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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
On your Oscar chats, the pressure line needs re-scaled to include your EPAP pressure from 8.6 cm. I would just scale from 8.0 to 15.0. There is a recurring obstruction or flow limitation through the night as you are at or approach the minimum pressure, so I'm inclined to take the EPAP min to 9.0.
Sleeprider
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RE: Looking for some help - almost 5 years and not feeling a lot better
Thanks Sleeprider.  I'll give 9.0 EPAP a try tonight.  I'll rescale my charts the next time I post.
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RE: Looking for some help - almost 5 years and not feeling a lot better
I'd incrementally raise min ps to try to increase tidal volume and inspiration time and to reduce flow limitations. your ahi is great. you have 4 oa and 5 ca. you could try raising min epap a hair (not max) if oa is a concern but you risk more ca as a result. if ca is a concern, other than avoiding them with lower pressure, you can try high and very high trigger if you haven't already.

I suppose it's possible a different machine is delivering different pressure (a possible reason for the difference in leak rates) but it's only been 3 nights since the 24th. give it a little more time to be sure it's a trend before worrying about it. the only way to figure it out would be to experiment with higher pressure settings and/or have it tested. previous leaks of 11 aren't bad at all but sometimes leaks prohibit the machine from responding and reporting accurately, possibly explaining higher ahi with the lower leaks. doesn't seem very likely, but again, give it a little more time to see if it's a trend.

your chart is good so headaches & congestion might be unrelated and could actually be the reason for your higher ahi (which at 1.56 is at a level many of us would love to achieve).
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RE: Looking for some help - almost 5 years and not feeling a lot better
For me, headaches ARE my indicator of bad night's sleep.  If my AHI is very low, I have no headaches.  I seem to be very sensitive to sleep disruption, with is why I also look at UFx.  UFx events are not apnea, but they DO disturb my sleep architecture.  I suspect these events prevent me from transitioning into deeper stages of sleep.  This was noted in my initial sleep study.  (Below normal amounts of REM sleep.)

I have plotted the sum of AHI + UF2 and found a strong correlation to how I feel.  The lower the sum, the better I feel.  Today I am at 2.15 and feel really bad, headaches and very lethargic.  Above 3 is really horrible.  When I had a single night at 7, I was incapacitated for days.  On the other hand, at 0.85 and below, I feel amazingly well.  So I'd like to head my numbers in that general (lower) direction.  Not looking for a zero index, but instead to feel more alive.  

My apnea charts have always indicated I'm "good", but rarely have matched how I feel.  It's only when my AHI is very low then I feel good.  Maybe I'm odd that way, but that's how it has been for me.
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RE: Looking for some help - almost 5 years and not feeling a lot better
are your respiratory stats, particularly tidal volume and inspiration time, similar or different, new machine vs old?

are you monitoring your O2 levels?

afaik, headaches are often the result of desats, but I have no experience with that.
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RE: Looking for some help - almost 5 years and not feeling a lot better
I've had, and do now have, the headache associated with Apnea and oxygen desats. Mine started back up soon after ASV therapy wheels fell off.
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: Looking for some help - almost 5 years and not feeling a lot better
@sheepless, it's hard to tell, with only 2 days on the new machine.  TV is 330 average on the new machine, and 342 on the 'old' VAuto.  My TV is low compared to most people.  My COPD might be to blame there.  Inspiration time is about the same between machines.  1.4 or so.  I haven't run actual stats on them.  Respiratory rate is about the same of slightly less.

Haven't been monitoring O2 for a year now.  Everytime I used the O2 monitor, there was nothing surprising.  No deep desats.  Desats only went to 90%, rare occasion, 89%.  Now, my Contec 550F display is unreadable since it is so dim.  Really don't want to buy another one, and don't want to spring for a more expensive one, especially since the Pulse Oximeter hadn't revealed an issue in the 3 years that I used it.

From what I can tell, my headaches are a result of interrupted sleep.  The fewer interruptions (lower AHI), the better I feel.  Sleep deprivation headacheSleep-related headachesAssociations between sleep disturbance and primary headaches & Sleep disturbances in tension-type headache and migraine.  The third & fourth links have a free download of the article.  I thought the fourth link was quite interesting.

I had headaches for about 5 years prior to being diagnosed with apnea.  Cluster headaches, many were migraine like.  It was awful.  Made me irritable and no fun.  Visited all kinds of doctors, went through all sorts of treatments.  No real cause was found.  When, by chance, I woke up in the middle of the night gasping for breath, the light bulb lit.  Apnea.  What I have experienced: the better my apnea treatment, the lower the headaches.  The higher the apnea I had, the greater the headaches I experienced.  Is apnea the only cause of my headaches?  Maybe not.  My doctors over the years haven't found anything.  If you have any additional ideas, I'll take a look.  Could be helpful.

My bilevel titration will become more refined.  (Thanks to AB for all the help!)  I hope and expect the headaches will reside again...
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RE: Looking for some help - almost 5 years and not feeling a lot better
I am not very concerned about Vt or the respiration timing. I have not found pressure support to be an effective means of making significant changes to tidal volume, or minute vent because unless obvious obstruction is present, the respiratory volume and rate is driven by CO2, not pressure. Let's keep it simple for now.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


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
@Sleeprider, I agree, earlier on, people were trying to increase my pressure to increase Vt.  Doesn't work for me, all it does is give me aerophagia, increase CA and no Vt increase.  I like the KISS principle.  Fix the stuff that's obvious before going after the subtle.  It's a great credit to AB that you can sort through the chaff and find the obvious hiding in plain view.  Not everyone can do that.  I'm thankful for your insight.

@SarcasticDave94, sorry to hear of your continuing struggles.  For me, headaches are most definitely associated with apnea.  I have 15 years of experience with that.  Hope you get your therapy back on track.
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RE: Looking for some help - almost 5 years and not feeling a lot better
I'm not concerned about the respiratory stats per se, only if there was a difference between old and new machines that might give us a clue about how to address your complaints. I see little else in your screenshot that would explain or help. you're in good hands with Sleeprider.
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