[Pressure] TheWallofSleep's Therapy Thread

[TheWallofsleep]

PLM is exactly what I was afraid of. PLM aside, assuming ideal conditions, is my logic correct?

[SarcasticDave94]

Within reason, yes. Since you can change the 4 pressure settings fractionally, you should be able to get things where they need to be, and for your reasoning. The PLM may make things a bit more complex of course.

[sheepless]

I think your logic with respect to epap is on track. and I think you could play with min ps a bit depending on whether your hypopnea is obstructive or central. your flow limitations stats are quite good, even with the asv's 1.0's that tend to increase that stat.

the problem with asv (for some of us) is that ps must be at least 5 cmw above epap. put another way, the lowest possible ps setting is 0-5 cmw. pressure swings of at least that magnitude will always be present, and for me at least, they are tiring. your ahi is good, just 1 ua and a few hypopnea in the last chart I looked at. good enough to leave well enough alone. but if you want to provide some closer screenshots of a couple hypopnea, chart readers can try to tell if they're obstructive or central. if obstructive, you can slowly incrementally raise min epap. if central, raise ps, particularly max ps. asv always raises ps against my plm breathing, up and down, up and down, repeatedly in pace with my movements. can't be helped with asv. consequently I've been using my vauto more, using settings that are effectively fixed epap and fixed ipap with very little variation.

all said however, I think you've done pretty well with respect to treating your apnea with more than one modality and at this point you'll get more bang for your buck towards relieving the kind of complaints you've been reciting by dealing with the plm.

[TheWallofsleep]

Thank you Dave and Sheepless. Right now, I am going to find the best settings I can get, sit on them a week or two and see what happens. I've been using a tens unit nightly, but since I just made a switch from VAuto to ASV, I am not willing to make any solid claims on it's efficacy quite yet.

[SarcasticDave94]

OK copy. Again you have the fractional aspect on EPAP and PS to play with. And like I mentioned, you can move the numbers about to get the comfort and a nice OSCAR. There's the good thing in ASV, you aren't locked into one answer.

[TheWallofsleep]

Literature regarding PLM is incomplete to put it lightly. I swear every source is copying and pasting the same general points, some even ending with the very honest, "more research needs to be done"—more bluntly, they have no clue how to fix it without prescribing nasty prescriptions that you probably don't want anyway. Taking that into account, does anyone have any insight regarding how useful a leg movement index really is? Is it comparable to AHI in terms of average arousals per hour?

Sleep physiology is intrinsically complicated, as reflected in how little is known about it, but is it completely unfounded to assume the leg movement index and the AHI can be compounded? For example, would an average leg movement index of ~2 events/hr with an AHI of 2 effectively equate to '4 arousals per hour'?

[SarcasticDave94]

Honestly I know very little about this, but it's possible to look at it from an arousal aspect. Other than that seeming to make some sense, that's about all I could comment on.

[TheWallofsleep]

No worries, and thank you. I was just curious about other opinions.

Last night on ASVAuto EPAP 6-13, PS 3.20-14 was terrible. I know I used it for less than 5 hours, but it feels like I didn't use it at all. Does anything on here seem off? The EPAP is what is throwing me, some nights it is very stable throughout the night, others, not so much. I have heard the trick with ASV is to set it where it needs to be and forget about it. I am not hung up on numbers, I just want to make sure I am going about this as efficiently as I can on the machine side of things.

[TheWallofsleep]

Or shall I answer my own question, which is to probably stop screwing with it, open it all the way back up and see what it does?

[sheepless]

I repeat myself for the last time: your charts and stats are good. it's not apnea and it's not the pap machine that's causing you problems. it's plm.

ahi is the average frequency of apnea and hypopnea events per hour, not an arousal index, so imo it wouldn't make sense to add plm arousals to ahi. I don't remember exactly but wasn't your sleep study plm arousal index something over 8/hr? waking up 8 times per hour is debilitating. add being jostled dozens and dozens more times by non arousal plm and you wonder you're still tired and brain fogged?

I've taken gabapentin and ropinirole with zero side effects. most prescribed meds have scary warnings and some negative consequences do happen to an unlucky few. discuss the pros and cons with your doctor. as you said, little is known so finding the right treatment is a matter of trial and error. meanwhile, I find that consistent use of TENS (operative word is 'consistent') helps to the point I'm considering reducing and maybe cutting out ropinirole to see what happens.

honestly, as I've said before, I don't think you will find further relief in continuing to mess with pap settings until you adequately reduce the plm.