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Please help! 4+ years fragmented sleep and insomnia – Extremely Desperate
#71
RE: Please help! 4+ years fragmented sleep and insomnia – Extremely Desperate
Damn, so that was a central after all? I was hoping it wasn't. I thought the squiggles looked different from the central before it. I figure Ill try another night to make sure, but that central was honestly terrifying enough to discourage me. Guess it's starting to look like I'll need to try an ASV soon.
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#72
RE: Please help! 4+ years fragmented sleep and insomnia – Extremely Desperate
Hi sleeplover69,

Normally you would want to make adjustments not more often than once per week.  But since you only have a one week trial to work with the VAuto, here are my observations and suggestions:

Overall, you did not have very many central apneas, so there may be room to increase PS, unless heartburn (LPR) becomes a problem.  Were you using a wedge to elevate the mattress under your head/shoulders? 

I think the long (one minute) apnea starting around 10:05:50 looks Obstructive in type.  (Notice how small the fast ripple is in the Flow, compared to the fast ripple in the Flow during the previous apnea, which was marked CA.) It seems strange that it was not marked as an OA.  If the Leak would have been really huge during the long apnea I would have thought the Flow was not detected correctly because of the huge Leak, but I think it looks like the Leak was small during that time.

I think your Leak looks low during the long apnea. The unit of Leak was set to Liters per minute, right? (24 L/min is not considered excessive.) So I think the Flow measurements can be trusted.

Your EPAP was low during the long apnea, near 5 cmH2O.  Your 95% EPAP was 6.34 cmH2O.  I suggest raising the Min EPAP to 6.0 or higher.  (A few Apnea Board members have reported they sleep best with the Min EPAP setting set so it nearly never needs to raise itself higher, because that tends to prevent obstructive events.)

What was the TiMin (minimum inspiration time) set for?  It might help to avoid very short inhalations if the TiMin is set to 0.8 (seconds). This would mean that when your inhalation effort lasts less than 0.8 seconds, the time for IPAP would be extended as if your inhalation had lasted at least 0.8 seconds, measured from when the pressure first starts to rise toward IPAP.

Take care,
--- Vaughn
Membership in the Advisory Member group should not be understood as in any way implying medical expertise or qualification for advising Sleep Apnea patients concerning their treatment. The Advisory Member group provides advice and suggestions to Apnea Board administrators and staff on matters concerning Apnea Board operation and administrative policies - not on matters concerning treatment for Sleep Apnea. I think it is now too late to change the name of the group but I think Voting Member group would perhaps have been a more descriptive name for the group.
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#73
RE: Please help! 4+ years fragmented sleep and insomnia – Extremely Desperate
One of the reasons apneas are not categorized and marked is if the Leak is larger than around 30 L/min.
(The vertical scale for Leak is not set for Liters/second, is it?)
Membership in the Advisory Member group should not be understood as in any way implying medical expertise or qualification for advising Sleep Apnea patients concerning their treatment. The Advisory Member group provides advice and suggestions to Apnea Board administrators and staff on matters concerning Apnea Board operation and administrative policies - not on matters concerning treatment for Sleep Apnea. I think it is now too late to change the name of the group but I think Voting Member group would perhaps have been a more descriptive name for the group.
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#74
RE: Please help! 4+ years fragmented sleep and insomnia – Extremely Desperate
Thank you so much for the insight and analysis. I too thought it looked like an OA because of how it squiggles, in contrast to the CA before it. Thanks for reminding me about leak rate and flagging of events. It really was weird that it wasn't flagged.
I'll try raising EPAP to 6 and PS to 5 to see how it goes if that's not too many settings to change all at once. Thank you so much for the suggestions.

I do have my bed on an incline on 3.something inch bed risers on Amazon, not sure if thats enough. I wonder if I can try slightly higher without slipping down the bed.

My TiMin and Timax were set to whatever the default is, at 0.3s and 2s I think. I did try 0.8 TiMin initially but I couldn't get comfortable with that. I thought id try leaving most things on default for the first night. Maybe increase my TiMin slightly? Like 0.5s?
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#75
RE: Please help! 4+ years fragmented sleep and insomnia – Extremely Desperate
(06-12-2018, 10:29 PM)sleeplover69 Wrote: Maybe increase my TiMin slightly? Like 0.5s?

Yes, maybe 0.5 seconds. TiMin should not be so long that it is at all uncomfortable. 

Please check on your vertical scale for Leak. Is it L per second, or L per minute?

Take care,
—Vaughn
Membership in the Advisory Member group should not be understood as in any way implying medical expertise or qualification for advising Sleep Apnea patients concerning their treatment. The Advisory Member group provides advice and suggestions to Apnea Board administrators and staff on matters concerning Apnea Board operation and administrative policies - not on matters concerning treatment for Sleep Apnea. I think it is now too late to change the name of the group but I think Voting Member group would perhaps have been a more descriptive name for the group.
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#76
RE: Please help! 4+ years fragmented sleep and insomnia – Extremely Desperate
OK, I'll try 0.5 seconds. Thank you. When I increase PS to 5, IPAP Max should increase to 14 from 13, right? It stays at 13. Do I change it to 14 manually? What happens when I leave it at 13? I still have a lot to learn.

