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[Treatment] Treating UARS with CPAP and bilevel
RE: UARS and APAP
(10-15-2019, 04:51 AM)slowriter Wrote: AHI instantly dropped from 3-5 (where it had been for awhile, even with trying different PS values) to below 1, and last night was 0!

Slowriter,  

I have been following your scientifically based journey through all your posts.  So happy to see this night's result!

Yes, the work for improvement continues forward but what a nice milestone to celebrate!

WillSleep

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RE: UARS and APAP
(10-17-2019, 01:56 PM)WillSleep Wrote:
(10-15-2019, 04:51 AM)slowriter Wrote: AHI instantly dropped from 3-5 (where it had been for awhile, even with trying different PS values) to below 1, and last night was 0!

Slowriter,  

I have been following your scientifically based journey through all your posts.  So happy to see this night's result!

Yes, the work for improvement continues forward but what a nice milestone to celebrate!

WillSleep

Thanks!

Been three nights in a row at 0!

That itself isn't the goal of course, but still pretty cool.
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RE: UARS and APAP
this may be common knowledge to the old hands here but may be worth repeating for the benefit of newer folks.

everyone says don't chase numbers, and we don't want to be obsessive about it, but I'm not ashamed to say that I'm disappointed with a daily ahi of more than about 0.4 because with the asv I can usually keep it there or lower. last night, otoh, was my highest ahi in 7 months at 1.53 in 10 fragmented sessions for just under 8 hours. the reason I feel awful today is probably less about apnea and more about fragmentation and my periodic limb movements that cause it, but I mention it in order to reiterate that in the end, how we feel is paramount. so, for example, as long as I have crummy days like today, I'll continue chasing 0.0 and 8 uninterrupted hours of sleep. I'll be happy to quit seeking and devote the time to other preferred activities once I consistently feel well, but until then...
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RE: UARS and APAP
(10-17-2019, 02:55 PM)sheepless Wrote: ... as long as I have crummy days like today, I'll continue chasing 0.0 and 8 uninterrupted hours of sleep.  I'll be happy to quit seeking and devote the time to other preferred activities once I consistently feel well, but until then...

Exactly!
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RE: UARS and APAP
(10-15-2019, 04:51 AM)slowriter Wrote: This is kind of interesting to me.

I made two minor changes a few nights ago.

I dropped PS from 6 to 5.2, and raised min EPAP from 6 to 6.2.

I also changed trigger from high to very high.

AHI instantly dropped from 3-5 (where it had been for awhile, even with trying different PS values) to below 1, and last night was 0!

That's something I've been doing lately. If I raise my PS above 4, I experience some centrals (real ones) but I'm still having some flow limitations at that level.So instead of raising the PS, I leave it at 4 and I raise my EPAP. I'm having better results this way.
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RE: UARS and APAP
(10-18-2019, 12:47 PM)alexp Wrote:
(10-15-2019, 04:51 AM)slowriter Wrote: This is kind of interesting to me.

I made two minor changes a few nights ago.

I dropped PS from 6 to 5.2, and raised min EPAP from 6 to 6.2.

I also changed trigger from high to very high.

AHI instantly dropped from 3-5 (where it had been for awhile, even with trying different PS values) to below 1, and last night was 0!

That's something I've been doing lately. If I raise my PS above 4, I experience some centrals (real ones) but I'm still having some flow limitations at that level.So instead of raising the PS, I leave it at 4 and I raise my EPAP. I'm having better results this way.

Yeah, it occurred to me that the key number to address the RERAs is the IPAP, but that I appeared to have developed a sensitivity to CA when I got into higher PS numbers. So why not raise EPAP instead, to see if I could tolerate it?

BTW, after a string of 3 nights with 0 AHI, last night I had two CA events, both of which were classic, real, central apneas. Two isn't enough to worry about, but interesting that even these changed when they showed up again.

Before this recent change, I was prepared to experiment with EERS, based on a hypothesis I have. I still may, depending.
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RE: UARS and APAP
(10-18-2019, 01:58 PM)slowriter Wrote:
(10-18-2019, 12:47 PM)alexp Wrote:
(10-15-2019, 04:51 AM)slowriter Wrote: This is kind of interesting to me.

I made two minor changes a few nights ago.

I dropped PS from 6 to 5.2, and raised min EPAP from 6 to 6.2.

I also changed trigger from high to very high.

AHI instantly dropped from 3-5 (where it had been for awhile, even with trying different PS values) to below 1, and last night was 0!

