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Please help! 4+ years fragmented sleep and insomnia – Extremely Desperate
RE: Please help! 4+ years fragmented sleep and insomnia – Extremely Desperate
High Trigger or any Cycle setting would not have helped since the machine did respond to your breathing attempt at 05:32:15 and there were not any further breathing attempts in the flow for the machine to respond to. With a complete apnea such as this, the machine can not trigger since it has nothing to trigger on!
Only the pressure at the time of the apnea matters, if it were higher the complete apnea might not have happened. The mask pressure at the time of apnea was 8.5 which is between EPAPmin=6 and IPAPmax-PS=9 so neither setting was actually limiting the machine. 

It was an interesting experiment, you taking Ambien proves that you do have OAs at pressure 8.5. Try to avoid repeating it as 112s of not breathing is really bad. 
Without medication and the obstructives were low - not necessarily better - maybe you are waking up quickly from OAs, and the arousals are destroying your sleep quality?

Anyhow, to have avoided this OA the pressure needs to be 9 at least. Try setting EPAPmin=9, PS=4, IPAPmax=13 at least, use ramp if it helps.
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RE: Please help! 4+ years fragmented sleep and insomnia – Extremely Desperate
Thanks for the explanation. Maybe I'm just slow but I just don't get why the breathing attempt at 5:34:15 didn't result in a complete breath but rather into a complete apnea since the mask pressure went up to 12. This is another reason to think that maybe I should've gotten an ASV instead. It's fine if I don't get it though, you don't have to explain it further.

My problem with increasing EPAPmin for me is that it's putting me back into CPAP territory before EPR as far as exhale pressure goes, which was waking me up frequently in the first place. Wow, I think you helped me make a very important realization as to why I've slept so poorly on PAP therapy so far and it's something I need to emphasize to doctors. It's such a difficult predicament to be in when the required pressure I need arouses me out of sleep.

I think you're right in that I'm arousing out of sleep before OAs get to develop fully, and at the same time I'm sleeping through OAs simultaneously (with medication making it worse), which is paradoxical.

I'll continue to try upping my EPAPmin with a higher IPAPmax and with a mix of ramp settings and see how it goes. Thank you, yrnkrn.
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RE: Please help! 4+ years fragmented sleep and insomnia – Extremely Desperate
(08-04-2018, 10:48 PM)sleeplover69 Wrote: Thanks for the explanation. Maybe I'm just slow but I just don't get why the breathing attempt at 5:34:15 didn't result in a complete breath but rather into a complete apnea since the mask pressure went up to 12. 

The AirCurve is responsive to your breathing pattern, when it sees the flow going down (Cycle) it starts lowering the pressure to EPAP.
Without effort belts we can't know if this was OK since you simply took a small breath or if it's not OK because you went into complete apnea during inspiration and an ASV would have kept upping the pressure and opening the apnea since the tidal volume was too low. The fact that the apnea continued for so long really proves that EPAP=8.5 was not enough at this time, possibly at other times as well.
This is not unusual, people use EPAPs=12, 18 ,20, ...
Personally I sometimes have apneas with EPAP=8, few with 9 and none with 10. I'm currently using EPAP=9.4.

When upping pressures you can go very slowly, even 0.2 every three nights. It's a neglible change that would not disturb your sleep but would get to your destination eventually.
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RE: Please help! 4+ years fragmented sleep and insomnia – Extremely Desperate
Update - Nightmare Timeline

Folks, never ever take finasteride/Propecia, ever. I might have just ruined my life.

After taking only one pill two and half months ago, my hormones are persistently out of whack. I suffer from muscle wasting and even my tongue has cracked and is sore. My obstructive sleep apneas have extremely worsened out of nowhere. Never before seen brutally long apneas at high pressures. Now I'm getting 80s+ OSAs at pressures far beyond what I could tolerate due to aerophagia so I can't do anything about them. I can't wear the Caldera Releaf cervical collar as it gets way too hot. I was starting to get better on the bilevel that I got off CL then it started to smell like french kissing a chain smoker so now it's unusable and I can't get approved for a bilevel by my current sleep doctor so I'm back on the CPAP.

Things were really beginning to improve after 4 years of hell all thanks to everyone who helped me in this thread then all it nosedived to a point much worse than when I started this thread. I'm sorry I have no good news to share.

Thank you, yrnkrn. I kept increasing my EPAP until I couldn't anymore but I need to badly. I'm at minEPAP 10.6 to 10.8 and I need it at 13 but I start to get blown up like a blimp already at 11! I'm going to get another bilevel. But maybe it's time to hunt for an ASV again? Can the esophageal sphincters be trained to withstand even higher pressures?? Right now I'm out of ideas.


