Problem with mask and EPR

[sheepless]

thanks. I recognize flat, sloping, jagged tops as indicative of obstructive flow limitations but I'm thinking decreasing volume as the curve flattens may not necessarily be obstructive.

[jomama]

Sheepless you can see it in the flow wave. One reason why a 2 min window is needed.

It does look like it's obstructive, but for the sake of argument, is it possible that it was not obstructive in nature? For example, what if I was having a dream, and I started to have different breathing, like I was scared or something, and started to huff in that way of sucking in a quick breath a few times. Or something along those lines: a change in breathing based on a dream experience. Is it possible that something like that was happening? (I'm not questioning anyone's expertise here, not at all, just brainstorming, for the benefit of all of us trying to understand how to interpret these charts...)

[sheepless]

if you're asking me, idk, jomama. I don't think recovery breathing or arousals necessarily tell us anything about obstructive vs central & I do suspect waning effort toward the end of your flow limited breaths, but I also know enough to defer to Sleeprider's superior knowledge & experience.

[jomama]

I don't know what causes it, but it is a lot more like a limited hypopnea than chronic flow limitation. It's disruptive, and it's going to be there with or without CPAP.

I'm curious if you (or anyone) know why PAP is unable to help with such events...? (Or, did you mean if it's a chin tuck? Because I really don't think they're caused by chin tuck, at least in my case.)

[jomama]

Okay, well, it looks like I've gotten all the help/advice I'm going to... which I have greatly appreciated, for sure. 

In case anyone out there is reading this thread because their case is somewhat similar to mine, I'll just share that I have decided to stop PAP therapy again, after trying hard for the second time. While I do seem to experience some hypopnea events during the night which seem to cause arousals, from all my charts it also looks like SDB events are not necessarily the cause of some, or many, if not most, of my arousals and difficulty staying asleep. I also have several instances where an event will be starting, and the pressure of PAP doesn't do a darn thing about it. The only solution for that is to try to raise pressure beyond a point which brings a host of other problems to try and solve, and I have a strong feeling that it wouldn't even help anyway. By most accounts, my "numbers" are good already.

The other option is to try bilevel or ASV, but, again, given that I have no real solid evidence that PAP therapy is actually addressing (or helping with) the main cause(s) of my difficulty staying asleep, I can't justify spending hundreds or thousands of dollars more on machines that may help, but which seem, at this point, like they probably won't. 

I wish that I had solid answers. I'm really suffering, and my quality of life has greatly diminished as I'm getting older and am less resilient after nightly lack of restorative sleep. And the problem is that PAP was my last hope. I have nothing left to try at this point, having already tried, or looked into, or tested for, pretty much everything else. I'm dead in the water, with no hope of ever getting restful sleep, which is a really bad place to be.

Part of me wishes that I had seen a moderate-to-high AHI on my sleep test and PAP therapy reduced that number and I felt even slightly more rested because of it, which is something I've seen a lot on this board. In such cases, it's clear that PAP therapy is doing something, is having a positive effect, and it's worthwhile continuing to solve comfort issues. But in my case, there is no such hard proof that any benefit is actually being had. Not only that, but PAP therapy itself was giving me pretty brutal middle of the night insomnia that I simply don't (normally) experience without PAP. In other words, it was making my sleep and life even worse, with no discernible upside. 

So, even though it's somewhat "sacrilegious" to say, I give up.

[Sleeprider]

I'll stand by my original assessment that PAP therapy is not critical for maintaining your health, but that you will keep an open mind if you find, after quitting, that it helped. I hope you will find your solution to good sleep, and will keep us informed of the journey, whether or not it involves a CPAP or bilevel therapy. I'm sure you are not completely unique in having these issues, and your story may help others. I suspect CPAP therapy may yet play a role in your eventual outcome.

[jomama]

Unless I try again purely out of desperation, which my experience has shown is an exercise in futility, I'm not sure what role CPAP could play in my future. That said, and even though I have given up, it would still be helpful (to others, as well, I presume), to get answers to my unanswered questions above....