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PSG Results: Could this be UARS?
RE: PSG Results: Could this be UARS?
(Recent Oscar data: https://imgur.com/a/ycrFJdo)

So I'm continuing to struggle. Last night was particularly bad....I've been waking up at least every hour for the past few nights. I've experimented with a few slight settings changes and nothing has helped.

I'm kind of running out of things to try. I experimented with using no BIPAP, and also not taping my mouth, which I've been doing for about 6 months, just to see what might happen, and I didn't notice much difference. I still woke up every hour or so.  I experimented with slightly higher pressure and higher PS and ended up experiencing some real CAs for the first time. They showed up quite a bit in the OSCAR data so I think it's pretty clear they aren't false flags. So that kind of means I can't really raise the pressure more unless I can tolerate lower PS, which I'm not sure I can. I tried messing with the trigger and cycle a bit, and didnt really notice anything.

I can't help but keep coming back to this idea that the Autoset is different from the Aircurve. I know everyone is saying they should be the same but I can't help but doubt that, given that I was sleeping better for about 10 days with the Autoset, and I've basically never had a noticeably good night with the Aircurve in 2 months, even with the same settings.  The Aircurve really doesn't feel the same, and it seems like it's not functioning in the exact same way. It seems to be more 'comfortable', and I can't help but think that whatever settings/functions/algorithms that it has to be more comfortable are also making it less effective for me. It feels like it's not intervening in the same way that the Autoset was. I could feel the autoset increasing pressure, pulsing if I stopped breathing, and it felt more responsive to my breathing. I don't ever feel the Aircurve doing anything. I just feel each my breath gets boosted a bit by the air, but it doesn't feel like it does as much as the Autoset. I still wonder if whatever these subtle differences are, it might be missing whatever the Autoset was doing for me. I'm honestly getting to the point where I want to either try to get another trial with an Autoset, or even buy a used one, just to prove one way or another.

I also recently started wearing a Vivos DNA appliance to expand my palate and fix my misaligned bite, which is supposed to improve nasal breathing and some other things, and I'm not sure if having that in my mouth has also been disrupting my sleep even more...it takes up some more space in the mouth and makes it so my tongue can't sit on the roof of my mouth like it's supposed to. But I can't really not wear the appliance, since it needs to be worn every night in order to do its job. And it is theoretically supposed to help in the long term so I don't want to give up on that. 

I'm not really sure what to do....I just needed to vent after a bad night Sad
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RE: PSG Results: Could this be UARS?
The autoset and vauto are the exact same hardware, with simply different firmware-based algorithms. I don't think those algorithms differ that much, save for the greater configurability of vauto.

Did you try trigger on very high?

What happens if you switch to cpap mode?

I forget where you are. Did you explore other explanations for the insomnia?
Caveats: I'm just a patient, with no medical training.
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RE: PSG Results: Could this be UARS?
I have not tried trigger on Very High. I could try that tonight.

I still wonder if the different algorithms between the machines could be subtly affecting me. The slightest difference in timing or pressure could be enough to catch a problem that is causing me to wake up. I dont know. All I know is the machines don't feel the same, and one of them was working and one of them is not.

I haven't really looked into insomnia much other than experimenting with sleep restriction therapy for a few days, but I gave up on it pretty quickly because I was so tired. And I figure if my problems are related to SDB, then restricting my sleep is just making things worse. I really don't think insomnia is the main issue. It seems to be a byproduct of something else, and I usually don't have trouble falling asleep or getting back to sleep....my main problem is really bad sleep fragmentation. I sometimes have difficulty getting back to sleep in the middle of the night, probably because of increased adrenaline from the awakenings, but it usually comes and goes for a few days and then I go on streaks for a few days without ever having troubling getting back to sleep.

I've experimented with using Ativan a bit when my anxiety flares up or my sleep gets really bad for a week straight or something, but it doesn't seem to help much other than when my anxiety is super bad and my nervous system won't let me stay asleep.

