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Switched from APAP to BIPAP
RE: Switched from APAP to BIPAP
You got less than 6 hrs of sleep, I would say feeling tired should be expected especially with the known poor sleep quality. 

Again your flow rate chart looks more consistent, I believe this has been the case each night you have tried a nasal mask. In case you don't know what I mean by this I have attached an image showing FFM on top and nasal mask below. I added a red line to each showing normal flow rate level for that night and you can see how with the nasal mask your breathing is at that level most of the night but in the FFM example you have multiple periods where the flow rate is lower. The flow rate being lower like that is a potential indicator for restriction and the fact that yours improves on nasal mask supports that you have less restriction when using a nasal mask. 

In the two recent nasal mask nights of data your tidal volume averaged 370 ml and minute vent ~ 7 lpm. Just flipping through some of your recent FFM data it seems like it was closer to 340 ml and ~6.2 lpm so it does appear that you are getting more air with the nasal mask further supporting this theory. If your symptoms are being caused by breathing then a nasal mask should continue to help but it might be a painful process to get switched over fully adapted to.  

I would be curious to see a few close up shots (~3-5 min length) of the fluctuating TV (say 7:00, 9:40 and 11:20) to see what this looks like with the nasal mask.


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RE: Switched from APAP to BIPAP
Hey guys,

After a long hiatus from this forum, I have some information to add. Talking to a sleep doctor and showing them my OSCAR charts did confirm the notion that those minute vent / TV graphs were abnormal, deeming a further titration study necessary (thank god). 

At the sleep study, I got a 2nd and 3rd opinion from the sleep technicians who confirmed the abnormality in my graphs. The completed titration showed that my optimal settings are:

Mode: Auto Bipap
Min EPAP: 9 cm H2O
Max IPAP: 16 cm H2O
PS: 5

After asking, they confirmed that an equivalent of a Medium trigger setting was used in the lab.



The preliminary report stated that "scattered Centrals were observed, primarily after arousals."

I will be getting my full report sometime this week, which I will share with you all as soon as I can.





As soon as I knew what my optimal settings were, I set them up on my machine, only to notice my AHI jumping to 6.39 as a result of having a CI of 5.08.
Knowing that raising the trigger setting could help with Centrals I tried one night of medium, high, and very high respectively just to get some data.

Here are the results for each trigger setting:

Medium:

   


High: 

   


Very High:

   



What are the observations any of you can make from this? The first thing I notice is that the medium night seems to have "wider" flow rate graphs, but a fairly unstable TV / RR, while very high seems to have fairly long periods of flow limitation (upon closer inspection) but a more stable TV / RR. 

The reason I ask is I'd like to continue testing these settings (for at least a week or 2 at each setting) with a priority for settings that would most likely improve sleep quality. I understand this might be a very vague question with no clear answer, but I understand that experienced members on this forum generally know what sleep-breathing issues to avoid.

One thing to add is I've been mouth-breathing pretty heavily. My humidity is maxed out with a heated hose (still lower than what would cause rainout) and I wake up just to get water because my mouth is extremely dry. I've been using the AirTouch f20 as my mask. For the past month, I've been taking Flonase and desloratadine daily for my nasal congestion, taking Flonase daily for even longer than that.


PS:

I would also like to mention, that I've been having the idea to use a machine learning algorithm that will take in an oscar graph, and more accurately detect periods of flow limitations as well as RERAS. This will require a large amount of sample data, which means I'll need the support of everyone on this forum. If I have the time to pursue this project, I will develop some kind of program that will allow you guys to retrieve sample data and deem each waveform as flow limited/normal. 

Hopefully, this program would support members of this forum to titrate their devices for optimal sleep quality.
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RE: Switched from APAP to BIPAP
(03-13-2022, 06:54 PM)AmirKas Wrote: I would also like to mention, that I've been having the idea to use a machine learning algorithm that will take in an oscar graph, and more accurately detect periods of flow limitations as well as RERAS. This will require a large amount of sample data, which means I'll need the support of everyone on this forum. If I have the time to pursue this project, I will develop some kind of program that will allow you guys to retrieve sample data and deem each waveform as flow limited/normal. 

