Could you please review ?

[sleepyzzz]

You say that you are sensitive to pressure so try CPAP (7.6) without EPR.  If that doesn't do it I think you may need training to not wake up.  That means professional help.

ok i'll try that first. i was sleeping normal though, this all started with the apnea few months ago. i am healthy and don't take any meds and always slept straight without any insomnia.
i thought i'm not maybe getting enough pressure.. or something wrong with the therapy.
Also how can i know it's not UARS? from the flow limit ?

[koy23]

I also don't see anything that should trigger an arousal.  Sometimes it is just spontaneous disruption of sleep. We will keep looking, but the sleep disruption does not appear to be related to therapy so far.  Your pressure is low with 3-cm EPR. None of the graphs seem to track the IPAP pressure, and I don't know why that is.  Give your consistently low pressure requirement, I think you should change to fixed pressure, either by using CPAP mode or by setting minimum and maximum pressure to the same value. You may be sensitive to pressure changes, but it appears you benefit from EPR.

I just found this great article by Dr: Krakow : http://www.sleepreviewmag.com/2014/01/a-...a-and-sdb/

And quote: "In general, insomnia patients do better with advanced devices. The driving influence is the anxiety factor so common to insomnia patients. During expiration, the discomfort from standard pressurized airflow seems to trigger an anxiety response that the insomnia patient cannot overcome; whereas with the use of auto-bilevel devices, including ASV, the patient’s comfort level is noticeably higher."

Now, I notice that in each time I wake up, I'm alert, as if I already slept thru the night, even I could go to sleep right away, I don't have the same ''sleepiness" I had when I was sleeping normally and for some reason I woke up in the middle of the night, that time I used to have my brain so sleepy.
It's like now I don't go into really deep sleep as before.

Looking back at my sleep study, I had a mix of apnea/hypopnea and RERAs. With almost 3 times more in REM.
Also this all started with globus feel in my throat that did not go away, wether it is inflammation or not I'm not sure.
I was also told I have narrow throat, smaller jaw with crowded teeth. Could I also have UARS specially now with that globus throat?

Good thing is I was able to switch my apap to a resmed aircurve 10 vauto to try.
What settings do you recommend me to do?
Also if I still have these awakenings, do you think an ASV would help? 
One more thing the Dr was talking about was expiration pressure intolerance, does it show in my graph? The expiration curve is not smooth ? 

That's all thank you 

[Sleeprider]

Apnea Board has published Dr. Krakow's thoughts on advanced devices in a Wiki article http://www.apneaboard.com/wiki/index.php..._and_BiPAP Mostly we look for indications of flow limitation or upper airway restriction as indicators someone may do better with a bilevel device. Idiopathic sleep disturbance with no apparent root cause is not an area we have looked at much, but perhaps we should. I know of a handful of members with highly fragmented sleep patterns. At least one, went on to try bilevel and even ASV. He seemed to sleep better, but objectively, he still had a high level of fragmentation as indicated by multiple therapy sessions with breaks.

[koy23]

Apnea Board has published Dr. Krakow's thoughts on advanced devices in a Wiki article http://www.apneaboard.com/wiki/index.php..._and_BiPAP  Mostly we look for indications of flow limitation or upper airway restriction as indicators someone may do better with a bilevel device.  Idiopathic sleep disturbance with no apparent root cause is not an area we have looked at much, but perhaps we should. I know of a handful of members with highly fragmented sleep patterns.  At least one, went on to try bilevel and even ASV. He seemed to sleep better, but objectively, he still had a high level of fragmentation as indicated by multiple therapy sessions with breaks.

Thanks for the link, I tried my first night onThe aircurve 10 with an epap of 4, PS of 4 and IPAP max of 12.
Unfortunately I still woke up with alertness, I'll post my sleeyhead data later here maybe if you could second look.

[Gideon]

Apnea Board has published Dr. Krakow's thoughts on advanced devices in a Wiki article http://www.apneaboard.com/wiki/index.php..._and_BiPAP  Mostly we look for indications of flow limitation or upper airway restriction as indicators someone may do better with a bilevel device.  Idiopathic sleep disturbance with no apparent root cause is not an area we have looked at much, but perhaps we should. I know of a handful of members with highly fragmented sleep patterns.  At least one, went on to try bilevel and even ASV. He seemed to sleep better, but objectively, he still had a high level of fragmentation as indicated by multiple therapy sessions with breaks.

Thanks for the link, I tried my first night onThe aircurve 10 with an epap of 4, PS of 4 and IPAP max of 12.
Unfortunately I still woke up with alertness, I'll post my sleeyhead data later here maybe if you could second look.

