HELP reading Sleepyhead

[racprops]

I can understand that.

Rich

[racprops]

OK I am hoping I can get some help here.

The last run I KNOW I sleep nearly 4+ hours, I feel asleep with my blood pressure cuff and my machine on at 1:17 as that was the reading of the built in clock and woke up at 5:12.

I again thought the machine was off.

There read outs are looking to my eyes as great BUT are they normal, after all the mask pressure just about disappears, drops off….everything else looks pretty good but for the tidal volume which looks low?

Please tell me these are OK.







IS this what I want to look for?

Rich

[racprops]

Also here is my O2 and pulse summery.

How does it look?? Any RED flags??



Again thanks to everyone for you help.

I am hoping all of there latest reports show I have turned a corner and am getting this thing settle in.

Rich

[racprops]

PS My Blood pressure is running nice as well.

I just got a reading of 118 over 70 with 56 BPM.

My BP machine shows a avg of 134 over 77 overall.

I find I get some of my highest readings right after waking like 140/85..or worst.

I am taking a Bata blocker and guys if your taking one that interferes with your performance...well the one I take is the V***** of Blood pressure pills...it is call Bystolic, it cost $80.00 per month but both my wife and I say it is worth it..all the other BP meds I have taken (and I have taken a few) have cut back (pun intended) performance.

So I often check during my wake ups, but in relaxing to get a good low reading I can relax too well and fall asleep right in the middle of taking a reading.

On the other hand it is a good way to know for sure when I last fell asleep, like last night, I woke up with the pressure cuff still on so I had not been up and did no sleep walking either, not that I have ever.

Rich

[vsheline]

Just to be sure the PS [Pressure Support] is not maxing out and needs to be allowed to go higher, I suggest you set the Max PS to your doctor's prescribed setting of 15, rather than the 10 you have been using. If you set the Max PS to 15, the PS won't necessarily ever go as high as 15, since it will not go higher than is needed.

As I understand it, I need a ASV partly so that the pressure is relaxed to clear my Centrals and pressure enough for and when I have OAs, and intelligent enough to tell the different.

I was under the impression the machine would not ram high pressure down my air pipe (pun intended) but lightly feed air though my clear airway to insure breathing.

No, Rich, neither the ResMed ASV nor the PRS1 ASV algorithms relax pressure to clear centrals.

It usually takes time to get into a central event, with CO2 levels in the blood gradually becoming too low, until there is a loss of urge to breathe. During the time that our CO2 levels are gradually building up again because we are not breathing, the O2 levels are plummeting.

If the pressure were to be relaxed during a central apnea the central apnea would merely run its normal (long) course.

Once a central apnea begins, the only way to keep us ventilated is for the ASV machine to immediately step in to ventilate us. In order to avoid hyperventilating us, it targets only 90% or 95% of the amount of ventilation which we were maintaining on our own before the central apnea started. Yes, every time we are forced to inhale during what otherwise would have become a central apnea, it is sorta like "ram high pressure down my air pipe", although it is not at all painful and we gradually get used to the feeling.

It kind seems counterattacking the problem.....My centrals are caused by CPAP like pressure so pushing a high pressure should make them worst...

The pressure does not directly cause the central apnea; according to what I've read, in some people breathing against pressure somehow causes enough gradual loss or washing out of the CO2 levels in the blood that they lose the urge to breathe. Our nervous system doesn't breathe because it senses that our O2 levels are too low (apparently it isn't able to do that), but because it senses that our CO2 levels are too high.

But I kind of see how once I am in a central, IE NOT taking a breath, then it need to VENTILATE me and push in the air..so then Higher pressure might be needed to get the air in.

Exactly.

So my thinking is the base pressure, the EPAP 10cm used to clear my OAs might be triggering the centrals I then NEED higher pressure to ventilate me with.

It almost seems a catch 22.

I will try your suggestion, but kind think it will go the wrong way.

Your most recent chart seems to show the PS (Pressure Support, the difference between EPAP and IPAP) still never gets higher than about 10, even when you are having central apneas which the machine seems unable to treat adequately (since it reports CA events are still occurring).

Have you postponed making the change of raising the max Pressure Support setting to 15 as per your doctor's original prescription?

