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OSCAR results seem to say I'm doing ok - so why do I wake up with a sore throat...
#1
OSCAR results seem to say I'm doing ok - so why do I wake up with a sore throat...
.. like in the bad old days BD (Before Diagnosis).

Hello everyone, it's so good to have such a great community of people to join as I start my journey out of sleepiness and into better health.

I'm in my late 50s, but reckon I've probably had undiagnosed sleep apnea since my 20s. Over the years, sharing hotel rooms or dorms at workshops and conferences, people would sometimes comment on my snoring. I did a lab sleep study back then but didn't snore that night and got sent away - a young, slim, woman was not seen to be a candidate for apnea. And because one person described my snoring as 'cute - like a kitten', I didn't think any more about my snoring after that.

Yet I visited doctor after doctor seeking answers to my tiredness and how I seemed to get every cold going (I reckon those sore throats weren't a cold - they were from snoring). I even had a name for a phenomenon I used to experience - I called them 'energy collapses', again, probably the result of terrible sleep.

In the last couple of years my snoring, need for naps got worse. Finally, my husband heard about OSA and hassled me to discuss it with my doctor. My sleep study results were terrible - AHI in the 90s, SaO2 below 88% for over a quarter of the night. But at last I had an explanation for things!

I was sent home with a cpap machine to trial and some verbal instructions. Ridiculous to expect a sleep deprived, freaked out person to take it all in. I got more written material on how to use my Brita water jug than I did the machine! 

Getting used to my trial machine, and having to learn about how to manage old injuries which, paradoxically are reasserting themselves now I’m sleeping like a log and not moving so much at night, has been a real challenge. I had to take a week off work as my sleep actually got worse and my mental health took a real knock. Thankfully I found this forum and drew on the collective wisdom to navigate my way through the challenging first couple of months.

But I reckon I’ve now pretty much got the machine going ok. The sleep! Wow – so that’s how people get to wake up straight away in the morning. Me, it would take hours to wake up. During lockdown it got so bad I’d get up, have cup of tea, and then need a nap. I’d do a morning’s work, and have a nap at lunch. Work in the afternoon, nap around 5, and then work again til around 7-8 to make sure I did my hours. Have to say, I do miss the snoozes (a bit).

In the last week I’ve taken delivery of some buckwheat pillows to manage my old injuries (shoulder and knee). I’ve started to sleep on my back for the first part of the night, as that’s supposed to be best for injuries. I’m anticipating that the machine will keep my airways open. 

But for the last few days I’ve been waking up with a sore throat and wonder whether my Oscar results give any clues as to whether anythings going on?

Is anyone able to offer any advice?

And once again, thanks so much to everyone who contributes here – it’s been a real lifeline for me, good to know I’m not alone and learn how other people manage things.

   
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#2
RE: OSCAR results seem to say I'm doing ok - so why do I wake up with a sore throat...
You are using a Resmed Airsense 10 Autoset For Her with a minimum pressure of 5.0 and maximum of 15.0 and EPR at 3. Your leak rate is excellent, however there are still some obstructive apnea clusters and a fair amount of flow limitation resulting in some hypopnea and RERA. It might be helpful to get a close-up view of the respiratory flow wave to see how flattened the tops of the inspiration flow wave is.

Your median pressure is 11.4 and the 95% is 13.4, so our first clue is that the minimum pressure of 5.0 clearly needs to be increased. Although well below your current actual pressure, I think you should increase the minimum pressure to 9.0 which will give you a starting pressure of 9.0/6.0 with the EPR (Inhale/Exhale). This should help put you into the therapy target zone faster and avoid some of the pressure fluctuation through the night. There is a cluster of OA at about 2:00 that looks like positional apnea. This is the result of chin-tucking which obstructs the airway, and while pressure increases rapidly, the best approach is to avoid using tall or firm pillows that can cause this, however many of our members eventually us an aid like the soft cervical collar to prevent that from happening. You may want to read the soft cervical collar wiki and article on positioal apnea
http://www.apneaboard.com/wiki/index.php...cal_Collar
http://www.apneaboard.com/wiki/index.php...onal_Apnea

There is no obvious clue to your sore throat. Humidity and heated hose settings look effective and leaks are very low and no apparent snoring problem. Flow limitations are apparent, and this is often associated with upper airway resistance which is common in women. A bilevel positive air pressure machine can help to overcome that resistance and you are already using the maximum pressure support (EPR) your CPAP allows. Let's take a closer look at the flow rate and we can perhaps see if flow limitation is worse than what is inferred by the numbers.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

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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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#3
RE: OSCAR results seem to say I'm doing ok - so why do I wake up with a sore throat...
Thanks for this information. I've gone and ordered a Releaf cervical collar as I noticed on the weekend when I was trialling pillow location that I tuck my neck in.

