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Switched from APAP to BIPAP
RE: Switched from APAP to BIPAP
I've already done a celiac test and tested negative. I'm currently 1 week into a gluten and dairy-free diet (since I mean it when I say I don't have the energy to meal prep for a full elimination diet. No improvements in energy/brain fog as of yet. I feel considerably more lethargic and down than usual today after what was a horrible night's sleep, which leads me to believe that poor sleep is still a significant factor into how I'm feeling.
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RE: Switched from APAP to BIPAP
Elimination diets aren't hard but it sounds like you are trying to do all of them at the same time. Do elimination diets in groups as is possible, one major food and then a few other small easier ones. Gluten and dairy are two of the harder ones and very difficult to do together (it sucks, I have been on that diet for 6 months now), if you can keep it up for 6+ weeks then good otherwise do one at a time. You have to do them for at least 6 weeks (most places recommend 8) and rather than noting the slow improvement that occurs you usually notice the faster worsening when reintroducing the food. Unfortunately this process takes months as there are multiple elimination diets to try (first typical allergens then good to try low fodmap then can try less typical allergens and all sorts of other diets). 

I don't doubt that sleep has an effect on how you feel but it isn't clear that your sleep issues are caused by breathing and it is even less clear if CPAP is helping. The fact you just previously said that 6/9 gave better results than 11/14 strongly supports this theory considering everything about the 6/9 data was worse. You can play with pressure and PS all you want but imo it won't provide the results you are looking for because you have other health issues (nasal congestion and elevated ESR for some reason being two obvious signs) and because you have already pretty much tried everything and none of it has worked. The only thing that might get you the results you are looking for is a nasal mask otherwise the goal is to find minimum effective EPAP, then find the best PS and then understand that you have found the best settings for CPAP and that you need to find other solutions to health issues. 

Nasal congestion is an issue and you won't have good sleep breathing until you can figure out how to improve the congestion. Our bodies are designed to breath through our nose and mouth breathing can and does cause issues. Using a FFM can also negate CPAP benefits and in some cases makes apnea/breathing worse. These aren't opinions they are facts backed up in numerous clinical studies.

I don't know if you are doing anything more about the nasal congestion but if you need something more to be able to try and use a nasal mask you could ask doctor about using Dymista. It is a combination antihistamine/steroid spray that is the most effective for nasal congestion. You could also try a decongestant but they can only be used intermittently so only helpful as a test to allow you to use a nasal mask for a night. Nasal sprays are like putting a bandaid on a wound that won't heal though, you won't have ideal results until you can find the cause of congestion and deal with it (mine was dairy but there are probably 100s if not 1000s of things that can cause nasal congestion and allergies and food sensitivities are only a fraction of the possible causes).

Getting to the bottom of this stuff can be extremely frustrating and take a long time. I am 3 years in now and still looking for more answers... The reason I keep trying to help is because I know what you are going through and it sucks. I have a had to give up a lot and if I don't find more improvement may have to consider giving up my career and don't know what the heck I will do if I have to do that... Poor health sucks and can ruin a persons life, you can't always fix it overnight or with hope. Keep digging and you will find little improvements that can make things more bearable and then hopefully at some point you will get an answer that fixes everything.
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RE: Switched from APAP to BIPAP
Why I can't resolve symptoms solely based off stress 

I'm hoping to resolve these issues as soon as possible. I'm doing an MRI next week and am trying to tutor on the side to afford a neuropsychological test. I know that my chronic and significant stress has contributed to my symptoms, and I've very understandably fallen into a feedback loop of symptoms exacerbating stress, and stress exacerbating my symptoms. My extenuating circumstances are quite extraordinary and because of the position I'm in, I have no control over anything except trying to grind my way back to normalcy, which is impossible given my level of fatigue and brain fog. I'm unfortunately not in the position to be able to take a leave from school to destress and reorient myself, since my circumstances don't allow me to do so. 

I'm confident that if I was able to function somewhat properly, my stress levels would still be elevated, but not enough to cause this level of dysfunction / disability. 

Why I'm focusing on sleep:

My focus on sleep comes from one observation, which is that my symptoms significantly improve once I'm awake for a few hours after my normal bedtime. The longer I'm awake, the better I feel / function. Not sure what over conditions that cause brain fog (have looked at fixmyfog.com), result in this observation. If you have any ideas, please let me know. I will certainly examine the cause of my inflammation and deal with it accordingly, but another thing to note is that my ESR was completely fine a year and a half ago, and these symptoms were still an issue (although not to the same extent). 


