Would appreciate interpretation on my OSCAR results

[JoyD.]

I finally got OSCAR working again after I replaced my Card Reader.

So I've been slowly increasing the Minimum Pressure - last night it was 10.8. I've also been experimenting with levels of EPR (which I need to reduce the Flow Limitations). I've found that EPR 3 causes too many Central Apneas. EPR of 1 shows too many Flow Limitations . . . so I've settled on EPR2.

I'm also noticing that when I wake up Supine, that I have pressure spurts during the time preceding that. (My 2009 Sleep Study showed 4X the Events when I was Supine). I'm normally a side sleeper. I'm using a buckwheat pillow behind my back to help prevent rolling over on my back ... but when I toss from side to side it's difficult to drag a heavy buckwheat pillow with me (probably causing a lot of SWJ in the process).

Normally I don't post ALL the graphs, but this once I thought I'd show all the info. in case another graph might shed some light on my situation as a 81-year old PAP user of 13 years with cardiac arrhythmia (a high number of PVCs, according to my cardiologist) & moderate Tricuspid Valve regurgitation which is being monitored by ECHO annually. (My O2 Ring worn nightly only rare drop to 90 or below, never below 88.)

So attached below is my full data from last night, Sunday, 12/4/2022 when I woke up SUPINE at 4:13am. (No Snore chart because it's zero).

I'd appreciate any feedback from the experts. (Thanks for Wiki - have learned so much!)

Here are my observations:
* It looks like the higher pressures (triggered by being SUPINE w/more events) are causing my nasal mask to leak. (My mouth tape is secure when I wake up.)
* I have been able to reduce the times I get up at night to pee (less liquids before bedtime) . . . but I still have a lot of SWJ periodically during the night when I zoom & look at breaths. I know that I toss from side to side frequently due to age-related hip pain. That is obviously causing disrupted & unrefreshing sleep (and I'm not sure there is much I can do about it than I already am, as I continue to age.)
* It also looks like I have pressure-induced Centrals (?) (Note: No Central Apneas were noted on my 2009 Sleep Study. It was primarily Hypopneas at that time.)
* Wondering if I should continue slowly increasing the Minimum Pressure??

Any observations or suggestions are welcome. (I'd be happy to take a zoomed in shot of a specific time.)

Thanks,
JoyD.

PS -
I use an AutoSet 10 on "APAP" mode, "Soft" Response, no ramp, full-time EPR level 2. My best mask results with my F&P Zest Nasal Mask.
(My AirFit P10 wont stay put on my thin silky hair & active tossing & turning & leaks too much; the F&P Evora w/different seal sizes has never been comfortable & leaks for me, probably because I toss & turn so much).

[OpalRose]

Hello Joy,
What I'm seeing is simply what we call "Positional Apnea".   Look at the apneas that are clumped together.   In your case, it's more than likely caused when you roll over on your back.  You may be allowing your head to tilt forward into your chest and cutting of your air supply... sort of like kinking a hose.

http://www.apneaboard.com/wiki/index.php...onal_Apnea

Things to be aware of:  What type pillow do you use?  If it's too tall, or if you're using more than one pillow, this will cause your head to tilt forward.  A thinner, but supportive pillow would help align your head and neck better.  If you can't overcome this, you may want to try a soft cervical collar.  Many here have been helped greatly by using a collar.

http://www.apneaboard.com/wiki/index.php...cal_Collar

Since you didn't experience clear airway events on your sleep study, I wouldn't worry too much.  They will probably lessen in time.  

I don't think you need higher pressure.  Raising the pressure won't help much with positional apnea and may even cause more CA's.  However, I would lower the maximum pressure a bit, maybe to 15.  Pressure is spiking due to the high flow limitations.  
The use of EPR is what helps flow limitation.  Try to work that back up to 3 if you can.

[JoyD.]

Thanks so much for your response, OpalRose.

I use a Pursleep CPAPFit (buckwheat+ some foam) pillow that I removed some contents so that it is not thick. I shake it so the thickest part is at my neck when I'm on my side with the center of it low (it where my head is). So it is serving to keep my chin raised. (I have not found a cervical collar that I can sleep with, trying several kinds).

