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Lingering fatigue: trust Resmed sleep report?
#91
RE: Lingering fatigue: trust Resmed sleep report?
(08-23-2019, 04:44 AM)mper6794 Wrote: Hi, Gchritley
Yes, I think a can see some very significant things:
(a) 2:16 to 2:23...too compressed, but there would be some plateaued type flow limitation not handled by the settled pressures; however, likely not awakening you;
(b) 2:27...plateaued type flow limitation not handled by the settled pressures, however, likely not awakening you...
© 2:39 to 2:41:30 (2,5 miniute duration).....more serious thing here.....suddendely awakening, not related to flow restriction, most likely associated with leg jerks (PLM's);
(d) 4:41 (1.0 minute duration)...suddendely awakening, not related to flow restriction, most likely associated with leg jerks (PLM's);

We together would need to explore your curves a little further, but if I were you, before next eye blink:
1_I would go to next shop and buy a  highly sensitive audio-recorder (the one I have been using to monitorate myself is this one : Digital 8gb Mp3 Knup Kp-8011; costs 38 boxes and works very well). Then, tonight strap it over you sheets,  at the height of your knees, so that you you be able to hear scratches and something of your respiratory flow. You will found out what have been triggering your awakenings (in my case can be: flow restrictions, PLM's, cell phone noises, noisy car running through, air plane, loud voices in the street;but mainly the first two ones)
2_start considering move to the bilevel VAUTO, to slow down and better manage your pressures/suffering;

Be otpmistic!: I am doing rather well, getting better, still with room to improve, without medications. Main goal would be work on your sleep efficiency; when it reaches some 85%, you start dancing rather walking in the streets!

For now, that is...not  much time left...I will return tomorrow if realized something else. 

Good luck

Thanks Mper6794 for these details. I will record myself, and also have an infrared video recorder to see what I'm doing. 

Also, I looked at my lab sleep study from one year ago - I had a PLM of 9.6 (68 events without arousal), which is considered mild. I had a total sleep efficiency score of 89% - even though I don't think I slept at all - they claim I slept well!! 

I also attached my overview from last night, and one zoom graph. I feel a little better this morning than yesterday.

Lastly - what could an Aircurve Vauto machine do for me that My current machine can't do? I'll watch for one for sale.

Thank you!!


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#92
RE: Lingering fatigue: trust Resmed sleep report?
Hi, Gchrtiley

Sorry if I strike you with the plausible PLMD drawback; no alternative to go. In my case, as soon as I moved to VAUTO and put FL under control, my PLM's highlighted. Intuitively, I knew I had RLS/PLMD since kid; however never realized it would account for my 50-year "insomnia" !. Bless Prana, when retired, and surprisingly in good healph but no memory left, new MD asked me to go for a PSG. I start comenting with him: APNEAS MAY BE JUST THE TIP OF THE ICEBERG!

(a) yesterday's picture: typical 1min-long awakening due to leg jerk; false flow limitation on top. These awakenings are pretty much destroying you.... curves suggest you would not properly cycling NREM to REM and backward, due to leg jerks;

(b) Comparing to myself, my careful notes and  plots, etc, I don't believe you would having such high SE; it would not be possible feel yourself so baddly under such 90%.....gross look on your graphs suggests your would be at maximum, say 60-70%, which is very poor score;

© concerning VAUTO, before I would ultimate suggestion, I would like to see more pictures of your graphs, particularly looking for existence and frequency of the couple "non-plateaued flow restriction - awakening". Let us see what the audio-recorder is going to tell you during these flow restrictions; in my case, rigth now, I am working and succeeding on eliminating some of these couples. I have been obtaining best outcomes these days with EPAPmin of 7.4 and PS of 4.4. 
However, one first benefit you would already have by just lowering your pressures: I suspect you could have same current or better results with much lower pressures, say starting up VAUTO with EPAPmin as low as 5.0; adding PS of 4.0 (magic threshol for so many people!!), leading to initial titring pressures of 9.0/...
In my therapy I lost 1.5 year on CPAP, then just 1.5 month on AUTOSET, and then VAUTO since April, 17th. Very happy with Vauto! 

(d) BTW, I would like to wellcome you in the thread created by Mouchet "RLS and plmd", where me and others start sharing experiences and solutions concerning PLM's.

GL
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#93
RE: Lingering fatigue: trust Resmed sleep report?
mper, I genuinely hope you are on to something because I'm facing periodic leg movement problems too. however, based on very limited personal experience I'm not seeing what you apparently are. displaying my ignorance perhaps.

first, I see no evidence of periodicity in any of the charts. no repetition; no uniform intervals between jerks. just single 'events' that look to me like throat clearing or roll overs, and some evidence of weak flow, probably central in origin.

gcritchley did say he had plm in the sleep study but very mild and apparently without arousals. plm might be there, but not in the charts I've seen.

second, I don't really see significant flow limitations. I'm not sure I know what significant is but gcritchley's look quite mild, at least compared to my charts.

not to be argumentative! and no wish to hijack the thread with this comment. I'm interested and will continue to follow along, hoping to learn.
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#94
RE: Lingering fatigue: trust Resmed sleep report?
(08-23-2019, 12:25 PM)sheepless Wrote: mper, I genuinely hope you are on to something because I'm facing periodic leg movement problems too.  however, based on very limited personal experience I'm not seeing what you apparently are.  displaying my ignorance perhaps.

first, I see no evidence of periodicity in any of the charts. no repetition; no uniform intervals between jerks.  just single 'events' that look to me like throat clearing or roll overs, and some evidence of weak flow, probably central in origin.  

gcritchley did say he had plm in the sleep study but very mild and apparently without arousals.  plm might be there, but not in the charts I've seen.

second, I don't really see significant flow limitations.  I'm not sure I know what significant is but gcritchley's look quite mild, at least compared to my charts.

not to be argumentative!  and no wish to hijack the thread with this comment.  I'm interested and will continue to follow along, hoping to learn.

