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Snoring and Chasing Pressure
#1
Question 
My AHI is generally low, below 3 and until recently below one. I snore according to SH. I have fragmented sleep and never, ever feel rested or restored when I wake up. I have been wondering if it is the snoring or UARS that is causing my poor sleep.

I previously had my APAP range set to 12 - 14 and my 90% and median are often at 14. Not always, but more than 50% of the time. Last night I changed my range to 13-16. I was wearing a Simplus FFM. My median was 15 and 90% was 16. There was no difference in my snoring. I did have some leaks earlier in the night until I got my mask straps adjusted.

It was just one night so too early to jump to conclusions, but does it seem odd that my snoring was unaffected? Is there anything else that the machine might interpret as snoring? Does this suggest that I need even more pressure to combat the snoring? This is getting into bi-level territory and far above what is needed to treat my non-snoring events.

The other thing I will note is my Tidal Volume. Note how "thick" it is. Some nights it have much less variation in range (as just after 1AM in this image) and I feel much better. Does anyone know what this is indicating?

[Image: DVR9mHl.png]
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#2
My first question is how many times did you take off your mask and stop the machine? According to your graph your had 5 separate sleeping sessions. If this is not actually the case then you may have a problem with your machine. Whatever, this all adds up to broken sleep so no wonder you are feeling like crap in the morning after only 6 hours of broken sleep.

The other concern which you have picked out is that your max setting of 16 got reached and maintained for the majority of time. Try raising it to the highest setting on your machine (20?) and see if that maxes out as well. If so then your point about needing more than CPAP might be valid. Can your mask handle that pressure without leaking? Another thought is that the high pressure is affecting your sleep.
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#3
Time to have a chat with your sleep doc. Have you ever been checked for hypoxia ... and considered supplemental oxygen?
"The object in life is not to be on the side of the majority, but to escape finding oneself in the ranks of the insane." -- Marcus Aurelius
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#4
hmmm... I'd be curious to know what your respiration rate and Insipire and expire curves looked like during this period of time.

Since the Tidal Volume is in the simplest of terms is; the amount of air passing in and out of the lungs for each breath (mL).

The key is for each breath.

If the graph of your Tidal Volume is correct, I'd expect you to be literally panting... but with the graph being so compressed, it's hard to get an idea about the real frequency of your breaths.

I dunno...
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#5
Once again, I am confounded by the inhalation / expiration ratio of nearly 2:1. For most of us, the inhale time is shorter or equal to exhale. I can find nothing on the significance of this, but have noted that where inhale is longer than exhale, the graphs tend to be 'busy'.

PR machines record a VS (vibratory snore) and VS1. How they are detected or what they actually mean is also not well understood. Robysue took at shot at it here in posts 451 and 454. http://www.apneaboard.com/forums/Thread-...14?page=46
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#6
What does a two-minute zoomed section of your graphs look like when your tidal volume graph is "fuzzy" like that?
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#7
Sleeprider,

At times when I see my inhalation/expiration ratio go above one, if I look at my breathing flow rate waveform graph, I will see that the "pause" at the end of exhalation seems to have edged slightly above zero on the graph. I'm not sure how that can happen, but it apparently has the effect of causing the pause at the end of exhalation to be counted as part of the next inhalation.



(08-18-2016, 08:44 AM)Sleeprider Wrote: Once again, I am confounded by the inhalation / expiration ratio of nearly 2:1. For most of us, the inhale time is shorter or equal to exhale. I can find nothing on the significance of this, but have noted that where inhale is longer than exhale, the graphs tend to be 'busy'.

PR machines record a VS (vibratory snore) and VS1. How they are detected or what they actually mean is also not well understood. Robysue took at shot at it here in posts 451 and 454. http://www.apneaboard.com/forums/Thread-...14?page=46

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#8
Thanks GW. It's something I see pretty often on posted charts, and it's usually someone having issues.
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#9
I was out wandering around on the SuperHighway and almost got run over by all the data...

While this appears to be a "technical sales" brochure, maybe it will help with some of this.. I dunno... I'm just a simple man..

http://www.carolinasleepsociety.org/docu..._avaps.pdf
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#10
I woke up several more times that the number of sessions shows. Those are only the times that the face farts were so loud they were causing the audience (aka my wife) to heckle me. The two longer breaks are a trip to the washroom and an early morning face wash when the skin oils would not allow any seal at all. Yes, waking up this often is why I feel so horrible. But what do about it?

I have an appointment next Tuesday with a new sleep doc. I am hoping he does not just say "Your AHI is low, give it more time". I have had a professional SPO2 monitor on all night and I was told the readings were fine. I also have one of the CMS ones and the last time I used it, my median as 97 and lowest drop (briefly) was 91. But that was not with a Tidal Volume like this. I will try and remember to were it tonight.

Some related graphs from that night:
[Image: YKKd0PY.png]

I never considered the inhalation / expiration ratio. I might breathe funny. I feel that I tend to be a shallow breather. Some detail graphs:

[Image: QNkHtVz.png]

[Image: BHkVSKd.png]

Quote:At times when I see my inhalation/expiration ratio go above one, if I look at my breathing flow rate waveform graph, I will see that the "pause" at the end of exhalation seems to have edged slightly above zero on the graph. I'm not sure how that can happen, but it apparently has the effect of causing the pause at the end of exhalation to be counted as part of the next inhalation.

If I am understanding that correctly, my graphs show the same pattern.

And now, filed under "What a difference a night makes", is last night's graphs:
[Image: bMcEWQa.png]

Snoring all but gone, but replaced my hypopneas. Interestingly, almost identical time in apnea. And the pressure is not maxing out. I feel a bit better today, but still sleepy and not overly mentally alert. One other change, I changed my fine filter before bed, it was noticeably dirty.

Thanks to everyone for their insights and ideas.

Chuck
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