Leaks - It tells me it's L/min.
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#77
RE: Please help! 4+ years fragmented sleep and insomnia – Extremely Desperate
Or does that lower IPAP min to 8. My 95% IPAP is at 10.34 and Max IPAP is at 10.88
If I'm understanding correctly, I should set it to 6/14/5 if I want to maintain min IPAP at 9.
Or maybe I'll try 6/13.5/4.5. My IPAP never reached 12cm though.
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#78
RE: Please help! 4+ years fragmented sleep and insomnia – Extremely Desperate
I am not sure this is central at 10:05:40. It starts with extreme hypopnea, very low flows going in & out. The catch is the machine is not triggering on this as the flows are so low and then it develop into zero flow that could very well be obstructive apnea. 

Personally I have these issues:

[Image: luItsti.jpg]


which do resolve with higher EPAP so I suggest you try higher EPAP with same PS.

edit: also, default Timax was annonying while awake/going to sleep, when I took a deep breath the pressure went away in mid-breath. I set Timax to 4s and happy with it.
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#79
RE: Please help! 4+ years fragmented sleep and insomnia – Extremely Desperate
(06-12-2018, 10:58 PM)sleeplover69 Wrote: My 95% IPAP is at 10.34 and Max IPAP is at 10.88
If I'm understanding correctly, I should set it to 6/14/5 if I want to maintain min IPAP at 9.
Or maybe I'll try 6/13.5/4.5. My IPAP never reached 12cm though.

If you want to try Min EPAP of 6 and PS of 5, then with Max IPAP of 13 or 13.5 or 14 the Max EPAP would be 8 or 8.5 or 9. 

Any of these values for Max IPAP should be okay, but if aerophagia is an issue then leaving Max IPAP at 13 might be best.

Or you could try Min EPAP of 6 and keep PS set at 4, which is less likely to make aerophagia much worse.
Membership in the Advisory Member group should not be understood as in any way implying medical expertise or qualification for advising Sleep Apnea patients concerning their treatment. The Advisory Member group provides advice and suggestions to Apnea Board administrators and staff on matters concerning Apnea Board operation and administrative policies - not on matters concerning treatment for Sleep Apnea. I think it is now too late to change the name of the group but I think Voting Member group would perhaps have been a more descriptive name for the group.
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#80
RE: Please help! 4+ years fragmented sleep and insomnia – Extremely Desperate
(06-13-2018, 02:20 AM)yrnkrn Wrote: I am not sure this is central at 10:05:40. It starts with extreme hypopnea, very low flows going in & out. The catch is the machine is not triggering on this as the flows are so low and then it develop into zero flow that could very well be obstructive apnea. 

Personally I have these issues:

which do resolve with higher EPAP so I suggest you try higher EPAP with same PS.

edit: also, default Timax was annonying while awake/going to sleep, when I took a deep breath the pressure went away in mid-breath. I set Timax to 4s and happy with it.

I took your advice to up TiMax, I have it at 3s but IDK if it's making a difference yet. 

Turns out it was an OSA. OSAs correlate with a certain I:E ratio number (100 in my case) different from a ratio number with CAs. But OSA or not, bilevel is turning out to be central city for me.


Bilevel Night 2 - Split Night 5.6/14/5 and 5/13/5 - Settings: 'High' cycle sens / TiMin 0.4 / TiMax 3s /All else default

Most likely didn't wear the collar for the first half, but did for the second half.

Felt sleepy and went to bed before 3 am, much earlier than usual, but I was rolling in and out of sleep before 4 am so I'm going to leave out sleep data for that portion. 

Night was split deeply after 4h30m of sleep. I don't remember awakening in the first half and there were very brief awakenings in the second. I feel demolished.

[Image: qZweDLc.png]

Aside from the OSAs, 2nd half looks more stable. Since I'm sure I wore the collar for the 2nd half, it complicates things

[Image: qpwxalb.png]

First half

[Image: XADg1hM.png]

And idea of how long the CAs (and OSAs) lasted. Don't know if I should keep going with bilevel at this point

[Image: oEKvQiE.png]

?

[Image: m8eBAb2.png]

More ? I don't see this in the 2nd half

[Image: UUYfbkS.png]

Centrals

[Image: jhsDvUW.png]

How does one get more OAs or hypopneic breathing at higher pressures?

[Image: E4uCZxY.png]

Aside from the OSAs, breaths may be not as deep, but are more stable?

[Image: 87gUzF9.png]

Some wave forms. But what could cause these flat extensions after the expiratory dips? Normal deviations? 
Mouth breathing?

[Image: a8Ct6Jj.png]

More examples of what I mean. And is that rippled one like a mini-CA?

[Image: k3JzxDS.png]

Arousal?

Thoughts and suggestions? What settings to try for tonight?
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