I appreciate you chiming in sheepless. I think we may be in slightly uncharted waters, and I hope will learn some additional ways to tighten things up in my therapy. For me this was always about exploring lingering fatigue when the "numbers are good" and when additional blood testing and even trials of a few other things (T therapy, B12 shots, vitamin D, blood sugars tests, thyroid etc) haven't helped or led to anything. 

I attached the PLM portion of my sleep study here now, in case that's helpful. 

I also don't know what constitutes a problematic flow limitation - no one seems to have numbers, although like you, several have said mine look "fine." Mper seems to think he sees something - and I hope he's right, so I can feel more rested.

I did notice today when I looked - I spent less than 10% in REM sleep.


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#95
RE: Lingering fatigue: trust Resmed sleep report?
I believe 9.6 plm/hr with only 1 arousal is pretty low. still, most of us are convinced one night in a sleep lab or home study is not very representative so maybe you have more arousals from plm some nights. IDK if plm shows up in everyone's flow rate graph like it does in mine but if so, you need to look for signs of periodic breathing.

I surely do hope mper knows something(s) I don't - which is entirely possible, even likely since my knowledge is limited - and this leads to something beneficial for you (and maybe me too).

so many things can affect our sleep. figuring it out is likely to be a trial and error process of elimination.
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#96
RE: Lingering fatigue: trust Resmed sleep report?
(08-23-2019, 07:40 PM)sheepless Wrote:   IDK if plm shows up in everyone's flow rate graph like it does in mine but if so, you need to look for signs of periodic breathing.  

What do "signs of periodic breathing" look like on your graphs? I'm very curious/
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#97
RE: Lingering fatigue: trust Resmed sleep report?
see post #77 above in this thread.
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#98
RE: Lingering fatigue: trust Resmed sleep report?
IDK if gcritchley has a periodic limb movement issue going on but because it's been mentioned a few times I thought I'd bump this thread with another milder, cleaner example of plm in my flow rate graph.  fewer moans, groans and flow limitations than the example in post #77, and leading to a full awakening.  this instance of this pattern ran for about 25 minutes.  the attached chart from last night, which looks to be replete with this pattern, also shows the highest ahi I've had in 4 months.  I suspect but don't know that these are related (there are no ahi events in the sleep session the pattern in this post was copied from).  without having figuring it out (meaning these are made up numbers), I'd guess this pattern occurs 25-50% of most nights.  not counting naps, I typically have 5 or 6 full mask/machine off awakenings a night, hovering around 80-85% sleep efficiency.  guessing further, since I am oblivious to plm, I'd surmise the pattern in this post causes fewer arousals than the one in post #77. 

to me there's a question as to whether plm is an issue here so I hope my largely speculative plm comments haven't distracted too much from gcritchley's questions and concerns about lingering fatigue.
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#99
RE: Lingering fatigue: trust Resmed sleep report?
(08-25-2019, 06:00 PM)sheepless Wrote: IDK if gcritchley has a periodic limb movement issue going on but because it's been mentioned a few times I thought I'd bump this thread with another milder, cleaner example of plm in my flow rate graph.  fewer moans, groans and flow limitations than the example in post #77, and leading to a full awakening.  this instance of this pattern ran for about 25 minutes.  the attached chart from last night, which looks to be replete with this pattern, also shows the highest ahi I've had in 4 months.  I suspect but don't know that these are related (there are no ahi events in the sleep session the pattern in this post was copied from).  without having figuring it out (meaning these are made up numbers), I'd guess this pattern occurs 25-50% of most nights.  not counting naps, I typically have 5 or 6 full mask/machine off awakenings a night, hovering around 80-85% sleep efficiency.  guessing further, since I am oblivious to plm, I'd surmise the pattern in this post causes fewer arousals than the one in post #77. 

to me there's a question as to whether plm is an issue here so I hope my largely speculative plm comments haven't distracted too much from gcritchley's questions and concerns about lingering fatigue.

Thanks for the post, and the bump, Sheepless. I'm away for a week's holiday, and will be doing some sleep video and will be reporting back with my findings.
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RE: Lingering fatigue: trust Resmed sleep report?
Hi, Gchritley,
Indeed, I suspect the audio-record is going to be very instructive and your follow up on the results will be of great value to understand our PAP’s therapy in general  and point better ways to follow, not only for you and me (many similar things), but also for so many people here, who, up to certain point have been  also facing similar situations.
Scrutinizing this blog, particularly on Flow Limitation and PLM’s, and BPAP, I have struck with so many guys, who after controlling their apneas, ended up disappointed with outcomes in terms of how they feel. As I am used to saying to my Doctor (he agrees upon, by the way): “Apneas themselves, is spite their more life threatening, in many cases, are just the tip of the iceberg”.
In my case, OA and H (AHI: 17 in REM) were things easily beat in the very beginning of my two-year therapy (CPAP, AUTOSET, and, finally, VAUTO last four months). FL, and, particularly PLM’s, on the other hand, have been much harder, not only to understand but also to beat.
Audio-recording, a very low cost resource, was impressively useful in my case, by allowing me to (1) calibrate my curves (particularly FR and TV), in terms of responses to awakenings, sleep phases and so on; (2) finding out main causes of my awakenings, (3) understanding relationships between flow restrictions (whatever the duration, and if it is flagged or not as a genuine Resmed FL), and (4) seeing how subtle such flow restrictions can be while still leading to significant awakenings (1….2…4…5…minutes long), sleep fragmentation and low efficiency index.
Looking forward….good luck
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