I tried "S" mode when I first got the BIPAP two months ago, but it couldn't record flow limitations, so I switched to Vauto mode and set the EP, IP, and PS so that it was a fixed pressure. Is there possibly a benefit of going in "S" mode ?
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RE: PSG Results: Could this be UARS?
(05-12-2020, 02:28 PM)deebob Wrote: I really don't think insomnia is the main issue.

Well, if you're having problems sleeping, it's insomnia, regardless of cause. That's all I mean; the prospect that it's something other than the machine, or SBD, but equally real.

(05-12-2020, 02:28 PM)deebob Wrote: II tried "S" mode when I first got the BIPAP two months ago, but it couldn't record flow limitations, so I switched to Vauto mode and set the EP, IP, and PS so that it was a fixed pressure. Is there possibly a benefit of going in "S" mode ?

No; S + EasyBreathe will be same as vauto how you set it. EPAP and IPAP will not change.

I do notice your expiratory time is a little long. Not sure what to make of that, or what to recommend, but there's some discussion of trigger and cycle here that may be relevant?
Caveats: I'm just a patient, with no medical training.
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RE: PSG Results: Could this be UARS?
Yes, I do tend to pause a bit before inhaling again.  A few months ago I had gotten pretty into Buteyko breathing exercises, and part of that involved reducing the volume and frequency of breaths, and also pausing after exhaling. I'm not sure if the breathing exercises were helpful or not....I eventually stopped because my sleep wasn't really getting any better from what I could see.  But the long expiratory time seems to be connected to me experiences centrals with higher pressure support. Even when I'm laying awake, sort of half asleep, I sometimes catch myself forgetting to inhale after the exhale, when my pressure support is set above 3.4. I would definitely try higher pressures but I don't think I can increase the PS without getting these centrals. It's kind of disappointing because it almost means I didn't need the Aircurve...unless I can make some other settings work.  I might just try going up to 9.0 and keep the PS at 3.0 or 3.2, and see if I can tolerate that without getting chipmunk cheeks and bloated stomach.
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RE: PSG Results: Could this be UARS?
Maybe keep settings the same, except for trigger to very high, and see if that helps any?

I found when I did that reported centrals took a big (for me) drop.

Also, you can experiment with these settings (trigger, cycle, TiMin/Max) while awake, and see if you notice any comfort differences?

You don't seem to need to change the Ti settings, but the other two (not sure on cycle though).
Caveats: I'm just a patient, with no medical training.
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RE: PSG Results: Could this be UARS?
I've seen slowriters data and I swear changing the sensitivity setting is what helped him the most. I think it is due to how the brain perceives pressure change and in his case getting the IPAP pressure a bit sooner seemed to help. It is the only thing that I think may potentially help you, there are no other machines or settings that are likely to help you as frankly you don't have the obvious sleep disordered breathing these machines are meant to treat.

When you wake up and have insomnia taking deep slow breaths will trick your body into activating the parasympathetic nervous system which will release hormones etc to help reduce the effects of adrenaline and help you get back to sleep. Adrenaline etc are released when your sympathetic nervous system is activated whether it be from anxiety, sleep disordered breathing etc. It doesn't matter what is triggering the situation, the treatment to try and get back to sleep is the same. CBTi (cognitive behavioural therapy for insomnia) is worth researching if insomnia is an issue.

I still haven't figured out my situation yet either and I have seen so many other cases on here and other forums of people like you/me that don't have obvious sleep disordered breathing and find minimal benefit from CPAP yet still have obviously interrupted sleep. I don't think it is caused by sleep disordered breathing, I think disordered breathing if anything was likely present before the issue started or perhaps can be a side effect. I am currently exploring nutrition as it and lifestyle changes seem to be the most effective treatment for people with similar symptoms. I have been doing some trial diets and my digestion was definitely more messed up then I had realized.
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RE: PSG Results: Could this be UARS?
I will experiment with "Very High" trigger, and maybe tweaking some of the other things, because it does seem like something subtle like that is part of the equation, and would explain why the two different machines might be functioning slightly differently for me.  It does feel like the 'timing' of my breathing is maybe part of the problem with the Bilevel machine.

