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Sanity check on next steps (still tired)
#71
RE: Sanity check on next steps (still tired)
Hi TSomm

Think I know how you feel. I've done this a long time and find the process hard.

Here in Ontario I don't get to choose the type of machine I can use. I don't get to choose my sleep doc either. I need a referral.

If I can offer a comment, in my experience medical treatment of sleep apnea plain sucks. I need to wear my mask and run my machine for hours. And have AHI<5. So the measure for effective treatment is awful. And sleep quality doesn't matter. Sound familiar?
DaveL
compliant for 35 years /// Still learning!



I'm just a cpap user like you. I don't give medical advice. Seek the advice of a physician before seeking treatment for medical conditions including sleep apnea. Sleep-well

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#72
RE: Sanity check on next steps (still tired)
What I'll toss in is a cockamamie theory others with better understanding will shoot down and offer better, I hope. Worse, other than what, from me, is a knee jerk reaction, I think with others you need to try a bi-level like the Aircurve VAuto or, maybe an ASV and a good titration.

I looked at inspiration and expiration time (I and E times) in all your OSCAR summary tables and without exception they are inverted (I-time greater than E-time) at least in the Med and 95% columns, all columns I think. Further, I looked at this view attachment.php (1344×756) (apneaboard.com) just now, others variously and not focused as much. Disproportionately long I-times take sleep-work in themselves and do cause arousals fragmenting sleep. 

A look at my consistently moderate to high FL of my Autoset days showed few with I and E times inverted. Next I toyed with your 2020-10-10 post image summary, boxing in values between median and 95% and Med, Min and Med. Best I can tell, if meaningful, is, with Resp Rate constraint, the indicated duty cycle (dC) was 0.50 to 0.61 in 5 of 6 values, 0.45 for the sixth. In a research setting with special equipment and a limited number of controls and subjects (diffferent givens), it was determined that those with a dC of 0.53 had Severe UAO, upper airway restriction.

My present overall impression/theory is your airway restricts flow in two ways: first and always, breathing through rigid tubing of insufficient diameter and cross sectional area; second there are some soft tissuess that flutter like a flag or a nearly turgid wind sock at small airports.

The other thing is in recent work on an old example and newer ones, I see duty cycle or respiratory rate is a co-key component, sometimes the single component, of many series of FL signals, all in varied proportions along with ventilation (tidal volume) drops. In this attachment of yours, at its time scale, you see pressure rises at FL flags where, yes, TV has to drop with FR drops, but there are a few clear increases in RR  (and dC?) without FL flags. attachment.php (1344×756) (apneaboard.com)

I did not see many clear 2-minute views of your waveforms other than your most recently posted ones. I believe those late ones, better as they are, are consistent with my overall impression. 

I see your tiredness, high tested RDI, posts and my own experience as all in one accord. Sorry, again I cannot presently offer you better.
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.  (Disclaimer use permitted by sheepless)

 
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#73
RE: Sanity check on next steps (still tired)
(01-24-2022, 08:19 PM)Burrbery654 Wrote: Wow this thread has been going on for years and your still doing this on a apap?? I am in the same exact place that you are in...Diagnosed with UARS and tired as hell everyday no matter how long I use the machine for and cant seem to get rid of my centrals like you on my apap and OSCAR

Check this article out,Ive been trying to do this on an apap because of what my doctor says "Trust me an APAP is what you need not anything else..ASVs are specialty machines" 

Theres alot of people who tried a Bipap OR an ASV and get better results..Im in the process of getting one as soon as my doctor may or may not allows me to get it.

https://sleepbreathe.org/asv-and-bilevel...-with-ifl/

Sorry for the delay, I thought I had it set up to let me know via email when someone replies. Apparently not.

I've thought about trying anything other than APAP/CPAP as well. The problem is seeing a sleep doctor right now. Not only is it normally a long wait for an appointment, but with COVID it's even longer and I'd have to go into a hospital to get to my current doctor, which is less than ideal.

Thank you for sending the links, I'll take a look at these. I've been trying to address different aspects of what could be the problem (overall AHI, then CA, etc, etc) and wave forms is what I'm on now. Happy to read anything and everything that might help.

If you're able to get onto ASV or something else, please let us know how it goes!

In terms of getting rid of CA - the mask type is pretty important, in my experience. When I use a mask that goes over my mouth and nose, my CAs drop. If I tape my mouth with a very small hole that's hard to breath out of and use a very tight chin strap, my CAs go down. I suspect there's something related to mouth breathing going on.
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#74
RE: Sanity check on next steps (still tired)
(01-25-2022, 06:13 PM)DaveL Wrote: Hi TSomm

Think I know how you feel. I've done this a long time and find the process hard.

Here in Ontario I don't get to choose the type of machine I can use.  I don't get to choose my sleep doc either.  I need a referral.

If I can offer a comment, in my experience medical treatment of sleep apnea plain sucks.  I need to wear my mask and run my machine for hours. And have AHI<5.  So the measure for effective treatment is awful.  And sleep quality doesn't matter. Sound familiar?

