Is Expiratory Puff Possible with FF Mask, Chinstrap, and Mouth Tape?

[Nocibur]

Further further, you don't like it when it happens:

new5.jpg (25.83 KiB) Viewed 3262 times

[Nocibur]

Oooh I almost forgot.

Your sleep continuity sucks.

I mean REALLY sucks.

[robysue1]

...arousals.

Point of Order, according to Da Rules, if the sleep disturbance lasts 3-14 seconds, it's an arousal. More than that it's Wake.

Thanks Nocibur.

Remember: I'm just a silly math professor so I don't know all those official rules (yet). But I do always appreciate it when you do point out something I've not got quite right.

[Tyler2]

Your sleep continuity sucks.

I mean REALLY sucks.

Are you referring to breathing disruptions in my flow chart when I'm asleep? Any recommendations to improve on this?

[Nocibur]

...arousals.

Point of Order, according to Da Rules, if the sleep disturbance lasts 3-14 seconds, it's an arousal. More than that it's Wake.

Thanks Nocibur.

Remember: I'm just a silly math professor so I don't know all those official rules (yet). But I do always appreciate it when you do point out something I've not got quite right.

I can hear you thinking

"WTF does that have to do with anything?"

And upon closer examination, probably nothing.

That said (actually, this was just an excuse to say "that said"), and taking a huge artistic license, arousals are usually caused by stuff (apneas, hypopneas, snoring, FLs, PLMs) while awakenings (wake) suggest bad sleep.

We're all aware of all the people who come in with "My AHI is 0.8 but I'm still tired so I'm gonna go crazy DWing and get an ASV!".

So perhaps the point of the point (there should be a point, otherwise what's the point)(did you ever notice if you keep repeating them same word over and over, it ceases to make any sense?) is in an attempt to perform Sleep Staging with a breathing waveform (Rechtschaffen and Kales are spinning wildly in their graves) one really doesn't need long runs of SWJ to need to focus on "sleep" instead of looking for a magic button on a CPAP machine.

[Nocibur]

...and get an ASV!"

IMO improper use of ASV is absolutely rampant; yet, OTOH, is it possible that, in some cases, can be used as a comfort measure?

Seems to me to be a really expensive comfort measure, but OTO,OH, ain't my dime.

[robysue1]

So perhaps the point of the point (there should be a point, otherwise what's the point)(did you ever notice if you keep repeating them same word over and over, it ceases to make any sense?) is in an attempt to perform Sleep Staging with a breathing waveform (Rechtschaffen and Kales are spinning wildly in their graves) one really doesn't need long runs of SWJ to need to focus on "sleep" instead of looking for a magic button on a CPAP machine.

A lesson that I had to learn the hard way back in 2010-2011. You (under the names of Muffy and NotMuffy) and -SWS both gave me substantial help in learning to focus on working on fixing my "bad sleep" rather than searching for a magic button on my APAP and then BiPAP to fix my problems.

I hope you'll be happy to know that these days, I usually sleep pretty good. Still too many nights where the severe night owl kicks in and simply doesn't get sleepy at a half-way respectable hour, particularly if I'm doing something interesting. But once I do go to sleep? I can fall asleep in a reasonable amount of time and (subjectively) stay asleep most of the nights. And when I wake up, it's drink a sip of water and turn over to a new sleep position and get back to sleep rather quickly. And when morning comes, I feel pretty decent.

[Nocibur]

I hope you'll be happy to know that these days, I usually sleep pretty good. Still too many nights where the severe night owl kicks in and simply doesn't get sleepy at a half-way respectable hour, particularly if I'm doing something interesting. But once I do go to sleep? I can fall asleep in a reasonable amount of time and (subjectively) stay asleep most of the nights. And when I wake up, it's drink a sip of water and turn over to a new sleep position and get back to sleep rather quickly. And when morning comes, I feel pretty decent.

That's absolutely great to hear! I'm telling ya, altering sleep is like steering the Titanic, and I really understand the effort and persistence it takes.

IMO another good philosophy to have is: No matter what happens, don't worry about it. Especially if you should worry about it. The importance of this was discussed in a blog that began:

You worry about all kinds of things when you are in bed or preparing to go to bed: You find yourself worrying about all the CPAP stuff; worrying about how little sleep you are getting; worrying about how long you've been lying in bed trying to get to sleep; worrying about how soon morning will come; worrying about whether the CPAP is doing anything for you or not; worrying about the fact that your sleep subjectively feels much worse now than it did before you started using CPAP; worrying about the worrying itself...

As you might note, I'm still a roaring short-sleeping ASPS, but I just let it happen (I admit being retired makes this easy) rather than getting excited about not conforming to normal ("Omigod! I need 7.8 hours of sleep! I need to stay asleep till 7 AM!"). Rather, the approach is simplified to: "Oh look! I'm awake, I can do stuff! Oh look! I'm not, I can't!"

But I digress...

[Tyler2]

Nocibur,

You said my "sleep continuity sucks." Are you referring to breathing disruptions in my flow chart when I'm asleep or something else? Any recommendations to improve this?

[Nocibur]

Nocibur,

You said my "sleep continuity sucks." Are you referring to breathing disruptions in my flow chart when I'm asleep or something else? Any recommendations to improve this?

I'm in the middle of fine tuning some other stuff currently, but will probably try as you suggested at some point.

[Tyler2]

Got it. You think I should try experimenting with the exhale sensitivity as a first line of attack. I'm still planning on doing that when I have a break in my schedule and I can afford a nose dive in my sleep if that happens.

[Nocibur]

Got it. You think I should try experimenting with the exhale sensitivity as a first line of attack. I'm still planning on doing that when I have a break in my schedule and I can afford a nose dive in my sleep if that happens.

