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Looking for some help - almost 5 years and not feeling a lot better
RE: Looking for some help - almost 5 years and not feeling a lot better
Whether today is an accurate indicator or not, today I feel awful, worst I have felt in quite a while. My sleep was far more disruptive than looking at the charts would indicate.
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RE: Looking for some help - almost 5 years and not feeling a lot better
To add to what I just said, I don't feel sick, just tired, a little cranky, worn, weary and headachey.  
I did find another instance of maybe chin tuck, or collapse of expiry waveforms last night, at PS=4.  10-14.  Right now, due to settings, the machine can't respond to changes.  
   
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RE: Looking for some help - almost 5 years and not feeling a lot better
That zoomed view has 2 arousals, can't tell why but definitely arousals.
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter

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RE: Looking for some help - almost 5 years and not feeling a lot better
to me the zoomed shot looks like flow limitations and a bit of snoring leading to recovery breathing (sinusoidal and spikey). abbreviated exhale, that lower case r shaped exhale, could be leak but also palatal prolapse perhaps?
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RE: Looking for some help - almost 5 years and not feeling a lot better
I appreciate we are getting into the fine tuning at this point, at least if I am remotely understanding.  Problem for me (at the moment) is last night's sleep is robbing me of good reasoning.  So I need a little bit of assistance, hand holding, to take the next step.

There's some conflicting things that I see.  They may not actually be conflicting, but my reasoning is not so good right now.
  • One person recommends increasing PS from 4 to 4.6 and moving EPAP from 10 to 11, and IPAP from 14 to 15.6.  I understand the reasoning.
  • A second recommends a trial of higher PS, which is compatible with the above, but do not suggest increased pressure.  The next statement is PS could drop to reduce CAI, which I understand to be true.  
I am guessing that one tries the increased PS as a trial, and if after a few days CAI drops all is good.  If CAI stays high, reduce PS some?  Is that the basic idea?

Some questions on this.  If I kept IPAPmax=14, with PS=4.6, then EPAPmin must be less than or equal to 9.4?  Or I could do the first item and IPAP would increase.  I'm not sure if it matters which one I try, as they are not that different.


Guess I'm still getting used to the support model here on AB.  Sometimes it is confusing, as I am finding I miss some of the nuances.  Certainly don't want dueling approaches or to pit one against the other.  Not my intent.  Still a new person, and am confused about this complicated world of apnea.

Well, I am going to pick #1 for the moment, just to move on.  Hope no one is offended.  Seriously I'm a blockhead this evening.  Haven't felt this fogged in quite a while.  No fever, normal SPO2 and pulse, just suffering from a lack of sleep last night.
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RE: Looking for some help - almost 5 years and not feeling a lot better
Two arousals, no flow limits and no "classic" AHI events.  UARS, perhaps?  The frequency of this expiry collapse is reduced from the night before.  Guess that's progress?

But as a counterpoint, maybe it was a fluke, but I felt like a million dollars at: PS=3.6 8.4-12  AHI=0.73.  Honestly I felt almost manically good.  Was a total revelation to me that I could feel that awesome.  I had more flattened expiry points, and a few arousals, but despite all that, it was the most wonderful night of sleep I have had in years.  Almost afraid to retry the settings.

Thoughts?
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RE: Looking for some help - almost 5 years and not feeling a lot better
Probably is palatal prolapse.  There was more prolapse at lower pressures, but surprisingly had better sleep quality at the lower PS and pressure.
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RE: Looking for some help - almost 5 years and not feeling a lot better
forget charts & numbers for a while. go back to your million dollar settings, see if you feel like that again.

you've mentioned movement a few times. I have plm which produces inhale spikes, groans & comparatively flow limited breathing between kicks & flow spikes. resmed machines raise pressure against flow limitations which can be disturbing. idk if this is the case with you but the pressure/pressure fluctuations could be causing arousals. could be why you prefer lower ps. I run my vauto on auto but with fixed pressure to avoid pressure changes. to do this, I set ipap to equal the sum of epap + ps.

edit: I see after the fact that the settings in your profile are already set as I mention above. sorry I missed it.
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RE: Looking for some help - almost 5 years and not feeling a lot better
sheepless, my sleep study didn't mention PLM.  More succinctly, it noted little if any movement.  

Nonetheless, my videos over the past few days indicate that 50% of my apnea (CA, H, OA) has some associated movement.  Sometimes it's just a minor movement, other times it can be my whole torso moving (roll over, or lifting the whole torso partially upright) or my head lifting up.  25% (from memory) might be leg movement.  However, I cannot tell if the movement is pre or post apnea.  I simply can't synchronize the different clocks of the different devices.

I know I'm being a bit irrational about this million dollar setting.  Part me desperately wants to try it again, to experience the feeling again.  It was almost too awesome.  Another part is scared to try and possibly fail.  Yeah, that's irrational...

I started bi-level on Oct 23rd.  Here's the short history

23 Oct PS=4    over 6.4-16.  AHI=6.97  98% CAI  Utterly devastating day.  Totally incapacitated
24 Oct PS=3.6 over 6.4-16.  AHI=3.71   "             Felt a tiny bit better but bad
25 Oct PS=3.6 over 6.4-16.  AHI=2.68                 Tiny bit better yet, but nowhere near good

26 Oct PS=3.6 over 6.4-16.  AHI=3.15                 Minor set back
27 Oct PS=3.6 over 8.4-12.  AHI=1.96                 Crimson Nape's suggestion.  A good improvement.  Limited machine authority.
28 Oct PS=3.6 over 8.4-12.  AHI=0.73                 "Million dollar day" - utterly amazing day
29 Oct PS=4    over 10-14.   AHI=2.73                 Much, much worse 
30 Oct PS=4    over 10-14.   AHI=2.34                 Dragging.  Not good, about as bad as 29 Oct.
31 Oct PS=4    over 10-14.   AHI=2.71                 Restless night.  Unrested, unrefreshed, dragging, mentally foggy.  Felt the day had to have  
                                                                         been over at 1PM.  Been just exhausted.  Almost as bad as 23 Oct


Not much to work with, but that's what I have plus whatever is already in the thread.
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RE: Looking for some help - almost 5 years and not feeling a lot better
Adjust your max to be 1 + PS over EPAP
I really think to boost PS may help, it may not but I do feel it is worth a try.
so
PS = 4.4 (take it slow)
Max IPAP = 15.4, the room of 1 should not hurt, and will give an indication of what the VAuto wants to do.
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter

Download OSCAR
New to Apnea? Helpful tips to ensure success
Soft Cervical Collar
Mask Primer
Dealing with a DME
Organize Charts
Optimizing Therapy
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