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Lingering fatigue: trust Resmed sleep report?
RE: Lingering fatigue: trust Resmed sleep report?
(10-21-2019, 09:02 PM)SarcasticDave94 Wrote: I suppose you could edit settings fractionally. If myself, I'd focus on how I was feeling with the AHI at 1.xx.

Thanks SD - so what would the fractional edits look like? 

1) how does one reduce flow limits? raise pressure support to 3.x? 
2) and tackling centrals are lowering the ipap, correct?
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RE: Lingering fatigue: trust Resmed sleep report?
I agree with Dave. You have 0.00 flow limit showing up in your 95% results. There is not much more to get. At this point you have minimal CA events, and more pressure support might increase that. You have 0.2 cm increments of adjustment as well as TiMax and trigger/cycle sensitivity to play with I'd be hard pressed to look at this chart and tell you what to do to improve. How are you feeling?

0.00 events is not something I strive for or experience often, but I have similar low AHI to yourself. I think at some point you just stop looking at the numbers, and go with your gut. I just checked my copy of OSCAR and it says I last downloaded data September 5, 2019, 45 days ago. For me, that's typical.
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RE: Lingering fatigue: trust Resmed sleep report?
(10-21-2019, 09:12 PM)Sleeprider Wrote: I agree with Dave. You have 0.00 flow limit showing up in your 95% results. There is not much more to get.  At this point you have minimal CA events, and more pressure support might increase that.  You have 0.2 cm increments of adjustment as well as TiMax and trigger/cycle sensitivity to play with  I'd be hard pressed to look at this chart and tell you what to do to improve.  How are you feeling?

0.00 events is not something I strive for or experience often, but I have similar low AHI to yourself.  I think at some point  you just stop looking at the numbers, and go with your gut. I just checked my copy of OSCAR and it says I last downloaded data September 5, 2019, 45 days ago.  For me, that's typical.

Thanks for that feedback - i would probably still play with tweaks in small increments, if I knew which direction or what parameter - and that's because I don't feel rested yet, but as I mentioned, that could be resolved elsewhere or could be a matter of living with these settings for a while.

Sounds like I'm right where I should be with my apnea therapy now (thanks in large part to all of you here), and perhaps with that check mark in place, exploration can begin to extend to other areas of suspicion.
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RE: Lingering fatigue: trust Resmed sleep report?
(10-21-2019, 08:29 PM)gcritchley Wrote: Popping in again on this thread, to share last night's graphs from my newer Vauto machine....., so then, gcritchley, one may see you could go with lower pressures, as I have suggested...this is great...hope you have got more comfort... with a couple of questions. Thanks for your time.

1) is it realistic to think that my flow limitations can be/should further reduced?...it could very realistic. You should bear in mind that flow limitations maybe you thinking about are just those flagged ones, that is just the conceptual, plateaued type ones. Actually, it may happens these flagged are not even the most significant. In my case, there are plenty of more types of flow limtations/RERA, not flagged, exremely disrupted, which could be eventually improved with fine-tuned EPAPmin and PS.  If yes, how would I do so?....you should be able to identify Unflagged RERA (U/RERA) on your chart, counting them daily, and cross plot agains EPAPmin + PS, and how it goes while changing parameters. (see attached pictures above), and this new one hereinbelow. 
If you post some ten-minute window, I could eventually be able to help identifying U/RERA on your charts....
2) Should I lower the IPAP further to continue to lower CA's?...based on your full night chart, strong suggestion all CA's area false events following awakenings.

I will say I think overall I'm sleeping better, but I know I wake up often, and at some point will have to investigate what else might be contributing, but with this new (to me) Vauto machine, I want to be in my optimal zone with CPAP before looking elsewhere. I think I'm close, but maybe a few small tweaks away.....you keep on going with too many awakenings, which need still to be tackled. Before this, It may happens, but is hard to believe you would feel consistently better.

good luck

Thanks again!
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RE: Lingering fatigue: trust Resmed sleep report?
...that also reminds the title of your thread: : "Lingering fatigue: trust Resmed sleep report?". I am afraid I could say with the experience I have been acquiring and learning these last 6 months, by myself, and with great insights  from so many others here and elswhere: no, don't  trust on Resmed sleep report, nor in its event flagging algorithms. They could eventually mislead and guide you to not work out your lingering situation.

good luck
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RE: Lingering fatigue: trust Resmed sleep report?
In theory, you could edit various settings .2 or .4 at a time up or down, in practice I don't know if it'll help. Track the numbers and "how you feel". Of the 2, how you feel wins. I'd probably go up first on actual pressure settings.

