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Snoring and Chasing Pressure
#11
I recall that I questioned my snoring and came to the thought that the machine was reporting my cough as a snore. I tested this out by coughing as I first lay down. The report showed a snore.

I need to clean and change the filters in the CPAP, Oxygen, Room Filter and Whole house often. If I forget my body will remind me until I slap my Face. By that time I am dragging so bad I do not want to do anything.

I need better control of myself. When I feel better all I want to do is go outside and play. Doctor says that one day when I do not follow orders I will need the EPIPEN he ordered. Now where did I put them...Dont-know
Just my personal opinion. My posts are not medical advice or a statement of fact. Please consult a qualified physician or other qualified medical personnel. Please comply with all applicable laws, codes, regulations, and protocols.
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#12
Yes, I do see the same thing happening in your flow rate graph. Yours bumps above zero then back below, though, and creates those sawtooth patterns in related graphs.

I read somewhere (maybe in the Phillips document linked to in this thread?) that the vibratory snoring recorded by PR devices can be silent. That still doesn't explain why it wouldn't go away with a large pressure increase.

Have you tried mask liners? I'm not a full-face mask user, but if I were, I think I'd definitely be using mask liners.
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#13
I think some of the stats are being thrown off by the apparent rebound at the end of exhale. I have seen this once or twice before, but I think that bump of inhalation is actually a part of your exhale cycle. If so, it explains a lot of weirdness in the tidal volume and the I:E ratio. I still have no clue of the cause or significance if any. The appearance is that of forced exhale, that has a natural rebound, rather than a normal exhale that results from relaxation of the diaphragm and elastic recoil from inspiration. Do you feel you need to force exhalation against the pressure? It might be interesting for you to zoom in on the graph and observe what kind of flow rate wave pattern corresponds to the wide swings in tidal volume.

Without over-thinking this, we can see the majority of your events, as well as the snores, flow limits and hypopnea are obstructive. Your pressure on the first graph maxes out at 16, and you are getting relatively little pressure relief on exhale from your flex setting. It might be interesting to play with flex a bit, perhaps to see if it can relieve that exhale rebound and improve comfort without causing CA. Your max pressure could stand to be increased, but it seems to disrupt your sleep, so maybe some obstruction is better than the breaks in therapy that seem to come when pressure is high. Your AHI is fine, but your sleep looks pretty disrupted. I am curious to know what your experience might be with more exhale pressure relief like you'd get in bilevel or even Resmed's EPR.
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#14
I have another theory about the recorded snores: mask farts. Once I got the Simplus tightened down so there were no side leaks, the snores pretty much stopped. The last two nights I have had only one or two. I still don't feel rested the next day.

My median/90% has also dropped from 14/16 that first night to 13/14 the last two nights with most of the time at the lower end.

I've tried mask liners and don't like them. They result in more leaks, move around, and I end up pulling them out.

I don't find exhalation difficult, my flex is on 1. I feel that I breathe fairly naturally with the mask on, I never really think about it. A zoom of the flow rate wave pattern corresponding to the wide swings in tidal volume is in my previous message. I don't see a lot of difference between when the TV is flat and when it is a sawtooth pattern.

I am going to bump my flex up to 2 tonight and see what difference it makes, if any. I have also gone to a lower anti-depressant dose last week which might also be having an effect on this. Too many moving parts on these darn bodies!

Chuck
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#15
(08-19-2016, 09:19 PM)chill Wrote: I have also gone to a lower anti-depressant dose last week which might also be having an effect on this. Too many moving parts on these darn bodies!

Chuck

Chill,

Rhetorical question on:

Have you considered having a quite conversation with your pharmacist about your anti-depressant, it's side effects and how it might cause you difficulties with ?PAP therapy?

Rhetorical question off:

For the most part; while your physician knows a great deal, I've found many pharmacists have seen the results, interactions and effects of a significantly broader swath of the population than the Physician.

They might be able to "point" you in a direction you'd not considered. Twa's just a thought, snot trying to suggest in the slightest the folks here aren't helping, I'm forever learning here too...

Warning: Eating chocolate may cause your clothes to shrink!
[Image: ry6XtE9.gif] <---- That's ME!
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#16
VS is an audible snore. VS2 is a vibration that the machine reads as a snore but not audible.
Dragging the hose over the head board can somtimes be read as a VS2.

From the looks of things flex setting is causing the rebound .
Id try going to aflex 2 , bring you max up to 18. And start bumping the min up .5 every three nights until I got my ahi down to below 2.
Im guessing that will happen at around 13.5 to 15.

Anti depressant can definitely cause all this.
If you can get ahi below 2 consistantly bet you wont need the anti depressant.
Im a dead man walking with ahi of 3.
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#17
The connection between anti-depressants, SSRI in particular, and adverse effects on sleep architecture and REM sleep is well documented. That is the reason for the lower dose, I am being weaned off of them.

I did not find this particular anti-depressant (Effexor) to be of any use until the day after my first night on CPAP when I found myself singing "What a beautiful day". It may be that with proper sleep that I don't need it. Even with crappy sleep, I feel pretty good mood wise.

I know what you mean about being a dead man walking with an AHI of 3. I start to feel like that above 2, a couple nights of three and life is not pleasant.
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#18
Poor sleep causes depression and I didn't realise how much until I started to get effective CPAP therapy. I've never taken antidepressants and I won't need to now that I sleep so much better so your comment about weaning off them may be a valid one.
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#19
Oh, Effexor has a bad discontinuation syndrome. I'm impressed that you are getting any sleep at all.

(08-20-2016, 12:22 AM)chill Wrote: The connection between anti-depressants, SSRI in particular, and adverse effects on sleep architecture and REM sleep is well documented. That is the reason for the lower dose, I am being weaned off of them.

I did not find this particular anti-depressant (Effexor) to be of any use until the day after my first night on CPAP when I found myself singing "What a beautiful day". It may be that with proper sleep that I don't need it. Even with crappy sleep, I feel pretty good mood wise.

I know what you mean about being a dead man walking with an AHI of 3. I start to feel like that above 2, a couple nights of three and life is not pleasant.

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#20
So far, getting off of the Effexor has not been that bad. I am irritable and less happy but that is about the extent of it. I have one more week on half the lowest dose (alternating days, not sure how useful that is given the half life) and then off of it. We will see how that goes.

Two night on a flex setting of 2 have yielded more events (but not more snoring) and a higher AHI and a sleepier me. I will try a flex of 3 tonight, just for scientific reasons. Lowering my AHI was my original reason for getting my flex down to Off.
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