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Switched from APAP to BIPAP
#81
RE: I've been using my APAP for a week, symptoms wors V2e.
To Cathy's point of considering positional apnea -

I'm not sure that chin tucking is the issue, however, I will try and find a way to have a video recording of myself sleeping tonight to examine whether that's an issue or not. My previous results, including my sleep study, haven't had clusters of OA's and Hypopneas as much as I can tell, with tonight being the exception. I did use a new pillow, the CPAPMax 2.0, yesterday night which could've been another factor that could've influenced my sleep. Aside from that, like Greer1, I believe that an EPR of 3 is definitely an issue as it has been since the beginning of treatment, so I will still experiment with an EPR of 1 tonight and post my results tomorrow.

Out of curiosity, do my flow limits during periods of non-apnea show fairly noticeable issues with UARS as you've said. I'm wondering whether I should bring up the possibility of using a Bipap with my doctors.
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#82
RE: I've been using my APAP for a week, symptoms wors V2e.
(07-04-2021, 12:17 AM)AmirKas Wrote: Out of curiosity, do my flow limits during periods of non-apnea show fairly noticeable issues with UARS as you've said. I'm wondering whether I should bring up the possibility of using a Bipap with my doctors.

Imo no to both UARS and Bilevel.

UARS can be tricky but the main theory is that sleep quality is poor due to arousals caused by respiratory effort and/or high CO2 levels. The odd time you have shown periods of high flow limitation you appear to sleep through it without obvious RERAs. Some argue that having those moments of flow limitation can cause fatigue just by the extra effort required to breath and I would say there may be merit to that (although it is a fairly unproven theory) but I would only anticipate that being an issue for people that have that kind of flow limitation the majority of the night whereas you only have it for short periods and not every night. For your interest sake I have attached some of my data from a bad night that you can see what a moment of obvious UARS/flow limitations/RERA's looks like. You can see how my breathing quality declines then flow rate spikes during RERA/recovery breaths then it happens again and again similar to how positional apnea looks (it was probably due to me sleeping in some strange position on edge of pillow or something). 

   

The main advantage a bilevel gives it the ability to use higher pressure support which is effectively what EPR is. Higher EPR appears to be an issue so it would be safe to assume a bilevel would not be helpful. Not to mention that 99% of doctors don't consider bilevel for UARS, it is more commonly used/recommended on these forums but it is not something that mainstream medical has adopted (at least not yet). 

I think you for the most part have minor obstruction/restriction that APAP is capable of treating (and for the most part is already being treating). I think the moments of flow limitation we see were probably an issue without CPAP but now they are at a level that is manageable and that you sleep through them without issue for the most part. I think the issue is adapting to the better flow your body is seeing and that your EPR levels need to be fine tuned or wait for your body adapt in order to realize the full benefits from treatment (assuming my assumption of centrals is correct).
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#83
RE: I've been using my APAP for a week, symptoms wors V2e.
That's good to hear. Having added complexity to my breathing is only going to make treatment more difficult. I don't have extensive results for last night since turning up the humidity caused water droplets to form in the tube, making a surprisingly loud drumming sound. Because of that noise, as well as water droplets dropping on my face, I ended up taking the mask off and sleeping the majority of the night without it. I feel absolutely terrible. I'll still post the results from the first part of the night if it helps at all.

First 3 hours:


[attachment=33449]
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#84
RE: I've been using my APAP for a week, symptoms wors V2e.
Like everything else humidity can be a bit tricky, too little or too much and you run into issues and it is different for everyone. I would return to standard settings unless you regularly note a sensation of dryness in which case try humidity setting of 5 (standard is 4). If you increase humidity setting (especially significantly) you often have to increase hose temp along with it to avoid rainout.
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#85
RE: I've been using my APAP for a week, symptoms wors V2e.
AmirKas, you being a physics student will appreciate this (My husband is a physics professor, and my 3 kids are physics grad students.) Early on in therapy I conducted the experiment of turning my temperature to the lowest level and humidity to the highest level.

"rainout" is not the right word -- more like DELUGE!!! I had to go find a dry pillow after resetting both to "auto"...
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#86
RE: I've been using my APAP for a week, symptoms wors V2e.
@Cathy, it was a double whammy - you're already suffocating in your sleep, and the machine you decided to use to avoid just that, just drowns you instead. 

I fixed the rainout issue, and will eventually adjust my humidity and hose temp settings since I do wake up with chapped lips and a dry mouth practically every day. I finally slept a full night with an EPR of 1 and the results look somewhat promising. My central apneas went down from sleeping with an EPR of 2, but like my previous results, I'd like to assess whether my OA's were actually CA's. Let me know what regions you'd like me to take a closer screenshot of, and if I need to change my y-axis range. 


Part 1:

[attachment=33494]

Part 2:

[attachment=33495]
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#87
RE: I've been using my APAP for a week, symptoms wors V2e.
Post zoomed shots of the pairs of apnea at 13:00, 16:55, 17:48 (include some of the breathing prior to first apnea).
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#88
RE: I've been using my APAP for a week, symptoms wors V2e.
One thing that I've discovered through my data is that you have to show leaks, because it appears that the machine doesn't account for leaks in the flow rates that it reports. It's also not clear how well the machine measures leaks at all.

(Over in my thread asking whether a particular region of flow rate wasn't being scored as an event, they've just been explaining to me that this weird section of flow rate that my machine reported is not weird, it's wrong. Because if that was my flow rate over those six minutes, that would have been a 6-minute apnea. And I would be dead. Or very very small (and even then brain damaged from six minutes barely breathing.) When I have a leak-fest of a night the machine reports lots of ridiculous numbers for flow rates during the big leaks. I don't understand how to make the correction, but it's clear that some correction is needed.)

As for the Flow Rate curve, I'd set it to 30 to -30, with divisions at 10 or even 5 if you can. While you have flow that would be off the top and bottom of the graph that way, it's not so important to know how much off the top/bottom.
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#89
RE: I've been using my APAP for a week, symptoms wors V2e.
Here you go:

13.00:

[attachment=33496]

16.40

[attachment=33497]

17.45

[attachment=33498]
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#90
RE: I've been using my APAP for a week, symptoms wors V2e.
Like the EPR 3 example we looked at these follow an arousal and there are no obvious reasons to believe the arousal was caused by a breathing issue.

When an apnea follows an arousal like that they are usually not a real apnea but instead you are holding your breath while changing position or something like that. There is also potential they are sleep transition centrals (especially the second one in these pairs).

Comparing averages rather than single nights of data would be better so maybe run EPR of 1 for a few nights then try EPR of 2 again and see if you notice any difference. At this point how you feel is more important than the AHI because it isn't that big of a difference stats wise.
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