It's certainly possible that there are other factors at play, but I just can't ignore the fact that I have basically every single symptom of UARS, including the physical characteristics that cause it. There are just so many clues that point to it, and there's almost nothing else that could be causing all of these symptoms, so I find it difficult to dismiss it. I may eventually do another sleep study hopefully to just to rule it in or out definitively.

I continue to consider the possibility that it's just some form of insomnia, especially since it becomes more severe when my mental health is worse, but that doesn't explain why I was experiencing unrefreshing sleep a year ago when I was feeling fine mentally and wasn't even aware of SDB or anything else. When I look further back the past year or so, I can remember having issues with unrefreshing sleep and fatigue, while being fine otherwise - so I can't help but think that SDB had been developing for years without me knowing, until it reached a breaking point this past year. And it is possible that happened as I continued to mouth breathe and my palate/jaw structure became worse over time from bad oral posture.

I'm not sure about the diet thing....it seems odd that I would just suddenly experience terrible sleep when my diet hasn't changed much over the years. Why would it start now?  I have experimented with the keto diet in the past, including in November when my sleep was really bad and I thought it was CSA, and I didn't really notice any difference in my sleep quality. And my stomach generally feels fine, I have pretty regular/normal bowel movements, and eat fairly healthy and take supplements and probiotics.  I eat some dairy and sugar but that's never really been a problem in the past, and the lack of sugar during Keto never seemed to help.

I also have felt my nose feel more stuffy recently, which has coincided with my sleep getting worse the past couple weeks, so I feel like there could be some connection there.  My current theory is that my septum is slightly deviated, as the dentist observed in my CBCT scan before I got the DNA appliance, and I also think my soft palate is possibly a little narrow and the skin might be a bit long. I sometimes can feel resistance in that area when I breathe through my nose. I'm supposed to see an ENT at the end of June so hopefully he might be able to address some of those things. In the meantime, I will continue to wear the DNA appliance to expand my palate, and correct my jaw position/malocclusion. There are quite a few people who have said it's worked for them so I remain hopeful of that.
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RE: PSG Results: Could this be UARS?
So I tried going with higher pressure: 8.6 IPAP and 5.4 EPAP (3.2 PS), and Very High trigger, with High Cycle. It was the first night in a long time  that I seemed to sleep for around 3 hours at the beginning of the night without waking up....Another change that I think was pretty significant is I changed the humidity to 5, instead of Auto, because my nose has been feeling pretty stuffy lately and harder to breathe through. The extra humidity seemed to be helpful......but I went to the bathroom around 4 AM and had trouble getting back to sleep after that for almost 2 hours. Whatever was going on with the Trigger/Cycle combination made my breathing feel a bit lopsided, and I almost felt myself forgetting to breathe after the exhale (i think). 
Something felt a bit off, so I changed the settings in the middle of the night to 8.2 IPAP and 5.2 EPAP, and turned the Cycle down to Medium, and I ended up feeling more comfortable, but I woke up every hour or so for the rest of the night, which is pretty standard for me. The second half of the night is usually the worst because that's when I start getting into REM consistently. So I usually go through a sequence of dreaming, waking up, dreaming, waking up about every hour.

I'm not sure but I think the Trigger/Cycle and even the Ti min/Max might be what I need to chase to make the Aircurve work for me. I definitely think my sweet spot for comfort is around 8 IPAP and 5 EPAP, but I don't know if it's the most effective for my breathing, so I'm trying to push the pressure a bit higher while keeping the PS closer to 3.0 because anything over that seems to make my breathing feel very unbalanced and cause centrals or at least some little gasps.
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RE: PSG Results: Could this be UARS?
Try trigger sensitivity high rather than very high.
Sleeprider
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