New user introduction

Curious_Steve · Post by **Curious_Steve** » Fri Dec 08, 2023 6:20 am

Rubicon, this has all been eye opening for me, and I'm truly grateful.

Here's last night, with the O2 Ring data added.
https://sleephq.com/public/590cc547-3ed ... 543ee2a1f4

Pugsy · Post by **Pugsy** » Fri Dec 08, 2023 6:33 am

Forgive me if I already asked this question but do you take any meds of any kind? If so, what?

Curious_Steve · Post by **Curious_Steve** » Fri Dec 08, 2023 8:02 am

Pugsy wrote: ↑
Fri Dec 08, 2023 6:33 am
Forgive me if I already asked this question but do you take any meds of any kind? If so, what?

I take an Armour Thyroid pill every morning for hypothyroidism.
I also use a Testosterone cream for hypogonadism.

I drink coffee. Avoid alcohol. But do smoke a cigar most evenings while I relax on the back porch after dinner.

I'm overweight. 5'9" and 210#, but down 35# from the end of June.

I don't take naps or feel particularly sleepy throughout the day, but I do have a sedentary job crunching numbers at a computer, so my brain is mush at the end of a shift.

Pugsy · Post by **Pugsy** » Fri Dec 08, 2023 8:28 am

Something to think about as I am throwing this out there as potential contributing factors to crappy sleep.

https://www.mayoclinic.org/healthy-life ... t-20045728

Testosterone therapy has various risks, including:

Worsening sleep apnea — a potentially serious sleep disorder in which breathing repeatedly stops and starts.

When is the last time you had blood work to evaluate both testosterone levels and thyroid levels?

What symptoms were you having that caused you to have a sleep study done?
Have any of those symptoms either reduced or gone away with starting cpap therapy?

Are you getting more used to the new mask? Having any problems with it that might be causing arousals (you may or may not remember those arousals)?

Curious_Steve · Post by **Curious_Steve** » Fri Dec 08, 2023 9:05 am

Pugsy wrote: ↑
Fri Dec 08, 2023 8:28 am
Something to think about as I am throwing this out there as potential contributing factors to crappy sleep.

https://www.mayoclinic.org/healthy-life ... t-20045728
Testosterone therapy has various risks, including:

Worsening sleep apnea — a potentially serious sleep disorder in which breathing repeatedly stops and starts.
When is the last time you had blood work to evaluate both testosterone levels and thyroid levels?

What symptoms were you having that caused you to have a sleep study done?
Have any of those symptoms either reduced or gone away with starting cpap therapy?

Are you getting more used to the new mask? Having any problems with it that might be causing arousals (you may or may not remember those arousals)?

Latest bloods was 8/7/23. I've been on the Armour and Test since 2011-ish.

Back in 2007-ish I had started going to an ENT for some upper respiratory issues. He recommended the sleep study since my wife told him I was keeping her awake at night and I was also complaining that she kept kicking me because she thought I had stopped breathing. Also, I used to mouth breathe at night due to a later diagnosed deviated septum, turbinate issues, and chronic sinusitis.

I'm really enjoying the new mask, my dry mouth is gone, and I feel better rested compared to the nasal mask.

With regards to the arousals, I don't know if my brain activity is a cause or an effect, but I feel like sometime after 2am my brain starts coming back online. I don't get up to urinate in the middle of the night, but when I start coming back to a conscious state I can feel the bladder pressure and other discomforts like a tender shoulder or achy lower back from lying in a weird position for too long and that causes me to toss and turn until the alarm goes off at 5:30.

It's been awhile since the alarm going off was a surprise. It seems most mornings, I'm just lying there waiting for it to go off like it is giving me permission to get up. LOL

Pugsy · Post by **Pugsy** » Fri Dec 08, 2023 9:27 am

Curious_Steve wrote: ↑
Fri Dec 08, 2023 9:05 am
other discomforts like a tender shoulder or achy lower back from lying in a weird position for too long and that causes me to toss and turn until the alarm goes off at 5:30.

