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Suggestions for "Fuzzy-headed, hungover" Feeling?
#21
(01-10-2015, 11:39 AM)kinger62 Wrote: He also prescribed trazodone. I do not want to use that unless absolutely necessary.

Hi kinger62,

I can see why you would not want to use Trazodone. It is used to treat major depressive disorder and has many negative side effects:

http://www.drugs.com/trazodone.html


Membership in the Advisory Member group should not be understood as in any way implying medical expertise or qualification for advising Sleep Apnea patients concerning their treatment. The Advisory Member group provides advice and suggestions to Apnea Board administrators and staff on matters concerning Apnea Board operation and administrative policies - not on matters concerning treatment for Sleep Apnea. I think it is now too late to change the name of the group but I think Voting Member group would perhaps have been a more descriptive name for the group.
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#22
Vsheline,

At this point I cannot attach files, as my quota of 200K doesn't allow it. Once I get my quota up I'll give it a try.

In looking at my history on SH, My CAs are always higher than the sum of the hourly averages for Obstructive Apneas plus for RERAs).

Last night, for example, shows:

AHI: 4.10
Cheyne Stokes Respiration 0.00%
Large Leak 0.35%
Clear Airway 2.82
Obstructive 0.26
Hypopnea 1.03
RERA 0.77
Flow Limitation 0.00
Vibratory Snore 0.00
Vibratory Snore (VS2) 2.31
Pressure Pulse 14.24

My statistics are now showing:

Details Most Recent Last Week Last 30 Days Last 6 Months Last Year
CPAP Usage
Average Hours per Night 07:47 07:48 07:46 07:40 07:44
Compliance 100% 100% 100% 100% 100%
Therapy Efficiacy
AHI 4.10 3.35 3.63 4.06 4.52
Obstructive Index 0.26 0.31 0.53 0.63 0.72
Hypopnea Index 1.03 0.73 0.89 1.00 1.13
Clear Airway Index 2.82 2.30 2.21 2.43 2.67
Flow Limitation Index 0.00 0.00 0.00 0.01 0.00
RERA Index 0.77 0.49 0.48 0.42 0.44
% of time in Cheyne Stokes Respiration 0.00% 0.05% 0.19% 0.13% 0.17%
L
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#23
Well, I put the machine in auto, min epap to 8, max ipap to 13, and ps to 3. (The machine wouldn't go lower than 3.) I had the night from hell, as I'd fall asleep but wake within 20 minutes all night long. I'm going to try it again tonight but I can't function on this little sleep. Hopefully it will be better tonight.
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#24
and pump out some numbers for each night, if you can. sorry you feel so awful. Sad

I have absolutely no experience in BiPAP settings, and trust vsheline.

I'll just make an observation, you may consider. You have consistently been at 10/14. So, if you were to most closely duplicate the same respiratory feel, but allow some automatic adjustment, you would keep a PS of 4:

- reflect on your 10/14 setting - equal to a PS of 4 and a min EPAP of 10 and a max IPAP of 14.
- add slight auto - min EPAP of 9 max IPAP of 14 and PS of 4 only allows 1 cmH2o movement.
- your current setting min EPAP of 8 max IPAP of 13 and PS 3 (or are you at PS of 2 - 3?) allows only 2 cmH2o movement.
- if your current setting is EPAP 8 IPAP 13 and PS 2-3, you get 4 cmH2o movement and variation in pressure relief.

- my suggestion min EPAP of 7 max IPAP of 14 and PS 4 allows 3 cmH2o movement but the same 4cmH2o pressure difference that you are used to. if you can adapt to a certain amount of variability, later you could adjust the PS to 3-4. etc.

Dedicated to QALity sleep.
You'll note I am listed as an Advisory Member. I am honored to be listed as such. See the fine print - Advisory Members as a group provide advice and suggestions to Apnea Board administrators and staff concerning Apnea Board operation and administrative policies. Membership in the Advisory Member group should not be understood as in any way implying medical expertise or qualification for advising Sleep Apnea patients concerning their treatment.
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#25
(01-14-2015, 07:49 PM)kinger62 Wrote: Well, I put the machine in auto, min epap to 8, max ipap to 13, and ps to 3. (The machine wouldn't go lower than 3.) I had the night from hell, as I'd fall asleep but wake within 20 minutes all night long.

Hi kinger62,

Here is data you emailed me of the night from hell:

   
   
   
   

I think the short triangular sawtooth pressure spikes are normal exploratory variations in the pressure, as the machine tests whether higher or lower pressure may be better. I think this is part of the Respironics treatment algorithm. These explorations are occasionally leading to sustained pressure increases above the minimum, indicating that the pressure was increased in order to better minimize obstructive events like Flow Limitation and obstructive apnea. It looks to me like the Min EPAP and Max IPAP settings look reasonable and appropriate .

By the way, I suspect that the Respironics algorithm for detecting RERA events is likely under-counting RERA events to at least some degree. I think the Respironics algorithm for detecting RERA events is more likely to miss a true RERA event than it is to be fooled into mistakenly deciding that a RERA event occurred which did not actually occur.

Most of the reported events are Clear Airway apneas, but the CAI (average number of CA events per hour) is only 2.76, which is considered by insurance companies as being too small to warrant coverage for an ASV machine.

I would think that lowering the pressure settings would likely reduce the number of Central Apneas, but, on the other hand, if it is the obstructive events which are waking you up rather than the central events, lowering the pressure may be the wrong strategy.

In the Flow waveform, can you zoom in around the times when there are spikes in the Minute Ventilation (which are usually associated with arousals, I think), to see what the Flow looks like during the minute or two preceding the spikes in the Minute Ventilation? (Minute Vent is the total amount of air being breathed per minute, which is the product of the Respiration Rate (in breaths per minute) times the Tidal Volume (in Liters or milliliters).

