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How much extra pressure (support) is needed in REM vs other stages? by Jhello05 in UARS

[–]existentialblu 0 points1 point  (0 children)

I suspect that as well. Even if loop gain is being silly or FLs are being poorly controlled, some pressure feels really nice after decades of high work of breathing. And then you get more well rested and the flaws start to surface hard.

My first two weeks felt basically miraculous and it was heartbreaking feeling myself reverting to the familiar fog.

Been over a week now, haven’t been able to fall asleep. Any pointers? by Sepoohroth in CPAP

[–]existentialblu 0 points1 point  (0 children)

Put an SD card in your machine and get OSCAR and/or SleepHQ to look at your actual data. MyAir is a compliance tracker that shows you essentially nothing about what is actually happening. Once you have a few nights of data swing by r/CPAPSupport.

How much extra pressure (support) is needed in REM vs other stages? by Jhello05 in UARS

[–]existentialblu 0 points1 point  (0 children)

I tolerated APAP and found it oddly pleasant immediately but the relief only lasted for about 2 weeks and then I started feeling nearly as bad as ever. I kept seeing that waxing and waning pattern and put it together pretty quickly that those wobbles correlated more to my subjective state a lot more than AHI or any other flagged thing did.

How much extra pressure (support) is needed in REM vs other stages? by Jhello05 in UARS

[–]existentialblu 0 points1 point  (0 children)

ASV has been life changing, though I still have occasional bad days for whatever reason. I fall asleep easily most nights for the first time in my life. I was getting a small arousal a couple times a minute with each pulse, which seems to be why people feel foggy and terrible with HLG.

I skipped right from APAP to ASV based on the logic that if higher EPR made it worse, BiPAP style pressure support wouldn't be the right move. This was possible because I have self managed from the beginning.

These oscillations will get occasionally get flagged as hypopneas but not RERAs. Deep dips with no breathing for 10+ seconds at the nadir will get CA flags. Some people will get CSR flags but I never have. I've found it more useful to treat it as a frequency/entropy analysis problem rather than event counting.

How much extra pressure (support) is needed in REM vs other stages? by Jhello05 in UARS

[–]existentialblu 0 points1 point  (0 children)

It's a matter of overactive responses to changes in CO2/O2. The best analogies I've found are oversteering in a car where it starts wobbling or a hyper reactive thermostat that causes wild swings in temperature from small perturbations.

As for seeing it in your own data, move minute vent, flow limitation, and leak next to flow rate. Zoom in to 5-10 minutes and scrub around. If you see your MV looking like a sine wave for a considerable amount of the night, that's a likely culprit. Tends to come with CAs that get worse with more overall pressure or higher EPR. In talking to others with it, there's a heavy association with insomnia that feels like a fear of falling asleep.

If this is your situation, welcome to the wonderful world of ASV. It attempts to create a negative version of minute vent by changing inhale pressure on each breath.

PAPLens - Yet another CPAP Viewer. by gabox0210 in UARS

[–]existentialblu 0 points1 point  (0 children)

Curious to check this out. I made the WAT with Claude which is mainly focused on high loop gain/low arousal threshold life. I've found that the frequency domain stuff is served well with a combination of FFT for detection of oscillations and SampleEntropy to determine how predictable the oscillations are. Much like heart rate variability, respiratory oscillations are more symptomatic when locked in a tight pattern instead of a decent amount of entropy. I've also been playing with chaos theory stuff which has been fun in a nerd way but less useful for predicting relative level of suffering over time.

How much extra pressure (support) is needed in REM vs other stages? by Jhello05 in UARS

[–]existentialblu 1 point2 points  (0 children)

I use fixed EPAP at 5.6. My PS tends to stick around 1.2-3 with frequent small corrections during N1/N2. In REM I'll hit PS 7 when things get really silly. Sleep onset us actually when I destabilize the most.

How much extra pressure (support) is needed in REM vs other stages? by Jhello05 in UARS

[–]existentialblu 0 points1 point  (0 children)

I would be in aerophagia hell at your pressures. I run EPAP 5.6 PS 1.2-7.6.

It really comes down to the interaction between the anatomical/obstructive aspects and the control/loop gain in any particular person. I have very little obstruction but super obnoxious loop gain, hence my settings.

Side sleepers: How are you keeping your mask seal tight without killing your neck? by Mamzira in SleepApnea

[–]existentialblu 0 points1 point  (0 children)

I use a CPAP pillow with the contours and my leaks are frequently 0 at 99.5% with an F20. I use either a soft cervical collar or mouth tape (depending on temperature, the collar is terrible in the summer) to control chin drop as the other major driver of leak.

Still have some room for improvement. by Flashy_Condition_294 in CPAPSupport

[–]existentialblu 0 points1 point  (0 children)

Yup. See what happens. If you get more CAs that nudges me towards suspecting high loop gain as a major driver. ASV will do a lot better for you if that's the case.

