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Problem with mask and EPR
#71
RE: Problem with mask and EPR
(03-02-2020, 06:47 PM)sheepless Wrote: wait to see if Sleeprider disagrees but I  don't see any arousals in the last 3 screenshots. can't tell what scale these graphs are; there might be some lower volume breathing but I don't think they're particularly flow limited.

We crossed posts, it seems. :)

Huh. So, I'm confused. I guess I'm still trying to figure out how to read these charts, how to tell if something is an arousal. The learning curve with this is so damn steep!
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#72
RE: Problem with mask and EPR
I can't enlarge the image wo losing focus. plus the scale at left of graphs are missing. however, the two raggedy breaths 4 & 5 from the right look to me like a snore or some other similar brief breathing hiccup.
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#73
RE: Problem with mask and EPR
Sorry they're out of focus. I don't know why that's happening. When I click on them, they take me to the external site and the image focuses.

Huh, so that might not be an arousal after all, you're saying. Interesting!

You mentioned FL breathing. Just so I'm not totally misreading the charts, this is FL breathing, right?

[Image: 3-1-20-detail-2.jpg]
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#74
RE: Problem with mask and EPR
jomama, I sympathize w your frustration. you'll get up to speed with a lot of this stuff in relatively short order but it's taken me 3 years to really sort out my own issues that go beyond apnea therapy (periodic limb movement severely fragmenting my sleep). at one point I was so frustrated at the slow pace of progress, I was taking it all way too seriously & felt I had to take some time away from the forum (not saying you should at all) & from thinking so much about cpap. I'm still working at it but trying to focus on progress to date rather than still not feeling as rested as I'd like. I'd really like to nap right now but things are improving to the point that I've cut most napping out & I don't want to backslide. anyway, I guess my point is that you'll figure it out if you hang in there. & unless you see a whole lot more flow limitations, it isn't clear how you'd benefit from bilevel right now, so I suggest staying the course. meanwhile you might start looking elsewhere besides apnea. there are so many things that can screw up sleep. I just don't see anything in those recent postings that need much attention. that's a good thing!
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#75
RE: Problem with mask and EPR
yes, flat, slanty, jagged tops indicate flow limited breaths. severely reduced volume or magnitude may also be considered flow limitation.
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#76
RE: Problem with mask and EPR
Flow Limitation...it's there, but is it important? That is the million dollar question. If I don't cherry pick my results, I have plenty of the same.  Is it important to my getting a decent sleep?  If I try to fix it will I break something else? 

The fact my response surprises you tells me I have been way over-the-top in looking at flow limitation lately.  I do see it as source of RERA and hypopnea. Perhaps I have been too much of a FL warrior recently.  We can make therapy better by reducing flow limitation, and I think I have even been pinned down to a 95% value where I might try to reduce it.  Your flow limitation is pretty low and your AHI is better than mine most of the time, so what is good enough?  The answer of course is, there is not right or wrong answer. If you're comfortable, it's good enough.  It's my fault for not following my own advise, which is to ask first, 'how do I feel'?  Then if the answer is 'not good enough' to ask, what can I do about it without making something else worse?

The problem with data is, it becomes far too easy to chase numbers and flow shapes to no particularly good end, which is, feeling better or more rested.  Once you have essentially eliminated AHI, why would you care about what shape OSCAR draws your flow chart?  Perfection is elusive and probably unimportant. So if I gave the impression that the goal of therapy was perfect charts, i failed.  This is my personal reality check, and I hope it puts back into perspective the intent. Coincidentally, we share the same Flow Limit statistics, and I'm not doing anything about mine. Does that help?
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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#77
RE: Problem with mask and EPR
Thanks, sheepless, I appreciate the supportive words. :) Yeah, I actually did take a complete break from PAP and the board for a few months. But I have looked into and tried freaking everything. Like, I thought, maybe it's the 2 beers I drink a day (but stopping well before bed). I used to drink a bit when I was younger, and up to bedtime, and I then found out that that could be bad for sleep. I honestly didn't know! Cut back to finishing 2nd beer a couple hours before bed, going to bed I'm guessing with BAL very low, or zero. Made no difference. Sleep just as fitful as ever. 

I thought, maybe steady, moderate drinking for many years screwed up my neural pathways, or messed with my sleep functions in a way that became permanent. So I went 2 weeks without any alcohol. Made zero difference on my sleep or health. 

Just recently, I've been so desperate that I thought, maybe 2 weeks wasn't enough. So, I made a commitment to myself to go 6 weeks, no alcohol, just in case. Then I thought, just to be sure, double that. So I committed to 3 months. Again, keep in mind that I'm not an alcoholic, I simply enjoy good beer; I have no problem limiting myself, meaning I'm not at all a compulsive drinker. It's been 2 months now, and yup, zero effect on my sleep. I've got a month to go, and while at this point I don't see the extra month making any difference, I am going to honor my commitment to 3 months, so that after that I can know pretty much for sure that it's not alcohol that's the cause. 

I tell this story to give an example as to how committed I have been to trying to figure out why I have such fitful sleep. I spent 3 months last year raising my vitamin D level to above 60, just on the chance that it would help, since I read something about that, and even though it seemed dubious, I tried. Every single thing you'd look at for the cause I've ruled out at this point. At least I think I have. 