By the way, perhaps your machine is managing to treat your centrals better than we have been thinking, because your latest Oximeter chart shows your oxygen levels were pretty good all throughout the period that the machine was reporting CA events. Except, for less than 10 seconds the SpO2 reading did drop from over 90% all the way down to 80% and then returned back up above 90%, but I suspect that was a false reading, maybe caused by movement of the sensor, because I think there is no way your blood oxygen level could drop that far and return to above 90%, all in less than 10 seconds. (We know the drop lasted less than 10 seconds because it was not listed as an event. SpO2 drops must last at least 10 seconds or they do not qualify as being an "event".)

OK I am hoping I can get some help here.
...
The read outs are looking to my eyes as great BUT are they normal, after all the mask pressure just about disappears, drops off….everything else looks pretty good but for the tidal volume which looks low?
...
IS this what I want to look for?

The latest chart looks like some of your earlier ones, where your ASV machine is often unable to completely eliminate central apneas, when you have stopped breathing on your own. (You can easily see when you have stopped breathing on your own - it is whenever the machine increases the PS, the difference between EPAP and IPAP.)

Your previous charts also showed you sometimes had few or no central apneas unless you first had obstructive events which caused the machine to need to go to higher EPAP pressure.

What do you think caused the lack of obstructive events in the last, long session? Was your head more elevated than it had been earlier?

Take care,
--- Vaughn

[racprops]

Just to be sure the PS [Pressure Support] is not maxing out and needs to be allowed to go higher, I suggest you set the Max PS to your doctor's prescribed setting of 15, rather than the 10 you have been using. If you set the Max PS to 15, the PS won't necessarily ever go as high as 15, since it will not go higher than is needed.

I did and I have watched it push up to 24cm. It made my mask fart and flutter and woke me up.

As I understand it, I need a ASV partly so that the pressure is relaxed to clear my Centrals and pressure enough for and when I have OAs, and intelligent enough to tell the different.

I was under the impression the machine would not ram high pressure down my air pipe (pun intended) but lightly feed air though my clear airway to insure breathing.

No, Rich, neither the ResMed ASV nor the PRS1 ASV algorithms relax pressure to clear centrals.

It usually takes time to get into a central event, with CO2 levels in the blood gradually becoming too low, until there is a loss of urge to breathe. During the time that our CO2 levels are gradually building up again because we are not breathing, the O2 levels are plummeting.

I have read a paper that supports that finding and some people retain the CO2 and can also be sick from it, I was asked if I had my blood gasses tested for CO2 retaliation.

If the pressure were to be relaxed during a central apnea the central apnea would merely run its normal (long) course.

Once a central apnea begins, the only way to keep us ventilated is for the ASV machine to immediately step in to ventilate us. In order to avoid hyperventilating us, it targets only 90% or 95% of the amount of ventilation which we were maintaining on our own before the central apnea started. Yes, every time we are forced to inhale during what otherwise would have become a central apnea, it is sorta like "ram high pressure down my air pipe", although it is not at all painful and we gradually get used to the feeling.

Thanks that helps me understand more.

It kind seems counterattacking the problem.....My centrals are caused by CPAP like pressure so pushing a high pressure should make them worst...

The pressure does not directly cause the central apnea; according to what I've read, in some people breathing against pressure somehow causes enough gradual loss or washing out of the CO2 levels in the blood that they lose the urge to breathe. Our nervous system doesn't breathe because it senses that our O2 levels are too low (apparently it isn't able to do that), but because it senses that our CO2 levels are too high.

But I kind of see how once I am in a central, IE NOT taking a breath, then it need to VENTILATE me and push in the air..so then Higher pressure might be needed to get the air in.

Exactly.

So my thinking is the base pressure, the EPAP 10cm used to clear my OAs might be triggering the centrals I then NEED higher pressure to ventilate me with.

It almost seems a catch 22.

I will try your suggestion, but kind think it will go the wrong way.

Your most recent chart seems to show the PS (Pressure Support, the difference between EPAP and IPAP) still never gets higher than about 10, even when you are having central apneas which the machine seems unable to treat adequately (since it reports CA events are still occurring).

I did set it up to 15...and a again I have seen it got over 20Cm and pop the seals on my mask...

Have you postponed making the change of raising the max Pressure Support setting to 15 as per your doctor's original prescription?

By the way, perhaps your machine is managing to treat your centrals better than we have been thinking, because your latest Oximeter chart shows your oxygen levels were pretty good all throughout the period that the machine was reporting CA events. Except, for less than 10 seconds the SpO2 reading did drop from over 90% all the way down to 80% and then returned back up above 90%, but I suspect that was a false reading, maybe caused by movement of the sensor, because I think there is no way your blood oxygen level could drop that far and return to above 90%, all in less than 10 seconds. (We know the drop lasted less than 10 seconds because it was not listed as an event. SpO2 drops must last at least 10 seconds or they do not qualify as being an "event".)