Also, keep an eye on how long events are lasting.

Sorry, but I cannot recommend anything other than returning to the pressure settings which helped the most, and making small adjustments weekly to try to optimize the therapy.

If you were to buy (on your own, without help from insurance) an ASV machine on the secondary market (such as a "Gently Used Respironics System One BIPAP Auto SV Advanced DS960 Machine with Heated Humidifier" for $1,400), it might help, but there are no guarantees that you would be able to adapt to ASV therapy. ASV therapy requires higher IPAP pressures (occasionally, whenever we are have central events) and, although I think most patients manage to become accustomed to ASV therapy, some patients have a very hard time sleeping with ASV therapy because the machine sometimes acts as if it has a mind of its own and sometimes overreacts to pauses in breathing, perhaps mistakenly raising IPAP sky high while we are still awake.

Still, there is a definite possibility that ASV therapy may help a lot, by allowing the EPAP and IPAP to be as high as needed to eliminate obstructive events, while treating/preventing the central apneas and central hypopneas which may be caused by the pressure.

Take care,
--- Vaughn








Membership in the Advisory Member group should not be understood as in any way implying medical expertise or qualification for advising Sleep Apnea patients concerning their treatment. The Advisory Member group provides advice and suggestions to Apnea Board administrators and staff on matters concerning Apnea Board operation and administrative policies - not on matters concerning treatment for Sleep Apnea. I think it is now too late to change the name of the group but I think Voting Member group would perhaps have been a more descriptive name for the group.
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#26
This seem to me to be great news. It looks like you are getting chucks of good sleep. I'll point at specific good news. But, also will make observation that may not be.

First a question - Is there a eyestrain, eye pain, eye itch, component to your fuzziness? I found that is something that I need to combat, and really affects my impression of sleep effectiveness, though subjective, and eye drops are helping.

Good news: I would label the following chunks as
* deep restorative sleep - 00:55 thru 01:35, 02:00 thru 02:35, 03:40 thru 03:55, 04:30 to 04:50, 05:00 thru 05:10 insp goes high and calm, expr goes low and calm.
* possible dreaming - 03:15 thru 03:20, 05:15 thru 05:45 - heightened respiration and bumpy.
q: do you remember dreaming upon waking at 05:45?

Bad news: potentially you are not getting REM sleep. That can really affect your brain wellness. It should normally occur at end of deep sleep session, such as at 01:35, 02:35, 04:00, 04:50, and 05:15.

Not sure how to correct this, but it may come in time...

I am thinking your settings as suggested by vsheline are fine, and good for you.

s/
QAL
Dedicated to QALity sleep.
You'll note I am listed as an Advisory Member. I am honored to be listed as such. See the fine print - Advisory Members as a group provide advice and suggestions to Apnea Board administrators and staff concerning Apnea Board operation and administrative policies. Membership in the Advisory Member group should not be understood as in any way implying medical expertise or qualification for advising Sleep Apnea patients concerning their treatment.
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#27
a few internet searches, primarily http://www.cantsleep.org/rem-sleep.html suggest that one reason for not REM sleeping is "too rested". irks me to no end.

it causes that "I don't feel rested" feeling.

suggested are natural sleep aids, including melatonin.

suggested are dumping caffeine, and alcohol.

good luck...

Dedicated to QALity sleep.
You'll note I am listed as an Advisory Member. I am honored to be listed as such. See the fine print - Advisory Members as a group provide advice and suggestions to Apnea Board administrators and staff concerning Apnea Board operation and administrative policies. Membership in the Advisory Member group should not be understood as in any way implying medical expertise or qualification for advising Sleep Apnea patients concerning their treatment.
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#28
additional notes -

reviewing the chart submitted, I did notice a few other things.

1. there are several pressure-pulses (PP) where are not coincidental OA, CA, H, or FL markers. If you zoom close enough to those you will notice other breathing stutters or pauses that were not long enough to be counted. Since your PP score is 17.45 but your AHI is 3.89 there are at least 17.45 - 3.89 = 13.56 other events per hour (average), probably more since not every scored event has a PP associated with it. Last night my AHI was 4.65, and PP was 0.99 per hour. I have scored AHIs in mid teens, but worst night PP were under 10 per hour. Really sorry, but bet that has something to do with your sleep quality.

1.note. You may set your own user defined flags that are more sensitive that the scored items. Under File Preferences, look at the CPAP tab. I set a user flag of 50% flow restriction for over 8 seconds, just shy of being counted as a apnea. You can set something based on the disturbances you see, then the program will count those for you.

2. your 95% respiration rate is only 15, which is rather low, in my book. This makes me think you are not in REM sleep long as I normally associate heightened respiration with REM sleep and dreaming.

2.note. If you change your Y-Axis settings on the tidal volume (TV) chart to MIN 100 MAX 1100, you'll see more detail. Throughout REM sleep, you should see about a 15% decrease of TV, which is visually distinct. In 95% of these periods the respiration elevates beyond 15.

3. noticed your ramp is for 30 minutes and set to start at 4 cmH2o. That won't matter if you never press the ramp button. Still if you are in the mood, you might want to set the pressure at or just below your low IPAP pressure (10 cmH2o).

Hope this is helping you steer the bus. Cool
Dedicated to QALity sleep.
You'll note I am listed as an Advisory Member. I am honored to be listed as such. See the fine print - Advisory Members as a group provide advice and suggestions to Apnea Board administrators and staff concerning Apnea Board operation and administrative policies. Membership in the Advisory Member group should not be understood as in any way implying medical expertise or qualification for advising Sleep Apnea patients concerning their treatment.
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