A Lost Cause?

[ajack]

I also think heading to 10 on a dreamstation should fix most of it. You may finish on 10 or 11, which would be about what a fixed pressure would be from your chart. They aren't as reactive as a resmed

[obob]

Thanks for the encouragement. I've set the pressure to 9.0 for tonight.

As for SWJ (I like that designation) I agree it is in a class of it's own, but that doesn't mean it has no effect on me. As little as the 20 minute bout with SW-Junk last night, I'm convinced, has left its mark on the "qualitative feelings" of this day. I'm sure I would feel better if it had not happened. I've taken much time trying to figure out how to escape from the grasp of Junk-sleep. Sometimes I can force myself awake. I've also once set the alarm to preempt it (for anticipated end of sleep SWJ that is). It is encouraging to hear you suggest that it will go away.

Qualitatively, I don't feel so great today but don't seem to have the muscle fatigue that I dread the most. I'm sure other non-sleep factors also are at play, such as lack of exercise.

obob

[Sleeprider]

SWJ is not pleasant, and causes the same panic or adrenalin response as other apnea. Just as you're falling asleep, you feel startled awake. We don't mean to minimize it, but it rarely lasts as you adapt to the therapy. It seems to be more of the hand-off from the voluntary respiratory response to the autonomic respiration of sleep. Be patient, and it should diminish or disappear.

[obob]

Thank you both,sleeprider and ajack, for your encouragement.

I will increment the minimum pressure by 0.5 cm for the requisite number of days to get to 10.0 cm, and post results without much or any comment. I'm supposed to be doing something else and must get started now. Should be free of this obligation by Tuesday.

obob

[obob]

Last night (at min 9.0 cm pressure) was a mixed bag in two sleep segments. First segment (on L side) was great, at least from my vantage point:
[attachment=10720][attachment=10721][attachment=10722]
The second segment started out OK but degenerated into a terrible bout of SWJ that seemed to take forever to extract myself from.  This was clearly caused by congestion and I'm almost certain that was because I'd forgotten to use my Azelastine nasal spray before going to bed.  It was a bad sleep experience.  Finally got back to so-so sleep by taking off my tennis ball thing and returning to my L-side position. 
[attachment=10723][attachment=10724]
Looks like I've exhausted my limit of snapshots for this post?

obob

[obob]

Min pressure set to 9.5 cm for last night (Attachments).  Definitely feel better.

Will set pressure at 10 cm tonight and see how that goes.  Wonder if I won't need to go a bit higher than that, which is fine with me.

obob

[Sleeprider]

As you have advanced pressure, the event rate, and flow limitation as well as respiratory statistics have improved. Your comfort seems subjectively better. I would not hesitate to continue increasing pressure gradually. You are the best judge of whether it is working better or worse under any scenario tried, and your current pressure is still only 50% of the CPAP range. I start at 13/9 bilevel pressure, and can go to 18/14, but rarely do. Many members on the forum routinely experience pressure of 12 to 18 cm. If you were using a Resmed Autoset, the machine would certainly increase pressure to treat these flow limitations, so with the Philips, we just have to do with the settings, what Resmed does automatically. I'll repeat my opinion that a Resmed would be a better choice for you.

The large cluster of CA earlier was a concern, and hopefully those also continue to diminish as they point to potential complex apnea, but the fact they do not occur every night, or even routinely is encouraging. We have plenty of time, and room to move the pressure around until you find what works. I appreciate your patient approach to slowly increasing pressure and observing both the AHI and qualitative results...carry-on.

[obob]

Thanks for the encouragement, sleeprider.  

• What ResMed machine would you recommend?  I can see what you mean concerning my PR APAP machine being sub-optimal to what you describe.  I might consider purchasing another machine out of pocket for two reasons; a) that it might do automatically what takes rather time-consuming titration with my PR APAP, and b) because I have two locations where I sleep and would prefer to not cary machine, mask(s) etc back and forth. c) Alternative to b), I might want to give the PR APAP to someone I know who needs it but has no insurance.
  
• Do you have any idea how Medicare would react to part-time use of my machine, now 2.5 months after giving me the PR APAP?
  
• My thought now is to continue incrementing by 0.5 cm pressure per night until I reach 11.0 cm.  I'll them post results for your appraisal on Wednesday.
  
• Patience is required, I fully agree, but my sleep clinic would have held me at 7-15 until mid-April  -- I can see now that would be a useless delay given my PR APAP.
  
• Think that of the seven CAs last night only two might be pressure related.
  

obob

[obob]

Sorry, I see you have already said the ResMed Autoset would be best for my situation.

obob

[Sleeprider]

The Autoset would be better, but the Aircurve 10 Vauto would be far out in front of that. The same machine I use, and it is available at an amazing price of $799 from Supplier #2 for a while.  The Aircurve 10 Vauto does everything the Autoset does, but far more. This machine not only provides the superior algorithm that avoids obstructive events, but can provide a much wider range of pressures support and allow you to customize the sensitivity of the trigger and cycle (when the machine triggers IPAP or cycles to EPAP), and adjust the time of inspiration.  So it's very flexible and suitable to deal with any obstructive apnea issue.  I happen to think that your particular breathing issues are poorly suited to the Philips Dreamstation auto algorithm and that is why we are having to manually titrate the pressure upward to find where it actually works.

In addition to that, even the Airsense 10 Autoset, as well as the Aircurve 10 Vauto will follow your breathing rather than try to predict it like the Philips.   When the Philips Dreamstation eases pressure ahead of exhale, it does so only momentarily, and resumes the CPAP pressure (same as IPAP) well before inhale begins.  Both the Autoset and Vauto follow your respiration so that as you begin to exhale, the machine follows that with lower pressure, and as you begin to inhale, it follows your breathing with pressure support.  This is easily seen by looking at the mask pressure chart next to the flow rate chart...something else your Philips machine won't do. Notice the blue line in this graph as it follows the flow rate set by the user, and the unique shape of that pressure curve.  It's just better!  This screenshot intentionally includes some disrupted breathing to show how the Vauto immediately responds to the user.