And so, in desperation, I decided to go back to PAP, just on the chance that FL are causing my bad sleep. So, I have been acclimating to PAP therapy again, and have begun being able to get nightly data. But even with those supposedly great charts, I sleep just as crappy. Or I should say I wake up (for the final time in the morning) just as not-rested. And from what you're saying, you're not seeing anything to indicate that FL or SDB are necessarily the cause. I have to say that that's what I think, too, but I just don't know. I mean, truly, I don't even know if I have any solid reason to think that PAP therapy will help at this point, but I'm trying because I honestly have nowhere else to turn, and don't want to give up, because it's incredibly depressing to have no viable solution, no hope of finding one. It's tough, as I am guessing you understand (and maybe others reading this, as well).

I'm hoping that Sleeprider might jump back in after reading more about my situation, and looking at all those images, and let me know what he thinks (or anyone else reading this who has a potentially productive thought to add). I mean, I see those flow limited breaths, and think: that's significant. But I don't really see arousals after it all the time, and my breathing doesn't always look like that, so it's just so hard to know if there's any reason to think that PAP therapy will help me when it hasn't so far, and I don't even think I have real apnea issues.
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#78
RE: Problem with mask and EPR
(03-02-2020, 08:48 PM)Sleeprider Wrote: Flow Limitation...it's there, but is it important? That is the million dollar question. If I don't cherry pick my results, I have plenty of the same.  Is it important to my getting a decent sleep?  If I try to fix it will I break something else? 

The fact my response surprises you tells me I have been way over-the-top in looking at flow limitation lately.  I do see it as source of RERA and hypopnea. Perhaps I have been too much of a FL warrior recently.  We can make therapy better by reducing flow limitation, and I think I have even been pinned down to a 95% value where I might try to reduce it.  Your flow limitation is pretty low and your AHI is better than mine most of the time, so what is good enough?  The answer of course is, there is not right or wrong answer. If you're comfortable, it's good enough.  It's my fault for not following my own advise, which is to ask first, 'how do I feel'?  Then if the answer is 'not good enough' to ask, what can I do about it without making something else worse?

The problem with data is, it becomes far too easy to chase numbers and flow shapes to no particularly good end, which is, feeling better or more rested.  Once you have essentially eliminated AHI, why would you care about what shape OSCAR draws your flow chart?  Perfection is elusive and probably unimportant. So if I gave the impression that the goal of therapy was perfect charts, i failed.  This is my personal reality check, and I hope it puts back into perspective the intent.  Coincidentally, we share the same Flow Limit statistics, and I'm not doing anything about mine.  Does that help?

Haha, we crossed posts!

It does help a bit. Thank you.

Just to be clear, I definitely don't see you as chasing perfect charts. In fact, my impression from all I've read from you is that your ultimate approach is that what matters is how one feels, so, no I don't think you've failed at all. My comment was because I swear (though I could be wrong) that I've seen you recommend to people with even moderate FL to look into bilevel. I've even seen some people respond to it. And I've been dreading the idea that I, too, would need bilevel if I were to have productive PAP therapy. 

To answer the question of how I feel: I feel like crap. I have suffered from chronic fatigue/exhaustion for years. And I know I get crappy sleep. I am tense in my sleep. I wake up often. I don't get restful sleep, and in the morning, I often feel like I haven't sleep at all. That's my normal. And as I get older, it gets worse/harder. So, the answer to your question is that even with those charts, that you say aren't that bad, I feel exhausted, and sleep badly. Or, I subjectively feel I sleep badly. And I'm not sure if I can tell from those charts whether I objectively slept badly. Like we all know, there are lots of causes of bad sleep, and I feel like I've looked into them all. Apnea/PAP was my last resort. I still suspect possible trauma, from a difficult childhood (and some very emotionally traumatic experiences as an adult, too, now). That could be the cause. But that's not easy to solve, either. To my mind, it's either that kind of thing, or SDB. Which is why I'm here, trying to find answers regarding whether it looks like SDB is the cause.

I am basically here to learn as much as I can, and gain enough data/knowledge, in order to essentially "rule out" PAP as possibly solving my bad sleep problem. Or to see if it will help. In the end, though, it comes down to whether I sleep better with PAP, right? So far, the answer is: I don't. And unless I'm mistaken, you guys don't see anything in my charts to indicate why I'm sleeping badly. So, the question now is: how long do I keep doing PAP before I can say that I've done it enough to know it's not going to help, in my case?
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#79
RE: Problem with mask and EPR
FYI, your numbers are better than mine, It is too easy to get fixated by numbers. Early in therapy we tend to focus on numbers, that is OK, knock off the low lying fruit, BUT there is a point where you pretty much need to forget about numbers and go by how you feel. Here is a challenge, Go 1 week without looking at OSCAR, and just noting how you feel. After that post an overall chart and how you feel, The chart is for us, not you, and pretty much just to see that nothing major has happened and to remind us of where you are at.
Gideon - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter

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#80
RE: Problem with mask and EPR
Well, I don't know much about PTSD, but appreciate it can be a huge factor in your life, sleep and well-being. I think CPAP has helped with one aspect of your sleep disorder by removing obstruction and respiratory arousal from the equation. As far as I know, this is the first time you have raised psychological disruption as an additional factor in how effective your sleep is. Needless to say, CPAP can't fix that. So do we toss out CPAP therapy because a secondary problem also prevents satisfying sleep?

Unfortunately, we can't pin all our sleep problems on CPAP, and in my experience the solution is additive, not subtractive. You have resolved your CPAP demons, and the scarier ones await your attention. If those are resolved, there may be others, but they are all steps towards a goal. It's not my nature to preach, because I'd rather share a beer, but I think you know what you need to do. You're halfway there, and the other part of the journey requires a different tool. Don't throw out this accomplishment.
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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