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Need help reading my charts
#1
Need help reading my charts
       
Hello,  could I get some help on understanding on what is happening with my stats.  It seems to take me 12 hours before I finally feel rested.  On these screenshots it does not show the couch nap I took without the machine.  I took 6mg Ambien at 10:30 pm, then 4mg Ambien when I woke up and removed the mask..  Also, note that I have Pulmonary Sarcoidosis with means almost half my oxygen receptors in my lungs are blocked up (that's a FYI, ignore it if you don't think it's relevant).  I switched from Respironics ASV to Resmed ASV about November 11 and am still working on getting it dialed in properly.  Thank you for any help.

To add -- I don't seem to be a mouth breather, but I do notice some trouble with mouth farts in the final stage of sleeping. I wonder if it might be the reason I wake up.
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#2
RE: Need help reading my charts
The zoomed segment shows a lot of variable breathing with pressure support maintaining most of the tidal volume through the section. The ASV seems to be working well. What happens if you allow a high PS max? The machine uses the allowed 10.4 a significant amount of the time, and that seems to stop apnea and hypopnea events. I suppose using a pulse oximeter might tell you if this is sufficient. Especially with the pulmonary impairment, you should be checking whether supplemental O2 should be used in conjunction with your ASV therapy.
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#3
RE: Need help reading my charts
the zoomed segment looks suspiciously like periodic limb movement. do you see this very often? post another screenshot of the same thing or another area with the same pattern at a 10 minute view scale with y-axis set to 80 and -80.
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#4
RE: Need help reading my charts
My PS max was originally 12, but I turned it down due to mouth farts and sometimes it seemed like it really wanted to blow me over -- and I was thinking the lower pressure would help.  Do you think I should make any changes -- and I'm guessing when you talk about "checking whether supplemental O2 should be used in conjunction with your ASV therapy. " -- I'm thinking that it is something I would have to check with my sleep/Pulmonology doctor , which I see in about a month.  As for the mouth farts, when I awoke this morning, they were obnoxious enough to make me take the mask off even though I wanted to just relax in bed awhile.
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#5
RE: Need help reading my charts
   
[attachment=30384]

Sheepless,  hopefully, this is what you're looking for.  And I have seen it, but not all the time.


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#6
RE: Need help reading my charts
I suppose it could be something else but the pattern is indicative enough that I'd want to rule plm out. did your sleep study report any? is there someone that you can ask to monitor your sleep occasionally? audio and especially video recorders would help too because you won't ever be aware of plm.

IF it's plm, it'll be sporadic. some nights none at all. I see it mostly in the beginning hours of the night but it can occur at any time. my episodes last from a few movements to up to an hour or so. the intervals between inhale spikes in any given episode are pretty uniform; mine are usually roughly 10-30 seconds apart, 4 -5 to 16 - 20 smaller breaths between them. while intervals may vary per episode, they're pretty uniform within an episode. but I suspect it varies per individual.

if you can't rule plm out, I can tell you more about how I've grappled with it with a resmed autoset, vauto and asv and with meds.
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#7
RE: Need help reading my charts
I've had 5 lab sleep studies, and it's been mentioned twice.  I've been sleeping alone a few years now, but I've never had any comments previously about leg movements.  But then again, I didn't have sleep apnea previously either. So it sounds like I can't rule PLM  out.  I'm open to suggestions, including having to buy a camcorder.
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#8
RE: Need help reading my charts
I went through your other threads. the 7 page sleep study isn't visible but the one pager you posted indicated 214 limb movements, 2 of which woke you up (and while not noted, I'm certain many others disturbed your sleep). you had moderate sleep apnea with ahi of 16.07. one apnea and 58 hypopnea. nowhere do I see that the study distinguished between obstructive and central so I'm not sure how you arrived at mixed apnea and an asv unless your doc is certain the hypopnea were central. actually, the hypopnea may well be a consequence of plm.

given your complaints, the suspect flow rate pattern, the fragmentation indicated on your other screenshots and your doc clearly writing Periodic Limb Movement Disorder on your sleep study summary, I'd say that if you're still feeling unrefreshed with very good ahi, plm is working against you.

