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[Pressure] TheWallofSleep's Therapy Thread
#31
RE: Help Calibrating APAP Pressure
It's OK about whether or not EPR 3 was tried. Give it a go for a few days and see how it goes.
Dave

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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#32
RE: Help Calibrating APAP Pressure
I have tried a few nights with EPR=3, it seems as if my AHI went up on one of the nights, but not significantly and one night is not enough to establish a trend. I have only had about two nights where I have more than an hour and a half of data to use. I do notice the flow limits being a fairly consistent trend, regardless of min pressure and EPR. I am uncertain how correlated this is to irregularities in breathing patterns, which are sometimes present even when an apnea is not detected by the machine. In 3 days I will have a titration for a BiLevel done, and I am assuming within a week or two of that, I will receive my detailed results to share here. In the meantime, I am just making sense of what is showing on my end through OSCAR, overall I would say I feel about the same.
I am not sure if I have mentioned this yet, but I am medicated for periodic leg movement, which as I understand, did show up on my initial PSG in Fall of 2019. I do believe they are incorrect to disregard my central apneas, even if the index is under 5.

In my closer screenshots of the FLow limits, the first one looks irregular, while the second seems more regular. These changes seem consistent throughout the night. I am not sure what a 'normal' baseline would be.


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#33
RE: Help Calibrating APAP Pressure
I was able to find my original watchpat study from early 2019, which was my first sleep test done that diagnosed me with OSA. I cannot post a scan of the document because it is very blurry and a document scan will not be legible. I will type out the summary here for the sake of context for future advice.

Severe obstructive sleep apnea noted with a total AHI of 32.4 events per hour. The central apnea index was 4.3, and %CSR was 0.0. Events were not increased in the supine position. Average saturation was 92% and minimum saturation was 82%. 6.0 minutes were spent with saturation less than or equal to 88%.

Total study time: 9:31
Total sleep time: 8:31
%REM sleep time: 21.9%
Sleep latency: 21min
REM latency: 38
Number of wakes: 17

Stages-
REM: 21.93%
Light: 65.75%
Deep: 12.31%
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#34
RE: Help Calibrating APAP Pressure
I would really appreciate any of your opinions on something I am toying with. Earlier this week I completed my titration study for BiPap. The results will not be processed for about another week and the earliest opening for an appointment to discuss the results is just over three weeks out. It was very hard for me to fall asleep, as per usual, even with with added convenience of taking a sleep aid. My technician was a good guy, normally they wake you and send you on your way at around 6:00A, but he let me sleep until 10:00A in order to get more usable data. I explicitly complained to him about my concerns with the last study such as how I only slept for 256.5min with a sleep efficiency of 55.8%, lack of consultation regarding centrals, flow limitations, only testing pressure ranges of 5-7cmH2O, etc. He seemed both surprised and mildly impressed when I explained how I have been self-titrating and how I have empirically proven that the results given from the first PSG were virtually useless. Overall, this alone breaks my faith in their system. I did feel better waking up that morning, it could have been the adrenaline from being in a different environment or even just being on edge about the whole thing, but I do know it was definitely better than my next two mornings on my APAP which I know I should have theoretically slept 'better' on because I slept more hours, in my own bed, and not hooked up to an EEG machine.

Here is my problem, I think I may jump the gun and purchase a refurbished ASV on my own. My logic is that my original sleep studies did not indicate I need one, even if this lab test helps me build a case, insurance will probably shoot it down because on paper I am treated, as you all know, they don't factor in how well you are functioning. I know I can build a case off of comfort and inability to tolerate my Airsense 10, but I have a feeling this will take a long time to do which will waste time feeling sleep deprived when I may not have to. I also am starting another job in two weeks that will require me to get up a lot earlier, which will be very difficult for me right now and to add insult to injury, I need to be able to return to college classes this fall which I had to put on hold because of my sleep. Long story short, I can't afford to live like this anymore. If they do end up covering a new machine (which seems improbable for most people), or if I buy a used one and it does nothing, I can always turn around and sell it to someone else who may need it and take the monetary loss on it.
I would love anyone's two cents on this. Given my centrals, and flow limitations, I am assuming purchasing a used ResMed AirCurve 10 ASV is my best bet. I will probably use someone on the suppliers list and I will keep an eye out for how many hours are on the machine. Is there anything else I should know or consider? I will post OSCAR charts from last two nights with EPR 3 as well. As always, thank you all!


