RE: periodic leg movement
(07-19-2020, 02:02 PM)sheepless Wrote: Shulamet, how plm fits in & what to do about it is what I hope we're doing in this thread.
I don't pretend to know much about the subject but in my experience so far pap has had no bearing on my plm other than to complicate apnea treatment. only meds have helped & even then only partially.
........
meanwhile, my suggestion is to ask your gp or family doc for help with plm. just show them your sleep study notes documenting them.
Totally agree. Sadly only PLM related meds have been helpful for me so far.
RE: periodic leg movement
(07-17-2020, 05:47 PM)sheepless Wrote: now that I think about it, while I've had max pressure support as high as it goes at times, I'm not sure I ever set min pressure support above about 5.4 cmw; maybe that would better address flow limitations.
I was having the same thoughts. Did you trial it? I'm getting consistently low AHI/RDI, but that doesn't translate to a long restful sleep.
Maybe lifting my minimum a little is in order as a test. I'll give that a go for the next week and report back.
7-15 is now adjusted to 8-15.
Cheers,
D.
RE: periodic leg movement
Damian, I haven't pushed min ps up yet but plan to. my lip leaks have been getting out of control so I've gone lower with everything (recently from 5.2 over 8.2-13.4 to 4 over 7-12) which has helped reduce leaks a bit, but not enough. in addition, my respiration rate has increased; minute ventilation and tidal volume decreased. flow limitations and oa also up a bit as well. going to try increasing min ps before pushing epap back up.
wish I could figure out how to stop the dang lip leaks. with more or less fixed settings, they aren't a function of pressure. seems to be as I get into deeper sleep, muscles must relax too much. can't tape with a beard, chin strap trial was ineffective, collars' losing effectiveness. the only thing I can think of is I've lost about 25 pounds in last 9 months or so but I don't know how that would affect lip leaks. I might be able to maintain somewhat lower pressure without significantly affecting ahi but as I said with new settings I think rr (~18, up from ~15) too high and tv (390-400, down from ~460-500) too low.
a positive thing: I'm now staggering my Ropinirole dose (for plm) to make it a little more effective for a longer time by taking 2mg at 8pm and another 2mg at 10 or 10:30pm bedtime. plm is still significant and wakes me in first short sessions, then not much after that. waxing waning flows with leaks, flow limitations and events dominate the rest of the night. ahi usually 3 and under but sleep still much too disturbed and fragmented...
more than you asked but thought I'd update my 'progress'. post back with results of raising your min pressure. with the autoset, min pressure and epr are the tools for flow limitations.
RE: periodic leg movement
sheepless, your grappling with PLM is difficult enough without lip fluttering. Here is my two-piece long time fix for my lip fluttering and leaks (with 95% pressure 11.8 cm H2O column). It requires some detail and explanation and is available here https://www.silipos.com/products/gel-e-r...2ff0&_ss=r . It may not work for a full beard up to the bottom of the nose and across the full width of one's face. Seems doubtful. Tape or something else may be better. A certain minimum gel to skin contact area below that horizontal line is a key limiting factor.
The mineral gel backed cloth element is from US manufacturer Silipos where it is available for about $28 for a roll 4 x 48 inches. It is elastic lengthwise, but not crosswise. Silipos specializes in such medical grade products, including those that reduce scarring from surgeries, etc. I can't recommend it enough for those who've long been troubled by and fought mouth leaks. It clings fast without slippage but does not adhere like an adhesive and there is no residue. I do not stretch it, only smooth it, and press it down a bit while holding my chin high upward so gravity holds the strip in place while I place the retainer over it, around my neck and fasten its velcro strap with two hands.
More details:
I use an ear to ear length of the gel strip along with a retainer like the one pictured. Wearing a mustache, presently, I have continued to defer trial of only a 2 inch wide ear to ear piece (can't remember why I changed/blundered? into using a longer piece than pictured--maybe the first, more worn out retainer fabric slipped some). If 2 x 9 inch works, then I'll cut that in half and try 2 x 4 inch size. Will only do those cuts and trials (as I should have by now) after my newer gel strip piece ages a couple of months and nears time for replacement. The reluctance to try is from resistance to fixing what ain't broken, what has worked perfectly almost every single night for two years or more.
