GiveMeAllTheSleeps Treatment Log

[SarcasticDave94]

Whichever study report caused the machine order will do. Get the detailed report of that.

[PeaceLoveAndPizza]

Could you post an OSCAR chart or two from recent nights?

[GiveMeAllTheSleep]

Apologies for not replying to previous messages.  I must have missed the email notifications and life has been hectic these last few weeks.  Still having an..... experience on the clinical side.  If anyone has recommendations for someone for a Dr in the metro-philly area that is open to diving in the Oscar weeds I am all ears.   

Here is a screenshot from Oscar with some pulseOx data imported.  This screenshot is from last night but it shows a very typical pattern that never really seems to get flagged by the device.   I have some sort of breathing disturbance and then my pulse sky rockets.  The nights I rip my mask off during the night I wake up in a mild panic.  Now that I have the pulse data I can see that when that happens my pulse goes through the roof right before I wake up.    

I am also very curious if anyone has any input on what the jagged\stutter step activity on flow rate graph.   

   

[katbrat]

Hi, GiveMeAllTheSleeps, I'm wondering if the jagged stuff could be snoring.

[GiveMeAllTheSleep]

I am not a snorer.  There is an Imgur link a couple posts back if you want to hear what I do in my sleep.   I feel like inhaling is not an issue and it’s the exhale that jams me up.  (Perceived, not sure about actual)

[katbrat]

I listened to your sleep and although you might not be doing what is traditionally thought of as snoring, you are making sounds in your throat when you breathe (either in or out) which might be showing up on your readout. Just a thought. What does your snore graph look like? Thinking it could be a soft tissue vibration of some sort.

[katbrat]

This Oscar illustration shows some flow limitation style breathing which includes inspiratory and expiratory snoring. Personally, I get some soft tissue motion in my throat even though I use mouth tape and don't outright snore. It shows up in my snore graph and the breaths in my flow rate graph look like snore breaths. The bottom example resembles some of the graphs you've posted.

   

[GiveMeAllTheSleep]

I had never thought of it as a snore before.  Snore graph in Oscar is clean and has never flagged a thing.  It's also not really an exhalation either.  From what I've been told by partners it's more like air is leaking out or I'm struggling to actually exhale.  Then at some point (maybe when I begin to desaturate or my pulse elevates) it's like a switch flips and I magically let all of the air out.  One partner has told me that she believed I was holding my breath in my sleep.   

Sometimes as I'm about to drift off to sleep, off PAP, I wake myself up due to what I assume\perceive to be my soft palate flapping during an inhale.  As I mentioned though - never been a "traditional" snorer, I've never been told that I gasp for air, I just do this thing where I take a breath and then the air seemingly gets stuck in my lungs\throat.   Waking up in a mild panic is something that started with the APAP.

[GiveMeAllTheSleep]

Interesting update from last nights sleep - 

I happened to procure an old, low hour (200), dreamstation 1 AVAPS (I am familiar with the recall and concerns with its use).  I had tried to use it once in BiPap ST mode and absolutely hated because I felt like the Timed part was miserable.   I was trying to use this as my partner, who is a respiratory therapist, thought I needed a backup rate to get me through *whatever* is causing my disturbances.   Well - last night I wound up sleeping at my house unexpectedly while my APAP was at my partners house.  I went down a rabbit hole based on the "expiratory snoring" prompt and started reading about things such as palatal prolapse.    

I have always been a mouth breather and drooler in my sleep.   I had initially tried nasal masks but suffered from mouth leaks and nothing seemed to stop them (chin straps, mouth tape, etc) so I progressed to a full face mask which is where I am today.  After finding the palatal prolapse bit and recalling other bits of info I have found along my journey I had a bit of an epiphany.....

We are supposed to be nasal breathers.  Mouth breathing has been found to exacerbate disordered breathing.   What if my soft palate were obstructing the nasopharynx region and my mouth breathing was compressing\constricting other structures?  My hypothesis was that moving to a nasal mask would correct any issues being introduced\exacerbated by the mouth breathing and simultaneously provide resistance so my soft palate didn't collapse\prolapse.   This would hopefully prevent the expiratory restrictions that caused me to "hold my breath" in my sleep.  

Early signs are promising........ I went to bed with nasal cushions, a chin strap, and mouth tape.  I setup AVAPS ST mode for the first portion of the night but the timed portion is still jarring.   About an hour in I woke up and my mouth was incredibly dry even though it was sealed and no air was escaping (mouth tape was still firmly in place).   At this point I bumped the humidifier settings higher, switched it to spontaneous mode, and dropped the pressures a hair.    I woke up at another point in the night and may have made another change and removed the mouth tape.   

Here's where it gets interesting - I slept for 3ish hours with just the chin strap and to my knowledge did not suffer from any mouth leaks.   

(I didn't have an SD card or pulseox so I have no objective data from last nights session)

I will likely be back on APAP this evening so I'm curious to see if I can get similar results, if I truly need the larger delta in EPAP provided by BIPAP, or if AVAPS is the magic ticket in this equation.     

I appreciate everyones input thus far and any insights\comments everyone may have about this post.  It's the first glimmer of optimism I've had with this process since I embarked on the journey of trying to improve my sleep.

[katbrat]

I'm glad to know you are being helped! I have also picked up on a lot of helpful suggestions even in other people's posts. I realized once again this morning however while looking at my various readouts that even though all factors seem to be the same, for me every night ends up looking different.