Getting a machine advice

[dolppl]

Results from Friday and Sunday night attached.  Saturday did not get any results (forgot to put the card back in the machine).

I was perusing my previous sleep studies and all of them I had done were in the supine position (even though i am a mostly side stomach sleeper) because it is all but impossible (at least for me) to sleep anywhere but my back when i am hooked up to a bunch of wires and a sometimes a CPAP.

My last at home diagnostic study (only at-home one i have done).  There were two small time frames that i rolled onto my right side (30 mins and 1 hour).   During these periods the events went down to almost zero.  

I tried rolling onto my side when i first got onto CPAP and the pressure just filled up my stomach and i felt like i could not breathe out against the pressure.

Over the weekend (last 3 nights) I was able to fall asleep on my side and I woke up on my side (no idea what happened in the middle of the night) and Fridays results and last nights results for the first 3-3.5 hours of sleep I had an AHI of ~1.5.

Am i onto something here that i should try to stay on my side?  If so, any recommendations to stay there all night?




       

[Sleeprider]

There is not any meaningful change in your therapy.  Obstructive apnea remains at a very low level, and if that was all we needed to worry about, we would clearly be fine and done with CPAP.  Ultimately, the best solution for this is ASV, but it is going to be very difficult to get the prescription for that, in part because you have a rate of apnea that is marginally acceptable, and even when subjected to a sleep study, the central apnea are very inconsistently distributed through the night.  It would have been easy to find several hours on either of these nights with practically no events.    That is a choice to be made after your physican follow-up and exhausting all other avenues.   I don't expect this pattern to significantly change, and you are currently using the most effective mode and pressure to reduce CA and H events to the extent possible, while preventing OA.  There is an ongoing trend for fewer events, and that is what we hope continues.

Since we have not tried EPR, that is something to consider. If you turn on EPR I would keep it to a setting of 1, however I suspect you will experience an increase in CA and H events with this option.  For all practical purposes, we have used the most viable options to optimize your therapy with CPAP, and time may resolve more events, however, your tendency for central events was pretty apparent in your titration.  Keeping in touch with your doctor about the number of events and especially if you find ths disruptive to your sleep and sense of well-being during the day is important to communicate.  Since you are still adapting and improving, it's safe to say you will be asked to continue as-is. Your current level of therapy efficacy is going to be deemed acceptable by most doctors and insurance.

[dolppl]

I appreciate your insight.  It looks like the thread you mentioned is about converting my machine into a BiPAP machine.  Per my titration my centrals shot up when they attempted BiPAP on me.  Why do you anticipate that as a viable option?

I think i might give the EPR at 1 a shot tonight as during my at home titration they had the EPR on and it did seem more comfortable than what i have going on now and i know i felt better after those couple of days.  (Could have been psychosomatic).  We will see what the results show and how I feel.

[dolppl]

Thanks.  I will keep that in my back pocket. 

Is there any reason I should not be lowering my pressure again.  If I have negligible OAs and Hypopnea s and almost all are CAs.  Should i drop the pressure down again to a 6 from 7?

Also, I have been doing some reading does what i have going on lead anyone to think that i have UARS?  I have been reading as much as i can on it and it is somewhat confusing and not clear cut.

Let me know your thoughts.

[Sleeprider]

If you plan to implement EPR, keep 7.0, otherwise fine. EPR will lower your exhale pressure so doing both is a bigger move.

[Gideon]

FYI, in general, your min pressure should not be LOWER than 4 + EPR. Also, many adults have difficulty breathing (inhaling) with a pressure of 4 or 5 so in addition to the initial suggestion of 4 + EPR, that, or a min of 6 whichever is higher is often suggested. additional changes, either increasing or decreasing may be suggested depending on data (charts) that are presented.

[dolppl]

Last night i feel like i tossed and turned all night.  I don't think it had anything to do with the CPAP, I had a couple of beers a little too close to bedtime and a big, salty dinner i think caused dehydration.  

But my results are the best i have had so far (not by much but i will take any victory i can't get).  

I kept the pressure at 7 and turned EPR on 1.  Centrals went down slightly and are still trending down.  Started at a little over 8 per hour 10 days ago and last night they were at their lowest of just under 3 per hour.  

There were no large leaks but it seems like the leaks got a lot worse.  Might not have had the mask on exactly right for most of the night.


   

[Sleeprider]

Leaks may be related to a more restless night. I felt the same, and I'm sure everyone has those nights. The trends are looking very positive, and it looks like EPR is not a problem at this point. We don't know until we try.

[dolppl]

2 questions:
 
Last night I had a slight uptick in my centrals than I have had recently.  What I notice though is that most of them are clumped into two distinct groupings toward the morning. 

1.  Is there a different reason for the clumping of the centrals verses being spread out through night?  Anything to gather from that?  Could sleep position have anything to do with that?

2.  I am using a F&P Zest mask.  It has a foam pad behind the area that blows up.  I like the mask because it is comfortable and generally don't have too many leak issues..  The last two nights, many times throughout the night I woke up feeling I couldn't get enough are in, which I thought was odd because I am at a pressure of 7 EPR 1.  Should be enough air.  Then I figured it out.  The mask was shifting slightly upwards and was real close to where I breathe through my nose and having the foam pad there it was hindering the flow of air.  Once I shifted the mask down slightly I was able to breathe fine, but the mask kept shifting upward on me.  I think the reason is I have been laying on my side and if I shift my face down slightly, the pillow holds the mask in place and my nose closes off.

Any recommendations to fix this?  If you think it is a problem with the mask and that foam pad and that I need a new mask can some recommend a mask that is good for side sleeping?

Thank you,

[SarcasticDave94]

There is a thing called sleep/wake junk or SWJ that may occur at either end of a sleep session. I'd think that SWJ could be involved, but I think that mostly involves obstructive apnea. I think it would be good to show an OSCAR chart that shows the sleep session you're concerned about. Include a standard no zoom view and one that is zoomed in a bit to focus on the cluster section.

As for the mask, I've got the ResMed N/P30i and was able to side sleep despite these have the air tubes coming down from the top. I'd consider looking at a specialized sleep pillow with a cutout for CPAP masks if you have trouble with interference.