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[Treatment] Treating UARS with CPAP and bilevel
RE: UARS and APAP
(10-25-2019, 07:53 PM)slowriter Wrote: Changing cycle from high to medium resulted in 1.32/2.44; so 0.54.

TV actually declined slightly, to 460.

This is one night though. 

Been a busy Saturday.   

Overall the chart looks good.  

Were you happy with the results?  

Did you notice any implied changes in SpO2 or CO2?
It seems like there after is pretty good patient-xPAP synchronicity on a breath by breath basis then the only real way to know that your MV or TV values are ideal is by assessing how they impact the O2 and CO2 levels in your blood and if there is still the right amount of CO2 in the air to incite the next spontaneous breath.


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Overall your results and settings look really good so at this point you could just leave them for a while.

If were me and I was to keep tuning I would lead the tuning from here with what you can know about the the nightly SpO2, HR and implied CO2 related results.

In my mind the simple two focusing reasons to care about I:E, TV & MV is to make sure:

1.  Protecting our lungs from injury over the years/decades of xPAP use to come so we will live longer happier lives.  Measuring your lungs is the only way to know for sure what your ideal tidal volume should be, until then if you adopt the ARDSNet Protective Lung Strategy Protocol as a guide on where TV should be then at 460mL your are pretty darn close.  ARDSNet Protocol TV at 6mL/Kg PWB for 6' is 466mL. 

2. The more immediate need (Lol.) of getting really good blood gas performance through the night, keeping the all the SpO2, CO2 and pH related metrics at ideal levels through the night.  


So for me once we get to and stay at the milestones finding what is for each of us a 'low AHI" and a reasonably healthy patient-xPAP long-haul configuration the tuning priority shifts to:

1. Seeking ideal blood gas & HR performance (SpO2, xCO2, HR & HRv)

2. Sleep Architecture & Quality of Sleep metrics

3. While keeping AHI within 2.5 (you pick the number) of our best ongoing AHI scores. Once we achieve a certain level of success improving AHI, a low AHI starts to shift from being the actual goal to being more an ongoing monitoring metric that helps us achieve success on the 'real' goals #1 and #2 just above.

The xPAP settings, AHI/RDI, RR, TV, MV, and our sleep improvement work all become (with what limited control we have) just knobs and tools for us to attempt to perfect our interrelated nightly SpO2, xCO2, HR, HRv and SA/quality of sleep metrics.   


Everybody have a great night.  

WillSleep

INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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RE: UARS and APAP
(10-26-2019, 08:24 PM)WillSleep Wrote:
(10-25-2019, 07:53 PM)slowriter Wrote: Changing cycle from high to medium resulted in 1.32/2.44; so 0.54.

TV actually declined slightly, to 460.

This is one night though. 

Been a busy Saturday.   

Overall the chart looks good.  

Were you happy with the results?  

Did you notice any implied changes in SpO2 or CO2?
It seems like there after is pretty good patient-xPAP synchronicity on a breath by breath basis then the only real way to know that your MV or TV values are ideal is by assessing how they impact the O2 and CO2 levels in your blood and if there is still the right amount of CO2 in the air to incite the next spontaneous breath.  

It could just be coincidence, but I slept ~8 hours, and had three brief arousals (above I said my target was 1-2 for "good"). So yes; translates into feeling better.

I have no way to measure CO2 (does that really matter, so long as the breathing patterns are "right"?), but SpO2:

I have two monitors with SpO2 sensors: the Garmin band, and the Dreem headband.

Unfortunately, I'm doubting the accuracy of the former (other than at a general level), and I don't have access to the data on the latter (yet; I'm hoping at some point they expose it).

I never invested in a pulse oximeter for sleep mostly because I don't have a history of major desaturations. But at this point of fine-tuning, might be worthwhile.

How do you use it? Have you documented it somewhere?
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RE: UARS and APAP
.. that's great!
Any medication?
GL
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RE: UARS and APAP
(10-27-2019, 10:10 AM)mper6794 Wrote: .. that's great!
Any medication?
GL

I've been taking eszopiclone a couple/few times per week, when sleeping well is a particular priority (to avoid developing any sort of dependency, or end up up with rebound insomnia)..

