[Diagnosis] New on the path to a better nights rest

[mhartley]

I'm a long-time CPAP user (since 2013) but a new Apnea Board member and would very much appreciate some assistance understanding the data from Oscar. I’m posting my redacted sleep study data (pretty old now) – and a sample of screen shots from Oscar from last night.

The problem I was originally trying to solve when I found the board, was waking up after sleeping several hours. Takes me a long time to fall back asleep. It occurred to me one cause might be CPAP max pressure too high (was 11) so I found the board and figured out how to change my max pressure to 10 from 11.  Alas, that didn’t seem to help. 

Next theory was my tube frame was too loose.  After trying to figure out how to purchase a tighter frame, I found these clips included with my last shipment and attached one to the frame straps.  Couldn’t believe all these years of using a CPAP and only now figured out these clips existed!  The frame fit better, and even my wife confessed to me that air leaks had been waking her up.  I even had a couple of nights when I didn’t wake up once! But, alas – that didn’t last long.

I began trying to understand the graphs in Oscar, so I began checking the data every morning and created a spreadsheet (one row per day) with some basic data.  (Date, Sleep time, Wake Time, Sessions, Sleep Duration 1, Duration 2, Overall AHI, AHI1, AHI2, LL, CA, OA, UA, H – and a note column.  Although I really don’t have much of an idea what the graphs are telling me, I figured that with effort and in time, maybe I’d be able to figure it out. 

After a night of high AHI readings, I found some forum posts with graphs similar to mine and I came to the conclusion that I might have positional apnea. I ordered a cervical collar from Amazon.  When it came, I tried it on and it was very uncomfortable.  I may have measured incorrectly because it felt too large.  I decided to consciously try to avoid sleeping on my back.  One board member suggested using a pillow between the legs, so I gave that a try night before last.  It seemed to work pretty well although I woke up after an LL and struggled about 45 minutes to fall back asleep … that night my overall AHI was 1.78 for both sessions, which is pretty good for me.

Last night I tried the pillow between the legs approach again, but it didn’t work as well.  My overall AHI was 5.51 – with 3 x CA’s and 39 x 0A’s.  Not too bad considering since I’ve been tracking the Oscar data over the past three weeks, my max AHI was 12.2 – and minimum for one night was only .58.

At this point, I thought it would be a good idea to reach out to the board for some opinions. Attached a standard and a zoom from a rough period.  I am a lucid dreamer, and I was wondering if perhaps some of these OA/CA sessions might correlate with intense dreaming? I noticed the sleep study has a REM N-REM graph and was wondering if any of the Oscar graphs can indicate REM.  

Sorry about the long post.  Any assistance or tips for better sleep you can gather from these Oscar graphs is very much appreciated. Thanks in advance for any helpful opinions!

[SarcasticDave94]

Welcome to Apnea Board,

A few things that will certainly improve your therapy.

1. Edit settings, you're trying to begin therapy at Min pressure of 4 and EPR 3. It won't work. The reason is in the math. Your PAP has a minimum pressure of 4, your current starting point. EPR tries to reduce that by 3. But it can't, because again 4 is the minimum. Try this solution, increase your pressure to 7 and keep EPR 3. EPR means Exhale Pressure Relief. So, the result is currently EPR isn't doing much for you.

2. You likely have Positional Apnea clusters. Test, sitting then try to point your chin down to your chest and breathe. Was it more difficult? Probably. OK next, check your pillows. How many? If you have a stack then you need to reduce it. If this doesn't help, then research about Positional Apnea and a soft cervical collar. I have a link to the wiki in my signature.

3. You're having some mask leaks. This reduces therapy effectiveness and adds disruptions. Check the mask fit, not with Mask Fit though. Lying back in the bed, turn your PAP therapy on and hold mask in place. Adjust the finger tension to make it leak free. Duplicate that tension with the straps. Also you may either need a new cushion or a different size.

[staceyburke]

You are on the right track of positional apnea. To get the best fit is to measure the distance from your chin to your sternum. There are different sizes of collars.

I completely agree with trying a min 7 and EPR 3.

One chart I always want to see are flow limits. Flow limits are apnea just like o and h events. They stop you from deep sleep and can wake you up. They are not part of AHI but are important also.

[mhartley]

Got it. Thanks for the help! I'll change my minimum pressure to 7 cmH2O, adjust mask fit, flatten my sleeping position, and experiment with cushion sizes as you suggested.

[mhartley]

Thanks for taking a look at my graphs Stacey. I'll keep an eye on the flow limit graph and see if it correlates to my waking periods.  The flow limit graph shows a peak for the night of .38 on 11/15 several minutes before I woke up (see attachment). How do I eliminate flow limit issues?  Are problems with flow limits related to mask fit?

[SarcasticDave94]

To take action against Flow Limits, EPR 3 should be your new best friend. My best description of these Flow Limits would be they signify either Hypopnea or full Apnea is right around the corner, and FL indicates the airway is beginning to close. Noisy or shaggy grass looking FL charts can indicate more pressure may be helpful, but increases to EPR should go up to bat for you first. The pressure differential leverages better control over these.

[staceyburke]

Flow limits on a ResMed drives pressure up. Because of higher pressure you could have more leaks but leaks do not make flow limit events.

The pressures go up to stop a larger event either O or H events. You can see how apnea is categorized in my signature.

[martyedb]

please keep us posted on what helps  you with positional apnea.     I find it a continual challenge with various degrees of success.     
 
Recently I tried a   "pregnancy pillow"  .     It was comfortable and I found  myself looking forward to the comfort of going to bed.    I thought it was helping me stay off my back  but   the clusters of OA s   increased,   so I am  using  my  backpack with pillows in it, again.    It seems to work best so far,   along with the soft cervical collar. 

There are various pregnancy  pillows .     I may research them again later.    This was a  very long, curved pillow.   The pillow went under my head and  behind my back and was supposed to  cushion my knees, too.    Some can be bought used on the internet.    Mine was $ 5.00  at a resale shop.   I washed it in our front-loader.   It is not supposed to be washed in a washing machine.    When new, they may come with a removable, washable cover.

Thank you for asking about the positional apnea.   And thank you,  Staceyburke and S. Dave,  for  explaining  flow limits.

[mhartley]

Thanks for the response! I think I'm still struggling with positional apnea. They don't haunt me every night, but clusters of OA's lasting an hour or more seemingly indicate I may be on my back. Thanks for the suggestion of pregnancy pillow as I was not aware of that product. I'll give it some thought, although not sure I could survive the teasing from my wife. Do you know of a way to take snapshots during the night - or some type of sensor to wear - to help track sleeping position? I googled "iPhone app sleeping positions" and found an app called "Somnopose" - maybe it could be programmed to play "Roll Over Beethoven" when it detects a supine position?

[SarcasticDave94]

My need to stay on my left side was in part due to bad back pain and somewhat Apnea. My solution was to get 4 large body pillow types and stack them 2x2 in a long wall. When I get in bed, I slide next to the pillow wall in such a way that I couldn't roll to my back. My room is such that the bed has a long wall parallel to the bed to facilitate that pillow wall staying in place.

For yourself, it could be sleeping on either left or right side, mine was specific left side only. My back pain was less intense on left and worse supine and right side. Despite mine being more pain based, maybe the pillow wall helps.