Therapy for LPR, OSA, and… UARS?

[hoselife]

Here are some charts to bring everyone up to date on my centrals journey. I'm still dealing with some unrelated major issues that could prevent me from tolerating pap in the long run, but I'll save those for another post. This phase of numbers chasing appears to have paid off. 

February 20th: Where I started. 57 centrals spread through the night.

February 21st: Sleeprider's settings (precision pressure range limiting + Trigger High) took me down to 23 centrals. 

February 22nd: I attempt Trigger Very High. Brings me down to 14 centrals. Now mostly individual apneas occurring with an intermittent rhythm through the night, along with the opening cluster.

February 23rd: I put Trigger back to Medium and drop PS down to 1.0. Immediately the rhythmic, intermittent centrals disappear. The onset clusters are unaffected. 13 centrals total.

At this point I became fixated on eliminating the onset clusters. Tried a lot of things unsuccessfully, had a lot of bad sleeps.

February 28th: I set Ti_Max to 1.6s, and Cycle to High. Onset centrals completely disappear. When interpreting this chart, note awakenings from 1:20 to 2:20 and 3:40 to 3:55. Adjusting for that, there are still 2 centrals toward the end of the night, one 32s long. 

March 1st: I set Cycle back to Medium. My VAuto shows an event rate of 0.0 over the whole night despite three awakenings, but like all unicorns, this one disappears. With my sleep deprived mess of a brain, I forgot to insert the SD card. 

March 2nd: Same settings. Zero centrals. Synchrony with the machine CO2 wise. 

Would love the thoughts of the experts here. And beyond centrals, do these charts contain any useful information to guide my next steps?

[SarcasticDave94]

How is the first half hour or so now? If there's some trouble during that time, maybe nixing the 25 minute Ramp would bring stability. With ResMed machines, Ramp settings activate every time therapy starts.

With relative stability overall and few events, it is likely you've got a setup to attempt building a longer term trend of weeks instead of days.

[hoselife]

Oh wow I still have Ramp on? Nice catch Dave. That was one of my failed experiments to prevent onset centrals. It might be a problem in terms of my reporting in those periods as well because I believe it doesn't flag events in that time? I'll turn it off and I guess I likely need to take my UF2's in these charts more seriously.

Thanks for the encouragement re weeks! I think I'm finally ready to maintain a baseline and that feels good, even if I don't just yet.

[SarcasticDave94]

Just note that it can actually take a few weeks and sometimes longer to really feel PAP therapy paying off. However you're on the right track according to data. And I think there's Apnea Board rule 22 that you can't quit. Seriously, do keep at it. It will pay.

[hoselife]

Thanks Dave, I'll do my best! Really struggling with ear stuff and my throat. 

Does anyone know what this type of flow behavior means? It looks like this all night, and I think there might be a clue to my woes therein.

[Sleeprider]

Normal sleep respiration.

[hoselife]

Thanks SleepRider! That's a relief. I thought it looked like Class 6 below -- but I don't know what the chart means. If I'm understanding correctly, Class 6 requires the breath to already be over the red line?  Whereas the pause before inhalation in my case at the redline is just normal breath holding?

[Sleeprider]

We prefer a 3-minute zoom to look at inspiratory wave form. This is over 8-minutes, so detail is hard to pick out.  I see a few flow limits, but at this "altitude" it mostly looks like normal breathing with well developed peaks.  The image of flow limit class you posted is the inspiratory wave, wile the Oscar chart is the full respiratory flow rate cycle. You can add a dotted line at zero so you can more easily see what is inspiration and expiration in Oscar. Just right click near the label at the Y-Axis and use the add dotted line function.  

A normal respiratory flow rate is a rapid increase to a rounded our slightly level peak that drops quickly to zero and continues as expiration below the zero line. As the air is exhaled from the lungs, the flow rate in expiration slows and approaches zero. You may looking at that normal ending to expiration and thinking it is a flow limit. A Class 6 flow limit is only if all of that shape is above the zero flow line,  rises, hesitates and the rises again to peak.

[hoselife]

Thank you so much for these explanations SleepRider. It really is going to spare me a lot of fruitless anxiety down the line and I'm so grateful for it.

Here's a 3 minute interval during deep sleep of what should be normal breathing (no flagged flow limits or events).

Still looking good from this altitude?

[Sleeprider]

That is a more useful resolution. Still looks good. Your apnea have been predominately central through out this thread, and I think it might be good to try EPR 1 for a while and see if that reduces those events.