Need help reading my charts

[Sleeprider]

Dave, I think you just hit the nail on the head. ASV never looked like the right solution here, and something like ST, AVAPS or iVAPS would be more appropriate for supplementing ventilation needs in the absence of central apnea.

[SarcasticDave94]

Of the options, I'd lean towards ST-A, the smart version, if applicable. The interesting thing on the ST-A is it's script code (HCPSC E0471) is the same as ASV but actually it's a small NIV when using iVAPS. Unless you actually need full sized NIV like Astral.

Even so converse with the doc to see if you can shake some answers out.

[sheepless]

idk, I'm not knowledgeable enough to be sure but I think I see both obstructive and central hypopnea in those screenshots. I'm hoping Sleeprider or Gideon or another with more experience than me can judge.

regardless, they appear in what resembles what I understand to be a signature plm flow rate pattern. consequently, I think there's a better than even chance that pattern and those events will go away in the absence of plm. your apnea is well controlled so what's to be gained from a different machine just now? I suggest ruling out plm first because there are strong indications of it, and if that's the cause, no machine or machine settings will resolve it. and if plm is the cause, minimizing them will result in many fewer disturbances and improved sleep quality, which, if I understand correctly, not feeling properly rested despite low ahi is the crux of your current complaint.

[Rich66]

Yes, I don't feel rested even though my AHI stats are low -- and not sleeping through the night.  Too many times I go to bed at 10:30 pm, and I sleep on and off until 11 am.  For one thing, I think I need to attack this through something I haven't gotten in awhile -- exercise.  I need to lose some pounds.
I'm starting to work on that.  Also, I've sent a medical release form to my sleep/pulmonary doctors office to get the other sleep study reports (the first one done in 2017).  They may have to mail them to me instead of email.  The one issue, other than PLMD, is the mouth farts.  I'm thinking maybe they are waking me up.  Is that a sign my pressure is too high, or that I need to use mouth tape (already ordered from Amazon).? A couple of days ago, I woke up on my stomach having to grab a deep breath like I'd quit breathing (I had fallen asleep in bed after taking my mask off).  Was my nose buried into the pilllow -- maybe.  I'm pretty drowsy whenever I wake up.

I want to thank everyone for your help.  But I think the ball is in my court now.  I'll work on gathering information and seeing what I can do about the PLMD.  And I am writing down questions to ask the doctor when I see her at the end of this month.  Again, THANK YOU.

[sheepless]

leaks can certainly be disturbing to the point of awakening. I use the p10 nasal pillow mask and have been plagued by lip leaks. I have the problem more on apap and asv pushing pressure up against flow limitations (which won't overcome my plm induced flow limitations) than vauto with which I can effectively achieve fixed epap and fixed pressure support. notwithstanding any other reasons you may need higher ps, setting your ps from 0-5 is the best one can do with asv to reduce the consequences (like leaks) of higher ipap.

otherwise, the standard solutions to mouth leaks are tape, chin strap that pulls up not back and/or a soft cervical collar (my preference). learning to keep your tongue at the roof of your mouth is the ultimate solution.

[Rich66]

UPDATE TIME

I got filmed sleeping for the first 2 hours 20 minutes.  About every 20 seconds I had leg twitches -- for about 2 hours.  PLMD ---but not RLS.  And they weren't light twitches, I could see them through the blankets and covers.  Previous sleep study's I had also shows leg movements.  According to my GP doc, there are experimental drugs we could try (he checked my blood for iron and everything seemed normal).  According to my sleep doc, there is no cure for PLMD.    I told her I didn't want to try any extreme drugs and that it could be a livable situation as is if it needs to be.  She said the leg movements do not disturb my sleep.   At my age, and with my health conditions, I'm thinking that sleeping through the night is just not going to happen.

[sheepless]

as a plm sufferer I couldn't disagree more with your doctors. in my experience, it's highly disturbing to sleep and it is treatable.

maybe you can live with it but I can't. after finally getting my ahi down to reasonable levels I still felt crummy. with no help from the sleep doc, I figured out I have plm, causing frequent awakenings. even when I didn't wake up to the extent of masking off (down to a few times a night now), I repeatedly woke up enough to roll over.

plus, I'm quite sure the equivalent of being shoved every 20 seconds much of the night doesn't do much for sleep quality (ask your docs how they think they'd feel in similar circumstances).

my iron, magnesium, etc., levels are within normal range so no help there, but I do get about an 80% reduction in plm with Ropinirole (guessing at a number), enough to feel noticeably better. others get relief from other meds.

if plm truly doesn't bother you, that's great (I'd be jealous). otoh, if you don't feel your sleep is as restorative as it should be and your apnea is reasonably well treated, I would insist on trying out various rls/plm meds until finding what works for you. there's risk with everything but imo sleep is so fundamental to our well-being that it's worth the small (but scary sounding) risks associated with some of these meds.

also, as I mentioned above and elsewhere, resmed machines ineffectively raise pressure against plm induced flow limitations and that can be as disturbing to sleep as the plm itself. it's possible to minimize this to a limited degree, but ultimately the only real solution is to reduce the plm.

[Rich66]

Thanks for the help Sheepless -- I'll get in touch with the GP and see what he's got in mind.  He did say he thinks he's got a touch of PLM and I can be his guinea pig..  And any internet site I've seen on PLM says it's disturbing to sleep quality.

[kappa]

Agree with Sheepless here. My sleep doc/pulmonologist is willing to treat the PLM even though he thinks it's not that bad (compared to other patients he has seen). I'm currently on his preferred drug, Pregabalin, which seems to be helping (based on reducing AHI and my direct measurement of leg movements). I also had some success with Clonazepam (from my Neurologist) but my other docs aren't happy with using that (too addictive, etc). I'm sure that Dopamin Agonists like what Sheepless is using work, but there is a risk of augmentation with those drugs and that doesn't sound like fun.

They key Iron measurement for PLM (and RLS) seems to be Ferretin levels. The "normal" range for this is huge - something like 30-500 ng/mL, but for PLM/RLS it's recommended to have a level over 75.

[Rich66]

Thanks Kappa, I'm taking notes so I can be properly armed when I see the General Practitioner.  Maybe the PLMD drug will let me stop taking the sleeping drug Ambien.