This was one of those nights.

In general, it doesn't have a major impact compared to supplements, but I do tend to wake up slightly less frequently.
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RE: UARS and APAP
Cool. Sounds like a great night


(10-27-2019, 09:16 AM)slowriter Wrote:
(10-26-2019, 08:24 PM)WillSleep Wrote: Did you notice any implied changes in SpO2 or CO2?
It seems like there after is pretty good patient-xPAP synchronicity on a breath by breath basis then the only real way to know that your MV or TV values are ideal is by assessing how they impact the O2 and CO2 levels in your blood and if there is still the right amount of CO2 in the air to incite the next spontaneous breath.  

... to measure CO2 (does that really matter, so long as the breathing patterns are "right"?),

The nightly stats and airflow waveform patterns we see OSCAR are a much better instrument to tell us when something about our O2 & CO2 levels is significantly impactfully wrong than to tell us when it is actually correct with any precision.

I 'supsect' that a focus on CO2 is less important than a focus on SpO2, and to this bias to SpO2 and a lack of widely available low cost products to measure CO2 has caused us to dismiss looking at CO2 to our detriment.

I 'suspect' that imperfect blood pH and blood gas levels (O2, CO2) are a significant and addressable contributor for SOME of the folks who have the experience "I had a low AHI for over a year now and I still feel tired".

I 'suspect' that at the level of precision we are working to perfect sleep CO2 levels is a topic that should enter our thinking processes, along with O2 levels and HRV.

I have a yet unproven hypothesis that for anyone like me, you, mper and others working at levels of precision to perfect sleep that it is important to at least assess/test to see if CO2 levels and CO2 variability signals is or is not a valuable component of our personal toolkits.

Evidence: Within the last month one member posted that CO2 levels in his blood were 'high' but there was nothing visible in OSCAR to suggest that to be the case.

Evidence: The importance of and roles xCO2 & pH metrics play in hospital ventilation.

Evidence: PR, ResMed & others acknowledge most xPAP products have been designed with a wide range of CO2 washout tolerance / imprecision to accommodate many types of masks, sometimes even those from other vendors.

Evidence: There appears to be a wide variance in the amount of CO2 rebreathing designed into the mask between models like the Dreamware style where most intentional leak takes place on top of the head and pillow / nasal masks with smaller rebreathing capacity and much larger amount of intended leak venting closer to the mouth.


... I could go on for a while but is too much detail for this thread.


Gotta run, will answer more of the questions later.

Rebuttals and Improvements anyone?

WillSleep

INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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RE: UARS and APAP
(10-27-2019, 02:16 PM)WillSleep Wrote: Cool.  Sounds like a great night


(10-27-2019, 09:16 AM)slowriter Wrote:
(10-26-2019, 08:24 PM)WillSleep Wrote: Did you notice any implied changes in SpO2 or CO2?
It seems like there after is pretty good patient-xPAP synchronicity on a breath by breath basis then the only real way to know that your MV or TV values are ideal is by assessing how they impact the O2 and CO2 levels in your blood and if there is still the right amount of CO2 in the air to incite the next spontaneous breath.  

... to measure CO2 (does that really matter, so long as the breathing patterns are "right"?),

The nightly stats and airflow waveform patterns we see OSCAR are a much better instrument to tell us when something about our O2 & CO2 levels is significantly impactfully wrong than to tell us when it is actually correct with any precision.

I 'supsect' that a focus on CO2 is less important than a focus on SpO2, and to this bias to SpO2 and a lack of widely available low cost products to measure CO2 has caused us to dismiss looking at CO2 to our detriment.  

I 'suspect' that imperfect blood pH and blood gas levels (O2, CO2) are a significant and addressable contributor for SOME of the folks who have the experience "I had a low AHI for over a year now and I still feel tired".

I 'suspect' that at the level of precision we are working to perfect sleep CO2 levels is a topic that should enter our thinking processes, along with O2 levels and HRV.  

