[Treatment] Acceptable AHI with worrying minute ventilation / tidal volume

[gainerfull]

@McRiver - a lot of the "central apneas" you're showing in screenshots follow a position changes - it's completely normal to hold your breath after changing positions. Is there a reason you're tossing & turning so much while you sleep? Also, why do you go to bed so late? The first screenshot lets us know you're not starting therapy until 2AM.

[McRiver]

@McRiver - a lot of the "central apneas" you're showing in screenshots follow a position changes - it's completely normal to hold your breath after changing positions. Is there a reason you're tossing & turning so much while you sleep? Also, why do you go to bed so late? The first screenshot lets us know you're not starting therapy until 2AM.

No idea why I toss and turn so much. I always have, and I assumed when I got the apnea diagnosis it was probably my body reacting to the apnea.

As for the late nights... Combo of being a graduate student where it's normal to keep later hours than most people, and just, I feel awake in the evening and don't in the morning, even when I get to sleep at a normal person time? I'm trying to shift earlier but it's not like I struggle to stay up that late. I don't think it's a caffeine thing or anything, since I don't drink coffee after ~3.

[gainerfull]

No idea why I toss and turn so much. I always have, and I assumed when I got the apnea diagnosis it was probably my body reacting to the apnea.

As for the late nights... Combo of being a graduate student where it's normal to keep later hours than most people, and just, I feel awake in the evening and don't in the morning, even when I get to sleep at a normal person time? I'm trying to shift earlier but it's not like I struggle to stay up that late. I don't think it's a caffeine thing or anything, since I don't drink coffee after ~3.

Thanks for the reply, the subjective quality of your sleep will be better, the earlier your go to bed. It can also be enhanced by maintaining consistency between when you go to bed and when you awaken.

It would be interesting to see if you start measuring sp02 if the position change is due to a desaturation you're experiencing while sleeping on your back. Have you tried sleeping on a wedge pillow at all?

[Sleeprider]

The use of EPR did in crease the CA events and some periodic breathing is in there. This looks like therapy induced central sleep apnea, and EERS may be a good solution. The alternative with bilevel is to use a high trigger sensitivity to stimulate the breaths, but you are clearly sensitive to the use of pressure support/EPR. Tidal volume averaged 300 mL with the EPR, so you get better volume with the pressure support.

[ChadBSr]

Thinking about trying EERS - I've read the wiki entries on it, and it seems it does often have the effect of upping minute ventilation and tidal volume while dropping respiratory rate? Just nervous that it won't work and then I'll have ruined a mask elbow and bought the modification stuff for nothing.

Just tape over the the vents and the whisper swivel isn't super expensive. If you can find the tubing in short sections its really cheap. I had to buy a whole length for $11. Its a lot cheaper than a bipap.

[McRiver]

Thanks for the reply, the subjective quality of your sleep will be better, the earlier your go to bed. It can also be enhanced by maintaining consistency between when you go to bed and when you awaken.

It would be interesting to see if you start measuring sp02 if the position change is due to a desaturation you're experiencing while sleeping on your back. Have you tried sleeping on a wedge pillow at all?

Not sure why the quality of my sleep would be improved by shifting the time when I do it, but I have been trying to improve consistency (and I'd like to get another hour or two). Hoping that getting more restful sleep will help me there.

Well, my smartwatch finally came back in so I could theoretically start measuring sp02 with that (or get a overnight pulse ox, tho the ones that plug into Oscar look pretty pricey) but no, I haven't tried a wedge pillow. My apnea was worse on my back when I did my test, though still had it on my sides, so it's definitely possible I'm tossing and turning due to desaturations. Not going to immediately try a wedge pillow yet because I think I'd prefer to try EERS first (If that lets me increase pressure support the sleeping position issue might be moot), but I'll keep that in mind.

[McRiver]

The use of EPR did in crease the CA events and some periodic breathing is in there. This looks like therapy induced central sleep apnea, and EERS may be a good solution. The alternative with bilevel is to use a high trigger sensitivity to stimulate the breaths, but you are clearly sensitive to the use of pressure support/EPR. Tidal volume averaged 300 mL with the EPR, so you get better volume with the pressure support.

Thank you! I think I'll return to this thread when I get the stuff for EERS, then, so I can perhaps optimize pressure support in combo with that.

Curiosity question about the difference between BiPAP and EPR - I always assumed that it was only that you could have a greater inspiratory/expiratory difference with biPAP but it sounds like it's more than that, with that trigger sensitivity idea? Is the trigger sensitivity basically a fine tuning of how quickly the device responds to changes in your breathing?

[McRiver]

Just tape over the the vents and the whisper swivel isn't super expensive. If you can find the tubing in short sections its really cheap. I had to buy a whole length for $11. Its a lot cheaper than a bipap.

Ooh tape instead of the silicone putty, that makes sense. That may help prevent me from worrying that I'm ruining the elbow, haha. I also saw that if I did do the silicone putty like in the wiki and did mess up, resmed elbows are out there for only $20 bucks, which again, helps me from being completely obsessively anxious. (Grad students make minimum wage, so the money concerns are actually reasonable, but also... anxiety disorder. I do literally have a formal diagnosis / medications for 'you worry too much.')

[ChadBSr]

Yeah, I actually taped an elbow from another mask onto the short tube from my nasal mask just to do an initial try before buying the parts used in the actual medical study. I'm buying everything out of pocket and this health stuff adds up fast so I understand that.  I'm at 3 lengths of tube now and tempted to try a fourth, but including the tube on my mask I'm already slightly over the maximum dead space used in the study. If you can afford a better o2 sensor it would be a good idea to get it for the EERS experiment. I have the wellue/viatom checkme O2 Max. Its great, constantly reading and the battery lasts days. I don't even charge it. The few minutes connected to my laptop to load data is enough.

[ChadBSr]

You're sleep data actually looks a lot like mine. Here's a quote from the doctor who pioneered EERS that you might find interesting:

"The main effect of EERS is to prevent the hypocapnia during the arousal related ventilatory blow off. When you arouse you always have large tidal volumes, and that drops the CO2, and that sets off this whole unstable sequence. You're providing essentially a CO2 shock absorber. That's what EERS is."

Dr. Robert J. Thomas