I turned the minimum pressure up to 9 and got a slight reduction in my AHI.

Your prompt to show close ups was quite an eye opener because my flow rate seems to be very variable at times. I've taken a number of screenshots, the first one shows fairly regular breathing, then I've chosen a selection of 'weird' stuff.

I'm still learning about all the terms, so don't feel yet in a position to make any comments on what I'm seeing but will really welcome your views.

           

As my flow rate seems to vary a lot over the night I've taken a couple more screenshots.

Here they are:

       
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#4
RE: OSCAR results seem to say I'm doing ok - so why do I wake up with a sore throat...
Always provide a full night screenshot as in the worst case it provides context.
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter

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#5
RE: OSCAR results seem to say I'm doing ok - so why do I wake up with a sore throat...
I definitely see flow limitation with flattened inspiratory peaks on the last two graphs. This is not an insurmountable issue, and you're using as much pressure support or EPR as your machine can provide. AHI looks better here with lower OA and H events. Hopefully that will stay constant. Notice in spite of higher minimum pressure, your median and 95% pressure was lower here, and there is still room to increase minimum pressure as you feel comfortable with that.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
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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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#6
RE: OSCAR results seem to say I'm doing ok - so why do I wake up with a sore throat...
Thanks for this info.

Below is the whole night that the zoomed in images come from.

I don't yet understand the significance of 95% this or median that. I've been reading as much as I can but finding it a bit challenging flipping between the forum, the wiki and the Oscar wiki, and don't have huge amounts of time to read, especially as my partner is really hassling me not to stay up so late learning how I can sleep better!

I've now ordered Dr Steven Park's Sleep Interrupted and Totally CPAP to hopefully get across some of the info a bit quicker than my current random clicking and inevitable rabbit hole diving. I WILL sleep soundly and wake refreshed! I WILL!

Anyways, re the OSCAR data. UARS is sounding like it could be relevant for me. So last night I didn't sleep on my back (cos that's not good for UARS, even with my APAP doing its thing?) and that got my AHI down another notch. But I still woke up very tired after around 7 hours sleep and still with the sore throat. I've been using APAP now for 10 weeks. 

Sleeprider you mentioned "there is still room to increase minimum pressure as you feel comfortable with that". I'm definitely prepared to do that - could you advise how increasing minimum pressure would impact on comfort - or do you mean "if you feel happy to do that" - and if you do mean that, why mightn't I be happy to do increase minimum pressure? I tried to find it out for myself, looked up the article about flow limitation, but still couldn't work it out.

Thank you! BTW I tried to donate via Mastercard on Paypal the other day and got an error message, which seems to be a pretty common thing that Paypal does - any hints there?

   
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#7
RE: OSCAR results seem to say I'm doing ok - so why do I wake up with a sore throat...
I guess we need to do a wiki on the basic statistics.  Median simply means the pressure that happens most of the time and in your case that is 11.3 cm of pressure.  The 95th percentile pressure is the pressure that is exceeded only 5% of the time, or your pressure is at or below that value 95% of the time. In your case 13 cm.  So we know your pressure mostly stays between 11 and 13 cm.  This is your effective therapy range, and it might be a good idea to increase your minimum pressure to be closer to 11.0.  This will result in even less pressure fluctuation through the night and will be somewhat less disruptive and more effective in preventing some events.  Feel free to try 10.0 and see if that feels better, and you can even move up to 11.0 and see how that goes for you.  I like to see pressure changes between the median and 95% not exceed about 3-cm.

