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Abletree's Therapy Thread
RE: Abletree's Therapy Thread
Your AHI was only 5.4 which is barely worth noting as mild apnea but your arousal index was 27.4 which is notably higher. Unfortunately it doesn't look like they scored RERAs so we have no idea if those arousals were breathing related or not.

One thing to note is the comment of using two pillows which is a poor habit especially for someone with apnea. Large or double pillows puts a link in your neck that closes airway, using a single thinner pillow that keeps airway inline and open is preferable.

If talking to doctors about this I would ask if the study could be revisited to see if high arousal index was related to RERAs. If asking for further studies what you would want to ask for us a titration study in which you would be in cpap and to ask to ensure they will score RERAs so that at the end of study if arousal index is still high they should have a good idea it is or isn't related to breathing.
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RE: Abletree's Therapy Thread
Geer note that using the 3% rule, his AHI was 13.1. Given that the rule 1A has arousals as part of the criteria, I'm guessing that the events that made the 1A criteria but not the 1B criteria had arousals at the ends of them and so qualified that way.
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RE: Abletree's Therapy Thread
As Kathyf mentioned, I was told that my AHI was 13.1 adjusted. This is coupled with an arousal index of 27 and impaired sleep efficiency of 73%

I'm also concerned with the high number of hypopneas with associated desaturation to 88% and a couple of incidents of 87%

Other concerns are my rapid leg movement with sleep fragmentation, REM latency of 138 and sleep disruption of slow wave sleep

During my brief after-visit meeting, the PA told me they were concerned that I only experienced 14 minutes of deep sleep

I would be very interested to explore a titration study including a rera score. I appreciate your comment about pillow use. I will continue to try to adapt to a single thinner pillow.

Thank you 
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RE: Abletree's Therapy Thread
Hi Dave - I have now obtained and posted my PSG in recently in the thread & would appreciate your thoughts. Thank you
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RE: Abletree's Therapy Thread
Hi Gideon - In case you missed it, I posted my PSG last night in this thread. I have my follow-up appointment tomorrow. I'd appreciate your thoughts if you have a moment.

Thank you
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RE: Abletree's Therapy Thread
I too would have highlighted the 2 pillows. Otherwise it's relatively straightforward moderate Obstructive Apnea & Hypopnea as best as I can tell. That doesn't mean other things may not be involved like RERA, etc.

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RE: Abletree's Therapy Thread
The AutoSet should be fine for you.
Your DeSats of 8 minutes of 87-88 is significant and is borderline on overnight oxygen supplement. What are your O2 Sats with CPAP?
CPAP use usually improves this stat. It is so important I do recommend a recording oximeter so you can periodically validate your overnight sats as acceptable.
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RE: Abletree's Therapy Thread
Thank you - I really appreciate you input & will make the ask for a titration test with rera score & a recordable s02 home monitor - Hopefully I can get one that I can upload to OSCAR Smile
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RE: Abletree's Therapy Thread
Yeah you are right 13.1 AHI with the 3% rule. One other comment worth making was that AHI was mostly in supine position which is common and the pillows could also be a factor in that.

The main thing now is that your AHI is treated with current settings. The only potential remaining breathing issue are RERAs which you can't really diagnose with OSCAR and a titration study with PSG data is about the only thing that can determine if there are RERAs remaining.
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RE: Abletree's Therapy Thread
I also looked at the sleep study, and was struck by a few things when reviewing your posted PSG.

(1) the REM flutter at 05:30 thru 06:10 with wakes in between.
(2) the N3 Stage sleep happened only once, and after a brief REM sleep at about 04:05. Generally, N3 sleep comes first and immediately followed by REM.  Your note about the slow wave sleep (deep sleep) being disrupted is interesting, the way I see it, the slow wave sleep was one continuous 14 minutes from about 04:35 to 05:00.
(3) Also, it is noted that the PLMS are all in a cluster before deep sleep and REM, and there is alot of fluttery Wake Sleep Wake stuff throughout that cluster.  The jerking or motion did not increase your heart rate like I would expect if stress or distress were associated with the movements.  Also, mostly it did not wake or even arouse you.
(4) All those pulse changes really strike me as heightened stress levels, though maybe not respiratory related distress. Anytime the pulse rate increased 15 bps (to 70 or above from 55 bps) or (to 65 or above from 50 bps) there was a distress that caused it.

you can see on the linked image how sleep stages typically get distributed throughout the night:


[Image: gr3.jpg]

And, notice that most jumpy O2 Sats are generally during sleep in supine position (on back).

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