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Plmnb - the journey continues now with ST-A.
RE: Plmnb - the journey continues now with ST-A.
Plmnb I think you’re still tired at this point from simple lack of sleep. Fl’s won’t completely go away. I still have them all the time. In the flow rate anyway. Once you start sleeping for 7-8 hours at a time then you won’t be so tired. I haven’t got much sleep myself the past few days and my therapy has been great but right now I need a nap. Sometimes it’s not about PAP, it’s just lack of sleep.
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RE: Plmnb - the journey continues now with ST-A.
(03-02-2020, 10:59 AM)Plmnb Wrote: I actually fell asleep at work a few days ago.  I can't even drive any appreciable distance without feeling drowsy.  I know MORE sleep is a big part of the puzzle, but I can't recall consistently having had this little sleep prior to starting therapy again.  Last night I laid down for sleep around 11:00PM, which is good for me, but I awoke numerous times without my mask on.  I also had air leakage part of the time.  In addition I awoke with Meralagia attacks.

This is most disconcerting.  Forget the flow limitations, you just need to find the right settings and mask that will allow you to keep the mask on and get more sleep.  To be honest, I look at my zoomed in flow rate graphs and at times they look pretty ugly, but never in a million years would I ever post them at this site.  If I did I would be up half the night worrying about them.

I don't recall if taking your mask off has always been an issue from the start or has it becomes more of a problem as the pressure has been raised.  If there was ever a time when taking the mask off wasn't an issue, that might be a good place to return to; but with your current machine, that is.  SarcasticDave94 made this statement a couple of days ago... IMO comfort rules. If better comfort results from these settings, keep it. Numbers guide while comfort rules.

I wish I could offer real advice that would help with the mask and leak problems.  Hopefully the discussion will turn in that direction.  I think you are doing and amazing job and I sincerely hope that you don't abandon this journey.

God bless,

John
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RE: Plmnb - the journey continues now with ST-A.
First, flow limitations are not a concern with any ventilator like ASV, ST or ST-A. Because the machine is supporting inspiration, the wave-forms typically look flat, and this should not e a concern unless it is clear that they are severely distorting respiration (long inspiration, poor flow rise etc). The data is nothing to obsess over and you're better off thinking why you find the therapy to be uncomfortable or ineffective. It's been a while since we looked at a whole night of therapy. Maybe you can let us see what is going on currently. You are in the process of the crash and burn I warned about earlier, and no matter what therapy efficacy we achieve, you must get more sleep! As I understand it, the settings you are using are:

Therapy: iVAPS
Height: 56 inches
Target Pt Rate: 14
Target Va: 5.1L/Min
EPAP: 15
Min PS: 5.0
Max PS: 15.0
Ti Max: 2.0s
Ti Min: 1.0s
Rise Time: 700ms
Trigger: Low
Cycle: Low

Please show some examples of current therapy, and we will look at them with a focus on comfort. With that in mind, what were the conditions of therapy that made you feel best since restarting CPAP, VPAP and iVAPS?
Sleeprider
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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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RE: Plmnb - the journey continues now with ST-A.
Thank you very very much 70sSansO.  You too Osiris357.

Osiris357, I'm sort of in a Catch-22 I think.  I need MORE sleep, but the repeated removal of my mask does not allow me to accomplish this feat.  I believe the removal of the mask is due to FLOW LIMITATIONS which when they are real bad are probably contributing to my "yoga" sleep which contributes to the Meralagia.  There is credence to the FLOW LIMIT issue in the articles I have found this morning.  In addition with my sleep hygiene not so great, it is compounding the issues.  All the great sleep hygiene in the world isn't going to stop the flow limits.  It would certainly help, but it won't "cure" it.  Especially with the addition of my huge, lol, tongue and narrow nasal passages, and I sound like a recipe for the queen of sleep deprivation.

