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RE: I've been using my APAP for a week, symptoms wors V2e. - Geer1 - 07-03-2021
You didn't say what type of allergy test that was (I assume IgE blood test). It doesn't appear to be a high result if the case but IgE is only part of the picture and rarely elevated in people that have dairy intolerance or sensitivity (I was just tested and do not have a dairy allergy although obviously have reactions to dairy). Those results and your comments about lactose intolerance, digestion and congestion are reasons to try a dairy elimination diet as it may be causing or at least worsening some of these symptoms. You want to talk about anxiety being caused for an unknown reason feed me dairy...
Elimination diet requires cutting out all forms of dairy for 6-8 weeks and paying attention to see if any of your symptoms (sleep, digestion, nasal congestion, anxiety etc) improve. At the end of the elimination diet you reintroduce dairy and see if you notice any of these symptoms reappear. It is often hard to notice the symptoms improving because it is a slow process (much like CPAP) but you will notice the effects more when you try to reintroduce it. In my case it was hard to pinpoint because the majority of my symptoms do not occur directly after ingesting dairy but rather 1-3 days later, because of this I had to try eliminating and reintroducing a few times to make sure it was the cause. If you reintroduce and think it may have had an effect but aren't quite sure cut out dairy for another couple weeks and try reintroducing agian. I had to do this a few times but eventually it became obvious when I realized the majority of my symptoms appear 2 days later.
Eliminating dairy is a bit of a pain but not that hard to do especially for a short time, there are lots of alternatives like oat milk, almond milk, soy milk, plant based cheese etc (I am far from vegan but they are a great source of dairy free food). The biggest pain is how many processed foods have thinks like modified milk ingredients or the odd restaurants that have poor dairy free selection.
If you find you do have a reaction to cows milk then it is up to you if you want to remove it from diet completely or if you want to try reintroducing lactose free dairy products. My recommendation is to avoid these during first elimination diet because many people are intolerant to the protein (casein) rather than lactose so remove both at first and then test lactose later.
Dairy intolerance is common and can have a huge impact on a persons health, unfortunately there are no tests for it other than elimination diets.
Edit: Here is a link on the topic, aimed at children but applies to adults as well. You can find many other similar sources but need to differentiate between allergy and intolerance.
https://www.urmc.rochester.edu/childrens-hospital/gastroenterology/conditions/cow-s-milk-protein-intolerance.aspx
"Cow’s milk protein intolerance (CMPI) is an abnormal response by the body's immune system to a protein found in cow's milk, which causes injury to the stomach and intestines. Cow's milk protein intolerance is not lactose intolerance."
"In IgE-mediated CMPI, symptoms can start within 2 hours of drinking cow milk, whereas in non-IgE-mediated CMPI, symptoms can happen from 2 days to 1 week after ingestion of cow's milk."
"The signs might manifest as a skin rash or eczema, or involve the GI tract, such as vomiting, abdominal pain, blood in the stool, mucousy stool, and diarrhea. Prolonged issues in infants could lead to wheezing, irritability and poor growth / failure to thrive."
"The diagnosis of CMPI is also supported by an improvement in symptoms after the elimination of cow's milk. Most of the time, blood tests and other invasive studies are not helpful."
I think this is potentially what happened to me. I had a known dairy intolerance as a baby that I was believed to have grown out of. I think 3 decades of dairy consumption damaged my digestive system. This can cause all sorts of issues as our gut is heavily involved in neurotransmitter synthesis, immune system, nutrient levels and more.
RE: I've been using my APAP for a week, symptoms wors V2e. - AmirKas - 07-03-2021
I'll definitely plan out an elimination diet and let you know after 2ish months how I'm doing. I wanted to post last night's results since they were poor and now I'm feeling pretty awful.
The only change I made was setting EPR to 3. I'm confused because central apneas weren't the main issue, but rather, I had a lot more OA's. I think I should change EPR back to 2 and keep the settings of 10cmH2O and 13cmH2O for a while, but let me know if there's anything else I should do. (Maybe up the pressure and keep EPR at 3)
Part 1: Great Sleep
[attachment=33423]
Part 2: Terrible numbers
[attachment=33424]
Closer look when AHI peaked:
[attachment=33425]
RE: I've been using my APAP for a week, symptoms wors V2e. - Geer1 - 07-03-2021
I am curious to see a closer view of 16:47 - 16:52, move mask pressure graph up into view as well (move it up below flow rate). This view will help me try and interpret a bit more rather than relying on machine flags.
You had nearly as many apnea flagged as centrals as you did obstructive and when you get into this periodic pattern these machines can struggle to correctly flag whether events are central or obstructive (sometimes I think it is because they are mixed apnea). You also had more periodic breathing and the data just looks worse in general so it appears that increasing EPR did not help.
The question becomes was this just a bad night or did EPR make things worse. If EPR made it worse then it was most likely central in nature. There is the possibility it made you more prone to obstruction by dropping EPAP pressure 1 cm but that doesn't appear to be the issue since the machine increased pressure and your median EPAP was pretty much the same as previous night. Most of your apnea and flow limitations actually occurred at higher pressures indicating the higher pressure wasn't helping (at least not last night).
I think we should try and fine tune EPR before making any more pressure changes. I will let you decide what to try next, you have three options. 1) Try another night at these settings to see if it was just a bad night. 2) Go back to previous settings and continue to give body time to adjust to them. 3) Try dropping EPR down to 1 to see if reduced EPR gives better results (it might).
Edit: Another question to ask yourself when making this decision is whether or not you think anything else might have influenced this data. Did you have worse nasal congestion last night? Stress was worse for some reason? If not then the only difference was EPR setting.
