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[Treatment] Treating UARS with CPAP and bilevel
RE: UARS and APAP
(09-19-2019, 06:49 AM)slowriter Wrote: Responding to mpers.

Let's look at a single, clear, example. At 2:00 AM, I awake out of REM (according to Dreem). Here's what the vauto data shows.

..not sure...suspicion here, you went through some 6min-long, suddenly move-driven arousal/aw at 1:57 and back to sleep at the "centrals"....at least it would be the way i would interpret on my audio-recorded calibrared curves...
Good luck
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RE: UARS and APAP
(09-19-2019, 09:04 AM)mper6794 Wrote:
(09-19-2019, 06:49 AM)slowriter Wrote: Responding to mpers.

Let's look at a single, clear, example. At 2:00 AM, I awake out of REM (according to Dreem). Here's what the vauto data shows.

..not sure...suspicion here, you went through some 6min-long, suddenly move-driven arousal/aw at 1:57 and back to sleep at the "centrals"....at least it would be the way i would interpret on my audio-recorded calibrared curves...
Good luck

The Dreem is saying I changed position (supine vs left vs right) a few times during that REM period. 

After that "central," I woke up for 30 minutes or so.
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RE: UARS and APAP
(09-19-2019, 09:10 AM)slowriter Wrote: The Dreem is saying I changed position (supine vs left vs right) a few times during that REM period. 

Which is a little confusing to me. If this is right (and I'm not sure how accurate the device's motion sensor and position algorithms are), isn't the average person "paralyzed" during REM, so that it would be uncommon to have position changes during that stage?

During this night, I was exclusively on my back (supine) during the REM stages after which I did not wake up, and I switched positions during the stages after which I did wake up.

Will have to monitor this over time.
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RE: UARS and APAP
(09-19-2019, 09:27 AM)slowriter Wrote:
(09-19-2019, 09:10 AM)slowriter Wrote: The Dreem is saying I changed position (supine vs left vs right) a few times during that REM period. 

Which is a little confusing to me. If this is right (and I'm not sure how accurate the device's motion sensor and position algorithms are), isn't the average person "paralyzed" during REM, so that it would be uncommon to have position changes during that stage?...well, I think this what would expected....as far as I remember, I am always in atony (my FFM f20 sharply give me this feedback) during REM, except, of course when I wake-up...last night, for instance, during my three REM's periods there was no move!

During this night, I was exclusively on my back (supine) during the REM stages after which I did not wake up, and I switched positions during the stages after which I did wake up.

Will have to monitor this over time.....yes, indeed, your machine may work and help.

-but, in conclusion, don't believe your 2:01 "CA" was a really one, most likely a holding breath after some moves.
GL
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RE: UARS and APAP
(09-19-2019, 06:45 AM)s.pneabonjour Wrote: Pretty much

I recall your "inconsistency of CAs" point.

I have not touched the pressure settings in 11 days, and even that was a minor change.

For a stretch, my AHI was below 1.

I had one CA during my titration study.

Last few nights, AHI has been around 5, exclusively composed of clear airway events, 

So I had a closer look at last night.
  • 41 events
  • 23 while awake (per Dreem)
  • looks to me like somewhere between 11 and 18 actual central apneas.
  • resulting AHI = 1.45-2.38
Dreem telling me I had less REM last night (18%), and hypnogram telling me two of my REM stages were fragmented (not a single block, but two). But those times did not correspond to any CA events.

On VAuto mode 6-15 with PS 6, but max IPAP only hit 12.76.

Given all this, stay the course for awhile longer?
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RE: UARS and APAP
If you feel your actual ahi was 1.5 to .2.4 ride it out.
I would ask your self what else changed. IAW your dreem something did.
The Centrals you zoomed in on we're IMHO real Centrals, not the holding your breath type we typically see as swj. In that case the likely immediate cause is likely the flushing out of too much CO2 from your blood. If that's the case the easiest thing to do is to decrease your pressure support.
Which came first, the sleep fragmentation discovered by your dreem, which you are interpeting as a wake state or the Centrals which caused a fragmented sleep.
Keep in mind that your trigger point and your sensitivity to this is a very individual thing.
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
OSCAR

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RE: UARS and APAP
(09-20-2019, 07:24 AM)bonjour Wrote: If you feel your actual ahi was 1.5 to .2.4 ride it out.

Will do.

The Dreem separately classifies the wake state in its hypnogram, based on the EEG. I'm trusting it's reasonably accurate. It corresponds to my impressions, when I turn off the machine to get up, etc. So it's not my interpretation there. I am awake, so the majority of the reported CAs are bogus.

So, I'm confident the real AHI is much lower than the machine is saying, BUT ... I also think my centrals have increased.

(09-20-2019, 07:24 AM)bonjour Wrote: Which came first, the sleep fragmentation discovered by your dreem, which you are interpeting as a wake state or the Centrals which caused a fragmented sleep.

The climb in AHI/CAs started with an abrupt jump (granted, we're still talking reasonably low) five nights ago, which has stayed constant.

I have only three nights with the Dreem, the first two of which show what look to me pretty good sleep architecture, with unfragmented REM stages. 

Last night was the first one that shows those two fragmented bits. AHI across the three nights was similar.

I don't know if the one night of REM fragmentation is significant. I just figured I'd add it, because it seems it could be.

Interestingly, I just noticed, last night FL max was 0.00.

   
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RE: UARS and APAP
I thought I included the screenshot above, but didn't. This is what I mean.

   
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RE: UARS and APAP
(09-20-2019, 07:49 AM)slowriter Wrote:
(09-20-2019, 07:24 AM)bonjour Wrote: If you feel your actual ahi was 1.5 to .2.4 ride it out.

Will do.

The Dreem separately classifies the wake state in its hypnogram, based on the EEG. I'm trusting it's reasonably accurate. It corresponds to my impressions, when I turn off the machine to get up, etc. So it's not my interpretation there. I am awake, so the majority of the reported CAs are bogus.

So, I'm confident the real AHI is much lower than the machine is saying, BUT ... I also think my centrals have increased.

(09-20-2019, 07:24 AM)bonjour Wrote: Which came first, the sleep fragmentation discovered by your dreem, which you are interpeting as a wake state or the Centrals which caused a fragmented sleep.

The climb in AHI/CAs started with an abrupt jump (granted, we're still talking reasonably low) five nights ago, which has stayed constant.

I have only three nights with the Dreem, the first two of which show what look to me pretty good sleep architecture, with unfragmented REM stages. 

Last night was the first one that shows those two fragmented bits. AHI across the three nights was similar.

I don't know if the one night of REM fragmentation is significant. I just figured I'd add it, because it seems it could be.

Interestingly, I just noticed, last night FL max was 0.00.

There is only one thing I would change, I would switch to fixed pressures instead of the VAuto mode. It may help your body stabilizes and you'll understand better the numbers. There is too much going on with the new PS value and the EPAP pressure varying during the night to figure what's working or not. I don't like Auto mode when trying to fine tunes my settings.
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RE: UARS and APAP
(09-20-2019, 08:05 AM)alexp Wrote: There is only one thing I would change, I would switch to fixed pressures instead of the VAuto mode. It may help your body stabilizes and you'll understand better the numbers. There is too much going on with the new PS value and the EPAP pressure varying during the night to figure what's working or not. I don't like Auto mode when trying to fine tunes my settings.

I was wondering about that.

Also, because of the complete absence of FL, maybe drop PS just a hair; 5.8 or 5.6.
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