clan therapy thread

[clan]

Hi,

My cover sheet numbers look really good so the pros do not take me serious. But I am not well at all. So I am now seeing how much I can optimize for myself. This is year 13 for me with PAP. To keep the story short I got a new machine 14 days ago. Things improved right away but am trying to dial things in.

P max unchanged at 16 - highest peak pressure seen is 11.5

Started out with P min 6. Very low AHI and obstruction events but see some VS events.

To test it out I tried with  P min 7 and SotPAP/EPR 2. This gave me 41 FL events in 3 hours and 33 minutes. And I felt so horrible I could not go straight back to sleep even though I was tired. I have not seen any FL at all without SoftPAP/EPR.

I have learned that I am a mouth leaker and have now taped up. I think I have really good control of my leaks now. This gave a nice improvement in sleep quality as well.

Tonight I had a very clean looking night with a magical AHI of only 0.26. Woke up after the first session as I usually do but was able to easily go back to sleep. After the second session I was still tired but my body did not feel comfortable lying down at all. This happened often previously with my Dreamstation but this is the first with the Prisma (Except for the SoftPAP/EPR night which was worse). That makes me believe it is related to my theraphy and not environmental or psychological issues. And I see my flow rate does not look good at these times.

I think I have cleaned up "the usual suspects" and I am not able to interpret my data any further myself. The Wiki has taken me as far as I can. I see things that looks funny to me but might be trivial or uninteresting for the expert.

My 03:50 hours overview looks like this:

   

I do notice that the pressure goes up before waking but not by a lot. I always see some noise in the data before I wake up. I am unsure if that aactually is an indicator of an issue or that is what is expected. From what I see elsewhere I do not think it looks normal.

What levers do I have left to pull? Does it make sense to keep increasing P min? Is it worth a shot to retry SoftPAP at these higher P min? Or have I simply run out of rope?

Any input would be highly appreciated.

Kind regards,
clan

[clan]

Session 1 images:

My respiration rate does go down at 01:45 but I would not think alarmingly so?

I have very few VS events but they seem connected to me waking up. This is what happens during the last 15 minutes of session 1. And 3 minute zooms of the interesting spots.

           

I could go straight back to sleep after this session.

[clan]

Session 2 images:

Of the very few events this night there is a VS event at 02:16. I usually have more that look like these. 2 nights ago I had 27 VS events with most looking like this and I found 12 unmarkeds location looking the same with the flatlined flowrate.

My respiration rate tanks completely at 03:15. That looks bad to me at first sight. But again I do not have the experience to evaluate properly.

This is the last 20 min of session 2 and a 3 minute zoom when the respiration rate drops.

           

I felt bad after this session and it felt uncomfortable to stay in bed even though I was tired.

[clan]

Bumping my own thread. Noone has any input? Too trivial? Nothing to see?

[PeaceLoveAndPizza]

At this point focus on quality sleep, not numbers.

Generally things look good, but there is a quite a bit of waxing/waning in the flow rate which could be enough flow limitations to impact sleep quality. All those micro-arousals take their toll over time.

If it was me first thing I would address would be trying to smooth it out. Maybe a bit more pressure, a bit of EPR/SoftPAP, all micro-adjustments, nothing too major. 

If it ain’t broke…

[clan]

Oh for sure! My numbers was not that much worse with the Deathstation but nobody listened when I talked about quality of sleep. The waxing/waning was even worse before but I did not have the vocabulary to express it and today I can feel how big a difference it has made. My own adjustments so far has already made a huge improvement. But knowing today how much better things has gotten I am very motivated to "go all the way". It pays huge dividends.

With a pressure around 9 - 10 I start burping so too much air gets into the stomach. And I have been at pMin 9 but maybe I have ramped up to quickly for my body to adjust.

Micro adjustments sounds like a good strategy. But how long is enough to push your limits? Is it day by day and simply nudging on? Or is a week? month?

I do understand that it can be different from person to person. I just want avoid someone telling me later that "ohh you should stay at your pressure for at least 3 months before trying to push your boundaries".

Thank you so much for your time! I highly appreciate it!

Kind Regards,
clan