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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
@Crimson Nape, thanks as always for your thoughtful observations.  I'm agreeing with your suggestions in the first paragraph.  My 2 minute window is ok.  Nearly all rounded inspiration, but occasionally with a little sprinkles on top or minor deviations.  Much, much better than before, pre-ResMed, but not as nice as at PS=4.4.  (It was a tough night at 4.4, but the peaks were more round.)  So some increased PS and EPAP could help.  Might try PS=3.4 over 9-14.  That would increase PS a little, and allow 1.6 for some slight control.  At this point, I think little steps will allow some progress without having big CA bumps.  If you don't agree, please comment, as I value your insight.

Thanks for your description of breath rate and flow limit reporting.  It helps me better understand the concepts.

For me, UF2's are only sort of a proxy for breathing interruptions.  I use the metric to get a handle on the what other sub-apneic interruptions might be occurring.  For me, most of my UF2's appear to be cessation of breathing that last for 9 or more seconds.  UARS is "in a way" when there are lots of these arousals.  UF2's are like baby apnea that never grew up.  For some time, my UF2 events have been comparable in magnitude to the number of apneas.  For instance 2 Nov.  CA=20, UF2=13.  So I do look at them, especially if there are a lot of them.  If there aren't all that many UF2, there's no harm to ignore them.  So not fixating on them, but still keeping an eye on them.

All that being said, if the numbers for apnea are reduced, UF2 seem to be reduced as well.  So, for the purpose of future therapy, I am content to just drive down apnea events.

Keep us posted on your experiments on Ti & Cycle.  I did have Ti_Min = 0.3 for some reason.  (Since the start of ResMed titration, I think.)  With Trig=Very High and Cycle=Med, I woke up twice feeling almost breathless.  However there was no evidence of anything on the flow rate.  Without evidence, it's hard to draw a conclusion.  Nonetheless, the waking up breathless was unpleasant.  At Ti_Min=0.7, Trig=High & Cycle=Low, last night was comfortable for me.  Certainly willing to try more in this area.
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RE: Looking for some help - almost 5 years and not feeling a lot better
Forgot to use my new soft collar last night.  Oh well, there's tonight.  Seem to be steady with respect to the numbers, but not feeling better.  Sort of dragging again.  Last night was neither restful, nor restoring.  Mood is less confident about progress, but at least I haven't had a major setback.

For anyone who is following on, here is a table of history and changes that I made

Date:  Events   AHI    Setting

       CA/H/OA
11/8   9/3/7   2.36    3.4/9-14    Cyc=L, Trig=H, TiMin=0.7, TiMax=2.4  single pillow
11/7   9/3/7   2.36    3.2/8.4-13  Cyc=L, Trig=H, TiMin=0.7, TiMax=2.4  single pillow
11/6   16/0/5  2.66    3.2/8.4-13  Cyc=M, Trig=H, TiMin=0.7, TiMax=2.4  single pillow
11/5   12/2/3  2.02    3.0/8.4-12  Cyc=M, Trig=H, TiMin=0.3, TiMax=2.4  single pillow
11/4   11/0/8  2.33    3.0/8.4-12  Cyc=M, Trig=H, TiMin=0.3, TiMax=2.4  single pillow
11/3    9/0/6  1.86    4.4/10-15.4 Cyc=M, Trig=H, TiMin=0.3, TiMax=2.4  single pillow
11/2   20/2/4  3.13    4.4/10-15.4 Cyc=M, Trig=H, TiMin=0.3, TiMax=2.4  single pillow
11/1   29/0/2  3.87    4.4/10-15.4 Cyc=M, Trig=H, TiMin=0.3, TiMax=2.4  single pillow
10/31  20/3/1  2.71    4.0/10-14   Cyc=M, Trig=H, TiMin=0.3, TiMax=2.4  single pillow
10/30  14/2/4  2.34    4.0/10-14   Cyc=M, Trig=H, TiMin=0.3, TiMax=2.4  single pillow
10/29  22/0/3  2.73    4.0/10-14   Cyc=M, Trig=H, TiMin=0.3, TiMax=2.4  single pillow
10/28   5/0/1  0.73    3.6/8.4-12  Cyc=M, Trig=H, TiMIn=0.3, TiMax=2.0  single pillow
10/27  12/3/1  1.96    3.6/8.4-12  Cyc=M, Trig=H, TiMin=0.3, TiMax=2.0  single pillow
10/26  21/2/2  3.15    3.6/6.4-16  Cyc=M, Trig=H, TiMin=0.3, TiMax=2.0  single pillow
10/25  18/0/3  2.68    3.6/6.4-16  Cyc=M, Trig=H, TiMin=0.3, TiMax=2.0  dual pillow
10/24  27/1/6  3.71    3.6/6.4-16  Cyc=M, Trig=H, TiMin=0.3, TiMax=2.0, dual pillow
10/23  56/2/4  6.97    4.0/6.4-16  Cyc=M, Trig=M, TiMin=0.3, TiMax=2.0  dual pillow

I have yet to try Trig=Very High with my current settings.  When I tried it (twice) while on TiMin=0.3s and Cycle=M, I woke up distressed and breathless.  Now that my settings are TiMin=0.7s and Cycle=L, adjusting Trig might prove beneficial.  10/23 was Day 1 on the ResMed.  10/28 may have just been a fluke.  In the past on my old Respironics I have had about 3 good days of therapy per year.  I'm really hoping it wasn't a fluke, but, it's very easy to be falsely persuaded by a coincidence.  Thought the changes for this coming evening will be: new soft collar + Trig=Very High.