I have a yet unproven hypothesis that for anyone like me, you, mper and others working at levels of precision to perfect sleep that it is important to at least assess/test to see if CO2 levels and CO2 variability signals is or is not a valuable component of our personal toolkits.

Evidence: Within the last month one member posted that CO2 levels in his blood were 'high' but there was nothing visible in OSCAR to suggest that to be the case.    

Evidence: The importance of and roles xCO2 & pH metrics play in hospital ventilation.

Evidence: PR, ResMed & others acknowledge most xPAP products have been designed with a wide range of CO2 washout tolerance / imprecision to accommodate many types of masks, sometimes even those from other vendors.  

Evidence: There appears to be a wide variance in the amount of CO2 rebreathing designed into the mask between models like the Dreamware style where most intentional leak takes place on top of the head and pillow / nasal masks with smaller rebreathing capacity and much larger amount of intended leak venting closer to the mouth.  


... I could go on for a while but is too much detail for this thread.


Gotta run, will answer more of the questions later.  

Rebuttals and Improvements anyone?

WillSleep

I ordered a CMS50I, so we'll see!

My Dreem 2 has spo2 sensors, but I have no access to that data currently. 

I do have access to the HR data though.

As I've been casually reviewing that data, I'm mainly looking for spikes out of the ordinary. But my average HR over the night recently has been 52 or 53 BPM, without any spikes.

It's obviously higher in REM, and lower in Deep.

I presume that's what we hope for?

On CO2, all makes sense. But what are you thinking to do with that info if you move forward with an experiment?

Are you thinking it will help both with mask selection, but also fine-turning EERS volume where that option is appropriate?
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RE: UARS and APAP
(10-30-2019, 12:04 PM)slowriter Wrote: I ordered a CMS50I, so we'll see!

My Dreem 2 has spo2 sensors, but I have no access to that data currently. 


 On the CMS50I, cool.  I have never seen that one.  Will be looking forward to your assessment.

So how does the dreem take advantage of that data now?
... and what does the Dreem share with you about SpO2?


WillSleep

INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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RE: UARS and APAP
(10-30-2019, 02:48 PM)WillSleep Wrote:
(10-30-2019, 12:04 PM)slowriter Wrote: I ordered a CMS50I, so we'll see!

My Dreem 2 has spo2 sensors, but I have no access to that data currently. 


 On the CMS50I, cool.  I have never seen that one.  Will be looking forward to your assessment.

So how does the dreem take advantage of that data now?
... and what does the Dreem share with you about SpO2?

It doesn't currently expose spo2 data at all. Maybe it uses it behind the scenes in its algorithms?
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RE: UARS and APAP
(10-30-2019, 12:04 PM)slowriter Wrote: I do have access to the HR data though.

As I've been casually reviewing that data, I'm mainly looking for spikes out of the ordinary. But my average HR over the night recently has been 52 or 53 BPM, without any spikes.

It's obviously higher in REM, and lower in Deep.     I presume that's what we hope for?

Yes.   The rise in REM, the low bpm rates and also the absence of spikes.  Low variability HR apart from the parties we throw during REM is awesome.   

Continuing, some say that in the overnight bpm low we want to see a number that is a 10-15 % dip/drop from day time resting levels.  

Also, generally the curve of change in HR through the night should follow a Hammock shape or the shape of the bottom of a Wok.  Slowly dropping to a general low and then slowly rising as it gets close to time to wake up.   


Your HR situation sounds great.

WillSleep

INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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RE: UARS and APAP
(10-27-2019, 09:16 AM)slowriter Wrote: SpO2: I have two monitors with SpO2 sensors: the Garmin band, and the Dreem headband.

Unfortunately, I'm doubting the accuracy of the former (other than at a general level), and I don't have access to the data on the latter (yet; I'm hoping at some point they expose it).

I never invested in a pulse oximeter for sleep mostly because I don't have a history of major desaturations. But at this point of fine-tuning, might be worthwhile.



