New, very tired, and need help

[Sleeprider]

A flow limitation is a restriction in your airway during inhale. If you zoom in on the flow rate graph around 4:00, so that you can see the individual breaths, a flow limitation would be seen as a good strong start to inhale that tails off as the flow decreases. A ragged descending line during the inhale would be a snore. Here is a graph that shows normal flow, compared with various forms of flow limitation. Compare with your own results by zooming in on your SleepyHead graph.

[beckysmith]

Thank you for all of your help. Maybe there is hope for me yet...

[beckysmith]

[attachment=3011]

Good morning! My numbers were worse last night.
Maybe that wasn't the change to make??

[Sleeprider]

What's odd is that we increased EPAP and you experienced exactly the opposite effect that would be expected with increased OA, while CA was stable or reduced. This may actually be good news because we are learning that you are apparently sensitive to pressure support (a difference in pressure between IPAP and EPAP), and we can closely correlate your CAI with pressure support. When you had a pressure support of 4, the CAI and hypopnea were a dominate feature of your AHI. That was reduced when we reduced pressure support to 3.0, and last night your PS was only 2, due to limits in the pressure range.

I think we need to continue with EPAP pressure increases to resolve what is becoming much simpler obstructive sleep apnea. Your leak rate was excellent last night. Your respiration rate continues to be less than 10 bpm, and tidal volume is steady in the low 500s. This is mostly confirming that the pressure changes have not had any effect on those aspects of your breathing.

If you were comfortable with pressure last night, then I think EPAP goes to 12, and IPAP stays at 13 or can increase to 14. At this point we are mostly targeting obstructive apnea, and that is actually a much simpler place to be than a couple weeks ago.

Edit to add notes:
Last week AHI of 16.8, OAI 4.33 and CAI of 10.63 at PS 4 over 9-20
11-20-16 AHI of 10.1, OAI 3.76 and CAI of 4.11 at PS 3 over 9-13
11-21-16 AHI of 11.91, OAI 4.02 and CAI of 2.47 at PS 3 over 9-13
11-22-16 AHI of 19.3, OAI 12.68 and CAI of 2.65 at PS 2 over 11-13

I have asked robysue to drop by for a second opinion, and hopefully she will find some time to lend her insights as well.

[beckysmith]

Thank you so much for your help. It is the only help that I have gotten. I will make whatever changes you think will help.

[robysue]

beckysmith,

I've been away from the internet over the holiday weekend. Sleeprider has pm'd me asking if I could look at this thread and offer some advice.

I've read through stuff, but I need some more time to digest everything. But I do have some questions for you that will help me help you.

1) Do you have a copy of the sleep study results? If so, do they say anything about central apneas or complex sleep apnea?

2) Did you have a formal titration study? If so, do you have a copy of its results?

3) You are on a bilevel device (the Resmed AirCurve 10 VPAP Auto). Do you know why you were set up with that device instead of the more ordinary Resmed AirSense 10 APAP or CPAP? In other words, why did the doc prescribe a bilevel machine instead of a CPAP or APAP?

4) You've done a lot of tweaking of settings recently. How long do you typically wait between tweaks? In other words, after making a change to the settings, do you typically wait only 1-3 days before making another tweak? Or do you sometimes wait a week or more?

5) How fragmented do you think your sleep is when you use the machine? Do you wake up a lot and toss and turn? Or do you go right to sleep and not remember any long wakeful/restless periods during the night?