Your thoughts on my sleep data?

[17WRX]

Your data shows obvious flow limitations and associated RERAs. 

The flow limitations appear to only be present at specific times indicating that they are related with a partially obstructed airway. In my opinion you have two options to try to improve them.

1) Higher pressure . One thing to note about Resmed algorithm is that it fairly aggressively increases pressure to 12 cm in response to flow limitations then has a much slower response. This is why your pressure is spending most of its time at/near this level. Unfortunately this pressure doesn't appear to be capable of stopping the obstruction/flow limitation from occurring and when they do occur the increasing pressure isn't stopping them, it is just continuing until you have a RERA. Trying a higher minimum pressure is the only option that might help avoid the issue and you could start with min 12 cm to see if it helps at all. 

I’ve tried the soft collar before but I just couldn’t stand it. I got a very comfortable cpap pillow that slightly tilts my head back. Side sleeping won’t work for me due to shoulder and back issues. I think part of my issue is my mask. I’ve been trying to get a different one and it’s an ongoing battle with the DME. But moving the minimum pressure up to 12 seems like something I can try tonight. Just curious when the minimum is set to 12 what level does the algorithm first bump the system up to when it detects something? 15?

Also is there any downside to running higher pressure other than possibly getting air in the belly? If I can tolerate it, would there be any harm at setting the minimum to 15 and max to 20? Can high pressure create other issues?

[RayBee]

I wear a couple of sleep devices and they all say I'm getting very little deep sleep and I must say I do not feel great even when I get a full night sleep like last night. But I didn't wake up with horrible headaches either so I've seen worse. But any thoughts on how I can get less interference from events and near events in my sleep would be appreciated.

I wake up with occasional headaches caused by two things. One, I'm not getting enough air - not a fault of the machine but more than likely positional. And two, My F30 headgear rides too low on the back of my head. If it puts too much pressure on the soft part of my upper neck just below the bony part of my skull, I will get some pretty persistent headaches.

I have to play a balance game on two fronts. The rear headgear pad has to be positioned off the soft part of the back of my noggin (or as best as it can) and the tightness of the headgear has to be just right. Too tight = headaches. Too loose = leakage and unpleasant fartty noises with my chubby cheeks a-flappin' in the breeze.

I use the Amara View headgear on my F30 mask since it has a larger rear pad and top strap adjustment. I have seen pictures of ResMed's F30 headgear with an adjustable top strap, but I haven't acquired one yet. Mine are fixed on top and just don't work well for me.

As far as the technical stuff - yeah, what the smart folks said.

[Geer1]

I’ve tried the soft collar before but I just couldn’t stand it. I got a very comfortable cpap pillow that slightly tilts my head back. Side sleeping won’t work for me due to shoulder and back issues. I think part of my issue is my mask. I’ve been trying to get a different one and it’s an ongoing battle with the DME. But moving the minimum pressure up to 12 seems like something I can try tonight. Just curious when the minimum is set to 12 what level does the algorithm first bump the system up to when it detects something? 15?

Also is there any downside to running higher pressure other than possibly getting air in the belly? If I can tolerate it, would there be any harm at setting the minimum to 15 and max to 20? Can high pressure create other issues?

I know you couldn't stand the soft collar but did you notice any difference in the data (a reduction in the periods of lower flow rates, and reduction AHI/RERA/Flow limitations)? Its more a test to see if it helps, if it does then a person can try to figure out how to get a comfortable solution. If it doesn't help then no point using it.

Pressure increase depends on multiple factors including starting pressure and type of event. I don't believe it would jump all the way to 15 cm even if a full OA but I almost never see those pressures so haven't analyzed that part of algorithm in detail. At 12 cm min pressure and with your type of primarily flow limitation I expect your average pressure to only increase slightly (maybe 13 cm) with only the odd periods of high 15+ pressure like now.  

High pressure can cause aerophagia, increases machine noise, increases venting, increases chance of leaks/leak rates. Some people it bothers noticeably and for others it has little effect or is advantageous due to the therapeutic effects. Some people require 15-20 cm to treat their apnea and there isn't any harm in trying it but my recommendation is to increase minimum pressure slowly and keep an eye on whether or not it is causing any improvements. If periods of reduced flow, flow limitations, RERAs etc are not improving then the higher pressure is not helping avoid the issue and the negative side effects likely outweight the benefits. If flow limitations improve noticeably and these periods of partial obstruction start getting avoided then the benefits may outweigh the negatives.

[17WRX]

Regarding the neck collar, I couldn't fall asleep with it. Was in bed for 5 hours and it felt like I was being choked so I couldn't tolerate it. Same for taping. 

Here is my data from last night. It seems the RERA went way up but the AHI went down? Should I try to go to 13 for the min. And On every screen shot I took using the view menu on OSCAR, it changed the chart on the left to the format shown. OSCAR will not allow me to take a screen shot of the screen with the chart in it on my Mac.

[17WRX]

And the rest

[Sleeprider]

17WRX, I'd like to see a zoomed view of your flow rate chart. A 3 minute section would be ideal. The flow limits are incredible, and I don't think any CPAP can deal with it and you will eventually need bilevel to improve. Any thoughts on what is causing the airway resistance?

[Geer1]

It looks like your flow limitation and like you mentioned associated RERAs might have actually been made worse by the higher pressure.

I see you are using a full face mask and I can't help but wonder if that might be causing you issues. Full face masks are known to be less effective (studies to prove it) because their straps often pull back on chin/lower jaw and also because pressure applied in the mouth counteracts some of the pressure applied through the nose negating its effect. Some people like my grandfather have uncontrollable apnea with a FFM but get decent results with a nasal mask and it could be the reason for your restriction.

My gut thought is to try returning to previous settings with a nasal mask to see what that data looks like. Next idea if you don't have a nasal mask etc is to try a lower pressure with FFM (say 9 cm max pressure) to see what happens but that might make your AHI worse. Trying higher pressure is another option but is probably a long shot (would try 14 min pressure if doing so).

[17WRX]

Unfortunately a nasal mask is out of the question. I have chronic rhinitis and a deviated septum which make it very difficult to breath through my nose.

[17WRX]

17WRX, I'd like to see a zoomed view of your flow rate chart. A 3 minute section would be ideal.  The flow limits are incredible, and I don't think any CPAP can deal with it and you will eventually need bilevel to improve.  Any thoughts on what is causing the airway resistance?

What changes when I use a bilevel machine? Other than the physical nasal problems I mention in the previous post, I have no clue. I've asked both sleep specialists I've seen in the past about the issue and they seem to know less about flow limits than the people on this board. I'm at my wits end with all of it.

[SarcasticDave94]

The big difference between BPAP and CPAP therapy is this: the CPAP EPR is limited to a Max power of 3 cmH2O while on a BPAP it changes names to Pressure Support/PS and has a lot wider range of pressure power than 3. This pressure differential, whether it's EPR or PS, leverages against your flow limitations.