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[Treatment] Treating UARS with CPAP and bilevel - Printable Version

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RE: UARS and APAP - slowriter - 09-07-2019

Thanks for confirming alexp. I even had my respiratory therapist complaining about my pressure because she was looking at some number on a dashboard, and I had to insist they weren't real.

RE: UARS and APAP - mper6794 - 09-08-2019

Hi, Slowriter
Almost there.... apologies, but could plot some more 10min windows, say some 5 around TV peaks of 625?
I am suspecting some of your arousals are PLM's- associated (hopefuly i am wrong!), so that i would this additional to make sure (sorry, I trust very little on lab studies).

RE: UARS and APAP - mper6794 - 09-08-2019

....in time : all 10 min windows should have all waveforms i asked, please not Just FR and TV.

RE: UARS and APAP - slowriter - 09-08-2019

If I had PLM, wouldn't my spouse observe symptoms?

Anyway, attached.


RE: UARS and APAP - slowriter - 09-08-2019

Bit more.

My wife has mentioned occasional limb movement. But looking through a few videos and such, she's not sure if what she sees matches. So inconclusive (though skeptical) there. She will pay more attention.

Sleep studies and PLM:

I've done two over past two months. I reported the first one (where tech also said "behavioral observations were unremarkable"; they attached leg monitors, and also video taped), but not seen the second yet.

While any single study may not be representative, would not two studies with consistent results be fairly reliable?

RE: UARS and APAP - mper6794 - 09-08-2019

Hi, Slowriter
My observations thus far; they may change eventually. You know, it is hard going through this piece by piece! Waveforms context count much more than details. However:
1- your sept 2th night, compared to sept 4th, was indeed better in terms of number, sleep stage cycling; that matches with your HYF;
2- absolute majority (if not all of them) of your arousals/awakenings on septh 2th are not preceded by TV reductions (even slight); they appear suddenly events and with some periodicity at certain stretches. Therefore, they would not be associated with flow restrictions apparently; then also, not responding to changes in pressures.
3-Whatever cause such these arousal/aw should be investigated furhter by your self. The best way I have done in my casse was strap a 38$ boxes highly sensivite audio recorder device over my sheets, at the height of knees; so that you can record not only your scratches, but also some of your breaths sounds. Sometimes I put it close to my head. Outcomes were amazed; could calibrated my FR and TV curves (not need for my wife staying awake); touch the button sometimes to further assurance.
3- I was expecting the contrary of yout data, that is, flow restriction more important than jerk legs. But you might know, relations between flow restriction and jerk legs can be very complex: sometimes you treat flow and commpletely work out jerk legs; sometimes goes on the contrary; you treat jerk legs and work out flow restrictions throughout.
4- in my case, after struggling for some 5 months, with pressures and medications changes, I think I have reached optimum regard flow restriction ( epap min 7.4, PS 4.4, pmax 12.8); but still tying to improve flow restrictions drawbacks (one significant per hour yet). Concerning jerk legs, still trying alternative medications and/or supllements; please refer to my details on this issue, in other posters of this forum.
Goodk luck

RE: UARS and APAP - slowriter - 09-08-2019

Thank you @mper6794; I appreciate this!

On your "best" way, do you just place the recorder on your sheets, or do you tape it or something? And would not a smartphone recorder (say with a sleep monitor app that records) work just as well?

On your point #3, yes, occurs to me possibility of chicken and egg to work out: whether limb movement is happening and causing arousals, or whether arousals are causing limb movements.

I guess if I recorded I would want to identify those places where there are arousals, and see if they correspond with audio of movement?

RE: UARS and APAP - slowriter - 09-08-2019

Broader question:

@mper6794 has prompted me to look into TV, which is something I've been ignoring.

As I scan through my results, the nights where I seem to make it through the night, with low AHI (low reported CAs) are nights where median TV is between 460-500, the 95% is close to 700, and the max between 1000 and 1300.

On bad nights, the spread is much higher. Example: last night was 540, 1320, 1660 respectively.

Is that significant?

RE: UARS and APAP - sheepless - 09-08-2019

"...whether limb movement is happening and causing arousals, or whether arousals are causing limb movements.

it probably matters little from a practical standpoint but fwiw, I'm of the opinion that there's no direct relationship between apnea and plm; i.e., I don't believe apnea causes or triggers plm. I thrashed a lot in the throes of apnea but all of that, including what I call leg rolling, is different than plm.

I have only my own experience plus a touch of common sense logic to support this. the logic part is that apnea isn't periodic and I don't see any correlation between apnea and plm in my charts. if fact, my ahi is below 1 and I still have significant respiratory response to plm show up in my flow rate graph. that's not definitive and some things affect some people differently, but these characteristics lead me to think apnea and plm are completely unrelated issues.

there is absolutely no question plm causes arousals. I don't believe arousals cause plm.

RE: UARS and APAP - slowriter - 09-08-2019

I also wonder if there's a possibly more obvious explanation of continuing arousals, which I've yet to raise: mask annoyance?

I don't get major leaks, but the noise from my mask is quite noticable to me (particularly at these higher pressures), as is the occasional minor leaks when I'm on my side.