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RE: Please help! 4+ years fragmented sleep and insomnia – Extremely Desperate
Good to hear from you.

Did you take Ambien on Oct 07? it's likely to make apneas worse since you won't wake up from the apnea and change positions.
Titration in a reliable sleep lab would provide much more reliable information, such as is this 87s apnea really obstructive and what pressure is needed to open it?
Other than this, have you tried not sleeping on your back? (I was never successful but some people are)
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RE: Please help! 4+ years fragmented sleep and insomnia – Extremely Desperate
You have options.
First, deodorize your S9 by getting a small can of Ozium spray, ans applying to a cotton ball or cloth, and let the machine take in the fumes.

Find a cooler alternative to the Releaf, like a wedge.

Get a different doctor that will look at your results and change your prescription.

Your side effects to a single dose of Propecia seem unrealistic. Find some medical help to find a more likely source of the problems and a complete work up, including testosterone and a PSA.
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RE: Please help! 4+ years fragmented sleep and insomnia – Extremely Desperate
Nope, I didn't take any Ambien or other medication on Oct 7 but I noted that I took 3g of glycine which I doubt caused them. I have these apneas on other days without taking anything at all and I haven't used any sleep aids in a while now. Both sleepyhead and ResScan are recording these events as obstructive apneas. I think I need 13cmH2O to eliminate most of them while I'm at 10.3 and decreasing because of worsening aerophagia. I guess I could try wearing something on my back to keep me on my sides.

Ozium - I am just going to get a new bilevel. Thanks for the suggestion, but I don't want to use a chemical spray that contains phthalates: https://en.wikipedia.org/wiki/Phthalate#Health_effects

Anyone know of a more breathable cervical collar than the Caldera Releaf? The Dr. Dakota doesn't work for me at all.

Re: Finasteride - The finasteride caused a bunch of nasty physical and neurological symptoms (including sudden sleeplessness/severe insomnia) that I won't go over including these suddenly worsened apneas that I've never had before in my life during a time when no other health changes took place. It's a powerful endocrine disruptor whose mechanism of action is shared by other drugs like retinoids like Accutane and supplements like Saw Palmetto. People have experienced persistent side effects from taking these drugs and supplements similar to the side effects of taking finasteride. 

Finasteride is usually well tolerated for a lot of people but can cause persistent life-altering side effects for some called Post Finasteride Syndrome which is a very rare and novel but real, documented phenomenon recognized by many countries. Many sufferers report getting full blown PFS from taking a few or only one dose while many more people could take it for several years and experience mild symptoms or no symptoms at all. The myopathy I'm having is recognized by Health Canada as a likely cause of taking finasteride.

Back to the apneas. I had a diagnostic and bilevel sleep study/titration done. The sleep doctor thinks these apneas I'm showing him aren't OSAs but centrals based on seeing a few centrals during the bilevel titration where my CAI was 2.1 in 90 minutes of total sleep time on the bilevel. For the diagnostic part, I slept for only 80 minutes and didn't get any REM and only 1.5 minutes of Stage 3 sleep which made it meaningless. 

He thinks I need lower pressures with CPAP, ie. min. of 4cmH2O and has made up his mind that bilevel would be worse for me. Nothing I show him would convince him that these are obstructives even though ResScan also shows that they're obstructive. He told me to just get a second opinion from another sleep doctor whom I'll have to find on my own and get a split CPAP/bilevel titration study with them.

https://imgur.com/a/3svNWeg
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RE: Please help! 4+ years fragmented sleep and insomnia – Extremely Desperate
See my post in "Why Cpap" for some tips from Hartley Street doctor on not getting to sleep.
It is all habit forming behaviour that helps people get to sleep.  It worked for the woman concerned, a lot better that she ever hoped for. 

Good luck.
>^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^<
I am NOT a doctor.  I try to help, but do not take what I say as medical advice.

I am just a long term user of c.p.a.p. and therefore I have some experience in using these machines and equipment.

However, I am NOT an expert, so advice given should be taken as given in good faith only and NOT medical advice.

Every journey, however large or small starts with the first step.   Coffee
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RE: Please help! 4+ years fragmented sleep and insomnia – Extremely Desperate
Got a trial for the bilevel again. Maybe the sleep doctor was right regarding centrals on the bilevel, but I'm only getting so many centrals now because I require higher EPAP pressures than before in order to get rid of my obstructive apneas. Unfortunately there's no way to increase EPAP max without increasing IPAP max as well or is there with bilevels besides the Resmeds?

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In contrast to before at lower pressures before finasteride use:

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RE: Please help! 4+ years fragmented sleep and insomnia – Extremely Desperate
EPAP can be increased without increasing IPAP by reducing PS. It appears you might do better with less pressure support while maintaining EPAP.
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