[Treatment] NightmaresOfTheBottom - Therapy Help Thread

[Crimson Nape]

The AS11's firmware currently does not recognize DST. You have to delete the current data before you can change the timezone. I would leave it for 2 reasons. 1. In 2 weeks it will be correct (Nov, 2, 2024-DST End). 2. It isn't important when you actually sleep, but for how long you slept is.

If insurance covers it, you may wish to have your Potassium level checked on the next blood test.

- Red

[NightmaresOfTheBottom]

Okay I will leave the time settings be. 

My potassium levels were normal at my last blood test, 4.1 mmol/L, normal range of 3.5-5.3.

[Dormeo]

It's good to hear you'll be trying CBT-I. I'll be interested to hear how it goes.

You had several stretches of OK sleep in the most recent chart, along with a bit of reduction in your FLs. CAs continue to be associated with arousals, so I would just ignore them for now. Your plan to stick with these settings for a bit is a good one.

When people take their masks off without knowing it, one trick they can try is to put a piece of tape across a mask strap, anchoring it on both side to the skin on their face. The tug is often enough to stop them when they try to take the mask off.

[NightmaresOfTheBottom]

Updated data in OSCAR and SleepHQ from the past week.  Missing a couple days because I forgot to put the SD card back in the machine.

As suggested, I increased the minimum pressure to 7-8 and decreased the ramp from 5 min to 0.  It has been more difficult to sleep with the higher minimum pressure.  I find myself waking up more frequently in the night and tearing off my mask, and my compliance has dropped.  I followed the suggestion of taping the mask to my face and that has helped somewhat.

AHI for the most recent nights captured with the SD card was 0.90, 0.89, and 1.07.  I don't feel as well-rested with these new settings compared to when the minimum pressure was back at 5, despite the lower AHI.

What do you suggest I try next: keep it at the higher minimum pressure setting of 7-8 and try to power through it until my body adjusts, or drop the pressure back to 5 where I slept and felt better?

Thanks

[Sleeprider]

If you drop your starting pressure, I would suggest also decreasing EPR. That will raise flow limits, and in my opinion, you are doing very good with the minimum starting pressure of 7.0 Let me explain. At a minimum pressure of 7.0 with EPR 3, your pressure is 7.0/4.0 (inhale/exhale). Your machine delivers minimum pressure of 4.0 regardless of EPR setting, so when you set the minimum pressure to 5.0, the starting pressure is 5.0/4.0, and it progresses to 6.0/4.0, 7.0/4.0 and finally exhale pressure starts to rise. This means that the lower pressure with EPR 3 prevents your device from preventing obstructive apnea until it can respond with higher exhale pressures. An alternative approach may be to prevent the machine from increasing pressure by keeping a constant 7.0/4.0 pressure. This can be done by setting both the minimum and maximum pressure to 7.0. This will continue to provide good treatment for flow limitation, but the constant pressure may be less disruptive to your sleep and more comfortable. Based on results so far, you don't have a significant OA rate with this starting pressure. My recommendation is to try a fixed pressure to see if you find that more tolerable and if it maintains your good AHI that you have observed with pressure at 7.0 to 15.0 with EPR 3. I could also see using a limited pressure range of 7.0 to 8.0 to have some response to obstruction.

[Dormeo]

Please follow Sleeprider’s advice!

[NightmaresOfTheBottom]

I changed the min pressure to 7, max pressure to 8, and turned EPR off.

AHI of 0.57 last night.  It felt easier to sleep with the near constant pressure than before.  PC remains high at 62.  Still waking up in the night, as seen in my SleepHQ sleep stage data, which comes from my Oura ring.

I'll stick with these new settings for a few more nights to see how it continues to go.

[Dormeo]

It's great that you felt you slept better last night. I'm not sure why you turned EPR off, though. As you can see, your flow limitations were a lot worse without EPR. About heart-rate variability: I'm not aware of any reason to think your variability is problematic.

Keep us posted, would you?

[NightmaresOfTheBottom]

I guess I misunderstood Sleeprider’s post. I thought they were suggesting keeping everything at a constant pressure (i.e. no ERP).  Upon rereading it, I realize they did not suggest that. I’ll turn EPR back on tonight.

Regarding the pulse changes (PC), my understanding is that they are associated with spontaneous arousals, which can negatively impact my sleep quality.  My in lab sleep study indicated mild PLMS.  I've read that PC is correlated to PLMS and spontaneous arousals.  Is that not the case?

Your sleep study showed a lot of spontaneous arousals. Those are arousals that aren't preceded by respiratory events. These can be difficult to address, and your best bet is to do everything possible to put in place the conditions for restful sleep.

Is there a better way to assess spontaneous arousals in a home setting than with PC?  What is considered a typical PC range? More broadly, what is PC used for with sleep apnea?

[Sleeprider]

I think you will do better wit EPR at 2 or 3. Fixed pressure or limited pressure changes can help with sleep disruption, but we really want to se a lower flow limitation that is enabled with some EPR or pressure support.