How do you use it? Have you documented it somewhere?
    
   
I looked and did not see any my previous posts on SpO2 that summarized content of value to this conversation.  

So I came to type up a draft of action oriented summary that I might be able to cut and paste in the future.  

Anyone, everyone please help correct or improve these thoughts. 

Mper I know you have much to share on the many wonders waiting for us if we can learn to get the Respiratory Rate chart to sing to us.   Lol.


WillSleep

///////////////////////


Benchmark OSCAR results against the results from a Pulse-ox to learn how to get more out OSCAR reports on an ongoing basis.    

When you view OSCAR better know what Minute Vent results & Resp Rate variability indicate good healthy therapy and know what results are not good messages. 

 
People who have been using therapy for some time and feel like they have not yet fully achieved the sleep results they desire might find some value by using the data captured from wearing night-long Pulse-Oximetry to answer a few questions and learn how to gain more value from the OSCAR reports they view each day. 
 
Establish your Best Case / Healthy Baseline - Establish / determine and document what your HR & SpO2 Average, High & Low values baseline/benchmark is on a good night so you will have a frame of reference to check against later if your not feeling well.

Establish your Baseline of Current State Undesired Scores - Establish / determine and document your HR & SpO2 Average, High & Low values baseline/benchmark is as averages among the worst periods you can find across multiple bad periods across a number of nights so going forward you can see where you are improving and by how much.
 
Should you wear a Pulse-Oixmeter? - Assess how big a concern monitoring and improving SpO2 is for you personally, especially if you are concerned that your average Minute Vent Median results over time like they might be low for someone your size or if you see time periods in OSCAR more than a few minutes long when your Minute Vent has dropped below 5.5 if your a male of average height.  A few nights on a Pulse-Ox should help determine if your O2 / SpO2 levels through the night are a significant concern or not.  
 
Gain more from OSCAR - Establish your personal daily Minute Vent Median key indicator values:  Assess against OSCAR results both really good and the worst periods of time for SpO2 in the Pulse-Ox results across multiple days to determine your Red- Yellow-Green boundary for your Minute Vent Median results (e.g. ~As long as my Minute Vent is above 7.2L/min and not a crazy high number I am really good.  At Min Vent 6.8L/min I can feel the difference and any number below 6.4L/min is a problem I need to give some attention). 
 
Gain more from OSCAR – Get more signaling value from the Minute Vent chart:  Establish / determine what your personal good / bad boundary numbers for momentary, short time frame Minute Vent chart results by taking the really good and the worst periods of time for SpO2 across multiple days to assess Minute Vent numbers at those same time periods.  I read that Minute Vent is not always accurate up to the current breath.  That Minute Vent has up a 5 breath lookback and sometimes during long expirations or CAs Minute Vent continues to report results of recent breaths even when in reality your breath has currently stopped like during CAs or heavy flow limitations. So use what is happening at that breath in the Flow Rate waveform, AHI events & near AHI events, the Respiration Rate, Leak Rate and Flow Limitations charts to clarify what is really happening with Minute Vent if a SpO2 desat left you expecting to see a Minute Vent drop that did not appear.  Also use those additional indicators to clarify Minute Vent when Minute Vent drops during Leaks but there is no corresponding destat, reported in SpO2. 
 
Gain more from OSCAR – Get more signaling value from the Resp. Rate chart:   I am starting to warm up to something mper said about the Respiration Rate chart being a powerful ‘proxy system metric’ that can tell us a lot about what is going on far beyond just Resp Rate.     Establish / determine what Resp Rate variability (quiet smooth curves vs large changes or spastic chaos) has very little impact on your heart rate and can be ignored and also the breaking point where Resp Rate has reached a point of disruption or chaos / variability that is signaling damage to your sleep and long term health from increased heart rate, increased heart rate variability, disrupting arousals, and interruption of your sleep cycles.  I have learned to use Resp Rate as a strong proxy for immediate heart rate and heart rate variability impact.      Mper and others may have more to add on how to further leverage the Resp Rate Chart.

INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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