I dampen my face slightly after carefully washing and drying it just before putting on the seal; dampness lasts and enhances fixity of the seal position. Fortunately, I don't have sensitive skin, if that might be a deterrent. My gentle washing of the flat-on-the-counter-top seal (as if finger painting it with a gentle soap and blotting and airing it dry-- about every 6-8 weeks) has long been trouble free.
Facial hair, my mustache, is the present concern explaining continued, more expensive use of the 4 x 9 large strip. The gel strip is unable to cling to hair as closely and securely as it does to clean skin so a shorter or/and narrower strip may not stay in fixed position as well as the larger piece--because of the latter's greater skin contact area. Moreover, friction between the gel strip's outer-surface cloth area and the elastic retainer cloth enables the gel strip to help keep the retainer up.
Various other retainer items will likely work for others. Long ago I got "to the end of my rope", needed and wanted a final solution now without more fiddling around and sleep disturbance. The retainer pictured and its professionally sewn replacement was made from the top of an elastic compression stocking which had a double thick band around its top. The doubling does put more pressure on and above my lip which I think is good. The top edges of the gel strip and its retainer are put about 1/4 inch below the bottom of the divider between nose openings.
I always use a bleep or a P-10 , with a soft cervical collar and am (without my gel strip device and c-collar) an incorrigible slack jawed, drooling, 23-BMI mouth breather when sleeping (entirely and forcedly) on my side to stop severe OSA in supine position. Further, I flunked the long tried tongue training exercise and method and dabbled with several unpleasant, ineffective and expensive tapes.
2SB
I have no particular qualifications or expertise with respect to the apnea/cpap/sleep related content of my posts beyond my own user experiences and what I've learned from others on this site. Each of us bears the burden of evaluating the validity and applicability of what we read here before acting on it.
Of my 3 once-needed, helpful, and adjunctive devices I have listed, only the accelerometer remains operative (but now idle). My second CMS50I died, too, of old age and the so-so Dreem 2 needs head-positioning band repair--if, indeed, Dreem even supports use of it now.
RE: periodic leg movement
2SB, thank you so much for the detailed method for reducing lip leaks. it's new and innovative to me. I'll study your post more closely tonight or tomorrow when I have more time. on first quick read I'm unsure if you think it can be made to work with a full beard; regardless, it might send me in a new direction at least. last night my 95% leak rate was 35mL/m with 24% of the night above the redline. not good.
I am at my wits end to find a solution short of shaving, something even my own dear departed mother encouraged me not to do as it's not a pretty sight (one's vanity tends to decline as we get older but this one is a tough one for me). of course, it might be the price I have to pay for better sleep, but it'll be the last resort.
I did try a tongue advancement holder thingy with a flange that between lips and teeth. should of worked theoretically but maybe only because of the protruding tongue I drooled and leaked all the more. it's been on my mind to try a pacifier with an internal protrusion that can be gripped between the teeth; just have to find one.
RE: periodic leg movement
My father tried an Abraham Lincoln style beard with the mustache and chin shaved and it has helped tremendously with his leaks without having to forgo the whole beard.
RE: periodic leg movement
great idea! if I can't manage to improve things some way some how pretty soon, that'll be my second to last resort :-)
RE: periodic leg movement
Beardless here so I can tape. Doesn't always work, but it helps.
On a side note, my initial results on lifting my minimum pressure to attempt to reduce PLM is inconclusive so far. The only biproduct is my mouth wanting to leak more than normal.
It gets too hard some days.
I've ordered the bluetooth movement sensor to strap to my ankle to start studying correlations. Let the data overload begin.
D.
RE: periodic leg movement
Bearded and I taped. You are taping the lips, not the beard anyway.
RE: periodic leg movement
Bonjour, did you have to make it super tight or was it more about getting tape that would cope with hair?
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