SDB therapy:

Anyways back to sleep apnea therapy. Last night was definitely rough to recover from but nowhere near as bad as the night before. Aerophagia wasn't too much of an issue and didn't feel too uncomfortable while asleep / falling asleep. Would using these settings for the next 2-3 nights, seeing if there is a noticeable improvement from previous settings and then adjusting PS, be the right way to go. 



Here are my results:

   
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RE: Switched from APAP to BIPAP
Looks good. You can see this setting is better for your snores.  What do you have user 2 flag set to?  I would hold here for several days. 

QAL
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RE: Switched from APAP to BIPAP
AK -- you have an event about 7:40 and then your tidal volume gets really choppy after that. Can you screenshot the next 12 minutes after the event in three 4-minute zooms? I'm curious about what the flow rate curve does.

You spend the whole night going back and forth between periods of relatively constant TV and really choppy TV -- what is going on with your breathing and what's the difference?

(OSCAR trick for quickly taking 4-minute zooms... Change the left sidebar to the events tab, and find the event and click on it. This will set your window to a 4-minute zoom with the event in the center. Also, there's a very clever widget that I just recently noticed on the bottom of the sidebar on the Events tab -- it's a slider that sets your zoom level to exactly 1,2,3,etc minutes -- which is really good for giving you standardized views. You can switch back to the Details tab and the zoom level is set exactly. Another trick is that you take a screenshot and hit the arrow key 8 times, and take another screenshot -- the two screenshots will exactly butt up against each other. So you can take multiple screenshots and get a longer "strip" of data.)
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RE: Switched from APAP to BIPAP
Yeah you need to use this for a few nights to have baseline data to compare against then can try changing PS. This looked pretty good but I expect it was a good night.
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RE: Switched from APAP to BIPAP
To Cathy:

The change from stable to choppy TV has been a recurring theme throughout the entirety of my therapy. I attributed it to the change in breathing patterns based on different sleep stages but would love to know if this isn't a normal occurrence. 

Here are the zooms you asked for:

   

   

   


I'd also like to ask a moderator whether it's possible to upgrade my allocated attachment usage. I'm constantly having to delete old screenshots to make room for new ones.
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RE: Switched from APAP to BIPAP
To Geer1. After a weird day, I ended up passing out without putting on my mask on Wednesday and don't have any data for that day.

Here's the data for last night:

   
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RE: Switched from APAP to BIPAP
looked at the waveforms posted.

Quote:Here are the zooms you asked for:

you were not sleeping in much of that timeframe -

awake 07:35:00 - 07:38:10
awake 07:38:30 - 07:40:50 OA there does not count, but machine will count it
transitional in and out of sleep 07:42:00 - 07:45:40

Quote:whether it's possible to upgrade my allocated attachment usage.

You can use over the internet dropbox or image storage, and then link and embed images from there.

I personally use imgur, they allow you to sign up for free.

QAL
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RE: Switched from APAP to BIPAP
Amirkas as I mentioned before I believe those tidal volume swings are the periods where your sleep quality is poor. Flow rate and TV charts like that are not normally seen in members on here (believe I previously worded it as those periods being specific to your case).

It appears to be arousals that spike the change in flow rates and it seems you have continued arousals that keep your flow rate in flux. Like QAL commented you appear to be "awake" for much of these periods although if that was truly the case you should be aware of these periods of being awake. It makes me think it is more likely you are bouncing around in light sleep and not cognizant of what is going on but not getting good sleep. I was hoping your titration study you had done would comment on findings that would explain this but it didn't indicate an issue breathing or sleep in general which kind of surprised me since this occurs every night in your CPAP data. 

I don't think this is caused by breathing issues although there is potential for it. The one time we see somewhat similar flow/tidal volume rate fluctuations is in central apnea cases where there is periodic breathing because of the fluctuating respiratory drive. I have wondered if that is what goes on with you and it could explain why those periods seem more pronounced when you use higher PS. 

It may potentially correlate with sleep patterns but it often happens during your initial transition to sleep which would indicate it is NREM/light sleep and not rem sleep. If it correlated with a rem sleep period I would have more inclination to obstructive/restrictive issue, but being NREM/light sleep I think it closer fits a central apnea type effect like say sleep transition central apneas. Fyi central apneas rarely occur in REM sleep and your "apnea" (central or obstructive) almost always occur during these periods of poor sleep. I think a lot of them if not most of them are sleep wake junk but it is too hard to tell as there is no clear indicator as to what is causing that poor breathing/sleep. Because it seems like it may be central in nature is why I pushed to get you to try the lower pressures and PS which seems helpful so far (just not too low that the flow limitations become an issue).

The main breathing test that I have been curious to try to see if it improves these periods is the nasal mask test but that keeps getting put off due to nasal congestion issues so it seems you need to find more relief from nasal congestion before we can focus further on breathing.
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