Your chart shows some clustering of the OA events and even the flow limitation. When you have an obstructive apnea, it seems to happen in pairs. This is a signature of what we call positional apnea or chin-tucking.  Don't be too quick to diagnose yourself with UARS until you do what you can to address that possibility.  The solution many members here have used is a soft cervical collar.  We have a couple more wikis that may help you:
Positional apnea  http://www.apneaboard.com/wiki/index.php...onal_Apnea
soft cervical collar.  http://www.apneaboard.com/wiki/index.php...cal_Collar

Dr Parks is a pretty respected guy but he is a surgeon and is biased to surgical solutions.  You should consider reading some articles by Dr Barry Krakow who treats UARS and obstructive apnea with positive pressure and has a different take on these issues.  http://www.apneaboard.com/wiki/index.php..._and_BiPAP
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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#8
RE: OSCAR results seem to say I'm doing ok - so why do I wake up with a sore throat...
Burra, your determination and your readiness to do some problem-solving will serve you well. I do truly believe you will experience better sleep.

The main question about increasing your minimum is whether you are able to exhale comfortably against a higher pressure. Sounds like you're fine with that.

A couple of little tricks might help you see what's going on with the FLs a bit better. Right click on the flow rate graph where it says "flow rate." Select Y-axis override and reset to something like + and - 45. Then select Dotted Lines and check the box for zero.

About the sore throat, does it feel better after you've been up for a while?
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#9
RE: OSCAR results seem to say I'm doing ok - so why do I wake up with a sore throat...
(11-04-2020, 06:03 AM)Burra Wrote: BTW I tried to donate via Mastercard on Paypal the other day and got an error message, which seems to be a pretty common thing that Paypal does - any hints there?



Hi Burra, welcome to the forum.  Coffee 

Sleeprider pointed me to your problem with PayPal.  Sorry for the frustration.  Sometimes, PayPal gets finicky with regard to all the info regarding a credit card donation.  If there's a mismatch or slight difference between what PayPal has down as your email address, mailing address or phone number, they might reject the donation.

If that's not working, I could suggest a few options:

1.  Use a different credit card on PayPal and see if that works.

2.  Go to our Patreon Page and try that method.

3.  Use check/money order to donate via U.S. Mail.

Hope this helps and thanks for considering a donation to help Apnea Board!   Coffee
SuperSleeper
Apnea Board Administrator
www.ApneaBoard.com


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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#10
RE: OSCAR results seem to say I'm doing ok - so why do I wake up with a sore throat...
After upping the pressure to 9 (from my prescribed 5 min) and getting a reduction in AHI I then took it a step further and went up to 10.

Well, that didn't go so well - it seemed  really forceful. I reassured myself that given my median was 11.3, not to worry about the pressure because this is the pressure I get when I'm asleep, it's just that I'm now feeling a higher pressure while awake.

Anyways, I woke up and felt very tight in my chest. So I got a bit worried. I googled around and saw some cautions about 'dial winging'. And some stuff about UARS that suggests sleeping on my back is a bad thing.

Given my polysomnography report showed I have blood saturation levels below 88 per cent for over quarter of the time I'm asleep, getting this right is critical to my health and quality of life.

So I've gone back to the beginning and am going to be a bit more methodical in my approach, with the aim of going back to my sleep doc for my six month review with some solid evidence and possibly move onto a BiPAP. 

Here's what I'm doing:

  1. I've set my minimum pressure back down to 5 for a little while
  2. I'm waiting for my soft cervical collar to arrive
  3. I've just ordered a pulse oximeter to measure my oxygen levels, heart rate and body movement
  4. I've now got 6 (SIX! count them - six!!!!) new buckwheat pillows that I'm using to to prop up my injured shoulder and make a sort of mattress topper over the rock hard mattress my partner loves
  5. I'm waiting for my Dr Park books Sleep Interupted and Totally CPAP to arrive to get a clearer overall picture of things
  6. I'm reading Dr Krakow's article and blog
  7. I'm reading up on flow rate, flow limitations, RERAs and M-tips on this site.
  8. I've started a word document where I'm placing all the relevant information I glean from here and there so I can be clearer about what it is I'm concerned about. I've realised one of the issues I'm having with coming to grips with the issue is that I've been using a tablet, and this makes it a bit hard when clicking from page tp page trying to see how things relate to each other and what all these darned acronyms mean. So now I'm using my laptop.
Once I've got all that stuff in place, then I'll start playing with the pressure and keeping a proper record of what happens next.
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