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#35
RE: Help Calibrating APAP Pressure
unless you have a heart condition there's probably no harm in trying asv. it will treat out your both your oa and ca. that said, your charts that I saw are, as you noted, acceptably under ahi 5 and flow limitations in these last screenshots aren't bad at all. however, you had 17 'wakes' in your watchpat study; that's an average of every half hour during your 8.5 hour sleep time. I wonder how many non-awakening arousals you had. I don't see you masking off in your recent screenshots but if you're still waking a lot, it begs the question whether sleep disordered breathing is really what's leaving you feeling sub par. my suggestion, whether or not you opt to try asv, is to try to figure out what's waking you. journaling and video are probably the best ways to go about that. also, dig into the details of your sleep test results to see if your awakenings were noted and ascribed to something, like movement for example. personally, I don't believe we have more than a few 'spontaneous' awakenings a night and that label just means unknown cause. there are causes, some of which can be identified if we look long and hard enough.

edited to add: be aware asv can be difficult to get used to and pressure support tends to be very active, swinging frequently and rapidly up and down. I am never aware of it when I use my asv but I believe it wears me down. I think that because I can set vauto pressures to be more or less fixed and despite generally higher ahi I feel better using it (and v. high trigger seems to keep my ca to a minimum).
  Shy   I have no particular qualifications or expertise with respect to the apnea/cpap/sleep related content of my posts beyond my own user experiences and what I've learned from others on this site. Each of us bears the burden of evaluating the validity and applicability of what we read here before acting on it.  
 
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#36
RE: Help Calibrating APAP Pressure
You have your ASV already? Let us know when you're ready to test drive it.

Humidifier and heated hose will be identical to the AutoSet so that's the easy part.

You'll want to consider these settings

Mode ASV Auto
EPAP Min 4 to Max 15
PS - pressure support 3-15
That's ResMed default titration settings for the ASV Auto mode. Use and show the OSCAR data plus tell us how you felt while using.

See attached for ResMed ASV titration guide chart

   

PS you can't directly adjust or set IPAP. The algorithm does it for you from adding EPAP to PS at that moment
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#37
RE: Help Calibrating APAP Pressure
(06-13-2021, 05:53 PM)sheepless Wrote: unless you have a heart condition there's probably no harm in trying asv. it will treat out your both your oa and ca. that said, your charts that I saw are, as you noted, acceptably under ahi 5 and flow limitations in these last screenshots aren't bad at all. however, you had 17 'wakes' in your watchpat study; that's an average of every half hour during your 8.5 hour sleep time. I wonder how many non-awakening arousals you had. I don't see you masking off in your recent screenshots but if you're still waking a lot, it begs the question whether sleep disordered breathing is really what's leaving you feeling sub par. my suggestion, whether or not you opt to try asv, is to try to figure out what's waking you. journaling and video are probably the best ways to go about that. also, dig into the details of your sleep test results to see if your awakenings were noted and ascribed to something, like movement for example. personally, I don't believe we have more than a few 'spontaneous' awakenings a night and that label just means unknown cause. there are causes, some of which can be identified if we look long and hard enough.

edited to add: be aware asv can be difficult to get used to and pressure support tends to be very active, swinging frequently and rapidly up and down. I am never aware of it when I use my asv but I believe it wears me down. I think that because I can set vauto pressures to be more or less fixed and despite generally higher ahi I feel better using it (and v. high trigger seems to keep my ca to a minimum).

