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flow limits, periodic breathing and unflagged events
#11
RE: flow limits, periodic breathing and unflagged events
I wasn't asleep during the first two segments. Tried but gave up and got out of bed. The third time, at around five, I fell asleep quickly.
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#12
RE: flow limits, periodic breathing and unflagged events
Here are the last three nights. 

   
   
   

Thanks again for the push to look for epr on my machine. It makes a difference in terms of how it feels with the mask on and also the flow limitation number has dropped. Are there any other improvements I can make? My original concerns from the title of the post really haven't been answered. Although the flow limitation number has dropped the waveform tops are still flat. Why am I suddenly taking a few deep breaths every twenty minutes or so. If the waveform/breathing disturbances are waking me up won't this interfere with my sleep archetecture? Are the awakenings caused by a twitching leg or is the twitching leg a result of the awakening? I've had two neurologists saying differently. And is the periodic breathing something to worry about? Any way to treat it?

So, any opinion?
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#13
RE: flow limits, periodic breathing and unflagged events
(08-18-2020, 08:24 PM)alembica Wrote: Here are the last three nights. 





Thanks again for the push to look for epr on my machine. It makes a difference in terms of how it feels with the mask on and also the flow limitation number has dropped.

That's good news.

Are there any other improvements I can make? My original concerns from the title of the post really haven't been answered. Although the flow limitation number has dropped the waveform tops are still flat.

Could you post a zoom from a night with the new settings where there are no flagged FLs but there is a series of flat-tops?

Why am I suddenly taking a few deep breaths every twenty minutes or so.  If the waveform/breathing disturbances are waking me up won't this interfere with my sleep archetecture? 

These could be arousals, and they could be messing with your sleep architecture, but it's hard to be sure using the data available

Are the awakenings caused by a twitching leg or is the twitching leg a result of the awakening? I've had two neurologists saying differently.

I hadn't realized you have night-time leg movements.  Did the neurologists specify restless leg syndrome or periodic limb movements?  Did they discuss treatment options with you?  More information about both conditions here, along with treatment possibilities:

https://www.mayoclinic.org/diseases-cond...c-20377168

https://my.clevelandclinic.org/health/di...-in-adults


And is the periodic breathing something to worry about? Any way to treat it?

Could you post an example from a night at your new settings?

So, any opinion?
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#14
RE: flow limits, periodic breathing and unflagged events
I think the new settings at 10/7 pressure looks about as good as we could hope for a fixed pressure CPAP, in fact it is an excellent result for any CPAP therapy. Your most recent charts seem to have an improved leak rate which will help minimize disruption. Now that you have found an effective therapy pressure scheme, it may take some time for this to translate into improvement in how you feel, and that is going to depend on getting in enough hours to satisfy your need for sleep. This is a pretty big shift in therapy efficacy, but 4-5 hours of sleep isn't going to leave you feeling like a new man. Are you working a late shift that you don't start sleeping until morning, or is the CPAP clock wrong?
Sleeprider
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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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#15
RE: flow limits, periodic breathing and unflagged events
(08-18-2020, 08:24 PM)alembica Wrote: Why am I suddenly taking a few deep breaths every twenty minutes or so. If the waveform/breathing disturbances are waking me up won't this interfere with my sleep architecture? Are the awakenings caused by a twitching leg or is the twitching leg a result of the awakening? I've had two neurologists saying differently. And is the periodic breathing something to worry about? Any way to treat it?

Hi Alembica,

I'd be most worried about the pattern of having to take deep breaths, I'd think they are indicators of other problems and yes, they might be disturbing your sleep. Ditto the leg movement.

Your question "are the awakenings caused by a twitching leg or is the twitching leg a result of the awakening" is the million dollar question and I am not sure there is a answer at this time. I do know that the sleep cycle is controlled by the Body's Circadian Rhythm. The Circadian cycle controls sleep, but it runs 24/7. Your body heals during sleep-without sleep you cannot be healthy and happy. The Circadian cycle has hundreds (or more) of inputs and is driven by hormones and by electrical stimulus from the body's own Central Nervous system. The point I'm trying to make is that sleep is a systemic issue, and without exhaustive tests of many known inputs into the body's chemistry, the solution cannot be found. I have to stress that we need to look for the cause and (conventional) doctors don't do this as a rule. They give you a pill and an order for the sleep test and they are done, you're cured, NOT. Sleep test are for apnea and related breathing issues during sleep. While apneas happen during sleep and they are important to know about and to treat, they might be just a symptom of other medical conditions-by treating them with a CPAP, we might only be treating a symptom.

I am curious, how is your diet? Do you eat gluten (which causes leaky gut syndrome)? Soy, toxic man made vegetable oil, sometimes called Canola Oil, Safflower Oil, Peanut Oil etc? Do you primarily eat prepackaged meals? Do you buy Grass Fed Beef, or just the hamburger you find at the supermarket? Do you eat hormone free chicken? Are the eggs that you buy and consume fed with soy? Are your veggies you consume from a can of from the organic section of the supermarket? I ask because our food is contaminated with artificial colors, bulking agents, preservatives, neurotoxins, biotoxins etc, these all degrade your health and interfere with the life cycle of the body-which most assuredly includes sleep.

