[Treatment] Need help titrating BiPAP

[originofstyx]

I kept all the settings the same other than bumping Trigger back up to Very High, and this seemed to get rid of the Centrals. I still had a couple Obstructive events but I think my problem is these RERA and hypopnea cycles. Still no restorative sleep. I'm wondering what the next step would be.

[Dormeo]

Hmmm. No evidence of a positional issue here, or flow limitations or hypopneas. Parts of your time in bed look like pretty peaceful sleep; other parts don't look restful at all.

It's possible that with time you will settle into more restful sleep with what now seem like good settings for you. But it's worth raising some other possibilities.

Can you manage more like 8-9 hours of sleep? Have you considered Cognitive Behavioral Therapy for Insomnia (CBTi), which some people find is helpful in consolidating fragmented sleep? Have you talked with your doctor about restless leg syndrome? Have you been tested for other contributors to daytime fatigue, fog, or sleepiness (e.g., thyroid deficiency, anemia, connective tissue disease)? -- Just trying to think outside the arena of PAP pressure settings.

[originofstyx]

Hmmm.  No evidence of a positional issue here, or flow limitations or hypopneas.  Parts of your time in bed look like pretty peaceful sleep; other parts don't look restful at all.

It's possible that with time you will settle into more restful sleep with what now seem like good settings for you.  But it's worth raising some other possibilities.

Can you manage more like 8-9 hours of sleep?  Have you considered Cognitive Behavioral Therapy for Insomnia (CBTi), which some people find is helpful in consolidating fragmented sleep?  Have you talked with your doctor about restless leg syndrome?  Have you been tested for other contributors to daytime fatigue, fog, or sleepiness (e.g., thyroid deficiency, anemia, connective tissue disease)?  -- Just trying to think outside the arena of PAP pressure settings.

Thank you, I'll definitely give it more time. 

Yes I have been tested for all kinds of things including full labs (vitamins, hormones, CBC, thyroid, antinuclear antibody to test for autoimmune diseases, etc), different chiropractors and a physical therapist, neurologist for brain MRI, nutrionist, allergist, all kinds of psychologists and psychiatrists, cardiologist for EKG, echocardiogram, etc etc but they couldn't find any problem beyond what the sleep study indicated.

My main symptoms include constant brain fog, fatigue, daytime exhaustion, poor concentration and working memory, and feelings of nervousness/anxiety. 

I am working with a sleep-focused Ortho to look into MARPE/MSE to expand my palate so I can nasal breathe (I can't breathe through my nose except with Afrin) and hopefully eventually MMA surgery.

[Gideon]

Have you done an overnight oxygen study to see what your levels are. PAP treatment eliminates most, but not all, of these issues.

[sheepless]

post a pic in the area of your screenshot that I copied below but at a 10 minute view scale from roughly 8:02 to 8:12. adjust the scale using the slider at the bottom of the daily/events tab.

edited to delete the image which can be seen in #39 below.

[Gideon]

Thanks Sleepless.

That chart segment shows a potential PLM that may be significant, talk to your doctor about that.
I did not even look at that because your O2 Sats say you are a shoo-in for any zombie movie.
Please, Please talk to your doctor now to move that important part of your therapy forward.

[originofstyx]

Thanks Sleepless.

That chart segment shows a potential PLM that may be significant, talk to your doctor about that.
I did not even look at that because your O2 Sats say you are a shoo-in for any zombie movie.  
Please, Please talk to your doctor now to move that important part of your therapy forward.

The problem was, I was only able to sleep 1 hour in my in-lab PSG, so that study was considered "inconclusive".
I noticed that my Minimum Oxygen Desaturation was 88%, and at some points in the night my heart rate spiked up to 120 BPM which is tachycardia (according to my understanding).
Is this what you mean by "your O2 Sats say you are a shoo-in for any zombie movie"?

[Gideon]

My apologies, I was thinking of another user here that has severely lower O2 Sats. Per your lab yours are on the low end of ok. You didn't have long-duration desats.
Again my appologies.

[originofstyx]

post a pic in the area of your screenshot that I copied below but at a 10 minute view scale from roughly 8:02 to 8:12. adjust the scale using the slider at the bottom of the daily/events tab. I'll try to delete the one below afterwards in case it counts against your attachment allotment.

[/quote]

This was that 10 minute chunk from yesterday between 8:02 and 8:12.

Apparently last night I only captured 45 minutes of data in Oscar because I must have accidentally turned the machine off at some point (maybe I had to cough or itch my nose or something then forgot to turn it back on, lol). Either way I'll give it another try tonight.

[sheepless]

I was hoping it would be more clearly plm, just so you'd know. it has hallmarks of plm breathing but isn't quite as uniformly repetitious as I'd like to see to be more certain. still, I think it's suggestive enough to warrant continuing to investigate the timing of your movements relative to flow limitations and events, maybe even trial rls/plm treatment to see if this pattern becomes less frequent and/or you feel any better as a result. not all sleep disordered breathing can be fixed by pap.

edit: it's really hard to judge. looking at it again, if my betting limit was a dollar, I'd wager 60 cents this is plm.