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Event clusters
#1
Event clusters
Hello everyone.

Past discussions here concluded with me probably experiencing positional apnea.
I tried a cervical collar with no improvement.

There also seemed to be a problem with the pressure going to max
Recommendation was to change my machine for a bi-level one.
The option to change is out of reach for me at the moment.

Still trying to improve the situation, I changed my pillow for a smaller and softer one.
My body position is always the same, I go to sleep on my left side and wake up on my back.
I have been doing this for the past month.
Oscar tells me that my 95% flow limitation is 0.25 for that period and the overall trend is going downward but for the last 14 days, the trend is going upward.

Screenshot 22-04-03 is typical of the nights where I see some improvement from the past.
Screenshots 22-04-02 and 04 are the worst yet.

My night sleep is always broken down into 2 or 3 sessions with the first ones doing well and the last 2 not so good.

For screenshots 22-04-03 and 04, I slept without a pillow, my head resting directly on the mattress.

I would like to know if besides positional apnea you can see a reason why I get those episodes of event clusters just after I had a good session in the same night.


Attached Files Thumbnail(s)
           

DanEm

"If life hands you lemons, make lemonade! Words to live by, especially when you keep in mind that the only way to make them into lemonade is to squeeze the hell out of them."
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#2
RE: Event clusters
Dan, we can get a better picture of how the events evolve with a closeup that captures 3-4 minutes leading into the cluster event. The idea is to see how the flow wave changes and perhaps figure out how the obstruction evolves. You are maxed out on pressure, so we don't have any room to use that tool without moving to bilevel. Your therapy is generally good but with chronic flow limitation, other than these clusters. What are your thoughts on the source of that flow limitation? Nasal, upper airway? Your snore statistic is unexpectedly quiet.
Sleeprider
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#3
RE: Event clusters
Thank you Sleeprider for the quick reply.

I got the screenshot you ask for and added a copy of my stats for the last month plus a view of the trends I mentioned.

I don't know if it will be useful, but my stats for the median pressure for the last 14 days are going up (15.2 to 17).

I tried some to control that flow limitation without much success.  I thought if I had my head down on the mattress it would help. I did that for 2 nights now and you saw the results. Maybe I am too anxious to see good results and should wait a week or two more.

I am out of ideas why my body does this.  I'm a bit out of my league. I do not feel my airways obstructed but that's no clue.  As for the snoring, it is down to zero since I started using the CPAP.  I am sure I breathe through my mouth sometimes because then it gets very dry.

If you would like more info, I have all my data in an excel file out of which I draw different charts. If you want part or all of it, I will send what you need.


Attached Files Thumbnail(s)
           

DanEm

"If life hands you lemons, make lemonade! Words to live by, especially when you keep in mind that the only way to make them into lemonade is to squeeze the hell out of them."
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#4
RE: Event clusters
We can see obstruction shows increasing inspiratory flow limitation ending in OA and arousal, so a pretty typical pattern for positional apnea. What collar and width did you try? Was your chin able to get behind the collar, or did it impinge on soft tissues behind the jaw? It could be you just need a different model or size. The Positional Apnea article describes a test where you sit relaxed and observe for obstruction as your chin drops toward your chest. Do you experience this obstruction without a collar? How about with the one you own? I still see positional issues, but they are not persistent, frequent or serious.

A couple alternatives are your choice. Your AHI on CPAP without a cervical collar is good, except when it isn't, so you can accept that these events will occur. While these clusters are disruptive to your sleep, they are in-fact infrequent, and maybe it's better to deal with that disruption than to try to treat it with a collar that might be worse for sleep integrity. A favorite trick of mine when laying on my side is to pull a corner of a soft flexible pillow between my shoulder and jaw. You can look at the collar reviews in the Reviews forum and see if something there inspires you.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
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Optimizing Therapy
Organize your OSCAR Charts
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How To Deal With Equipment Supplier


INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#5
RE: Event clusters
Thank you again Sleeprider.

The collar is about 3.25 in. high and it's a "UniForU Neck Brace Foam Cervical Collar".  The wear is comfortable, not impinging on soft tissues behind the jaw. My chin is not able to get behind the collar. I did look at the Reviews forum and the thing I thought was to maybe get a rigid collar.  But I hesitate to go there fearing getting into a worst situation and discomfort

I did the test you mention and could not feel any obstruction (without the collar). I did the same test lying down, forcing my head towards my chest and felt a slight obstruction.

I did something similar to your trick with the pillow last night.  Results are not conclusive but you just gave me the idea of getting a neck roll pillow to try.

I will monitor the clusters and get an idea of their frequency. I have no clue how big a cluster I should watch for. I would probably relate them to AHI or another indicator.  The same question applies to the frequency.  Anyway I will think of something and be back here if I still have questions.

I know how to get the count of events out of Oscar but I don't know if they are all of equal importance (CA - OA - H - RE).

DanEm

"If life hands you lemons, make lemonade! Words to live by, especially when you keep in mind that the only way to make them into lemonade is to squeeze the hell out of them."
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#6
RE: Event clusters
Analyzing Oscar is easy, it's your sleep quality we want to preserve. You don't have a CA problem, so ignore those. RERA, H and OA are all on the obstructive continuum and have increasingly disruptive impacts on your sleep. Some members have very satisfying sleep with less than 3 AHI and other don't feel right with less than 1, so it's all about what you need to avoid too many arousals at night
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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