While probably minor issue...any discomfort that messes with sleep is a potential factor in overall sleep quality declining.
Been there and done that myself and have the T shirt. A problem I have every day/night of my life.
It's not always so easy to fix that sort of problem even when we know that it can and will affect our sleep in general.
I have that T shirt as well.

So do I understand you correctly....you got the initial sleep study mainly because of non restorative sleep and wife causing you more non restorative sleep with poking you because you were likely either snoring or she was witnessing episodes of your non breathing and messing with her sleep quality as well??? Since starting cpap your overall sleep quality has improved somewhat but perhaps isn't where you would like for it to be????

I don't know how much of an impact your FLs are actually having on your overall sleep quality.
So I don't know just how important it might be to go trying to kill those FLs.

I like to use the KISS principle whenever I can because sometimes it works.
In your case we know for sure that your sleep was disrupted by various factors with the old mask and you just started a new mask and they always come with a few challenges of their own that we have to sort through.
That's why I suggested a couple of weeks with the new mask (to give you time to work out those new challenges) and THEN work on what's left in terms of arousals or sleep problems once we eliminated the mask itself as a potential sleep disruption source.

Fix the obvious first and then worry about what's leftover a wee bit later.

Curious_Steve · Post by **Curious_Steve** » Fri Dec 08, 2023 9:55 am

Pugsy wrote: ↑
Fri Dec 08, 2023 9:27 am

Curious_Steve wrote: ↑
Fri Dec 08, 2023 9:05 am
other discomforts like a tender shoulder or achy lower back from lying in a weird position for too long and that causes me to toss and turn until the alarm goes off at 5:30.
While probably minor issue...any discomfort that messes with sleep is a potential factor in overall sleep quality declining.
Been there and done that myself and have the T shirt. A problem I have every day/night of my life.
It's not always so easy to fix that sort of problem even when we know that it can and will affect our sleep in general.
I have that T shirt as well.

So do I understand you correctly....you got the initial sleep study mainly because of non restorative sleep and wife causing you more non restorative sleep with poking you because you were likely either snoring or she was witnessing episodes of your non breathing and messing with her sleep quality as well??? Since starting cpap your overall sleep quality has improved somewhat but perhaps isn't where you would like for it to be????

I don't know how much of an impact your FLs are actually having on your overall sleep quality.
So I don't know just how important it might be to go trying to kill those FLs.

I like to use the KISS principle whenever I can because sometimes it works.
In your case we know for sure that your sleep was disrupted by various factors with the old mask and you just started a new mask and they always come with a few challenges of their own that we have to sort through.
That's why I suggested a couple of weeks with the new mask (to give you time to work out those new challenges) and THEN work on what's left in terms of arousals or sleep problems once we eliminated the mask itself as a potential sleep disruption source.

Fix the obvious first and then worry about what's leftover a wee bit later.

Thanks for the indepth response, Pugsy.

When I don't sleep with my CPAP. Yes, I do snore and I have instances where I stop breathing or struggle to breathe.
Before the CPAP, my sleep was garbage.
After getting the CPAP, my sleep was better.
After sinus surgery, I slept without a CPAP for a couple years and didn't mouth breathe, but did snore some. Didn't really feel like there was a difference between the CPAP and no CPAP after the surgery.
Fast forward serveral years, I gained weight and went back to using my CPAP because I was sleeping much worse.

So for the last 9 years or so, I've been using my CPAP every night. Had I not upgraded machines last month, I'd have no idea any of this was going on. I truly was living in a state of "ingorance is bliss" regarding my sleep quality.
New machine, new mask, data dumps, and gobs of learning...I'm already sleeping better than previously. And I agree with you about letting my face/body get used to the new mask.

I would certainly like to minimize my arousals.

Curious_Steve · Post by **Curious_Steve** » Mon Dec 11, 2023 7:58 pm

Good evening, all.