Your deep breathing cycles and the leg twitches might be a cause of the sleep disturbance or a symptom of another medical issue and without a systemic analysis approach, the sleep study is only detecting symptoms. The leg twitches are caused by a malfunction in the brain, which normally controls what is called 'paralysis' during the sleeping hours. Paralysis is a misnomer, it doesn't paralyze, it actually relaxes instead. The muscles also have healing functions that can only take place during sleep, which is controlled by the Circadian Rhythm. I believe RLS and/or PLMS are serious issues, ones that conventional medicine practitioners consider as an annoyance, so they aren't investigated or considered to be as a health problem.

Finally, have you checked your B-12 recently?

ABA
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#16
RE: flow limits, periodic breathing and unflagged events
These are zooms that Dormeo asked for, all from last night. The first is typical. I know its subtle, but there is a definite osscilation pattern. This occurs throughout the night.

   

This is a typical set of flat top waveforms. Its about half and half flat and curved. I think it's an improvement over what I was seeing before the pressure adjustments.

   

And here is a five minute zoom of the periodic breathing when it wasn't so subtle. This happened two or three times last night and is typically a reaction to a breathing disturbance

   

To sleeprider: I'm actually happy overall with the therapy. Just trying to optimize it. I need to improve my sleep hygiene but its easier said than done. Since March, I haven't had much of a fixed schedule.

To ABA: What you say about systemic problems makes sense. I'll look into some of the things you mentioned. My main focus when I eat is not to raise my blood sugar which I do imperfectly, but sufficient in that my long term blood sugar (glycerated something) stays below 6.5. I also take metformin. So I basically have diabetes but manage it with minimal medication and diet. I would like to lose weight, as I believe that would help various systemic issues but I haven't been able to do so.

About the periodic leg movements. The plm and rls diagnosis have a lot of overlap but the diagnosis was plm from the first sleep study which had an AHI of 0.5 so I wasn't given cpap therapy. I was  given, sequentially over three years, clonazapam, pramipexole, over the counter melatonin and pharmaceutical slow release melatonin (brand name Circadin) and then nothing. Subjectively, I didn't feel any particular effect and,  with hindsight, it seems clear I should have tried cpap therapy before the drugs.

The mid-sleep awakenings also have parallels when I'm falling asleep and during the day. If I pay attention, I'll usually feel an electrical shock, localized somewhere on my body and of varying intensity, before I fall asleep. It actually wakes me up but at the same time its my body's signal that I'll be falling asleep soon so I might use it to turn off the light, put on the mask etc. The parallel during the day is that I almost always have a desire to take a deep breath or yawn and its satisfying only some of the time. Obviously, I'm not thinking about my breathing all the time but its something that I become aware of at various points in the day.
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#17
RE: flow limits, periodic breathing and unflagged events
Many thanks for the zoomed view. I hope Sleeprider can review them. To me, they suggest that you are right at your apneic threshold, meaning that even small increases in ventilation via increases respiration can wash out enough CO2 to depress the drive to breathe. But I don't have the expertise to pronounce on this.

Electric shock sensations can be among the ways in which RLS presents itself. There is a different class of drugs you have apparently not yet been prescribed. Here is the information from the Mayo Clinic web site:

"Drugs affecting calcium channels. Certain medications, such as gabapentin (Neurontin, Gralise), gabapentin enacarbil (Horizant) and pregabalin (Lyrica), work for some people with RLS."

I think several of the forum members use gabapentin and pregabalin with some success. Worth a discussion with your doctor?
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#18
RE: flow limits, periodic breathing and unflagged events
I agree with Domeo. The apneic threshold is something we need to write a wiki to help with. The root cause is ventilation that results in CO2 levels dropping which reduces respiratory drive. The body responds by breathing more shallow or a central apnea (loss of respiratory drive) and recovery breathing with larger volume. So where we see an oscillation in respiratory volume without obstruction, that is usually what we're dealing with. I think we can actually reduce pressure a bit and reduce EPR to 2. I think you are pretty comfortable with things, so let's try a small change to a pressure of 9.4 and see what EPR 2 does.

I don't see flow limitation as an issue, and I think the fixed Elite CPAP is probably better in this case than and Autoset.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


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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#19
RE: flow limits, periodic breathing and unflagged events
I'll make the adjustments and post after three nights. Thanks for the ideas.
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#20
RE: flow limits, periodic breathing and unflagged events
I'm going to postpone posting charts because a new issue arose. There is a hole in my hose. kind of obvious I suppose but I missed it for a week or so because it started around the time I made the changes suggested here so I assumed it was related. Also the hole in the hose only opened when the hose was bent. Located right before the mask, the air escaped in the same direction as the air escaping from the mask vent so I mistook the former for the latter. 

I taped up the hose with the same tape I use for my mouth. I made the repair in the middle of the night and it held for a few hours. Any suggestions for hose repair? I assume the hose is standard, it is plastic and has a coil running through it. I never confirmed what model mask I have, but I seem to remember Resmed f30; it's a full face mask and its a replacement for the one that came with the machine.
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