Vauto, PLM, FL & Mixed Apnea

[sheepless]

vauto. 11/20/19. ps 5.4 over 8.4 - 13.8


session ending ~23:27 ended after after a period of my typical plm pattern.

session ending ~2:18 ended after pb, then a ca.

session ending ~3:07 ended after ca, fl, plm


with respect to ripinirole, I'm supposed to take 0.75mg every night at bedtime.  because my plm is most notable early on, I try to take it 1 or 2 hours before bedtime.

[mper6794]

....not good! Were are approaching fine-tuned parameters, from both sides of the seesaw, 8.2/5.4.
....Could you please post some five ten-minute windows, anteceding and involving your awakenings (increases FR, etc), before i suggest.
..... return later
Thanks

[sheepless]

3 of 5 shots of session ends from 11/20/19.

[sheepless]

2 of 5 shots of session ends. 11/20/19

[mper6794]

Hi, sheepless

_ Don’t know HYF, but chart looks worse than 8.2/5.4’s, including slightly higher flagged FL and too many awakenings.

_Today, I was revising your full night charts, which usually had lower general low RR in the second part of the night; meaning to me that PLMS-driven awakenings and fake CA’s were concentrate on that second part, like yesterday and many previous nights. Then, I suspected Requip (6-hr half life) could not be covering that second part of the night. Then, in accordance with this,  when  I asked above, you said you indeed take the medication too early in the night. You have been sleeping much better on first par the night.

_ this last night, that generalized lower RR (CA tendence) of second part, due to EPAPmin, individually a little higher 8.4, would have provoked that low RR spread to the first part of the night (first time a see this), as well .

_ You know, in my opinion, you are a typical UARS-PLMS case, we tendence to trigger CA’s, like everyone, under increased EPAPmin and P.S. To treat this, first of all, we would need to do best we can to reduce arousal/awakenings. How? First, Increasing EPAPmin and/or P.S, and taking medication. There has been indication pressure adjustments have been favoring  your PLMS, in accordance with literature and some guy on the Cpap.talk.

_It looks that, individually, we have reached maximum bearable of those two parameters, 8.4 and 5.4 (see attached). However, there would still possible combinations, for instance 8.4 with 5.2 down to 4.6 (see attached). Eventually, we would have to go back to 8.2/5.4 (best outcoming HYF, maybe?).

_looking at your ten-minutes windows there are suggestions a great deal of your awakenings are respiratory effort-driven; not only PLMS.
_ therefore, for next night, and for some two or three more, I would suggest keep 8.4, slowing down P.S and trying to reduce CA tendence.

_EPAPmin: 8.4, P.S: 5.0. IPAPmax: 13.4….and, also, I would suggest, if a may, you take Requip later, just before bed, or even later; could split? So that second part of the night would be also covered.

_What do you think?
Goo luck

[mper6794]

.... Apologies to everyone: RR, above, actually is RR/2, which i use to facilitate cross plotting.
Sorry.
Gl

[sheepless]

vauto. 11/21/19. ps 5 over 8.4 - 13.4.

mper, let me know what 10 minute segments to show, if any.

ignoring the nap which was at the previous day's higher pressure, the first nighttime session was my typical plm pattern from start to finish.  the later sessions ended on the more csr-like pb. I have a screenshot of that entire hour; interesting how much more hairbrushy it is compared to the later sessions.

this is why I thought I should take the ripinirole earlier in the evening; i.e., the trend seems to be that my typical plm pattern occurs early in the night, changing to the more csr-like pattern later in the night.  for now I assume but do not know that the csr-like pattern is plm as well.

edited by OP to remove faulty image.

[mper6794]

......much better thans yesterday's.....HYF?
would you mind repeat with RR on top?..plus somoe five 10-min anteceding and involving your awakenings.
thanks

[mper6794]

... sorry, did not get: what time was the Requip? just once or split?

[sheepless]

revised image plus some session endings.

HYF: 6  / 10.  ready for a nap.

edited by OP to remove faulty images.