[Treatment] Treating UARS with CPAP and bilevel

[mper6794]

....is that significant? Maybe not in numbers like this. However, TV, in my opinion, particularly when properly calibrared like mine, is one of the most significant waveforms at same rank as FR. TV reflects pretty much everything that goes during sleep, stages, cycling, arousals, awakenings, wakeups, causes of those, and so on. I kind of see TV as EEG on the contrary, in terms of frequence, etc.
GL

[sheepless]

mper, would you be willing to explain a little about how you interpret tidal volume in the context of your list: i.e., stages, cycling, arousals, awakenings, wakeups, causes of those, and so on. I know it's a lot to ask; I haven't spent much time with tv and would like to learn. slowriter may be interested but if you're willing and it's inappropriate in this thread, pm me or start a new thread?

[mper6794]

Hi, sheepless
..... "or start a new thread?" Good point......yes, I think, it would be too much noise going further on this here!. I would be happy to go through those points I made, plenty of examples from my curves, scientific literature (look, for instance, the original Dr. Guilleminauts paper on UARS),  etc. However, not sure about availability of my time to go through this.
For you just have a flavor, I would suggest start reading everything you can on (1) sleep stages universal durations, and yours, themselves; (2) how brain waves frequence and aplitude reflects on FR and TV, and vice-versa (for instance, what happens once you enters on N3/N4 stage, REM instability, and so on); (3) and, of course, you have to properly calibrate your curves with audio-recording.

GL

[slowriter]

We should definitely have the TV thing documented somewhere.

Wiki?

[slowriter]

Looking through the last two months, not a single night looks normal in the TV graphs, by which I mean pretty tight range around 500 for most of the night, with increases at spaced intervals that would indeed correspond to REM (googling around shows they do exist)..

Not sure what to do with this, but definitely another helpful variable.

Thanks again to mper6794!

[mper6794]

Slowriter, 
I will take the risk! On sept 2th, it appears, lucklly, you have gone through some good strecthes of N3/N4 (look for stability on TV), and  REM 1, from 23:20 to 23:40, REM 2, from 0:50? to...?, REM3, from 2:16 3:10...

I forgot to mention one very important aspect on using FR and TV curves: they, combined, allows you to quickly spot false events (central, OA, FL, while awake), and consequent misleading numbers and interpretations, as alexp mentioned earlier. Everyday, I am using to recount all my events; never trust in Resmed report, particularly in my case, with so frequent arousals/awakenings, wake ups. 

GL

[slowriter]

Slowriter, 
I will take the risk! On sept 2th, it appears, lucklly, you have gone through some good strecthes of N3/N4 (look for stability on TV), and  REM 1, from 23:20 to 23:40, REM 2, from 0:50? to...?, REM3, from 2:16 3:10...

Thanks!

But you would agree that ideally (so we all understand what you've been seeing), we want to see a more stable and tight range, with more distinct areas of increase, that we think correspond to REM stages?

As in, if my therapy is going well, in two months we'll see improvement along those lines?

[mper6794]

Hi, slowriter
those are important questions. Why have we gone into all these discussions? where and why all this started? so, what? what next aiming at improving your therapy?
Let me make my points, mixing your case with mine: first, I have stepped in because your case is similar to mine, I think; flow limitations and PLM’s are my main and single focuses in this forum.
Second, prior different opinions before I stepped in, pointed you had already worked out your apnea events, and your remaining FL’s had reached a point at which it would not be worth going any further chasing them. I almost agree up on these points, taking into consideration only numbers (my reference for this, in terms of flagged FL, are P95 = zero, and Max < 0.10). [However, in my case, after surpass this stage, I keep facing non-flagged flow restrictions, which still produce awakening/wake-up of 1 event/hr on average, and I have still been trying to improve].
Nonetheless, you (like me, sometimes) quite often keep on going with poor sleep quality and rather low HYF index, while trying distinct pressure and PS combinations. Therefore, what is going on? What is your ultimate diagnose? You remain only with non-flagged flow restrictions (at least on sept 2th, this appears not be the case, yet should explore more this)? Or there would be something else, like PLM’s or whatever cause for your so many arousals/wakening/wake-ups? THIS SHOULD BE YOUR NEXT STEP: to investigate cause(s) for these ar/aw/wk. I have tried to provide you with some suggestions above, concerning rule out or not PLM’s.
In my case, no doubt that PLM’s is the main curse left (I have RLS since kid)! PLM’s still bother me some 2/3 times/hr! And, you might know, for PLM’s, no other way to go rather than medication and/or supplements. I have been trying softer alternative solutions, yet I know very well safe harbur with big shots (Clonazepam 0.5mg, for instance), which overnight, bring high HYF index, enough to dance rather than walk in the streets (see my posts elsewhere on this).
Good news: at least for me, I have found out, by carefully plotting everything against a HYF index, the main goal is SLEEP EFFICIENCY (SE), no matter how many ar/aw/wk(s) you have. Once you bracket a time for sleeping (in my case 0:00 to 6:30) and estimate SE within, you are going to see that once you reach some 85% or more, you will start dancing.  
Good luck

[slowriter]

What's HYF index?

[mper6794]

HYF: "how to you feel index"....created this daily number to measure how am feeling during the day...varies from 0 to 5....how to do this? pretty easy: look for yourself some 5 to 7 times during the day, say, as you get up, exercise, go for a walk, how much sleepness in critical hours for you, how is your social, your face, and son on....it is an individual thing! works very good to me....I can plot it on excel against other parameters. It is a great metrics!

GL