Appreciate help adjusting settings (UARS)

[Gideon]

I like the numbers, the issue now is to improve your sleep. See if you can get a better definition for "breathing really weirdly".

I'd say let's keep these numbers for at least 3 days to see how things settle out.

2:38 closeup. ends in larger breaths, slightly more frequent with the combined effect of washing CO2 out of the system reducing pCO2 (blood gas and trigger for breathing) reducing the trigger to breathe and causing the brief (short) centrals then finally the main central and the awakening.

3:51 closeup. Is this one in which you were woken up? the last 5 minutes you see small variations in the length of your breath where you breathe a little faster then slower and repeat ending with more separation between breaths

5:21 closeup. This shows several small stoppages, it looks like you were moving around almost settling in

6:16 closeup. This is similar to the others with a mixture of somewhat faster and slower breathing ending in rapid breathing and an expected central following that and recovery then you are awake.

The numbers say there is not enough to be concerned about other than the awakenings, and as you said your husband is at fault for two of them. Let's see, as I said, what happens going forward.

[cmcphee]

Thanks @alexp - good to know. My doctor mentioned that she thinks I seem to wake very easily during sleep transitions. I'm debating biting the bullet and doing this study to get more data: [/url][url=http://axgsleepdiagnostics.com/product/comprehensive-type-2-diagnostic-home-sleep-study-unattended/]http://axgsleepdiagnostics.com/product/comprehensive-type-2-diagnostic-home-sleep-study-unattended/. I've never had an in-lab before because my insurance declined it. What do you think?

@slowriter I feel terrible that I woke HIM! So darn tired today. I know it is still early, but I think I was feeling better on the other machine. Did you use your Dreem 2 last night? I ordered one, and it should be here in the next few days. I've been following your chain - I also have lower than normal deep sleep numbers (from my at home test and a Zeo I used in the past). Let me know what you learn!

[mper6794]

@mper6794 my median RR on a machine seems to range from 12-15 - it was not included on my sleep study (previously posted).

@bonjour Thank you. I went with the same settings as last night and didn't have aerophagia this time (?). I slept with a cervical collar on for the first part of the night again, but have gotten into the bad habit of taking it off in my sleep somehow.

My FL was a record low and the centrals greatly subsided. I woke up 4 times however (two of which were because my husband woke me because he said I was "breathing really weirdly"). I feel more tired now than on the previous machine, but that could be because I slept so poorly the past few nights and woke up 4x last night? Should I continue to stay at these low settings or start moving back up?

_ you still need to fine-tuning your perfect PS;
_ indications of PLM's got very much stronger; with great potential of sleep disruptions, including wakeups; sorry to say this! I wish i could go otherwise!
Good Luck

[slowriter]

My wife is temporarily sleeping in another room as we figure it out; easier for both of us.

Should you do an in-lab sleep study? Maybe. You could see if your doctor can try again to get approval; maybe as I did, as a titration study (something which is enhancing your treatment).

But if not, the Dreem seems pretty promising. It gives me data on sleep efficiency, onset, awakenings, and also the key (EEG-derived) sleep stage hypnogram. See attached, from last night.

So, for example, I could confirm that last night waking up way too early corresponded to the end of a REM stage, but that overall I'm doing OK on REM; significantly better than during my sleep studies.

   

[sheepless]

fwiw, of the charts in post #88, 3 of the close up screenshots show some degree of periodicity punctuated by larger inhales that may be the respiratory response to periodic limb movement. i.e., they have characteristics similar to the pattern in my flow rate that I have come to associate with my own plm. I'm pretty sure of 2 of them (starting at 3:36 and 6:57). a 3rd, the one with the ca, looks somewhat periodic but it's not clear that it's associated with plm (starting at 5:18).

[mper6794]

What I have suggested is a very standard treatment following established procedures.  I am not familiar with the techniques mper6794 has proposed but am curious.  
What I suggest works for the majority of people.  I would encourage mper6794 to start a new thread and present/teach his technique and include evidence of its success.  We have had things like this that we have adopted in the past.  The soft cervical collar for positional apnea from chin tucking.

Ok., Fred! I would be happy to do so, as long as i have some time available; you know, i am retired, so that time is a very scarce good! Have plenty of illustrations and examples. Love numbers and some statistics; all significant things came out of my 192 days on Oscar are plotted and cross-ploted in Excel graphs. That's reason why some maybe not so much straitforeward relations come out; hopefuly this way of getting a fine-tuning PS would work indeed...."I think has already been proven by other researchers that you actually need higher pressure to keep the airway pinned open on inspiration and a lower pressure on expiration. If that’s so, then is bilevel the best system because it provides the exact pressure you need (not too much and not too little) during expiration"; Barry Krakow, this blog.
I wish numbers and a semi-quantitative way of doing things could work out the complexities of body functions, yet at least they may shed a dim light on them.
Good luck

[mper6794]

Hi, cmcphee, good morning

_ 4:21....possible PLM
_4:23:15 ----typical PLM leg jerk awakenings (those like this, are properly audio-recorded calibrated in my every day  charts....look at how often it repeat on your charts.....
_based on charts you posted, I have started up your PS x RR graph...what would be your normal rate (lab studies, etc)?

good luck

NOTE: forgot to mention when you eventually are going to plot RR against other parameters, to pinpoint your needed PS ,you should have to discard sick days, particularly infection ones, which boost RR during the night (up tô 50% in my case).
Good Luck

[slowriter]

Question: is there any reason for the OP to consider S mode?

I was just watching lankylefty's video on bilevel titration, and he argues the auto mode can be problematic for some patients because of the fixed PS, which can drag up the EPAP in ways that cause CAs.

[Gideon]

Lanky is right, the key is to observe and correct. I have worked many into either a very narrow range or even a "fixed" pressure in auto mode.

[slowriter]

Lanky is right, the key is to observe and correct.  I have worked many into either a very narrow range or even a "fixed" pressure in auto mode.

So possible her problem is not PS per se, but rather what's happening with EPAP.