[CPAP] PSG1 - Therapy Thread

[PeaceLoveAndPizza]

The first and third charts show flow limited breaths. The peak should be nice and rounded, but those are flat and sloped. Enough flow limitations to affect the breathing, but not enough to trigger the counters. 

The middle one looks no different than the others you posted previously. I do not see any palatal issues.

Aerophagia is quite common when first starting out. Reducing pressure helps, but in most cases it is self-resolving over time as you adapt to it and learn to use proper tongue placement. Whilst reduced pressure may help aerophagia, it does nothing to help with quality sleep.

There are different centrals. The ones to be concerned with are the ones where your body is not getting the appropriate signals to breathe. I do not see that in your charts. What I see is more likely treatment emergent CA’s or ones from tossing/turning.

Do you have the original sleep study summary showing your AHI breakdown? The one you posted I assume is the titrated study.

[PSG1]

The first and third charts show flow limited breaths. The peak should be nice and rounded, but those are flat and sloped. Enough flow limitations to affect the breathing, but not enough to trigger the counters. 

The middle one looks no different than the others you posted previously. I do not see any palatal issues.

Aerophagia is quite common when first starting out. Reducing pressure helps, but in most cases it is self-resolving over time as you adapt to it and learn to use proper tongue placement. Whilst reduced pressure may help aerophagia, it does nothing to help with quality sleep.

There are different centrals. The ones to be concerned with are the ones where your body is not getting the appropriate signals to breathe. I do not see that in your charts. What I see is more likely treatment emergent CA’s or ones from tossing/turning.

Do you have the original sleep study summary showing your AHI breakdown? The one you posted I assume is the titrated study.

Yes, that was titrated. I attached my original split-night study and a zoomed from CPAP earlier this year, similar breathing pattern. UARS? The sleep disturbances are almost always the last half of the night when there is more REM.

Honestly, I am feeling overwhelmed with all of this and lack of restorative sleep. Ready to just go without BiPAP and see if that helps. I only ever tried it for the PTS.

[PeaceLoveAndPizza]

You are feeling overwhelmed due to not getting the support you need. We can help with that. For now keep all therapy related information in this thread. I’ll ask the admins to rename this thread “PSG1 - therapy thread” so it is easier to track.

BTW, your sleep lab did an excellent job with their analysis. One of the best I have seen in a long time.

Per the sleep study, your main events are hypopnoea’s, which are resolved with pressure. Any idea why they put you on a bilevel? My assumption is due to the flow limitations, but there may be something else that I do not see. I think everyone should have a bilevel, but I attended the SleepRider school of CPAP analysis so there is that.

I suggest we go back to the suggested baseline and work from there.

[PSG1]

You are feeling overwhelmed due to not getting the support you need. We can help with that. For now keep all therapy related information in this thread. I’ll ask the admins to rename this thread “PSG1 - therapy thread” so it is easier to track.

BTW, your sleep lab did an excellent job with their analysis. One of the best I have seen in a long time.

Per the sleep study, your main events are hypopnoea’s, which are resolved with pressure. Any idea why they put you on a bilevel? My assumption is due to the flow limitations, but there may be something else that I do not see. I think everyone should have a bilevel, but I attended the SleepRider school of CPAP analysis so there is that.

I suggest we go back to the suggested baseline and work from there.

Thank you, I really appreciate it.

After I complained about CPAP they gave me another home sleep study that showed the CPAP was not properly treating the sleep issues (AHI averaged 7.x; higher in REM with CPAP), tolerance and aerophagia were secondary. Higher pressures previously did not seem to change sleep much. 

I have moved to the setting you recommended and will report back.

[PSG1]

Upped pressure, rainout has been an issue despite insulating and heating the tube. Low humidity around 3, in AZ, so not sure why.

Aerophagia much worse with the pressure increase. Hard to go back to sleep after the group of OAs, in and out of sleep. 

Giving it some time to feel better. How long do I give these settings a go?

[PeaceLoveAndPizza]

You can drop the pressure a bit and/or decrease PS as well. Understand though that while it may be more comfortable for now, it is likely not going to do much to help with sleep quality as at lower pressure you had many arousals impacting your sleep.

Go back to some lower settings and let’s see how it goes.

Mode VPAPauto
EPAP min 5
IPAP max 11
PS 4
No ramp

Depending on how it goes we can start a process from there increasing pressure and PS by small increments until the arousals start to abate.

[PSG1]

So it seems the last couple days the centrals slowed down. 

I still, however, start to go into dreaming and then am awoken feeling like I wasn't breathing or breathing through a straw. This morning, my nose wasn't super congested, but passages and throat swollen like blood pooled (similar to what happen with anxiety and blood goes to my head). This closed off my nasal passages until I pulled the mask off and gave it a few minutes, then my nasal passages opened back up and I could breath again. I put a detailed capture of this event in the 065819 screenshot, it wasn't classified as anything in Oscar, but definitely long enough irregular breathing to wake me up. These unclassified breathing events seem to happen through the night, mostly around REM.

Lastly, considering going from an N20 to P10 because it seems to cause my nose hairs to itch even after trimming and even with warmth and tubing insulation the mask can build some humidity. Although the nasal blockage has me consider a full-face

Try upping pressure?

[PeaceLoveAndPizza]

Everything looks pretty good. The zoomed in sections show nothing of real interest. The first is a typical arousal likely from a position change and  the second is normal sleep breathing.

You do need to start increasing your pressure as I said before. How you do that is up to you. You can slowly creep up by increasing 0.2 every few nights, or move in 1 cmH2O increments, your choice. I think for now the target should be EPAPmin=7 and IPAPmax=12, but however you go about increasing to get there is up to you.

[PSG1]

Hello,

I have really been trying to let things lay for a while and see if I can just let things go. Aerophagia seems mostly gone, and some nights sleep is much better...no where near what I would say is acceptable.

I seem to be having intermittent issues and it is hard to tell if the poor sleep is solely anxiety or something else is still amiss. Sleep isn't usually excellent, but things have gotten a little better where I don't wake to stress dreams until early morning rather than all night on at least half of nights.

That said I am still having these episodes where I wake up feeling like I have "forgotten" to breath. Sometimes it is correlated to an event in the data, sometimes not.

As I am posting this, I am waking up from a night full of stress dreams and awakenings. It does seem the more tired I am going to bed, the worse things are. Hard not to be tired when sleeping poorly... A couple physical items to note:

My nasal passages seem to fill with blood sometimes causing my airways to narrow and the feeling of breathing through a straw. This may be caused by pillows compressing my neck/carotid and some combination of anxiety.

Toward the end of the night sometimes I can get myself relaxed more, but every time I start to fall asleep I am jolting awake from the forgetting to breath feel... 
like I am too relaxed.

I am noticing a "clicking" in my throat from the pressure. Like a little balloon is inflated. I can still breath and can sort of "reset" it, but it is uncomfortable.

What can I try? Are these true centrals? I didn't have those before.

[PSG1]

Adding zoomed shot.