RE: I've been using my APAP for a week, symptoms wors V2e. - AmirKas - 07-03-2021
Asides from the typical deviated septum there wasn't any noticeable nasal congestion. Stress was fine and actually better than most days and had no upcoming deadlines.
Here's the closer up:
[attachment=33426]
RE: I've been using my APAP for a week, symptoms wors V2e. - Geer1 - 07-03-2021
I think those are incorrectly flagged and actually central in nature. I believe you had an arousal at 16:47:40 and then these were sleep transition centrals as you transitioned back to sleep.
Central apnea like this (imo are central) are caused/exacerbated by the CPAP making your breathing more efficient which lowers CO2 levels in lungs/blood. The lower CO2 levels decreases respiratory drive causing central apneas or hypopneas which creates the periodic breathing (less drive, then catchup breaths, less drive, repeat). Your body can adapt to this over time as it gets used to the lower CO2 levels. I believe in cases like this the arousal breathing triggers the low CO2 level which cases the apnea and then rinse and repeat until steady state is reached.
My recommendation would be to go back to EPR of 2 or try EPR of 1. EPR of 1 may further reduce the periodic breathing that has been occurring and may help. Eventually after you adapt EPR of 2 or 3 may be beneficial but so far it appears that your body is not ready for EPR of 3. EPR 2 results so far have been decent, they show periods of periodic nature but no significant apnea so its unclear what clinical relevance those periods have.
RE: I've been using my APAP for a week, symptoms wors V2e. - Geer1 - 07-03-2021
I explained how CPAP treatment can induce centrals (by lowering CO2 level below what your body is used to seeing after years restrictive breathing) and how this periodic central phenomenon works (coming from computer science and physics background maybe you would understand if I called it an underdamped oscillation) but what I didn't explain is how EPR plays a role. EPR creates a pressure differential both during inhalation and exhalation which speeds up flow more efficiently evacuating CO2, higher EPR means more central apnea in people susceptible to this issue.
In your case the potential is that your obstructive/restrictive breathing is already treated but you are now seeing effects from the central side caused by CPAP treatment. This is where the time to adapt comes into play. As your body accepts the lower CO2 levels and starts reacting to the CPAP treatment efficiently then these new central effects will hopefully wear off. Good nights vs bad nights can be as simple as how your body reacts to the pressures/flow that night.
Anyways figured I would get a bit technical with you because of your schooling background. When you understand the physics behind the subject and are able to interpret what is happening from the data a lot of this starts to makes sense.
RE: I've been using my APAP for a week, symptoms wors V2e. - AmirKas - 07-03-2021
Good to hear that my OA's are actually just CA's. I'm aware of the existence of treatment-emergent central apneas and I guess I'm part of the unlucky percentage who has it. I will attempt using an EPR of 1 and have adjusted my humidity to a higher level so that, even if negligibly, I can help clear my nasal passages and improve my airway flow. Depending on the results I get tomorrow, I'll maintain a setting of EPR 1 or 2 for the next month or two and hope that my body adjusts enough to use an EPR of 3.
I do like and would like to think I'm good at interpreting data and making hypotheses, conducting experiments, and making conclusions. So that I can continue to do so in a more accurate manner, are there any resources you can direct me to so that I can really delve into the subject of OSCAR data analysis. It'd be great if I could learn enough so that I can give valid advice to members of this forum one day.
Thank you Greer, you've been a real one.
RE: I've been using my APAP for a week, symptoms wors V2e. - cathyf - 07-03-2021
Geer -- is it possible that is some sort of positional apnea? Maybe he's chin tucking? My clusters last for 45 minutes or an hour, but maybe his don't last for very long because it wakes him up right away, he moves out of the chin tucking position right away, but slides back into UARS hell?
That was the key thing you guys showed me -- is that I've got two separate independent things going on, and even after fixing either one the other one is still going on. Which leads to the (wrong) conclusion that whatever I was trying wasn't working. When what's really going on is thatI'm only fixing 1 thing at a time!
RE: I've been using my APAP for a week, symptoms wors V2e. - Geer1 - 07-03-2021
You can learn a bit from some of the wiki articles like the following.
http://www.apneaboard.com/wiki/index.php/CPAP_Data_Interpretation
http://www.apneaboard.com/wiki/index.php/Optimizing_therapy
Reading some threads on other peoples cases can help learn as well but don't waste too much time on it, you have enough going on that is better to focus on right now.
A lot of what I comment on (and some of what I have commented on here) is based on my opinions after researching my own data and others for over a year now.
RE: I've been using my APAP for a week, symptoms wors V2e. - Geer1 - 07-03-2021
I see I missed Cathy's post. I don't really think it is positional because they aren't clearly obstructive in nature. The odd moments of high flow limitation might be positional in nature (shifting down onto edge of pillow etc) but nothing worth trying to treat imo (other than being aware of positional apnea and using a thin pillow instead of a thick one etc).
One of the things that made me think those apnea were central is that they were preceded by a pretty obvious case of arousal breathing and prior to each apnea the breaths decline in amplitude but none of the breaths show signs of flow limitation. The recovery breaths are somewhat obstructive looking but I think that is because they might be mixed apnea (which usually start as central in nature during which time the obstruction sets in). The last "OA" had 3 very small visible breaths and clearly was not complete obstruction.
Earlier on in treatment he also showed worsening with the implementation of EPR and then improvement with reducing it. His data has shown times of periodic nature throughout and this recent test of higher EPR again seemed to make things worse. EPR doesn't make positional apnea worse but it does make central apnea worse. My conclusion on this being central in nature is a combination of considering all these factors rather than focusing purely on that one example. The upcoming test of reduced EPR will help confirm, if this is positional apnea then it will remain present in data, if it is central in nature as I hypothesize it should improve.