Flow Rate Graph - Clarification Sought

[Sleeper396]

I did change to sleeping on my side as well, which dramatically improved my AHI from back sleeping.  This exhalation imbalance, however, seems to be a separate issue for me.  Thanks for pointing this out anyway, SideSleeper.

[Sleeper396]

Quick update, on Sleeprider's recommendations of EPR.  Unfortunately, increasing pressure with EPR of 3 triggered a rash of CA's, along with other apnea events, which had previously been under control before EPR.  I had this happen before on my testing.  I am still experimenting with EPR of 2, as well, but I am not hopeful about EPR due to its triggering effect on CA's for me (I had CA's during my lab sleep test).  How long do you feel that I should work with an EPR test?

Another question, please. For each of the last 3 nights only, I noticed my respiratory rates increased significantly on all of the 95%, 99%, and median rate measurements shown on the graph -- to respiratory rates of 48, 29, and 15, respectively.  This differs from my 6 month average of 25, 18, and 13, respectively for the same 3 measurements -- 95%, 99% and median.  Any ideas why this could be happening and should I be concerned or do anything further?  

Thanks.

[Sleeprider]

It may help to see an updated graph on Oscar. If EPR 3 triggered CA evets, we would want to back off on that recommendations to a lower or zero EPR setting.

[Sleeper396]

Here is the Oscar shot from when I started the EPR (it is only a couple of hours). It was CA's and other events that immediately were noticeable as I began EPR. I stopped the EPR after this initial two hour flurry, as I was concerned that I was triggering CA's, which had largely been consistently tamed prior to engaging EPR that night. Maybe I was premature in stopping the EPR test? Not sure.  Thanks for reviewing.

[Gideon]

Yes it appears that YOU were triggering CAs by tossing and rolling and holding your breath. Do note that at the scale you posted it is very hard to interpret.

Do check your charts scale, pressure is set to 3 times the machines max of 20.

And do give EPR another try. If that was 3 try 2.

[SarcasticDave94]

Six Central Apnea within that 45 or so minutes isn't the trainwreck that you think. There's likely various causes other than EPR. SWJ (Sleep Wake Junk) is possible.

I've not read the entire thread history, so I'm asking what was your data on your diagnostic sleep test? Specifically the Central Apnea events count. Reminder the diagnostic is the first test, without PAP.

[Sleeper396]

Dave, here are my sleep labs:

AHI 14 = Mild Sleep Apnea. Consisted of 71 total events -- 28 OSA's, 23 Centrals; 20 Hypopneas. Note: AHI for total time on my back (supine) was 35; then dropped down when shifted to side. 
Arousal Index 18.9/hour; consisted of 96 arousals; 71 were AHI events; and 88 were RERA (respiratory effort related arousals). 
Sleep O2 Saturation: Avg. 95%; Minimum was 78%; 6.3 minutes below 88%  --- these were without any PAP support (untreated).

I previously did an in-home test which was much worse.   
Home Sleep Study 5/5/21 prior to lab study showed the following:
40 AHI - apnea events per hour 
O2 at 65% = Hypoxia (insufficient oxygen level)
Severe apnea + severe O2 desaturation

[SarcasticDave94]

OK so there's tendency to some CA historically, but it appears not enough for specialized therapy devices. Do what's most comfortable is what comes to mind on EPR. You might need to plan on a balancing act, choosing a middle ground between the 2 types of events, a teeter-totter thing might be in place where Centrals are one side and Obstructive Apnea and Hypopnea, flow limits will be on the opposing end, signifying opposing actions to address the 2 types.

I'm not indicating CA are a major thing of concern but noting the concept if it becomes applicable.

[Gideon]

With your history of low extended O2 SATs I would like you to do an overnight O2 study. I do suggest you get a recording pulse oximeter that is compatible with OSCAR so you can combine the reports mostly to verify that you don't have a continuing issue. I don't expect one since pap usage mitigates this. Why? Because 6+ minutes at or below 88% marginally calls for supplemental oxygen overnight

[SarcasticDave94]

Good catch, I missed the O2 data.