That's something I've been doing lately. If I raise my PS above 4, I experience some centrals (real ones) but I'm still having some flow limitations at that level.So instead of raising the PS, I leave it at 4 and I raise my EPAP. I'm having better results this way.

Yeah, it occurred to me that the key number to address the RERAs is the IPAP, but that I appeared to have developed a sensitivity to CA when I got into higher PS numbers. So why not raise EPAP instead, to see if I could tolerate it?

BTW, after a string of 3 nights with 0 AHI, last night I had two CA events, both of which were classic, real, central apneas. Two isn't enough to worry about, but interesting that even these changed when they showed up again.

Before this recent change, I was prepared to experiment with EERS, based on a hypothesis I have. I still may, depending.
Hi, Slowriter,
my first suggestion you could eventually quickly fine-tuning your PS, by semi-quantitative analysis against RR and EPAPmin, CA, etc..... and (EPAPmin+PS), by semi-quantitative analysis against RERA/FL/U-RERA (unflagged); you could do this latter counting, by yourself, daily events/hr, those one significant, that awakening you.
I was wondering if you take a look on my posts on that semi-quantitative approach I have been suggesting, such this one:
http://www.apneaboard.com/forums/Thread-...=lingering

good luck
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RE: UARS and APAP
(10-19-2019, 08:04 AM)mper6794 Wrote: Hi, Slowriter,
my first suggestion you could eventually quickly fine-tuning your PS, by semi-quantitative analysis against RR and EPAPmin, CA, etc..... and (EPAPmin+PS), by semi-quantitative analysis against RERA/FL/U-RERA (unflagged); you could do this latter counting, by yourself, daily events/hr, those one significant, that awakening you.
I was wondering if you take a look on my posts on that semi-quantitative approach I have been suggesting, such this one:
http://www.apneaboard.com/forums/Thread-...=lingering

You mean this (linking to the specific post)?

I don't totally understand it.

A thought: I wonder if you, or someone, could post a spreadsheet (maybe in your thread) that would have some basic input columns, and then include the formulas to calculate the numbers, and generate the graphs, automatically?

My median RR, BTW, doesn't seem to vary that much in relation to those variables. It's always right around 15.

I'm making progress though; perhaps I'm just adjusting to the therapy.

Reported CAs this past week are mostly gone.

Most nights I'm waking up briefly (as in, I don't remember) 2-4 times, which I'm OK with.

I wake up slightly less with the eszopiclone than with the supplements, but otherwise, results are similar.

A couple of OA and H events have popped up, that do at times correlate to those wake ups. I guess that means I could bump EPAP a bit more.

   
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RE: UARS and APAP
(10-20-2019, 08:57 AM)slowriter Wrote: A thought: I wonder if you, or someone, could post a spreadsheet (maybe in your thread) that would have some basic input columns, and then include the formulas to calculate the numbers, and generate the graphs, automatically?...well, it could be a good idea...

My median RR, BTW, doesn't seem to vary that much in relation to those variables. It's always right around 15....yes, this would be expected, as it looks you would not be changing EPAPmin and PS quite signficantly...

I'm making progress though; perhaps I'm just adjusting to the therapy.....yes, it seems...great!

I wake up slightly less with the eszopiclone than with the supplements, but otherwise, results are similar....I am interested on this experience, please, let us informed on followup 

A couple of OA and H events have popped up, that do at times correlate to those wake ups....it looks false events for me.... I guess that means I could bump EPAP a bit more.....not sure, then..

good luck
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RE: UARS and APAP
A few weeks ago, when my CAs were higher than I wanted, I bought parts to experiment with EERS.

I've assembled the simple mod. In this case it's of the Bleep, but the same strategy would work for masks like the p10: plug vent holes on mask with silicone, add length of tubing, end with swivel vent. 

   

I've also confirmed it works, and there's no impact on spo2.

I don't think I actually would benefit from this, as my CAs are under control without, but just posting this for the record, in case helpful for someone else.

This does seem a cheap and elegant option more people might try.

Also posting a screenshot of OSCAR with the impact and earlier one with almost same settings (PS 6). 

I don't read much into the difference in CAs,  because I think decline recently is probably just my body and brain adapting. So I'll probably reserve this for later, if I feel desire to experiment with still higher PS.

Also, while the machine flagged a few CAs, those are while awake, so AHI was really 0.

One notable difference in comparison to past few days (aside from waking up more) is higher median TV (usually it's 500, or just under). I assume that's actually not helpful?

       
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