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+--- Thread: 18 mths of apap: need help optimizing settings to feel better [ASV] (/Thread-18-mths-of-apap-need-help-optimizing-settings-to-feel-better-ASV)
RE: 18 mths of apap: need help optimizing settings to feel better - sheepless - 05-31-2018
is this what periodic breathing looks like?
RE: 18 mths of apap: need help optimizing settings to feel better - sheepless - 05-31-2018
this can't be normal can it? the entire night is like this.
RE: 18 mths of apap: need help optimizing settings to feel better - Sleeprider - 05-31-2018
Check out your 5/26/18 results from 2:11 to 2:28, or 3:10 to 3:30. In fact it goes on all night, every night. This is the central periodic pattern I was telling you about.
RE: 18 mths of apap: need help optimizing settings to feel better - sheepless - 05-31-2018
Sleeprider, 1 hour 18 min nap at suggested 9/9cm epr3, cervical collar on. not waiting until full night at this setting to post graphs because duration and number & type of events surprised me. this nap is longer than most; usually they're closer to 20 minutes & produce 0 - very few events. have to give it more time to see if I can achieve longer segments overnight but longer duration is one outcome you thought might occur at this 'counterintuitive' setting. and while the increase in osa you kind of expected didn't happen during this hour, hypopnea seems to have. on the plus side, flow rate looks like it evened out a bit toward the end. will continue these settings overnight and post tomorrow.
RE: 18 mths of apap: need help optimizing settings to feel better - Sleeprider - 05-31-2018
What is important to see is if you can tolerate a lower EPAP pressure, in this case only 6-cm. There is a lot of periodic breathing in your nap that an adaptive machine could take out selectively. Hypopnea is okay, OA is something I hope not to see a lot of.
RE: 18 mths of apap: need help optimizing settings to feel better - sheepless - 06-01-2018
last night's daily screen. let me know if and what I should zoom in on.
btw, I have refrained from doing it today but in my struggle to regain my life through sleep I am attempting to learn how to read these waveforms. in so doing I have often posted graphs with a summary my own interpretation. sometimes my statements are not accompanied by qualifying words and sometimes I add phrases like "I wonder if" or "it looks to me like". as a neophyte I expect to be wrong more often than not. I suspect most understand this and some are not shy about straightening me out (thanks). I just want to be clear that I'm not pretending to knowledge I don't have and I am pleased to receive both confirming and corrective responses. it's important to know when I'm wrong and why.
thanks.
RE: 18 mths of apap: need help optimizing settings to feel better - Sleeprider - 06-01-2018
Mainly I wanted to see what your tolerance is for lower EPAP pressures. The same patterns as always are present here, and the AHI is frankly no worse or better. There is still a lot of periodic variation in flow rate. I looked at a lot more of those patterns last night, and they are a constant feature of your breathing. You have tried pressures from this low of 9/6 to variable pressures that went to 20 cm, all without much change from the big clusters of CA and OA and the fragmented therapy. I can't think of much else to do with CPAP.
Given your original diagnosis in sleep study of central sleep apnea, and your follow up sleep study showing complex or mixed apnea, I think you should try ASV is the opportunity presents itself. My suggestion is an EPAP of 6 to 12, PS 3 to 12. We can hope that you can change your habit of breaking therapy every hour, or that the therapy works well enough that you won't feel a need to. I tend to think this is going to be a difficult habit to break and the only help we can offer is to make the sleep you get as good as possible by evening out periodic respiration and breaking the cycle that leads to the clusters of OA. I think a good soft cervical collar will continue to be your friend..
RE: 18 mths of apap: need help optimizing settings to feel better - sheepless - 06-01-2018
okay then. will wrangle an asv asap.
RE: 18 mths of apap: need help optimizing settings to feel better - sheepless - 06-01-2018
is it possible that the soft cervical collar that has worked so well to reduce my leaks is also worsening periodic breathing, flow limitations and rera? looks to my eye that these are more frequent and more pronounced than pre-collar.
these are two naps today. earlier time settings of 11 / 13.4 epr3. later time settings of 13.4 / 13.4 epr3.
RE: 18 mths of apap: need help optimizing settings to feel better - Sleeprider - 06-02-2018
You were just a little difficult to persuade that a collar was the answer.
The collar does not make your PB worse, it makes it more visible by limiting the leaks which mute the flow rate. What we see in this graph is inspriatory flow-limitation causing a reduced amplitude, followed by periods of recovery or normal breathing. ASV can supplement pressure during flow limitation to normalize those breaths.