Sanity check on next steps (still tired)

[TSomm]

Of course! If ever I find something that really works and I don't feel tired, I'll definitely share! It's been a long, long process, and I'd love to help others in a similar spot.

That's great info! I was wondering about that, so this checks something else off my list.

Thank you again!

[TSomm]

Hello again,

So, I've had these settings (min/max the same) for a bit and I thought I'd report back with some info. When I went up to 10.4 I found I had some issues with my stomach. I may have been setting the mask too tight, but I'm not sure, so if going to a higher pressure is worth trying, let me know and I'll figure out if it's a pressure thing or a mask thing.

October 10th is interesting because I only had CAs. I felt just as tired as I had the few days prior and after (I've been a little more tired than usual the past week/two, which might be because of the weather changing). I know it's only a day, but to me this suggests that it's not necessarily OAs that are causing my tiredness. It could be CAs, or it could be something else.

I posted a couple other days, as well as some of the overview bar charts (I was away for a week, took a portable APAP with me, so no data for the week).

• The period from August 12 through September 17 seems to be quite a bit better than before and after that period.
  
• I want to say there's a loose correlation between lower pressure and lower AHI, but just before my trip I was turning up the pressure and the AHI was going down, so that throws this theory out the window.
  

Based on this, I'm thinking of turning down the pressure, to lower the centrals. Of course, it's going to be a game of obstructive vs central, so we'll see how that goes.

If anyone has any other thoughts or ideas, please let me know. As I mentioned, I'm willing to experiment however I can to help figure this out and I appreciate any ideas and thoughts you fine folks may have.

Thanks again for all your support!

PS. Dormeo - thanks again for this recommendation. It's definitely been interesting and these kinds of experiments really help to keep my morale up.

[Dormeo]

Your flow limitations are certainly reduced! Now I would suggest keeping EPR at 3 and coming down slowly from 10.2, pausing at each new pressure for at least several days, to see what happens to OAs and CAs. If there's a sweet spot, with a reduction in CAs and negligible numbers of OAs, that would be a good way to find it.

I can't remember whether this has already been discussed in your thread, but I wonder whether you need more sleep than you are getting. Some people really need 8 or even 9 hours to feel rested during the day. Any way you can give that a try?

[TSomm]

Your flow limitations are certainly reduced!  Now I would suggest keeping EPR at 3 and coming down slowly from 10.2, pausing at each new pressure for at least several days, to see what happens to OAs and CAs.  If there's a sweet spot, with a reduction in CAs and negligible numbers of OAs, that would be a good way to find it.

I can't remember whether this has already been discussed in your thread, but I wonder whether you need more sleep than you are getting.  Some people really need 8 or even 9 hours to feel rested during the day.  Any way you can give that a try?

Thanks, I'll take this approach to step things down. I'm also going to get a better cervical cushion. I'm fairly tall and the generic one I have feel short.

I've been getting about an hour less sleep than I normally get, so I will definitely increase that for a few days, see what's what. The only problem there is that I naturally wake up after about 7 hours, but I may be able to train myself out of that.

Thanks again! The flow limitations have been much better and I'm happy to see progress there.

[TSomm]

Still struggling along... Tired during the day, etc, etc. I adjusted some settings over the past couple months and found that where I was experiencing better AHI numbers (larger pressure range), my flow limits were much worse. I'm not entirely certain of the correct balance there, but I think that's a problem for another day.

First off, thank you to everyone who has offered advice and support. I've struggled with sleep issues since my teens and it's really uplifting to know that when I get really frustrated and depressed from my sleep issues, there are friendly people willing to do what they can to support random strangers. You're all amazing people, truly.

Could someone please take a look at the attached and let me know if the flow rates are normal? It's a little tough to tell from the Wiki whether these are normal (it'd be great if the final, "good" image was zoomed in similarly to the first two, as the change in zoom makes the details harder to see). The Wiki is awesome and has so much info! If these are abnormal, I understand that changing the pressure is of little value (is that correct?), but would it potentially be helpful to increase pressure settings? My EPR is set to 3, and I believe there's a response setting on my machine that's set to normal (as opposed to gentle, or something like that).

Thanks in advance!

[Dormeo]

The zoomed-in views do show some flow limitation in a majority of the inhalations. Dented and flattened tops indicate some degree of flow limitation even when the FL flags are absent.

