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Lingering fatigue: trust Resmed sleep report?
RE: Lingering fatigue: trust Resmed sleep report?
Hi, Sheepless
Just to let you know I am taking into consideration what you have been added here; appreciated. Just was wondering if would be worth putting significant noise on Gcrithley’s thread, in particular before he returns to us more information on the audio-recording process and curve calibration. Moreover, after going through your thread “18 months……”, maybe it would be better leave room and resume discussions there. What a quest and suffering from your part all these years; I empathize! I am still studying the thread and wondering if I could add anything, after so many efforts of more experienced people of this forum. I will return to you as soon as I can on the “ 18 months….”.
good luck
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RE: Lingering fatigue: trust Resmed sleep report?
Hi All - I was away from home for a couple of weeks with my mom's 90th birthday, and then a return to some Dorian scares and an evacuation week.

I have been trying higher pressures with (EPR enables at 3) to get rid of the flow limits (which I'm guessing contributes to my lingering tiredness/sleepiness during the day). I also had a full blood panel drawn last week and will go over the results next week, so see if all of that is outside the realm of my PAP therapy.
I'm posting full nights' graphs from 
1) last night (nasal pillows/mouth taped) in APAP mode with 12/9 cm pressures, 
2) the night before last in CPAP Mode (Fixed 10 cm pressure) with a full face mask, and 
3) 3 nights ago with nasal pillows in CPAP mode at 9.2cm. 

The settings in #3 above were untouched for a couple of weeks prior. I decided to mess with things again, mostly because the flow limitations weren't being eliminated, and I am still feeling sleepy, brain foggy and needing daily naps.

So in summary thus far:  
I like how the higher pressures seems to have addressed some (but far from all) of the flow limitations from my long established apap settings from a month ago and prior, which had been the same for months and months  - (APAP - Min 6.6 Max 7.4 with nasal pillows) - With this setup I indeed had many nights with a zero AHI but still had lots of flow limitations in my graph, so I've been attempting to resolve those FL's in my quest to feel better. Now the FL have lessened, but with those higher pressures come new issues - the main one, "chipmunk cheeks," where the air billows up in my cheeks (my mouth is taped) and wakes me. This can happen several times a night, replacing one problem with another to the same end - repeated arousals from sleep.

So here's where I'm at now - i want to continue to try higher pressures to address FL's and hopefully get at this sleepiness to go away. I can't tolerate any of the 8 or more Full faced masks I've tried over time (just look at my graph from 2 nights ago wearing a FF mask, and you'll see why I felt like death the next day). I do love my nasal pillows, (which never leak) and don't mind mouth taping, but mouth tape, pillows, and higher pressures, I have the issue of  chipmunk cheeks

My specific questions today:
1) I have an Airsense 10 autoset now. Would buying an Aircurve VAuto allow me to raise my pressures even more, without the chipmunk cheeking? (I've made it into a verb) I assume that the chipmunk cheeks happens on exhalation, as that's when there's more pressure in my body, so maybe using the Aircurve's PS of 4 (or higher) would eliminate that issue while allowing more pressure to attack the FL's? Maybe it would even allow me to stop taping?
2) assuming the answer to #1 is "yes" - is there anything the aircurve Vauto CANNOT do, setting wise, that the airsense I already have CAN do? I think it's worth a few hundred $$ to try it, unless there's some downside I'm missing. i would need everyone's help with the setup of settings, and would likely start at about where I left off with the airsense machine. For me, if there's no downside, I'm ready to try it.
3) still assuming the answer to #1 is "yes" - which exact model of aircurve should I get? I know there's an ST and a couple of other choices.
4) how do we know that FL's happen on an inhale? Early in my apnea diagnosis and journey, I had always thought the important pressure was against the exhale, not the inhale, as purported by over the counter products like theravent etc, that cause back pressure against exhaling. When lying on my back on the sofa, for example, wide awake, I sometimes breath out through my mouth because a valve or flap in my throat closes, forcing my exhale through my mouth. I assume this happens while asleep too - when sleeping without treatment, I often "puff" air out through my closed lips (as reported by my partner). My ENT didn't think this was an issue, and a throat scan showed nothing out of the ordinary to him. So, with EPR or PS settings in place, thereby removing some of the the back pressure on exhale, (which of course is comfortable), wouldn't that remove/lessen any potential treatment of expiratory events? 
5) on the FL graph, I assume that above the line is an inhale and below is an exhale?

Finally, so everyone knows where I'm headed with this journey, (as per fellow forum member "mper's" suggestion), I'm going to video myself sleeping and record audio starting (hopefully) tonight, and see how much I'm moving, if that is an issue I'm unaware of. My sleep lab didn't show it as an issue, but that entire night was weird - I swear (in fact I know) i didn't sleep barely at all in the lab, and they claim I slept quite well. Amazing the difference in perspective. It was one of the worst sleep nights of my life.

Also - although I've been through it before, I did blood panels again to see if there's anything else going on that could be causing the fatigue. The last round showed that I was fine in all other areas, but just making sure. I get the results on Tuesday. last time, despite "normal" numbers, I did try Testosterone pellet therapy - my numbers went wayyyy up, but it still didn't address the sleepiness.

thanks for being on this ride with me. Please let me know your thoughts.