I'm curious how last night's graph looks to y'all. I feel like I slept pretty good, but I did feel like I was crashing at 3pm this afternoon.

https://sleephq.com/public/5bbf0a37-4ce ... 13557198c2

Pugsy · Post by **Pugsy** » Mon Dec 11, 2023 8:20 pm

All but one of the CA/central flags appear to be post arousal. There is one central that appears to be the real deal in the midst of asleep breathing flow rate. That is meaningless. It's normal to have a few every now and then.
Sometimes the arousals are brief but sometimes not so brief.
My first thought again....crappy sleep quality with lots of arousals.
Flow limits are a bit active but not horribly horrible. I don't know if they are impacting your sleep quality or not but it is a possibility.

Want to add back in some EPR and see what happens to the FLs and sleep quality???

Curious_Steve · Post by **Curious_Steve** » Mon Dec 11, 2023 8:22 pm

Pugsy wrote: ↑
Mon Dec 11, 2023 8:20 pm
All but one of the CA/central flags appear to be post arousal. There is one central that appears to be the real deal in the midst of asleep breathing flow rate. That is meaningless. It's normal to have a few every now and then.
Sometimes the arousals are brief but sometimes not so brief.
My first thought again....crappy sleep quality with lots of arousals.
Flow limits are a bit active but not horribly horrible. I don't know if they are impacting your sleep quality or not but it is a possibility.

Want to add back in some EPR and see what happens to the FLs and sleep quality???

Sure, I'm game to try that.
How much EPR should I start with?

Pugsy · Post by **Pugsy** » Mon Dec 11, 2023 8:38 pm

I tend to think along the lines of "go big or go home"

I would start with EPR set to 3 full time and see what happens.
We may need to increase that minimum a little to compensate for the drop during exhale but I don't suggest doing that until a need is proven. If you start seeing a marked increase in the numbers of OAs or hyponeas then we would need a little more minimum....or back off and reduce EPR. Several options there.

I personally really like that difference between inhale and exhale from a comfort aspect if nothing else....but that is me and there are lots of people who feel totally opposite of how I feel. I use a 4 cm difference between inhale and exhale...my machine will do that but yours only lets you do 3 cm difference.

Curious_Steve · Post by **Curious_Steve** » Mon Dec 11, 2023 8:43 pm

Pugsy wrote: ↑
Mon Dec 11, 2023 8:38 pm
I tend to think along the lines of "go big or go home"
I would start with EPR set to 3 full time and see what happens.
We may need to increase that minimum a little to compensate for the drop during exhale but I don't suggest doing that until a need is proven. If you start seeing a marked increase in the numbers of OAs or hyponeas then we would need a little more minimum....or back off and reduce EPR. Several options there.

I personally really like that difference between inhale and exhale from a comfort aspect if nothing else....but that is me and there are lots of people who feel totally opposite of how I feel. I use a 4 cm difference between inhale and exhale...my machine will do that but yours only lets you do 3 cm difference.

I love it!
My shooting buddies call it "Go big, then go home.". Lol

Curious_Steve · Post by **Curious_Steve** » Tue Dec 12, 2023 5:49 am

Here's last night.

https://sleephq.com/public/80864bba-4e5 ... 913177acdf

I'm not sure what I'm seeing, but it definitely looks different.

Pugsy · Post by **Pugsy** » Tue Dec 12, 2023 7:52 pm

Maybe some slight improvement in the FLs and maybe a little less arousals and maybe a little less evidence of crappy sleep. Again the bulk of the centrals are post arousal with maybe a couple of them being real asleep centrals but the bulk are post arousal.

One night does not a trend make though so lets continue with this experiment for a few more nights.

Curious_Steve · Post by **Curious_Steve** » Tue Dec 12, 2023 7:53 pm

Pugsy wrote: ↑
Tue Dec 12, 2023 7:52 pm
Maybe some slight improvement in the FLs and maybe a little less arousals and maybe a little less evidence of crappy sleep. Again the bulk of the centrals are post arousal with maybe a couple of them being real asleep centrals but the bulk are post arousal.

One night does not a trend make though so lets continue with this experiment for a few more nights.

Understood. Thank you.

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