There's no telling whether this contributes to your continuing problems of daytime tiredness. For some people, this relatively minor level of FL wouldn't matter at all; for others it would.

I don't think increasing the pressure would help. What can be the most helpful is higher levels of EPR (called pressure support for the machines that can deliver higher levels). But I don't really recommend that you focus on having a different machine.

Just FYI, the little squiggles around the zero line are almost certainly what are called cardioballistic artifacts (or the cardioballistic effect). Your heartbeat very slightly changes the contours of your airway, and that's visible when you pause between breaths. Absolutely nothing to worry about; just wanted to clarify that those squiggles don't have any connection with FL. (I have the same thing and learned what it was through this forum.)

Any progress on sleeping longer?

[TSomm]

Thank you! Yes, there was a period over the holidays where I was able to put in 8+ hours regularly. There was a bit of a difference, especially early in the morning (it was a bit easier to get up and get started), but the evening crash was fairly similar. With work picking up that hasn't been something I've maintained, but I'll get back to averaging 8 hours soon, I think.

I've found that fiddling with the settings and getting to a point where my AHI was relatively low (sub 2), but where the flow limitations were a bit higher led to an increase in my feeling of rest. I'm flip flopping a little now, trying to see where I can find a decent mid-point and how I'll feel then (between flow limitations and AHI).

Sounds like the best advice right now is sleep more and see how that goes. I'll get back on track to 8 hours, see if maintaining that for more than a few weeks makes a difference.

[TSomm]

Hello again! So, over the past while I've gotten to ~8 hours on average per night for quite a while. Though helpful, I still awake tired, with heavy eyes, occasionally with headaches, and am extremely tired and fighting sleep by the afternoon.

My first approach was to go down in pressure, which did offer some reduction in AHI, but I ended up feeling a lot worse.

I've now moved the other direction and increased the pressure slowly, over time. My thinking was that perhaps my UARS wasn't being captured by the system and I need a higher pressure to combat it. This is definitely better than lower pressures, but I'm still tired during the day (much less than at low pressures). I went from a pressure of 7.5 up to a pressure of 15.

One thing I've found is that using a mask that covers my mouth and nose lowers my CA. If I tape my mouth closed very well and use a nasal mask, it also lowers my CA. It appears that there's a relationship between mouth breathing in a nasal mask and CAs for me. I thought that mouth breathing would be captured as leaks, but perhaps not.

I'm hopeful that someone can take a look at the two samples of my flow to help shed some light on whether this is caused by high pressure or UARS. I don't want to push the pressure higher without getting a better picture of whether I should do so. My read is that one shows flattened flow caused by pressure and the other is collapsed airway, but I'd really appreciate other opinions.

Thanks in advance for any thoughts on the flow charts attached.

[2SleepBetta]

I don't know if this will be helpful with your concerns and focus. It is response to your post #68 wave forms, alone, although I have been interested in and have dipped into your FL related thread before. 

Your two wave-form views show wave tips like my best and increased number of (few) nightly ones over my 6+ years of Autoset and VAuto treated OSA. I do not have what I understand UARS to be, just obstructive inspiratory flow limitation at a chronic low level as treated. These pressures are typical of the past 4 months of my most recent 3 (?) years using the  VAuto: PS 3.4 cmH2O, Oscar Summary pressures of 9.24, 12.62, 13.58, 14.02. (My bio info at left shows where I started with CPAP.)

Strange if correct, I assume that only the extra 0.4 cmH20 above the Autoset's EPR3 has made all the difference lowering FL dramaticallly. I had long used PS 4.0, but tried 3.4 on a whim and will try 3.0 to see if my high Autoset levels of FL pop up again. If not, answers why will be confused: my body's ventilation system either will seem improved (doubtful) or my VAuto's algorithm differences, not more PS, mostly account for present FL suppression.

[Burrbery654]

Wow this thread has been going on for years and your still doing this on a apap?? I am in the same exact place that you are in...Diagnosed with UARS and tired as hell everyday no matter how long I use the machine for and cant seem to get rid of my centrals like you on my apap and OSCAR

Check this article out,Ive been trying to do this on an apap because of what my doctor says "Trust me an APAP is what you need not anything else..ASVs are specialty machines" 

Theres alot of people who tried a Bipap OR an ASV and get better results..Im in the process of getting one as soon as my doctor may or may not allows me to get it.

https://sleepbreathe.org/asv-and-bilevel...-with-ifl/