*PS - It has also occurred to me that the flow limits I have might be deemed a non-issue, and that I might be chasing a fantasy - one of the problems is that I really don't know how that graph "should" look, and there's no consensus anywhere. How does one know when to let go of the need for clearing that chart of events and acceptance? I certainly see many other FL graphs that look much worse, but I still don't feel good).

*PSS - i eat well, exercise every day (a revolving schedule of yoga, weights and HIIT on a bike) - that always clears the brain fog for a while, but I always need a nap.

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RE: Lingering fatigue: trust Resmed sleep report?
Hi, gcritley
Well come back. Your curves, If i may:
1_poor nights' sleep, very S.E., due tens of arousals/awakenings. What is causing the arousals? Will see soon, i believe, in ten-minutes windows calibrared by audio-recording;
2_flagged FL yet not totally under control; provoking arousals/aw.
3_unflagged Air Flow Reduction (AFR) may be a big issue; provoking arousals/aw;
4_both 2 and 3, and high pressures drawbacks, could very much be benefit from going to BPAP;
5_Plm's-associated arousals/awakenings keep on going as strongly suspected.
To start with: could you please post some ten-minute duration windows embracing arousals/aw?

Lot to learn with your case; similar to mine at the beginning.

Good luck
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RE: Lingering fatigue: trust Resmed sleep report?
I don't believe that flow limits are the source of your issues. I believe that they are well enough managed at this time. Yes you could marginally improve them, but as I said I douby that that will resolve your issues.
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RE: Lingering fatigue: trust Resmed sleep report?
Hello, gcritchley, I'm responding to your problems with the ballooning cheeks.

I think in my case, little bubbles of air sneak around my imperfect tongue seal over a period of minutes and pile up until (a) my cheeks puff up or (b) I swallow the air or © I loosen a corner of the mouth tape and let it out.

I experienced this problem whenever I made pressure increases both with the Airsense ResMed 10 Autoset that I used to use and with the Vauto I use now. I doubt you'd see any difference switching to a Vauto.

What always seemed to help was just to raise pressures very slowly, staying at each new pressure for at least a week (usually longer). At each new pressure, I would renew my attention to the position of my tongue and jaw. (I used a collar for a while, though no longer feel the need.) Over time my body would somehow learn to adapt. I hope time will be on your side too.
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RE: Lingering fatigue: trust Resmed sleep report?
I have the same problem with chipmunk cheeks and lip leaks. best I can do to minimize lip leaks is with a c collar but they just won't quit. can't tape with a beard.

seems my leaks aren't so much associated with higher pressure as deeper sleep.

maybe a ffm is the solution if I can find one that'll seal over my beard. but I really like the minimal footprint of the nasal pillows. so I live with ~ 1% to ~ 12% of the time over the leak redline. and too many arousals from the noise and a dry mouth.

my sense is that my inability to master the tongue suck method that would force air out my nose rather than into my mouth is the problem. well, the problem is the misdirection of air and the only way I've heard will help this is the tongue suck technique.

I wish it isn't so, but just saying some of us might simply have to learn to live with some arousals from balloon cheeks and some large leaks.
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RE: Lingering fatigue: trust Resmed sleep report?
Let's start with you causing the air blowing out of your mouth to occur "on demand".  Put your mask on, under pressure, any position is ok.  Open your mouth while still holding the seal, no air should escape your mouth.  Now, consciously, open the back of your throat bu moving your tongue.  I had to, at least initially, shut the machine off to stop it.  

Another exercise is to talk while under pressure.  That too takes some time to get it down.  Do this frequently and you will learn how to handle it, eventually stopping it without turning off the machine.  I can assure you that this doesn't happen overnight.
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RE: Lingering fatigue: trust Resmed sleep report?
thanks for the pointers bonjour. I can do those things but usually avoid them because they're difficult. hadn't occurred to me to actively practice them. helpful to me for sure, maybe gcritchley and probably others struggling with chipmunk cheeks, lip leaks and the ol' tongue suck method.
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RE: Lingering fatigue: trust Resmed sleep report?
I have been on APAP for over 17 years. I love it and cannot sleep without it. I used to sleep up to 10hrs if I needed it and after starting therapy my daytime drowsiness stopped. As I have aged, I an not sleeping so well and my nightime urination needs have increased, sometimes 3 times a night. I have recently been testing my blood sugar and finding that I am borderline diabetic. Might be that the fatigue you are experiencing is a blood sugar problem because I am getting daytime fatigue again. IMHO
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RE: Lingering fatigue: trust Resmed sleep report?
(09-15-2019, 07:02 PM)bonjour Wrote: I don't believe that flow limits are the source of your issues.  I believe that they are well enough managed at this time.  Yes you could marginally improve them, but as I said I douby that that will resolve your issues.
Thanks Bonjour - I appreciate definitive statements like this, and I know you've seen many other cases with flow limitations as a factor. I've been following waketired's thread and have read your comments there, and hoped you'd weigh in. Thanks for all you do - your help here with me, and with the others in this awesome forum.
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