70s, Yes, the mask removal was an issue early on, but it started mostly when I tried PAP therapy in 2003.  EVERY morning the mask would be on the floor.  This time it stays on a bit more.  And yes, the numbers in regards to comfort is an important issue.  My problem is I don't think I'm at the best settings for comfort.  Both the Phillips and the ResMed masks are comfortable.  Other than they both seem to be tight to prevent leaks, the tightness doesn't bother me, at least when I'm awake.  Maybe the tightness is bothering me while I'm trying to sleep?  The DME has pretty much stated she is out of options for me.  I have never had good luck with straight nasal masks, especially with my mouth breathing.

Oh, well, more pondering on my part.

Speak to ya all later.

Plmnb
Huhsign  WARNING: It may take a while to sink in...I tend to get befuddled at times.
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RE: Plmnb - the journey continues now with ST-A.
Phoebe, you have an upcoming discussion with a pulmonologist and I think your concern about flow limitations is completely valid. Thinking back on your history of CPAP and VPAP therapy, we used to see abundant obstructive apnea and hypopnea that was associated with clusters of severe flow limitation. That symptom is easily visualized in the flow rate graphs. We don't know what causes the flow restrictions that switch on and off during sleep, and tried to address it with positional correction (soft cervical collar) without any effect, and high pressure support with some success, and now with iVAPS with what looks to be much better success. We think the ST-A works better because it maintains or increases pressure support during extreme flow limitation, rather than backing off on pressure support when flow is reduced due to whatever restriction is present.

Learning whether the restriction arises from the upper airway or at the pulmonary level or somewhere in-between is the job of your medical team as neither you or I can possibly make that determination. I see your frustration in trying to research flow limitation, but you should not have to do the research for a specialist. Just take your problem to him, then work together to test and evaluate what the cause may be. I think your many flow rate graphs are the most helpful visual aid, and your ability to explain the symptom and complications are all you need to bring to the appointment.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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RE: Plmnb - the journey continues now with ST-A.
'my "yoga" sleep which contributes to the Meralagia'

interesting. I was thinking the other way around; that the pain might be the reason for your sitting up yoga sleep.
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RE: Plmnb - the journey continues now with ST-A.
Thanks Sleeprider! I’ll keep all you have said in my arsenal.

Nope Sheepless. I’ll be “asleep” and SUDDENLY the pain and agony begin and awaken me. Fully awake. The only connection between the Meralagia and the “yoga” is the mechanism of injury to the subcutaneous femoral whatchamacallit.

Sleep well all!
Huhsign  WARNING: It may take a while to sink in...I tend to get befuddled at times.
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RE: Plmnb - the journey continues now with ST-A.
I have that same pain in my outer thigh. The first time it happened a couple months ago I jumped out of bed, forgot I had my mask on and almost dragged the machine onto the floor. Wow did it hurt. Now it’s more of an annoyance more than anything and doesn’t happen all the time. It will happen while standing also but just a slight burning sensation. Thank you for the name of it.
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RE: Plmnb - the journey continues now with ST-A.
I think I have also had the numbness in my thigh (quads). It is not there now, but it was not that long ago, and I never knew it had a name. I learn something here everyday. In my case it is not painful, but kind of like rubbing lidocaine on my leg. Who knew? I think this is external to your therapy, so I can't advise how to deal with it, except to say you should probably treat it as a separate issue.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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RE: Plmnb - the journey continues now with ST-A.
Good afternoon Sleeprider. Sorry, I didn't see your other recent post. FWIW, the doctor I will be seeing this time is a neurologist that also treats patients for psych and sleep issues.

I have been trying to not post a bunch of charts because it seemed silly with this upcoming appointment. But I am sort of jonesing for some feedback about them. So thanks for the offer to look at a couple.

Having a computer glitch of some sort though at the moment. Will get something up soon or late, late tonight.

Regards,
Plmnb
Huhsign  WARNING: It may take a while to sink in...I tend to get befuddled at times.
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