you can get a whole week of good results with the VAuto then you'll know where you stand.

Why don't you scroll through last night's data looking at the zoomed waveforms... I suspect you'll find that they look "decent".

[Plmnb]

I apologize for the long post but I find this comparing video to the OSCAR charts very interesting.


Ok, so looking at OVERVIEW from last night, and zooming in on the period from 2:56 ish AM to 3:04AM: (Longer than 2 minutes for purposes of question):

Recorded are 4 events.  A CA followed by an OA, and then another OA, followed by a CA.

I am attempting to line this period of the chart with my video recording.

My video time stamps for around this OSCAR chart time frame starts at 2:30AM when it detects a motion, but the next time stamp isn't until 2:58AM, a motion detected.  Notice in the FLOW RATE graph that my FLOW RATE wave forms go nutso at approximately 2:58AM ish.  

In the video, time stamped 2:58AM, mask on, I can be seen rousing.  During this clip I start off not moving then lifting my arms above my head, pretty much like stretching.  I do the crossing of the legs, placing one leg on the knee of my other leg.  Then I uncross them and recross with the opposite leg.  I do this motion a number of times, each time with opposite leg.  My arms remain stretched above head until the very end of this clip.  

Next video clip time stamps are 2:59AM, 3:00AM, 3:02AM, 3:03AM, and 3:04AM in which clip I finally sit up.  (Not the "yoga" thing).  In this clip eyes are open while sitting up and I take my mask off.  The other flagged events listed above occur in these various clips.

In the approximately the middle part of the 3:02AM clip my husband puts his head on my chest.  In the approximate middle of the 3:04AM clip he removes his head from my chest.  I believe it would be a no-brainer to say this motion by him apparently is what caused me to "wake up" and remove my mask, and turn off the machine.

  NOW the really, really scary, freaky part.....I appear to "SLEEP SMOKE".  NO JUDGEMENT ZONE PLEASE.   . (Video clip time stamp 3:06AM).  For gosh sakes, my eyes are closed, I'm sitting cross legged on the bed, and I have a freaking lit cigarette in my hand!  It is not uncommon for me to take my mask off and stop the machine during which periods I do sometimes have a cigarette, but this is the FIRST time I have evidence of possibly being a SLEEP SMOKER.  Is that even a thing??  I must research this!  And without question I will be speaking to the shrink about it.  And obviously I will remove said cigarettes from anywhere near me.  I will also tell you that I know I have fallen asleep with a cigarette in my hand on other occasions, but I have always known, (at least I thought I did), that I started smoking the cigarette while fully awake and cognizant. Yes, yes...I know incredibly dangerous this all is and PLEASE believe me when I tell you that I have been trying to stop smoking.  I do for a month, then I get caught back up with it.  As I have previously mentioned my primary doctor will not prescribe me anything, especially Chantix, because of my Bipolar.  I have tried cold turkey, I have tried nicotine gum, I have tried nicotine patches, and nicotine lozenges.  All work for a short time and then bam, back to this nasty habit.  I think I will ask the shrink about hypnosis.

At 3:13AM video time stamp I settle back down to go to sleep, with mask and machine on.  I'm not going to detail the entire night but I will mention that at approximately 3:15AM I have an OA flagged.  I do NOT see anything in the video clips time stamped for this time range that shows any outside activity that would disturb my sleep.  




Thank you for your time if you have read this post.

Regards,
Plmnb

Oh, almost forgot...here is the zoom for the period I am referring to:

[attachment=19323]

[Plmnb]

Uh oh sleeprider, I already posted, written while you were probably writing, a looong analysis post.  I'm sorry for the bother.

Plmnb

[Plmnb]

Hi ApneaQuestions.  All good points.

Based on all we know at this very moment what should my settings be tonight?  The same?

Oh, btw, thank you for the CBT info.  I don't believe I have 5 of these issues, maybe 1 or two.  

Will, see what the head doc says.

Regards,
Plmnb

[slowriter]

Maybe don't worry about changes at this point, given the titration study next week, and the likelihood you'll end up on ASV?

[Plmnb]

Morning slowriter.  I wasn’t sure.  And I think ApneaQuestions might be thinking I won’t need ASV after all? (See his recent post). I don’t know, teeny tiny bit confused on what to do.

[ApneaQuestions]

Since the most recent results appear to be "good", then the sensible response is to keep the settings as they are.
Keep the additional bumps in reserve in case your teasing results take a turn for the worse.

As for the cognitive distortions, I believe that we make all ten of those mistakes frequently. The trick to CBT is to catch them when they happen and to have an arsenal of techniques to challenge them and reframe our thinking as soon as we detect them. It's a bit like apnea.... I'm trying to get my cognitive distortions down from 100 times per hour to under 5.

EDIT: BTW.. CBT is more involved than simply spotting these 10 distortions. We could talk for hours about underlying belief systems and mental schema and some of the additional work carried out by people like Martin Seligman and others. That's waaay off topic for an apnea forum but totally relevant for a "how do I improve my sleep forum". Indeed, one of the interventions used commonly these days for sleep improvement is CBT-based.
More on that here: https://www.google.com/search?client=fir...ep+and+CBT