Abdulfakih - Therapy Thread

[Sleeprider]

In both your recent charts, there are periodic spikes that suggest arousal. It may be useful to look at zoomed images to see what precedes these arousals. Thse may be periodic leg movement or similar problem. At a big picture view, they do not appear to be respiratory, and all respiratory events appear to be resolved. It may be interesting to track your intermittent fasting and see whether that affects your sleep quality at all.

[Abdulfakih]

In both your recent charts, there are periodic spikes that suggest arousal.  It may be useful to look at zoomed images to see what precedes these arousals.  Thse may be periodic leg movement or similar problem. At a big picture view, they do not appear to be respiratory, and all respiratory events appear to be resolved. It may be interesting to track your intermittent fasting and see whether that affects your sleep quality at all.

Okay, is this what you asked for? if not please let me know if i should zoom in more or modify something else.

https://imgur.com/a/DEQ2556

[Abdulfakih]

its 4pm now and I can say I am completely exhausted

[Abdulfakih]

In both your recent charts, there are periodic spikes that suggest arousal.  It may be useful to look at zoomed images to see what precedes these arousals.  Thse may be periodic leg movement or similar problem. At a big picture view, they do not appear to be respiratory, and all respiratory events appear to be resolved. It may be interesting to track your intermittent fasting and see whether that affects your sleep quality at all.

Good morning sleep rider. Tonight was one of the worst nights I have had in my entire journey. I felt like I wokeup probably 10 times during the night. I did feel like it got worse from 12:30 onwards. I fully wokeup at 1ish, then at 3ish and inbetween. I felt everything. I looked at the data and I can see why, however I cant explain how tired I am feeling


https://imgur.com/a/aFuszTL

[Jay51]

Abdulfakih, thank you for posting that chart.  Since things have not gone as well as you expected after surgery, and the fact that you have already made a lot of tweaks try to optimize your therapy, it may be time to try to lobby for a more advanced machine (most likely the VAuto). Your choice to go the insurance (Dr.) route or self pay also.  

You still have a few leaks (not a concern IMO though since they are very low).  Also, still have a lot of H's.  Usually increasing EPR or pressure support stops the H's.  Some of it is clustered, so lowering pillow height, side sleeping instead of back sleeping, and even a soft cervical collar could help also.  Your tidal volume is still a bit low as well.  

The VAuto has more capabilities than your current machine (can take care of OSA and has higher pressure support than just EPR 3 full time).   I am personally on my 5th different machine since I started in 2021.  If you feel that you have exhausted every option with your current machine, then it is most likely time to move to a more advanced machine to help you with greater capabilities.  And there are even more machines after the VAuto (the ASV for example is even more advanced).  

What do you think?

[Sleeprider]

Jay, he switched over the Vauto last week. We are currently working with EPAP min 5.8, PS 3 and max IPAP at 9.4 with very-high trigger. My next step discussed before is to increase PS to 3.4. I can see periodic flow spikes in the charts and I don't know what those are. Probably need to get some zoomed shots of those. I sent a PM to Jay to get his input back into this thread because he is very helpful in these more complicated cases. I should have mentioned the Vauto.

Abdulfakia, please minimize the monthly calendar in your graphs by clicking on the triangle in the date-line or using the screenshot function (not sure what that is on a Mac).

[Jay51]

My apologies. That is right you did.  Totally agree with Sleeprider here in that increasing your PS "slowly" will hopefully get rid of the H's and maybe even increase your tidal volume a little bit.  No hurry raising PS drastically though.  OSCAR charts will show the best PS for you.

[Abdulfakih]

Abdulfakih, thank you for posting that chart.  Since things have not gone as well as you expected after surgery, and the fact that you have already made a lot of tweaks try to optimize your therapy, it may be time to try to lobby for a more advanced machine (most likely the VAuto). Your choice to go the insurance (Dr.) route or self pay also.  

You still have a few leaks (not a concern IMO though since they are very low).  Also, still have a lot of H's.  Usually increasing EPR or pressure support stops the H's.  Some of it is clustered, so lowering pillow height, side sleeping instead of back sleeping, and even a soft cervical collar could help also.  Your tidal volume is still a bit low as well.  

The VAuto has more capabilities than your current machine (can take care of OSA and has higher pressure support than just EPR 3 full time).   I am personally on my 5th different machine since I started in 2021.  If you feel that you have exhausted every option with your current machine, then it is most likely time to move to a more advanced machine to help you with greater capabilities.  And there are even more machines after the VAuto (the ASV for example is even more advanced).  

What do you think?

Hey man,

Thank you for replying. I was refreshing the post like every 5 minutes to see if anyone had replied .  The machine is already Vauto. I was using the settings sleeprider suggested and posted the results. I was awaiting his input to see what should be my next step but I guess he is currently busy.

This is what I think; CA have been resolved but in doing so I am waking up like 10 times during the night without explanation. Also Hypoapneas seem to be appearing, which were treated before. I am currently extremely tired where my eyes are hurting. Honestly I dont know what would be my next step and I am infront of the computer trying to figure it out

[Abdulfakih]

Jay, he switched over the Vauto last week. We are currently working with EPAP min 5.8, PS 3 and max IPAP at 9.4 with very-high trigger.  My next step discussed before is to increase PS to 3.4. I can see periodic flow spikes in the charts and I don't know what those are.  Probably need to get some zoomed shots of those.  I sent a PM to Jay to get his input back into this thread because he is very helpful in these more complicated cases. I should have mentioned the Vauto.

Abdulfakia, please minimize the monthly calendar in your graphs by clicking on the triangle in the date-line or using the screenshot function (not sure what that is on a Mac).

Hello sleeprider,

Perfect nice to meet you Jay and thanks for the support.

This is the zoomed in data requested https://imgur.com/a/p8cdUya Please let me know if this is what you meant or if more zoom is required

[Jay51]

I just looked over all the zoomed in images.  Very thorough.  Thank you very much.  

The H's are almost gone with VAuto's increased pressure support.  But a lot of CA's now.  Some CA's occur individually, but a lot of your CA's are grouped together also.  

You already have "very high" trigger setting - this is best to stop CA's.  It will help start the inhale with the least amount of effort on your part.  

You might want to try these settings for a few weeks and see if you "adapt" to it and the CA's decrease or not.  


If the CA's don't decrease, you may be headed to ASV IMO.  

If Sleeprider sees anything I missed, he will post.  He has been doing this a lot longer than me (most of what I have learned is from him).