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[Treatment] cps22 - Therapy Thread
#11
RE: cps22 - Therapy Thread
Here is my chart from last night, as well as my overview info. Settings changed to AutoSet 8-12, EPR 1. Overall, things don't look too much different from usual, other than more CAs, which I expected with the EPR on. 

If you want to see detail of some particular segment, let me know. 

My sleep stages as best I can gather from my Apple watch:
deep: 23:14-23:35
rem: 23:44-23:49, 00:41-1:30, 3:13-3:50, 5:14-5:22, 6:24-6:48

It looks like the pressure increases correspond pretty directly with my REM sleep.


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#12
RE: cps22 - Therapy Thread
Thanks for trying that. From a numbers perspective fixed 8 with no EPR looks to be a good setting for you. The flow limitations look to be related to the use of EPR and may be self-limiting e.g. TECSA, so it is your choice whether you try it a few more days to see if they being to resolve themselves. 

You also seem sensitive to the pressure increase in response to FL’s. Something to keep in mind.

What do you think about the difference in how you feel between the fixed 8 and pressure range 8-12 EPR 1? From the chart it looks like the 8-12 EPR 1 is better for numbers (better TV, less FL), but the differences are not significant. 

If you want to continue with fixed 8 or keep trying the 8-12, or even try a fixed pressure of 9 as your median is closer to 9, it is a choice for comfort since as you noted the differences are minimal.
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#13
RE: cps22 - Therapy Thread
Thank you for your help. 

With just the one night to go by, I "feel" about the same as I usually do lately, which is tired (but not extremely tired). At this point in therapy, I have pretty much gone from "worse than before I started CPAP" to "about the same as before I started CPAP". 

My sleep felt pretty similar to previous nights. The mask was less comfortable with the higher pressure though, and I have pretty deep mask lines this morning (and very puffy eyes). When the mask lines have been this bad before, they don't go away until evening, if at all. I have an afternoon event tomorrow where mask lines like this would be pretty embarrassing and photos will probably be taken, so I will probably go back to the fixed pressure for tonight. But after tomorrow I might try the Auto settings again for a few days and see if anything changes.
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#14
RE: cps22 - Therapy Thread
The night before last I had the machine set to AutoSet with the settings as listed previously. AHI was 2.27, but with a bunch of CA's, mostly in clusters in sleep/wake transitions. But I felt horrible in the morning, and again, with deep mask strap lines. I had planned to try this setting out for a week, but decided I just couldn't take it so I was going to go back to the fixed pressure of 8. 

But when I went to bed last night and was changing the settings back to the fixed pressure, I decided to set the pressure at 4 instead of 8 just to see what it would be like. Not surprisingly, I had some Hypopneas as I was first falling asleep. and then I had a cluster of OAs. The OAs appear to at least partly have occurred while I was awake, though I suppose it's more likely that they started happening and woke me up. But it still looks like at least some of them were after I woke up. This was at about 2:30ish. I got up to go to the bathroom, and when I went back to bed, I changed the pressure back to 8. I slept that way for about 2 hours but then woke up again and took the mask off for the rest of the morning until I woke up a bit before 8:00.  

What is kind of weird to me is that my flow limits look slightly worse during the second session when the pressure was 8 than they did with the pressure at 4. But the AHI graph is definitely worse during the first session. 

My respiration rate and SP02 don't look much different between the two segments, and even without the CPAP, my SP02 doesn't look substantially different, other than some drops in the 6:00-6:30 area when I was in REM sleep. 
  • What, if anything, does this tell me? (Other than that I seem to do best with a fixed pressure of 8 and no EPR.) 
  • Should I be concerned that my flow limits didn't really change much, no matter what the pressure rate is (since they were basically the same using the 8-12 range as well)?
My charts from last night are attached.


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#15
RE: cps22 - Therapy Thread
Just my opinion, I'd think the oxygen desaturations to be a topic for discussion with your medical team. Are they extremely low? No, however your lowest desat was 86% but it was fairly brief at the lowest it seems, yet there's lots of these drops overnight.

As for the clusters of events at the bookends of sleep sessions, this can probably be wrote off due to what's called SWJ, sleep wake junk. It's caused by a clumsy handoff in your wake to sleep breath control within the transition between these states. Most everyone does this, some worse than others.
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#16
RE: cps22 - Therapy Thread
My sleep doc has seen my O2 reports and seems unconcerned about the drops, as long as it's OK overall. And he isn't concerned that my respiration rate is so low (averaging 10.5 bpm - both before using CPAP and in the 3 months of using it) as long as the O2 is alright. 

Yes, I do understand the SWJ. Most of my nights I have only a couple of CAs, and they're pretty much always at sleep/wake cycles. I was mostly just surprised by my flow limits not changing much with the various pressures, and that they actually appeared slightly better at 4 than at 8. Maybe that's not abnormal? Or might it suggest something going on that can't be addressed with CPAP - nasal polyps or something? I have not seen an ENT, so I have no idea what might be going on in my air passages.
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