Hopefully, this program would support members of this forum to titrate their devices for optimal sleep quality.
Note: The solicitation of data from forum members is not allowed.  The OSCAR team has permission to do so (SD Cards) BUT we share this data with no one, and we anonymize that data anyway.  
If you wish to solicit data for this project PM the Admin, SuperSleeper, and advise him of what exactly you would like to do and how you would both solicit and manage the data and ask for permission.
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RE: Switched from APAP to BIPAP
(03-13-2022, 07:49 PM)Gideon Wrote: Note: The solicitation of data from forum members is not allowed.  The OSCAR team has permission to do so (SD Cards) BUT we share this data with no one, and we anonymize that data anyway.  
If you wish to solicit data for this project PM the Admin, SuperSleeper, and advise him of what exactly you would like to do and how you would both solicit and manage the data and ask for permission.

Didn't realize that. Thank you for clarifying. I will PM the admins to discuss this idea.
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RE: Switched from APAP to BIPAP
It looks like higher trigger sensitivity definitely affects the efficacy of your therapy and specifically targets tidal volume, respiration rate and minute vent. As far as soliciting data, you are offering your own data to those willing to download and analyze the data. You should remove personally identifying information, but this is not what our policy intends to control, which is the request of other people's data.
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RE: Switched from APAP to BIPAP
How many nights have you used the very high at those settings? I would keep trying it for a week or so and see what average results look like, your data has always been variable night to night.

Do you have any other dry eyes, nose or mouth symptoms not related to cpap use? This is something I struggle with and the biggest reason I still sleep with cpap (I wake up eith extremely dry mouth/nose if I dont).
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RE: Switched from APAP to BIPAP
Here is the redacted pdf of my second titration study. Not sure what new information to gather except for the fact that I have real central apneas. Not sure how to move forward with this information.


.pdf   second titration full_Redacted_compressed.pdf (Size: 339.83 KB / Downloads: 7)
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RE: Switched from APAP to BIPAP
No other interpretations by them?

I am curious why 13/8 was the recommended titration when 11/6 was almost twice as long of a period and showed no apnea, hypopnea or reras. They did comment about flow limitations being present occasionally and I am curious if they were trying to treat them or just increasing the pressure periodically.

If possible I would try to get them to confirm if they saw any breathing like the fluctuating TV breathing we have noticed. Your CPAP data shows it every night so you would think it would happen during titration study but neither of your studies have commented on it.

Your arousal index was ridiculously good. You got limited sleep but when you were able to sleep you seemed to sleep decently.

The central apnea almost all occurred at max settings (15/10) and imo they were most likely treatment induced centrals at that high pressure/PS. Having central apnea like that is a sign of your body believes it is getting more than adequate ventilation.

Imo this study does much the same as the first one in indicating that your breathing issues appear to be treated and remaining symptoms likely are caused by something else.

The main thing that caught my eye was your awake leg movements averaging a leg movement every 36 seconds. This disappears when you are asleep but was present all times you were awake. Are you aware of these leg movements or do they occur without you realizing? Although this is the main thing that popped out to me I don't know what relevance it has or what is considered normal/abnormal, this is the first time I believe I have even seen awake leg movements scored.
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RE: Switched from APAP to BIPAP
I was conscious of my awake leg movements. The wires and bed were rather uncomfortable leading to tossing and turning. 

I did ask the sleep technician and they did confirm that they saw the same fluctuating TV periods as my OSCAR data. I showed them my data beforehand and they confirmed the abnormality of the breathing patterns. 

However, the sleep tech did not elaborate on the meaning of those fluctuating TV periods. I'm hoping the doctor has more information and more answers for me. 

Also, I believe they picked out 13/8 as it is the first setting that allowed me to get REM sleep.

Are they any questions I should keep in mind during my doctor's appt? 



Also, my psych has agreed to prescribe me modafinil as a placeholder till I can get proper treatment. Not sure what experience the sub has with it but I'll keep you guys updated on how that goes.
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RE: Switched from APAP to BIPAP
The first rem sleep stage usually occurs 60-120 minutes into sleep. You entered rem sleep at that time because you were around 60 minutes in to sleep not because of the settings. The only thing I can think of is that they were seeing flow limitations, fluctuating TV or something else that improved with the higher pressure but there is no data available to us to draw those conclusions. The pressures above 13/8 give worse results so it makes sense why that is the highest they would recommend.

Do you believe you have restless leg syndrome?

Only things I can think of to ask doctor is why 13/8 was recommended over 11/6 and if they saw any fluctuating TV and if so what may be causing it. Could also ask about the leg movements if they are troublesome.

Modafinil is an interesting choice, I assume to try and regulate your sleep pattern. My understanding is that it helps keep you awake/alert during the day so you sleep better at night. Interestingly Modafinil affects dopamine which is one of the main treatments for restless leg syndrome (although different medication/mechanism of action is used for RLS).
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