[Treatment] Noob; wondering about equipment, info dump below

[ZPrime]

Crazy part, if you read my whole thread from the beginning, is that the initial Rx of 21/17 was done by a doctor I never met, who interpreted my ESG (which was supposed to be a Titration study) results. An APRN is who actually "wrote" the original Rx, which you guys disagreed with based on my original home test showing centrals.

Armed with that info, I got a consult to a sleep MD, who promised me that she would "re-examine my results" and either set me up for another ESG with a different machine, or write the Rx she felt was correct... shocker of shockers, she just copied the original Rx, and even omitted the advice from the first MD who suggested starting me at lower fixed pressures for a few weeks before moving up to 21i/17e. I don't even know that she actually re-examined my results or even really listened to me. As someone who has a huge distrust of doctors, it certainly doesn't help my opinion.

For the record, I did toss a donation to the board, because I'm truly appreciative of the support here. It wasn't a lot, because I've been unemployed for 6 months and have been trying to keep spending down (living off unemployment + savings). I intend to throw more money when I'm getting a regular paycheck again. I'm still worried that an ASV might be required, based on what y'all have said 6 months back, but I'm not going to get worked up over it unless the AutoBi can't keep the numbers in check.

[SarcasticDave94]

If me, I'd consider changing to a competent doc, AKA one that you've not mentioned in the recent post. I have some issues with my pulmonary doc that will be addressed soon. So don't worry, you're being treated like most of the rest of us on AB.

[ZPrime]

Yeah, I've been hoping a friend could give me a suggestion of a competent sleep doc. The woman I had my virtual referral with was nice enough and everything, but she was adamant that "if your AHI is low, you're being treated, a different machine won't do any better" which seems ridiculous.

I've got at least one friend who is also a hose-head, but his wife is an MD, so it's possible his wife may have just written him the Rx and he's figured the rest out himself (he was who suggested looking for forums and/or talking to people on Reddit).

[SarcasticDave94]

FWIW different machines can and do make a difference. We've seen some switch from Respironics to ResMed and changes were drastic. I know some get treated well with their Respironics, so it's not a bashing of the brand. Just an example. And that is just a brand change.

If one switches from CPAP/APAP to BPAP, and if symptoms warrant, it also can be drastic in therapy changes even while on the same brand.

[ZPrime]

Well, here's another night, again the AHI at least speaks pretty loudly. (The "hole" at the beginning was my fault, not the machine's or OSCAR's.)

Since my pressures are no longer near maximum, I tried the "nasal canoe" mask piece instead of the "pillows," and I was able to get a good seal with that. I find it a bit more comfortable than the pillow mask, only because the pillows tend to try to creep into my nostrils a little bit.

Questions:
How can the machine possibly measure an RERA? I.e. how can it know that the airflow pattern change "triggered an arousal"? Are those accounted for in AHI, or is it truly only looking at Apneas (CA/OA only?) and Hypopneas?

And is there any reason to worry about snoring if the machine isn't showing OAs or Hypopneas?
My wife said she noticed a little bit of quiet snoring last night / this AM (the period prior to 6:30am).
There was an RERA and a Hypopnea detected in all of that, here is a zoom of those, and this is even closer on just the RERA.

[Sleeprider]

A RERA is normally characterized by a period of increasing flow limitation (which may include snoring), followed by an arousal as indicated by increased flow rate.  In the first up-close example you posted, the RERA is flagged at 06:22:00, but my interpretation would place it at 06:23:30.  Note the jagged peaks indicating a snore, then increasing flatness of the inspiratory wave starting at 06:22:30 then the arousal indicated by increased flow at 06:23:30.  That is the signature of RERA, not the location of the actual flag.

A suggestion to help you interpret the flow rate graph. In OSCAR right click near the Y-axis where it says Flow Rate, and add a Dotted Line at zero. This will show the crossover of inspiration and expiration.

Finally I'll add your donation is certainly appreciated by the forum. It's the only way Supersleeper can keep the site available to us to help each other. Even a little means a lot, especially when times are tough. It appears your therapy is good enough to preclude the need for ASV at this point, especially if you are sleeping comfortably.

[ZPrime]

Slept "forever" last night / today. I really need to shift my schedule back to normal human hours, being unemployed has seen me going to bed later and later... but that's not an xPAP problem.

AHI is still below 2, and I do feel pretty good (although I woke up with a decent headache today).
Should I consider tweaking anything due to the 9 OAs and 8 Hypopneas during the sleep? Would increasing PS possibly help with this?

Also, once again the data is showing 3 "sessions" even though I never stopped anything until the very end. I can maybe understand why it "ended" the first one, looks like it happened right at noon and it's my understanding that the PR equipment and DreamMapper consider noon to be the end of a "night." But that doesn't explain the ~30 minute session followed by nearly 2 hour session. Very weird!

[ZPrime]

Another day, slightly higher AHI yet again, but still sub-5.

Should I make any adjustments to try to fight these, or just ignore since I'm still below 5? Still feeling pretty good.

Once more there are two "sessions" even though I never stopped the machine, but again I slept through noon and I suspect the PR does some sort of "roll-over" then.

[ZPrime]

Maybe the best course of action is to just stay the course, because my AHI are back below 2 last night. [The break in the middle was a bathroom pause.]

[Sleeprider]

Assuming you are not suffering from aerophagia or other discomfort, increase EPAP min to 6.0 and leave other settings the same. Everything is obstructive and this will resolve that. At a minimum EPAP 4 the snoring is telling us your airway is unstable. Once we get you to a good EPAP, we may look at PS min as the next adjustment to take out flow limitation. Your results are pretty good, but we're going to make them better and more comfortable. It's up to you to give us the comfort feedback.