Please don't hijack someone else's thread

[sleepyzzz]

thanks for the link.

i have seen this post: http://www.apneaboard.com/forums/Thread-...RS-Updated  which i found real helpful
and i think i might try a small pressure, should i use an epap of 4 and ipap max of 5 to try first? or epap of 4 and like sleeprider said ipap max of 7 ? (does higher PS disrupt sleep? like is EPAP 4, PS 3 and max IPAP 7 better OR epap 6 and IPAP max 7 and PS 1 is better ? )

In my sleep study my sleep efficiency was 60%
in 5.35 hrs of sleep i had : 122 arousals , 69 associated with apnea/hypopnea and 35 RERAS and delayed onset REM. total AHI: 17/hr and RDI was 23/hr.





here is my last night screen :




based on the dr Krakow's analysis, i'm thinking maybe i also have UARS, because of my throat inflammation and genetically small throat, this is how it looks like almost(image from google):


also i woke up at 7am, stayed awake till 9:45am then slept from 9:45 till 11am, and i noticed this maybe the explanation what is happening: before i dose off, almost dreaming, so i'm between awake and asleep still but i am dreaming already, for less then a second, i hear my throat "noise" it is not snoring but noise, and i feel i'm trying to inhale as if i am trying to breath from a straw, it was hard and in that split second i wake up, and my throat opens and i am breathing normal. so i know it happens in that time frame, i tried to zoom in looking for it in the graphs, but i can't tell exactely where i woke up in this hour and 15 mn, so i'm highlighting these maybe you can see something i am not. i can only see that in the inhale curve, there is some jagginess, or little flatness before the curve goes up, maybe that is that ?


and



Also took some random zooms in the normal night sleep where i saw some abnormalities :

[Gideon]

That picture is nowhere near as bad as my wife post-surgery. I see nothing that can be done to improve your apnea. Any adjustments would be just to improve your comfort.
I would suggest you see an ENT. My wife's airway was over 80% closed from a condition that I'm sure you do not have.

[sleepyzzz]

ah i'm sorry about your wife, hope she got better.
My airflow is limited and i think it is also because i have narrower throat, my previous settings seem to tackle to hypopnia but not RERAs. so i wanted to try UARS settings.
Last night i tried the IPAP max at 5, EPAP at 4 and PS 1.
- I almost noticed i slept (deeper?) but i still had few waking ups, maybe because i was so sleep deprived as well ? also i slept longer hours yesterday so i feel fine today.
- the top of airflow seems rounder than before, but at the exhale some periods have those jagginess as in the screenshots.
- flow limitation seems little higher and repeated each REM cycle.

could you take a look and tell me if i should maybe try another night with same settings or increase pressure maybe to 6 or 7 ?

thanks

[Gideon]

She is much better now, the initial night was issue filled including a direct to bed in a critical care unit to monitor airway and admin steroids to shrink swelling from the surgery.

You have some flow limits, sufficient that you are reacting to it.  I suggest trying a series of experiments, each one should be at least 5 days long, 7 would be great.  1 night does not make a trend.  These are designed to conquer your flow limits, and as such any RERAs you may have.

current - Test 1
Mode: VAuto
Min EPAP: 4
Max IPAP 5
PS: 1

Test 2
Mode: VAuto
Min EPAP: 4
Max IPAP 6
PS: 2

Test 3
Mode: VAuto
Min EPAP: 4
Max IPAP 7
PS: 3

Test 4
Mode: VAuto
Min EPAP: 4
Max IPAP 8
PS: 4

Take notes on each of these, The one to use in the end, I won't be able to say because it will be determined by how you feel.

[sleepyzzz]

She is much better now, the initial night was issue filled including a direct to bed in a critical care unit to monitor airway and admin steroids to shrink swelling from the surgery.

You have some flow limits, sufficient that you are reacting to it.  I suggest trying a series of experiments, each one should be at least 5 days long, 7 would be great.  1 night does not make a trend.  These are designed to conquer your flow limits, and as such any RERAs you may have.

current - Test 1
Mode: VAuto
Min EPAP: 4
Max IPAP 5
PS: 1

Test 2
Mode: VAuto
Min EPAP: 4
Max IPAP 6
PS: 2

Test 3
Mode: VAuto
Min EPAP: 4
Max IPAP 7
PS: 3

Test 4
Mode: VAuto
Min EPAP: 4
Max IPAP 8
PS: 4

Take notes on each of these, The one to use in the end, I won't be able to say because it will be determined by how you feel.

I'm glad it was a passing incident, hopefully she would fully recover soon.
It's amazing how fragile and in the same time resilient our body is.

Thank you, i'll try this 20 days experiment and see if i can get rid of these horrible RERAs.
I would like to take your opinion based on what you see my graphs/sleep study are, Dr Krakow said that UARS patients benefit most of ASV machine, do you think an ASV would get rid of my RERAs better than the aircurve 10 vauto? do you think i should "try" to convince my doctor to do a titrating sleep study with ASV and bilevel ?

thank you.