Note all your current settings for reference so you can return if needed. Your choice on doing 1 or more setting edits at once. If it were myself, I'd start with one at a time then if you can't get anywhere, add 2 edits at a time if they seem to logically connect together in their effect. You may need to edit, use it a night, view the data and evaluate how you feel, repeat as needed until you're headed to your goal. Reverse directions if you're feeling worse and/or the numbers are headed the wrong way. (Alternately, you could edit whatever x is to a certain point, then edit y to a certain point, tracking numbers and feel as you go. Positive then keep it, negative go back.)

You can apply this to any and all edits, singularly or grouped. It's probably going to feel like you're trying to split atoms with a sledge hammer, but if you can gain feeling better then obviously it's worth it.
Dave

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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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RE: Lingering fatigue: trust Resmed sleep report?
BTW here's my real life example:
I did a fractional edit on my EPAP Min from 9 stepping .2 over several nights to 9.6. At first it seemed OK, on each step the numbers looked OK still, feel was OK too initially. However, at 9.6 over several days, feel told me that 9 was better so I brought it back and left it.
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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RE: Lingering fatigue: trust Resmed sleep report?
(10-22-2019, 05:44 AM)mper6794 Wrote:
(10-21-2019, 08:29 PM)gcritchley Wrote: Popping in again on this thread, to share last night's graphs from my newer Vauto machine....., so then, gcritchley, one may see you could go with lower pressures, as I have suggested...this is great...hope you have got more comfort... with a couple of questions. Thanks for your time.

1) is it realistic to think that my flow limitations can be/should further reduced?...it could very realistic. You should bear in mind that flow limitations maybe you thinking about are just those flagged ones, that is just the conceptual, plateaued type ones. Actually, it may happens these flagged are not even the most significant. In my case, there are plenty of more types of flow limtations/RERA, not flagged, exremely disrupted, which could be eventually improved with fine-tuned EPAPmin and PS.  If yes, how would I do so?....you should be able to identify Unflagged RERA (U/RERA) on your chart, counting them daily, and cross plot agains EPAPmin + PS, and how it goes while changing parameters. (see attached pictures above), and this new one hereinbelow. 
If you post some ten-minute window, I could eventually be able to help identifying U/RERA on your charts....
2) Should I lower the IPAP further to continue to lower CA's?...based on your full night chart, strong suggestion all CA's area false events following awakenings.

I will say I think overall I'm sleeping better, but I know I wake up often, and at some point will have to investigate what else might be contributing, but with this new (to me) Vauto machine, I want to be in my optimal zone with CPAP before looking elsewhere. I think I'm close, but maybe a few small tweaks away.....you keep on going with too many awakenings, which need still to be tackled. Before this, It may happens, but is hard to believe you would feel consistently better.

good luck

Thanks again!

Hi, gcritley,
 
following up a little bit on this above: if you are going to post 10min-window and trying to identify U/RERA, Respiratory Rate chart is needed, beyond FR and TV; no way to go without RR chart.
 
Something on UARS and my case/yours: since early days of your thread, when I suggested FL as your main drawback, your charts have been suggesting you would suffer from UARS (and, eventually PLMS, still need clarification), which lead you to tens of awakenings and poor sleep quality.
And, you might know, UARS is a tough thing to treat, usually way much harder than OA/H. That mainly because UARS's brain is hypersensitive, intact nervous system, provoking (in my case) arousal/awakenings with noises as stupid as flying mosquito, dog scratches, loud voices around, cell phone bips of any kind, running car, motorcycles, airplanes, and, in particular with any signal of restriction/effort on inspiration, no matter how long, amplitude, concepted RERA (is there any satisfactory concept?... I don’t think, so).
To give you an updated idea on my case: on April 16/17, 2019, overnight, I experienced the magic of taming flagged FL, while moving from EPR 3.0 to PS:4.0, as you did. In the last 6 months I have been learning on UARS/FL/RERA, back and forth between literature/blogs and my waveforms. Unfortunately, I had to do all this, no clue for effective shortcut anywhere. It has payed off, however. I would say, currently, on EPAPmin: 7.2/7.4, PS:4.8/5.0, Max IPAP=EPAPmin+PS (any bit above this, because machine starts take care of false events, increasing pressure, and bother your sleep).
It worth the effort, because, otherwise, you might know what you may eventually would have to face (you can select among): fatigue(me), tiredness(me), nocturia(me), nightmare all night(me), anxiety(me) panic attack(me); high blood pressure, low blood pressure, bruxism, reflux, cold hands/feet,…..
 
Good luck
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RE: Lingering fatigue: trust Resmed sleep report?
....just to complete on way to go, from where you are: fine tune your PS, likely <4.0; start increasing EPAPmin; daily counting of RERA (in particular, unflagged ones), cross ploting against your EPAPmin, PS, and CA's, sleep efficiency (easy to get from your waveforms). This latter matters a lot (eventually, your have to use some medication to increase your arousal threshold, aiming at improve S.E). All this, up to getting the best you can on how you feel.
goodk luck
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