Starling's therapy thread / what are these events?

[starling]

Hi everybody!

I’d like to thank this community for the learning so far, and huge props to those who maintain OSCAR!

I am 32F with unrefreshing sleep and autonomic problems (unexplained tachycardia, jitters, trouble falling asleep) for ~5 years. My FitBit shows a lot of arousals and low estimated percentage of deep sleep compared to my age group. I'm normal weight and don't snore or have airway issues that I know of.

I did a WatchPAT One study and it came back as moderate OSA (image 1) with a prescription for APAP. I didn’t want to wait, so I bought a refurbished Airsense 10 Autoset for Her, and more recently a Wellue O2ring, and have been making a go of it for the past month while waiting to see a local sleep specialist. Here is a typical night with my current settings (images 2-3).

As I understand it, either my OSA is easily treated, or the OSA diagnosis is questionable. From the start I have seen almost no OAs, and only occasional hypopneas or RERAs, even with pressures as low as 6 cmH2O. At first my AHI was 17, the same as in my WatchPAT study, but it was almost all CAs, at least half of that was sleep-wake junk. As I've changed the settings (CPAP mode instead of Auto for Her, EPR off, raising pressure to 7 and now 8.4) the AHI has come down to about 3. However, I am still having frequent arousals and waking up tired.

I notice there are a lot of some type of event, about every ~4 minutes throughout the night (images 4-6). It looks like this is happening whether or not I wear the machine. With these events, there’s a body movement, some really deep breaths with HR spike of 10-20 bpm, then often (not always) a brief CA apnea without much change in SpO2. Raising the pressure seems to shorten or get rid of the apneas, so the AHI goes down, but the rest is still happening. These events seem to match the arousals on my FitBit, even when there is no apnea.

Can some of you good folks look at the events and let me know if this is familiar? I assume the CAs here are merely the result of the big deep breaths (losing CO2) but why the big deep breaths?

Your time is greatly appreciated!

[hh9797]

I mean honestly that doesn't look all that bad, not sure about the first image, but the rest all look pretty normal all sub 5, like this is what 9.03 with events as long as 28 seconds each looks like, yours is not startling in the least bit, sure it is not perfect but it is not startling.

[starling]

Thanks for your reply hh9797! But I wrote "Starling" (like the bird) because that is my username    I see now how that could be misread but I don't know how to edit the post title.

As William Howard Taft wrote, "Don't write so that you can be understood, write so that you cannot be misunderstood."

[Crimson Nape]

I just renamed your thread to, Starling's therapy thread / what are these events?.

- Red

[hh9797]

Ah, lol, yeah brain definitely auto filled the "t" into the word, kind of like how the brain will also read teh as the without even noticing the typo, just auto filters what it thinks it sees. I was confused what was so startling about it, but yeah the edit the moderator made makes it a lot harder to misread the word now. Thanks mister/miss/whatever moderator for making it more clear.

[cathyf]

Is it possible that those are coughs you are seeing?

[starling]

Cathyf - I suppose it could be, but I would be surprised. I’ve recorded myself on audio sleeping once before, and did not hear any coughing.

[Millstone50]

I have a few questions... first how come you settled on 8.6cm with no EPR and no Auto? The flow limits suggest your pressure might be a bit low.

Also, how is your caffeine intake?

[starling]

Hi Millstone50,

So far it has been trial and error, based on decreasing AHI (virtually all of which seem to be CAs) and trying to avoid settings that seem to wake me up. Auto seems to result in more CAs than fixed, even at the same pressures (no idea why) and does not make a difference in the few other events. Turning EPR off seems to make the CA apneas shorter, I'm guessing because in the preceding breaths I exhale less CO2. When I used Auto 6-15, the highest it ever got was 8.5, so I started trying fixed pressures around 7 and have been gradually increasing it based on comfort and how long I could continuously sleep. But it's a little iffy because I’ve also tried a few different masks (pillows, small and medium nasal cushion).

Maybe I will try raising the pressure a bit more to see if I can decrease the FL.

My caffeine intake is very little. Only decaf or an occasional green tea and not close to bedtime.

[ECM5]

Hi starling:
So you said you had centrals in your in lab study because I don't see any on the wabtchpat study (I had one too and had no centrals but have them now on Oscar) so just wondering if the in-lab study showed CAs and when it was done.