Please help! 4+ years fragmented sleep and insomnia – Extremely Desperate

[sleeplover69]

All right. I forgot about having much lower centrals with a PS of 4. I'll see how it goes with 6/13/5.

[yrnkrn]

Note how the machine did not respond to your trying to breaths 7:33:10 resulting in OA and pressure up.
I missed this, but you did write 'High' cycle sens whereas you need is 'High' Trigger sensitivity for the machine to properly respond.
'high' cycle sens. will cause the pressure to cycle back to EPAP more quickly, which may cause you to feel out of air.
You may actually prefer 'low' cycle sensitivity. Try it while awake, how it feels to you.
Anyhow what was the Trigger sensitivity?

PS=5 may be causing too much centrals -or- we're reading into random results.
I think fixed pressure settings may work better for you. In VAuto mode, could you try EPAP=8 IPAP=12 PS=4 ?

[sleeplover69]

I'm just glad to get a response from you, yrnkrn. Last night, like so many nights in a row over so many years felt traumatizing.

I did try High Trigger the first night, I thought it'd be what I needed but my breaths felt hurried by the machine. Right now it's on Medium, but I'll try High again tonight. I changed it to High Cycle because it felt smoother breathing out against the machine as I felt my exhale breaths were faster than the machine could switch pressures.

I'll try 8/12/4 EPAP/IPAP/PS and that's in S mode, you mean, right?

Edit 1: Oh, PS is already accounted for in S mode, so I guess you did mean VAuto. I'm just not sure if EPAPmin 8 may be too high as I did well with 8-12/EPR 3 on the S9 Autoset (cept for the arousals), but I could try 8/12/4 in VAuto tonight. Or wait, that can't be in Vauto with those numbers

Edit 2: Settings now: High Trigger, High Cycle, 8/12/4 in VAuto

[yrnkrn]

S will work the same as VAuto for 12/8/4 except the machine in S mode does not compute the flow limitation channel, it is alwasy 0.31 or something.
I'm quite sure about Trigger=High as the machine did not respond to some of your breaths, see the mask pressure channel.
Choose the Cycle sensitivity whatever you breath most comfortable with.
And go to sleep only when you're really tired, regardless what the clock says.
You can deal with sleep timing, possible DSPS and whatever later after you got regular good 7-8 hours of sleep. Solve one problem at a time.

[sleeplover69]

OK, thanks. One last thing, I did just try High Trigger just now and it was uncomfortable and felt like my lungs are blowing up too fast for me to finish breathing. Stick it out for the night at that setting so that the machine could pick up the obstructive apneas?

[yrnkrn]

Uncomfortable is not good start for sleep... if you lie down for couple of minutes and just breath do you get used to it?
Also, Easy-breathe is ON, right?

[sleeplover69]

High Trigger is forcing me to slow down my breathing. It was harder to fall asleep the first night I tried it and I ended up switching it back to medium after that session break for the night and it felt much more natural for me.

I can't find Easy Breathe in Vauto mode in clinical settings? I see it under S mode though.

Edit: I can't do High Trigger, it seems to actually strain and hurt my lungs. I don't think that's quite right. Oh, well. I'll test out 8/12/4 tonight with Medium Trigger.

[yrnkrn]

Right, you can turn off Easy Breathe only in S mode.
You need comfortable with the settings so go with medium trigger.

[sleeplover69]

Bilevel Night 4 - 8/12/4 - Med Trigger, High Cycle, TiMin 0.4s, TiMax 4s, cervical collar

Just couldn't go to bed this morning. Maybe knock-on effects from the night before. I had a lot of phlegm and some heartburn and had to take a PPI before bed. I slept for maybe 5 hours and couldn't go back to sleep. I woke up briefly a few times again catching myself kicking around the duvet as I tossed and turned.

Also really bad news as I'm rejected from getting a sleep study at that Sunnybrook Sleep Clinic that has neurologists on the team. I'm beyond the postal code cut-off point according to a change in policy due to their patient load probably.

Some screen shots of interest. Which of these possibly look like RERAs and which of these don't?





Could phlegm cause this?



Ragged breathing before possible arousal pt.1 of 2



Pt.2



Series of decent breaths before possible arousal pt.1 of 2



Pt. 2



Swallowing?



Maybe not this one?



Centrals



Another event pt.1 out of 2



pt. 2



Final one, more centrals.

So what next? Try 6/13/4?

[yrnkrn]

This night actually looks quite good. The waveforms are not flow limited and both the flow graph and the tidal volume graph are quite stable.
The median tidal volume is 460ml which is OK. Given that you do remember being awake (we usually forget) my guess is that many of these CAs are post-arousal or while being awake. We can't know for sure from this data but some points:

8:07:20 huge breath followed by CAs
11:05:20 short leak before the CA - you awake, adjusting the mask?

I would have kept these settings for several more nights and go solving other sleep issues

* sleep hygiene - going to sleep only when tired. if not tired go and do something else you like to do
* leaks - try to have less - you may be sensitive to them? do you get a dry mouth?
* phlegm.
* heartburn.