Thanks, yeah, I'm in Ontario and it's a long process to get to a sleep doctor. What's even worse is trying to get that sleep doctor to do more than get you through a sleep study and then give you a machine and say "good luck".

I've gotten my AHI down below 5, last night it was 1.39. The problem is, I still have to take medicine to keep me from being so tired I'm falling asleep and I need a coffee to keep me going in the afternoon. I'm tired every day (my eyes burn, I have headaches often, etc).

I purchased one of those adjustable beds and I sit up when I sleep. I've got a soft collar and a head strap. It's at the point where I'm serious considering acupuncture and whatever else might be even close to realistic in helping with this. I'm running out of options and tweaking machine settings isn't cutting it.

What really helped in getting my AHI down from the initial settings (6 to 16 was my original pressure settings) were the people here and reading as much as I could find on sleep apnea and UARS. The advice is generally great for overall reductions, it's just the odd case (like mine, I think) where people still aren't feeling refreshed after sleeping where things hit a wall. Hopefully you can get your AHI down and feel a lot better with some advice from the great folks here.
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#75
RE: Sanity check on next steps (still tired)
(01-26-2022, 05:02 PM)2SleepBetta Wrote: What I'll toss in is a cockamamie theory others with better understanding will shoot down and offer better, I hope. Worse, other than what, from me, is a knee jerk reaction, I think with others you need to try a bi-level like the Aircurve VAuto or, maybe an ASV and a good titration.

I looked at inspiration and expiration time (I and E times) in all your OSCAR summary tables and without exception they are inverted (I-time greater than E-time) at least in the Med and 95% columns, all columns I think. Further, I looked at this view attachment.php (1344×756) (apneaboard.com) just now, others variously and not focused as much. Disproportionately long I-times take sleep-work in themselves and do cause arousals fragmenting sleep. 

A look at my consistently moderate to high FL of my Autoset days showed few with I and E times inverted. Next I toyed with your 2020-10-10 post image summary, boxing in values between median and 95% and Med, Min and Med. Best I can tell, if meaningful, is, with Resp Rate constraint, the indicated duty cycle (dC) was 0.50 to 0.61 in 5 of 6 values, 0.45 for the sixth. In a research setting with special equipment and a limited number of controls and subjects (diffferent givens), it was determined that those with a dC of 0.53 had Severe UAO, upper airway restriction.

My present overall impression/theory is your airway restricts flow in two ways: first and always, breathing through rigid tubing of insufficient diameter and cross sectional area; second there are some soft tissuess that flutter like a flag or a nearly turgid wind sock at small airports.

The other thing is in recent work on an old example and newer ones, I see duty cycle or respiratory rate is a co-key component, sometimes the single component, of many series of FL signals, all in varied proportions along with ventilation (tidal volume) drops. In this attachment of yours, at its time scale, you see pressure rises at FL flags where, yes, TV has to drop with FR drops, but there are a few clear increases in RR  (and dC?) without FL flags. attachment.php (1344×756) (apneaboard.com)

I did not see many clear 2-minute views of your waveforms other than your most recently posted ones. I believe those late ones, better as they are, are consistent with my overall impression. 

I see your tiredness, high tested RDI, posts and my own experience as all in one accord. Sorry, again I cannot presently offer you better.

This is really interesting. I spent a few days reading about inspiration and expiration and thought mine were inverted, but I wasn't positive. I also read a lot about how the machines might not be counting this properly, so I didn't put too much effort in continuing with this line of thinking.

This is really interesting and it is helpful. Thank you very much for taking the time to look through this and present these ideas. It means a lot to me.

I've been pushing up my pressures in an attempt to cut down on flow limits. I also thought it might help with the inversion between inspiration and expiration... I also wonder if there's something to do with masks there. If I tighten a mask as much as I can, it's harder to breathe (I suppose it doesn't sit right and blocks the airway). I have almost every type of mask there is (I don't have a full face mask that encompasses your entire face, eyes and all).

Experimenting with masks is something I've done, but I try not to change too many variables all at once. Right now it's a question of whether I push up the pressure (from 16, where it is right now), lower the minimum pressure from 16 (my min and max is 16), or try something different.
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#76
RE: Sanity check on next steps (still tired)
In the interest of putting more information out there, please find attached a few 2-minute screenshots and a couple full nights (last night I woke up quite early and couldn't get back to sleep, despite being tired, so I missed my 8 hours of rest).

I note that things seem to look a little better at pressure 15.4 over pressure 16. It's driving me a little crazy looking at all these different variables and trying to find out what to focus on, especially because, though I feel better than not using the machine at all, I'm tired as crap every day... Ugh.

3 attachments is the limit, so I'll post again with 3 more of the 2-minute zooms.

Thanks again to everyone for all their thoughts, support, and well wishes. If I ever figure this out, I'll be sure to let everyone know what worked and didn't Smile


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#77
RE: Sanity check on next steps (still tired)
A few more 2-minute zooms.


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