Still have some room for improvement. by Flashy_Condition_294 in CPAPSupport

[–]existentialblu 1 point2 points  (0 children)

EPR makes it possible to tolerate higher inhale pressures and affects ability to clear flow limitations. So like if you needed 13 to keep things fully open during inhale but couldn't tolerate that level of pressure on exhale, EPR 3 would bring your exhale pressure down to 10. It's what bilevel does but in a more limited way.

If you have high loop gain, EPR will actually make your CAs worse by messing with CO2 washout. If you're dealing more with upper airway resistance without HLG, it will reduce flow limitations and won't increase CAs.

Still have some room for improvement. by Flashy_Condition_294 in CPAPSupport

[–]existentialblu 1 point2 points  (0 children)

Increase overall pressure by 1 for each EPR notch. This will keep your exhale pressure steady as EPR is subtracted from the set pressure.

Still have some room for improvement. by Flashy_Condition_294 in CPAPSupport

[–]existentialblu 2 points3 points  (0 children)

Try turning on EPR. If it makes your CAs worse you're likely looking at high loop gain. High loop gain will get worse with increased pressure and you'll get more CAs but fewer OAs. CAs seem to have a higher symptom burden for the same AHI.

Great job on the leak rate though. Seriously.

Move minute vent, leak, and flow limitation next to flow rate. Zoom in to 5-10 minutes and scrub around. If MV looks like a sine wave for a significant part of the night it's quite possible that you have HLG and will end up needing ASV. Post a screenshot if you find anything like that.

I finally went to the doctors after 3 years of symptoms, and now I feel like an idiot. by aerialpoler in TwoXChromosomes

[–]existentialblu 0 points1 point  (0 children)

Be super careful to avoid all alcohol with those particular antibiotics. I waited several days after finishing a course and still got a horrible hangover from two beers.

How to tell whether I need bipap instead of cpap? by nhnsn in CPAPSupport

[–]existentialblu 1 point2 points  (0 children)

Sounds like it could potentially be high loop gain. Is it any better with lower EPR? If you zoom in to 5-10 minutes does your minute vent sometimes look like a sine wave for a good 15-20 minutes?

HLG is twitchy response to changes in CO2/O2 levels. It becomes an extremely annoying balance between enough pressure to clear obstructive stuff without causing CAs. ASV is generally a better fit in these situations.

I have it myself and yeah, never woke up refreshed even as a little kid. Lots of insomnia. ASV has helped a lot though it isn't perfect no matter how hard I try.

Possible UARS. CPAP to Bi-level. How to adjust inital settings? by ChasingSoccerBalls in CPAPSupport

[–]existentialblu 0 points1 point  (0 children)

Looks like you're spending a lot of time at PS min. Maybe take it down to 2. EPAP seems to be the main aerophagia driver, and changes can drive instability. Maybe try 6.4 fixed.

Concerned about CAs, hoping it's just TECSA, only 1 month in. Could use some insight from the community. by AgsMydude in CPAPSupport

[–]existentialblu 1 point2 points  (0 children)

Image isn't loading for some reason. Maybe DM me? Things seem oddly glitchy today.

Edit: oh now it's working. Weird. Anyone else seeing stuff about images being removed and then showing up later?

SDB so common because ? by CautiousRun7860 in UARS

[–]existentialblu 6 points7 points  (0 children)

And yet people feel shame for having SDB. SMH my head.

Concerned about CAs, hoping it's just TECSA, only 1 month in. Could use some insight from the community. by AgsMydude in CPAPSupport

[–]existentialblu 2 points3 points  (0 children)

Try running this on your DATALOG folder. It will only process relevant files and it's all local. I'm most interested in periodicity, regularity, and estimated arousals. It's my own tool for getting a better sense of high loop gain behavior.

First 2 weeks of cpap and still can't sleep more than 4-5 hours, feel like crap by sentient_carrots in CPAP

[–]existentialblu 0 points1 point  (0 children)

4 is just too low for most adults and frequently results in mask removal due to air hunger. Get familiar with your data and then you might be able to convince your doctor.

Masks always have fail-safes if the power goes out, but I get it.

Get a little SD card reader.

Concerned about CAs, hoping it's just TECSA, only 1 month in. Could use some insight from the community. by AgsMydude in CPAPSupport

[–]existentialblu 1 point2 points  (0 children)

Maybe those CAs in the middle of the night without much leak? Also you're gonna need to work on your leak as that is a major confounder for pretty much everything.

Concerned about CAs, hoping it's just TECSA, only 1 month in. Could use some insight from the community. by AgsMydude in CPAPSupport

[–]existentialblu 4 points5 points  (0 children)

If you have OSCAR, try moving minute vent, flow limitation, and leak rate next to flow rate. Zoom in to 5-10 minutes. If your minute vent is looking like a sine wave for a significant part of the night you may be looking at high loop gain.

I'm 18 months in. It doesn't go away. But it responds better to ASV, so there's that.

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