I've experimented with EPR levels, and I've found that level 3 causes way too many centrals. I've compromised at 2 which helps reduce the flow limitations w/o increasing centrals much. (I can revisit this in the future, after I'm finished with my current "experiment".)

Most recently, I've been experimenting with increasing MINIMUM pressure (slowly by 0.2) over time so it covers my "non-supine" pressure needs w/o having to waste time "moving up" from a too-low minimum pressure. As for the Maximum pressure, I just want it to be high enough to ramp up sufficiently when I'm SUPINE to take care of future clusters of events.

SEE my attachment from last night, 12/5: which clearly shows the differences when I'm Supine & on my Side (my preferred & normal position). I allowed myself to go to bed SUPINE at about 10pm (since my hips were hurting when on my side), and woke up at about 4:30, still Supine. Compare Session 1 having lots of events, OA clusters & subsequent pressure surges while Supine . . . to Sessions 2/3 when I went back to bed on my Side & woke up on my Side, much fewer events & needs for pressure increases. I'm watching this, and hope to discover what my Max pressure should be to take care of needed Supine pressure surges.

My goal is to get as comfortable & refreshing sleep as possible, and not be anxious about whether I'll end up on my back which itself interferes with a good night of sleep! Therefore, I am trying to have my min/max pressures set optimally & a max pressure that will take care of any increased challenges when on my back.

BTW, I notice that my 95% Flow Limitations was only 0.06 last night, which is not high, so in this case FLs wouldn't account for the pressure surges, would they? It seems to me that it's the supine clusters of events causing the pressure surges as the algorhythm is preparing to take care of future events. Am I wrong? Since last night's pressure in Session 1 surged to almost 16, I'm reluctant to reduce the maximum pressure right now (since it may be needed to take care of events when I am supine) ??

Since my hips have been bothering me when sleeping on my side lately . . . my plan is to allow myself to go to bed Supine if needed, and watch what happens to my events, pressure, FLs, AHI. Then reevaluate after a week before making changes.

Does that sound reasonable?

[OpalRose]

A lot of folk here use a buckwheat pillow. You should be ok with it.

Actually, your FL is down, so that's heading in the right direction. And I see no problem with keeping EPR at 2.

Yes, the algorithm responded to the supine clusters of events, but usually higher pressures won't tackle those clusters. If you look, you will notice that the pressure took a nose dive then shot up and down a few times trying to deal with the clusters.

I think you have a pretty good handle of what's going on, as long as the pressure roller coaster doesn't disturb your sleep.

I understand that you can't sleep on your sides for any length of time. I have a similar problem with pain and turn over quite often. I end up on my back many times.
I tell myself "comfort first".

Keep on what you're doing until you find that happy medium.

[JoyD.]

Thank you, Opal Rose, for your kind reply and reassurance!! It is good to know that at least I am on the right track.

I'm keeping in my mind your point about reducing the Max pressure to 15 to see what happens. After my current week-long experiment with "comfort first" rather than fretting about being Supine . . . I will assess what I have found and then perhaps try another experiment with Max pressure.

Thank you again for your feedback!

Joy

Below is last night's Oscar report . . . very much like the previous night re. pressure surges & clusters of events the first part of the night (while SUPINE), and few events w/ pressure never reaching 12 during the last part of the night (while on my SIDE)! The 95% FL did rise a bit from 0.06 to 0.08. (I'm leaving settings alone during this week-long experiment.)

[Gideon]

That cluster from 0230 to 0320 is likely positional from tucking your chin or other cervical misalignment. If I'm correct no pressure will fix that.

[JoyD.]

Thank you for your input, Gideon.

Currently I've been using a buckwheat pillow (CPAPFit by Pursleep) to keep my cervical area aligned so my jaw doesn't drop. With disturbed sleep it is possible that I move away from the ideal position on the pillow.

I've tried several different kind of cervical collars & haven't been able to wear/tolerate them (perhaps I haven't gotten the size or fit right, or found the particular one that would work for me).

BTW, I want to thank the Apnea Board for the great Wiki!! I continue to make a study of it, and go back to re-read when I come across challenges. It is so very helpful and educational. Thanks to all who contribute to its contents!

JoyD.