Thank you for the insight. I am barely in my 20s, so as far as heart conditions go, I am good. Other than sleep disorders, my body is still pretty much a clean slate. Luckily this got caught while I am as young as I am. I am diagnosed with RLS, which I am medicated for, however, I do not know how much that contributes. I am medicated for it. When you said it wears you down, do you mean your lungs feel wore down when you wake up, or do you mean that you feel tired when you wake up?

Dave, I have not gotten an ASV yet. I am still deciding if I want to buy one out of pocket or if I should just get an AirCurve Vauto. Thank you for the titration advice, if I do get one, I was wondering if I should start from scratch or transfer my min=10cmH20 from my APAP over.
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#38
RE: Help Calibrating APAP Pressure
As a side note, what exactly am I seeing here? Is this chin tucking or something else? There are five events marked here, each with a duration of 13, 10, 16, 15, and 16 seconds respectively. I am assuming this is not caused from a jump in pressure as the pressure seems fairly stable at this point. This is a zoomed in shot from the last night in the previous post.


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#39
RE: Help Calibrating APAP Pressure
The cluster of OA and CA events does not look like a chin-tucking issue, but hard to know for sure. I would look for more obstructive flow limitation ahead of events and this zoom is too far out to interpret the flow-wave. I think RLS complicates your results, and often results in CA events that are similar to anyone that experiences periodic arousals from restless movements. These pauses in breathing from movement are difficult to nail down, and almost needs to be synced with some kind of of movement sensor or video to rule-out. Your CAI is relatively low and not typical to the kinds of central events that we usually advocate ASV to treat. Instead, they seem random in occurrence with relatively little clustering.

My impression of your therapy is that it is pretty good with a relatively narrow range of pressure changes. The EPR has worked to reduce flow limitation and has not significantly increased the CAI. This further argues against a hypocapnic source for the events. For a young male individual your tidal volume and minute vent seem low and would be more typical of a small person or female. Whether bielvel pressure support would increase this or if it is even important is more than I can say, so just an observation.
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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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#40
RE: Help Calibrating APAP Pressure
when I say I think active asv pressure support wears me down, I mean I feel more tired during the day than with stable epap and ipap with vauto.

your rls supports my suggestion that you're pretty well treated with your machine and that sleep disordered breathing isn't the culprit.

I think of rls as voluntary movement while awake vs plm (periodic limb movement) as involuntary and uniformly spaced movements in sleep. when I have rls before bed, I always have plm in sleep. I also have plm in sleep without having rls before bed. sometimes I have neither. in my experience, rls/plm is as fatiguing as apnea. ropinirole dramatically reduces but does not eliminate my plm, but seems to limit it mostly to the first 2 or 3 hours of sleep (or attempting to sleep since it wakes me a few times before settling down).

search my forum name and you should find plenty of screenshots of what my respiratory response to plm looks like in my flow rate to see if it shows up in yours (if my screenshots have been removed, I'll post one here). since you are already 'treated' for rls I have nothing to offer other than to suggest trying other meds. some work for some people and not others. I've only tried gabapentin and ropinirole and neither has completely eliminated my rls/plm. it may be enough to tell your doc that you aren't sure your current med is doing the trick. alternatively, s/he may look at you like you have 2 heads, but I'd take oscar screenshots of the periodic pattern in your flow rate if you see it there. your latest screenshot isn't definitive to me but is suggestive of plm. we're unaware of plm in sleep so witness reports and audio/video recordings are other ways to determine if it's affecting your sleep.

I have no idea if this applies to anyone else but something new to me: I realized some time ago that my leg activity doesn't originate in my legs but rather from discomfort in my lower back in a lateral band from hip to hip and traveling vertically down through the buttocks to the back of the thighs. it's only been a couple days now but initial results from use of a $30 usd TENS unit bought online are promising. TENS = transcutaneous electrical nerve stimulation.
  Shy   I have no particular qualifications or expertise with respect to the apnea/cpap/sleep related content of my posts beyond my own user experiences and what I've learned from others on this site. Each of us bears the burden of evaluating the validity and applicability of what we read here before acting on it.  
 
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