Might also see an ENT guy to evaluate the palate.

Also add some EPAP. 4.0 does nothing.

PP causing arousals:

pp.jpg (31.22 KiB) Viewed 2774 times

If we go back to my image on page 1 that tracks flow vs pressure, it may be that PP occurs when EPAP <6.2 cmH2O.

Good a WAG as any.

[Tyler2]

Thanks Nocibur. Will reply back when I've had a chance to experiment.

[Tyler2]

Ok Nocibur, I tried some of your suggestions to see how it would effect the relatively small number of sharp exhales in my breathing flow chart that sometimes lead to a wakeup. I'm curious your thoughts. Again, this is on an Aircurve 11 VAuto, PS 4.2 over 4.2-8.4, FFM, inhale "trigger" set to very high to eliminate previously experienced CAs and a time synched Wellue ring suggesting the few reports of OA or Hyp are just due to movement (hence my low EPAP of 4.2, up from 4.0 at which I previously experienced a few real OAs or Hyp). SleepHQ data available at at https://sleephq.com/public/teams/share_ ... d8f4cab676

1] I tried setting exhale sensitivity ("cycle") from "medium" to "very low" (23 Mar) and the sharp expiratory waveforms were still present in about the same small quantity and still leading to a wakeup, almost always on left side or back with head facing left to some degree (e.g. 0210-0230, positional info confirmed with a WYZE Cam v4 in case of use to anyone else here).

2] I then tried setting exhale sensitivity to "high" and expiratory drops seemed to increase a little, again, almost always on left side or back with head facing left to some degree (24 Mar, e.g. 0300-0315 leading to a wakeup).

3] I then set exhale sensitivity back to the normal "Medium" setting and tried setting min EPAP from 4.2 to 8.0 and the expiratory drops seemed to decrease but still present and leading to wakeup (26 Mar, e.g., 0556-0615). Lots of sleep disruption due to discomfort of increased pressure and a few leaks; oura ring said only 18 minutes of deep out of 6.5 hours of sleep.

4] Didn't like the increased EPAP so decided to take seriously the fact that these expiratory drops occur almost always on left side or back with head facing left to some degree. Decided to go back to min/steady state EPAP 4.2 and try sleeping only on right side or back with head facing right. To sort of remind me to do this I put a small pillow that my left shoulder would hit when I rolled over from right side to back. Resulted in almost no expiratory drops and a decent nights sleep of 7.5 hrs w/47 deep and 97 REM but still 9 wakeups I wasn't aware of (27 Mar, only expiratory drops are at 0059, 0102, 0107).

So I think I'm going to try sleeping only my right side or back with head facing right for now on and see how that goes. What do you think? Also, you previously said, "Your sleep continuity sucks," which I assume would apply on my right side too. Do you see anything I might try to improve my Mar 27 sleep data (which is all on right side)? Do you see any reason to try for more PS? I tried PS 4.4 a while back and it seemed to disrupt my sleep, but maybe I needed to get used to it?

[Tyler2]

Your sleep continuity sucks.

I mean REALLY sucks.

Posting a reply again with a quote from your post in case that was needed for you to notice it Nocibur. Definitely interested in any of your suggestions.

Ok Nocibur, I tried some of your suggestions to see how it would effect the relatively small number of sharp exhales in my breathing flow chart that sometimes lead to a wakeup. I'm curious your thoughts. Again, this is on an Aircurve 11 VAuto, PS 4.2 over 4.2-8.4, FFM, inhale "trigger" set to very high to eliminate previously experienced CAs and a time synched Wellue ring suggesting the few reports of OA or Hyp are just due to movement (hence my low EPAP of 4.2, up from 4.0 at which I previously experienced a few real OAs or Hyp). If needed, SleepHQ data available at at https://sleephq.com/public/teams/share_ ... d8f4cab676

1] I tried setting exhale sensitivity ("cycle") from "medium" to "very low" (23 Mar) and the sharp expiratory waveforms were still present in about the same small quantity and still leading to a wakeup, almost always on left side or back with head facing left to some degree (e.g. 0210-0230, positional info confirmed with a WYZE Cam v4 in case of use to anyone else here).

2] I then tried setting exhale sensitivity to "high" and expiratory drops seemed to increase a little, again, almost always on left side or back with head facing left to some degree (24 Mar, e.g. 0300-0315 leading to a wakeup).

3] I then set exhale sensitivity back to the normal "Medium" setting and tried setting min EPAP from 4.2 to 8.0 and the expiratory drops seemed to decrease but still present and leading to wakeup (26 Mar, e.g., 0556-0615). Lots of sleep disruption due to discomfort of increased pressure and a few leaks; oura ring said only 18 minutes of deep out of 6.5 hours of sleep.

4] Didn't like the increased EPAP so decided to take seriously the fact that these expiratory drops occur almost always on left side or back with head facing left to some degree. Decided to go back to min/steady state EPAP 4.2 and try sleeping only on right side or back with head facing right. To sort of remind me to do this I put a small pillow that my left shoulder would hit when I rolled over from right side to back. Resulted in almost no expiratory drops and a decent nights sleep of 7.5 hrs w/47 deep and 97 REM but still 9 wakeups I wasn't aware of (27 Mar, only expiratory drops are at 0059, 0102, 0107).

So I think I'm going to try sleeping only my right side or back with head facing right for now on and see how that goes. What do you think? Also, you previously said, "Your sleep continuity sucks," which I assume would apply on my right side too. Do you see anything I might try to improve my Mar 27 sleep data (which is all on right side)? Do you see any reason to try for more PS? I tried PS 4.4 a while back and it seemed to disrupt my sleep, but maybe I needed to get used to it?