Comments?  Observations?
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RE: Looking for some help - almost 5 years and not feeling a lot better
Pretty soon you'll have an entire book of pressure setting combos. Just a guess, maybe attempt to eliminate all possible combos left. Seriously, I do hope you find the right combo pretty quick. This seems like your sleep is mostly a wreck still. And if you want to take a break, we can meet in the AB cafeteria and grab a virtual 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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RE: Looking for some help - almost 5 years and not feeling a lot better
Running out of possibilities, but can say quite a few have been tried.  Maybe those more clever than I can point out a few more possibilities.  Everyone keeps telling me to try Trig=Very High.  I want to do that, but haven't yet tolerated it well.  So there has to be a tweak or two to get me there.  Higher PS helps with H+OA, but higher pressures give me aerophagia.  There has to be a happy medium somewhere.  But to answer you, yes, sleep is still a wreck.  Needs to be better...

Wandering OT.  Funny you should mention a virtual coffee.  Ten days ago I received a mail order of real whole bean coffee.  At first I was worried I was coming down with covid, as the brewed coffee seemed tasteless and aromaless.  A few more days went by and the coffee wasn't getting any better.  As I still seem to have a pretty good sense of smell, I instead concluded the coffee was far beyond stale.  Yesterday, I proved the coffee's staleness conclusively when I was able to buy some coffee from a local roaster.  Yes, the locally (and recently) roasted coffee was great, and I could both smell it and taste it when served black.  With all of coffee's interesting overtones.  So yeah, where is the AB caf?  Coffee And umm, where can I dump all this stale old coffee?  Where's the AB compost heap?  Too-funny
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RE: Looking for some help - almost 5 years and not feeling a lot better
I think the compost heap is just outside the emergency exit at the end of the west hallway. I'd say that coffee you'd gotten was a bit past its prime. As for off-topic, it's your thread, so you can drift it OT somewhat without penalty. But if you do it too many times, we make you drink decaf.

lots-o-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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RE: Looking for some help - almost 5 years and not feeling a lot better
On topic.  Finally something to report.  OSCAR was grouchy this morning and refused to import.  Reported in Software Forum.  After a reboot, OSCAR finally imported last night's data.

Much better results!  CA/H/OA = 0/3/2  AHI=0.63.  Feel really clear headed this morning - like raring to go.  I like this!  Was singing in the shower a bit.  Can't remember how long ago I last did that.

What changed?  Just 2 things from the night before.
  1. New soft collar - wow that was kind of stiff!  More likely the old one was unsupportive.
  2. Trig = Very High.  Stopped the CA's.  Just amazing.  I needed Cyc=L to tolerate Trig=Very High.
Complete settings were:
Date   C/H/O  AHI     Setting
11/9   0/3/2   0.63    3.4/9-14    Cyc=L, Trig=VH, TiMin=0.7, TiMax=2.4  single pillow, new soft collar   

There's a small amount of aerophagia at this setting.  Headache is still there, but way down.  Might yet make some minor changes, but will try again with the same settings tonight.  It would be good to validate this wasn't a fluke.  Even if it is, I'm still taking this day as a gift!  like Going to make some coffee - no decaf for me!   Coffee
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RE: Looking for some help - almost 5 years and not feeling a lot better
OK glad to hear that win. Hopefully it keeps headed the right way.
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: Looking for some help - almost 5 years and not feeling a lot better
Day two of a better life...  Yesterday may not have been a fluke!  

Last night's AHI=0.64.  Increase of UF2 events from 1 to 5.  (You all told me not to fixate on them, but the number of UF2 events IS comparable to apnea events)  CA/H/OA/UF2 now: 0/5/0/5.  Not quite as well rested, as yesterday, but it's still good.  Feel much less mental fog, and quite alert.  It's a good change.  Headache is down from yesterday.

There is a little more palatal prolapse than before.  For some reason, there was congestion in my throat last evening, to the point it changed the tone of my voice.  Might have impacted the night's therapy.  Seems to have gone away by morning.

There's still some work on improving comfort, but finally things are going in the right direction!  Woohoo!

I want to thank everyone on AB, especially @Crimson Nape, who stuck with me to give me guidance.  Sorry to have been so dull-witted.  Also many thanks to @bonjour for words of wisdom.  @Sarcastic Dave94, thanks for reminding me of Rule 22.  This rule, DON'T EVER GIVE UP, made me persist, despite the difficulties of the titration process.  You don't want to know how many times I wanted to quit, but kept on going, because of thinking about that rule.  Thanks @Sleeprider for nudging me back onto the forum to ask for guidance.  Thanks to every kind soul here on AB who pointed me in the right direction and guided me to a PAP that is better matched to the apnea I have.  What a difference!   

Sleep-well I can do that now!  Hope to have some happy dreams!
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RE: Looking for some help - almost 5 years and not feeling a lot better
Excellent! After reading your post above about your congestion, I thought you might try playing with the humidity. Sinus can be a sign of too little humidity.
Crimson Nape
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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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RE: Looking for some help - almost 5 years and not feeling a lot better
Last night humidity was 4.  I'm a little less dry throated than on the days I had used 3.  Will try 5 tonight. 

Still pondering how to add a little more PS without increasing aerophagia.  Currently at PS=3.4 over 9-14.  Pressure: 12.4/12.62/13.42/13.98  min/med/95%/max    Have 1.6 cm-H20 of range to address apnea, which appears to be used.  

Would PS=3.6 over 9.4-14.6 work?  That still gives me 1.6, correct?  Because of the exhalation palatal prolapse, thought it would be helpful to slightly increase EPAPmin.  Comments?
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