Newly diagnosed and on dream station

[Marshapnea]

I did some changes in my sleep position last night (pressure stayed at 9min and 15 max) and used a different pillow (I'm a side sleeper) and I did get better AHI overall).

At this point (other than increase of pressure by .5 to 9.5 min), I'm started to suspect that my uptick in AHI may be due to establishing sleep after wake up, this is possible one of a few items:

1. Positional apnea (cervical collar to avoid chin tuck is on it's way)
2. Pressure on the min setting needs to be increased (I'll dial this in tonight)
3. Using the ramp feature after wake up (I'm going to give this a try tonight)

Initial sleep onset is within 7 minutes or so, I suspect that ramp may help in this situation.

I've attached two screenshots
1. First - AHI was ~6 and shows cluster of events after wake up
2, Second - AHI was ~3 and shows cluster of events after wake up (this was with the new pillow)

   
   

[Marshapnea]

Hope all are well,

1. I didn't change my pressure range, since I'm still evaluating.
2. I did order a collar, but if was the wrong size (yep, I'm a 19 inch neck..but they sent a small collar). I have addressed thus issue via a new pillow and keeping aware of my sleeping position. I'm lucky that I can get to sleep in 10 minutes initially and a few minutes in cases of wake-up.
3. In the case of false positives (OA, RERA, or hypopnea during wake states), I've been able to reduce them by matching my respiration rate during these wake states. I start on inspiration and count to complete expiration (3 secords for me @ 20 per minute). I've attached a screenshot of my latest. This is reducing my AHI and allows better analysis.

   

My current goal continues to be contiguous sleep for 6 hours to 7.5....which is proving a challenge. I'm following the thee point below.
1. no napping during the day.
2. reduced water at night (after 6 or 7pm dinner..less water).
3. exersize activities and portion control. alcohol reduction/elimination.


Nasal congrestion is being handled by a nightly Allegra/Singular/Flonase in addition to a neti pot lavage before administration of flonase. I also will use a benadryl to occasionally achieve sleep.
I will use a afrin spray on really bad nights (I'm mindful of rebound congestion).

I'm just documenting my journey and imply no advice to anyone else from a medical perspective. My initial AHI was 72 and initial O2 reached 67%, so cpap has helped greatly.

[ajack]

Your apnea seems well controlled. Do you have a recording spo2 meter to check your o2?
Are there dips in you minute vent and tidal volume, that could indicate something.

[Marshapnea]

I don't have a recording O2 meter, just being cheap and tired of all the gizmo's around this therapy. But, I will as budget permits.
Interesting enough, I see spikes in minute vent and tidal volume before/during wake up. I am on O2 support of 2 liter/minute.
Thanks

[Marshapnea]

I was out of town in Rangeley, Maine on a hiking trip. It's a great place to visit, with a great State park.

My sleep doc said it was ok to take a day or two without additional O2 (I'm currently at 2 liters per minute, when I'm home)
I did go out and buy a O2 meter (CMS50F) and decided to check out my O2 levels.
The first screenshot cover the daily with O2 and pulse rate graphs

   

The second screen shot covers the clear airway event which pushed my O2 to 86 for a brief time.

   

I read that there's an assumption that you should be in the 90's when sleeping...so I'm definitely below that level,

Question:

Do the experts out there think these O2 levels are a problem? 

Thanks for all the help!!

[Gideon]

IMHO these O2 levels are marginally low. I base that on the fact that Medicare says 8 minutes below 88% qualifies for Oxygen supplement. Normal night is lower than normal day. I would put a line at 88% as needing to estimate time below and a flag to discuss with your doctor.

[Marshapnea]

Thank you, I’ll pursue as suggested.

[ajack]

I would also try having the min pressure at your 95% which in some labs would be you fixed pressure. so try min 11, It may resolve some low areas.

[Marshapnea]

I'll try the higher pressure for min, but it may blow my ears off  

My O2 reading without O2 supply  (previous post)
and
My O2 reading with O2 supply (see below)
   

are basically the same stats...so I'm wondering if my prescribed setting of 2 liters minute is too low. I'll discuss with sleep doc, but if there's a O2 person out there with a opinion...I'd be interested.

Sigh..it seems that these sleep centers are "set it and forget it" operations....the DME provider is a ghost as well. No wonder there's compliance issues.

Any help would be appreciated.

[Marshapnea]

Log update:

I changed my O2 level to 2.5 liters per minute and noticed that it moved my O2 into low 90% (pulse rate increased to 68bpm)  , so this was an improvement for me.
More importantly ...I felt better. I don't have comorbidity (just hypertension and allergies) and I would expect my O2 levels to be in the mid 90%.

I've lost 30lbs since being diagnosed in early april (roughly 10lbs per month),  290 to 260 @ 6'2"

I'll move the O2 to 3 liters, and then do a more comprehensive review.