I've gotten my ahi down below 1 and still find plm to be almost as debilitating as apnea. I suggest you take a copy of any studies that indicate plm to your doctor, not necessarily your sleep doc, to talk about remedies. in my limited experience, docs won't attend to this unless you press. and press. and press. it may take considerable trial and error to find the remedy that works for you.

meanwhile, unless you really have mixed apnea, which so far I've seen no evidence of, the asv may be causing more problems than it helps. you can see in your zoomed shot how ps is rising and falling between about 8 and 20 cmw every 10-30 seconds. I didn't realize it until I tried vauto that these swings were wearing me down.

an interesting experiment would be to reduce ps. if you have ca, you need lots of ps to trigger a breath when you don't do so spontaneously. reducing ps will do 2 things: we can see if your apnea event count goes up (suggesting ca) and it should reduce the disturbances created by the machine's ps response to your plm breathing (which I believe but can't say authoritatively is from non-passive flow limitations ps won't overcome). the lowest ps the asv will allow is 0-5 so you'll still get pressure swings but they'll be less dramatic. (alternatively, you might learn something from increasing ps but I'm not sure what's to be gained since your ahi is already below 2; apnea isn't your current problem.)

in an attempt to achieve more constant bilevel pressure I've used the vauto set to epap that eliminates most obstructives, with ps that helps reduce hypopnea and flow limitations, and capped max pressure to be the sum of those 2 numbers. in effect, constant epap and constant ipap. setting trigger to very high brought my ca down to next to none.

after finding meds that help reduce my plm I find I can use either my asv or vauto and achieve similar results. before meds helped my plm, there was no question that I felt better on vauto even though my ahi (and ca) was a little higher than with asv.

your situation and results may differ. I can only tell you about my experiences.

I don't think you need more 'proof' of plm but if you want additional confirmation, by all means use an audio and/or video recorder. my phone sleep app has a noise activated recorder that was useful. in addition my wife audio recorded me. I can clearly hear the rustling of the sheets with movements, often followed by a grunt/groan. (my wife used to count 'sheep' by counting off the seconds between my kicks. I finally got her to record it for me.) of course video will be more enlightening. others here have used phones or other devices to record movement but I haven't spent the time to figure out how to do that since I'm sure enough that I suffer from plm. search the site for more info. if I remember correctly 2SleepBetta and Kappa, among others, have posted about this.

not sure what else to tell you at this point. ask if you have questions.
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#9
RE: Need help reading my charts
You can always get a reasonably priced recording pulse oximeter and add it to the OSCAR charts. I've got the CMS 50F which does well enough. Certainly bring the oxygen question up with the doc, but monitoring can be done whenever you get the pulse oximeter.

I wonder if lowering the EPAP Max and adding it back to the PS Max may benefit. Alternately, just add some PS Max if there's not enough for the ASV to work with as is.
Dave

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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#10
RE: Need help reading my charts

.pdf   Scan-1.pdf (Size: 212.88 KB / Downloads: 7)
.pdf   Scan-2.pdf (Size: 206.73 KB / Downloads: 7)
.pdf   Scan-3.pdf (Size: 162.93 KB / Downloads: 7) I'm attaching the only lab sleep study paperwork I've received (from the newest sleep study).  The sleep lab tech mentioned, at the second lab sleep study, 'a lot of leg movement' while I was still in the lab -- the sleep doctor said nothing about it.  I tried three other machines before settling on the Respironics ASV -- BUT, after a year and a half, I end up with insomnia, with lots of sleep issues, and the doctor put me on Ambien.  It sounds like I need to attack the PSMD problem over anything else though.
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