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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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