I wonder about that and agree it might..

OK I am hoping I can get some help here.
...
The read outs are looking to my eyes as great BUT are they normal, after all the mask pressure just about disappears, drops off….everything else looks pretty good but for the tidal volume which looks low?
...
IS this what I want to look for?

The latest chart looks like some of your earlier ones, where your ASV machine is often unable to completely eliminate central apneas, when you have stopped breathing on your own. (You can easily see when you have stopped breathing on your own - it is whenever the machine increases the PS, the difference between EPAP and IPAP.)

Thanks that is new info to me...

Your previous charts also showed you sometimes had few or no central apneas unless you first had obstructive events which caused the machine to need to go to higher EPAP pressure.

OK A cause and effect...I need to keep OAs clear to avoid CAs

What do you think caused the lack of obstructive events in the last, long session? Was your head more elevated than it had been earlier?

I think so as I fell asleep in a more upright position in my recliner, and I when back to sleep later in the same position and got a good readout then too.

I have to sleep nearly sitting fully upright.



Take care,
--- Vaughn

[racprops]

Sorry to bother you again BUT:

I am reaching a near braking point.

Currently I seem to only sleep an hour of two at a time.

Four days ago I thought I had a break though when I had a good night, during that night I had a long sleep of 4+ hours, with only want seems to be only 2 Hypopneas and one snore events.

I figured I was making head way.

BUT The three nights sense have been horrible. As above, only an hour at a time and only when I am so tired I fall asleep at a drop of a head.

And the reports are also horrible: the 12th only 6.21 hours of sleep with a AHI of 14.78, the 13th 4.53 hours of sleep on the machine and a AHI of 25.52.

Tonight with only 2.52 of sleep with the machine and a AHI of 27.90 (so far)

I even gave up and tried to sleep in my bed without the machine, sleeping on my side.

No good: one hour later I woke up sore and upset..I checked the O2 recorder and sure enough I had a lot more trouble with sats during that hour, so far on desating below 88 % for a few seconds…but I feel the many more ups and down during that hours shows I cannot sleep safely.

It looks like I have to figure this out, I have no other choose.

BUT It is getting harder and harder to sleep on the machine.

I am running into two main problems, ONE I have had to tighten the mask to the point of pain, because even when I lower the max pressure the machine will blow so hard it make the mask fart..a leak like a fart and this wakes me up.

OR I wake up with so little air flow I feel like I am suffocating from lack of air. For the first time I felt closeaphobtic , trapped in a too tight a place.

Yesterday morning around 5PM this happened for the third or fourth time and I could NOT put the mask back on, so I got up.

Another too tired day with me trying to fall asleep on and off all day.

AS I have said before IF I cannot stand the mask and machine even if the treatment is not as good as I need, then it will fail completely. It nearly has.

Then there is the machine over reacting as I try to fall asleep, and taking over my breathing..or jumping to max pressure and blowing the mask off…waking me as I am just about to drop off…

AND I find that the higher the EPAP Pressure the more the machine wants to be in control.

At 9CM it follows my breathing and if I hold my breath takes a few seconds to react. And will return to my controlling breathing.

BUT at 11cm it does NOT follow my breathing but instead does its own breathing and if I fail to keep up reacts with higher and higher power pressers blows. It takes over. It seemly will not allow me to be in control.

IS this normal?

So I am going nuts: Is the settings wrong (for me) of is the machine going bad??


Is it me OR the machine OR the settings and can they be set better??


Rich

[Sleepster]

You might want to try a hybrid mask.

Sleeping without the machine is a regression.

Believe it or not, you are making progress. It's two steps forward, one step back. Eventually you'll get there.

Checking your data for leaks is a good idea. Other than that, one or two days of data is meaningless. You're looking for long term trends here. It took your body a long time to adapt to sleep apnea. You are now asking it to un-adapt and re-adapt to something new.

Once you have a month's worth of data with the machine settings unchanged you can make an appointment with a doctor who specializes in sleep apnea.

I understand your frustration but there's not much else you can do. Try to enjoy the good days. That'll get you through the bad days. And remember, there are lots of others who are going through the same thing.

[vsheline]

Sorry to bother you again BUT:

I am reaching a near braking point.

Hi Rich,

Don't give up. But you probably need to try other mask types to see if you can find one which works better for you.

Please check your Private Messages.

Take care,
--- Vaughn