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Introductory info: I’m a 67 year old male, 6’ tall and 170 pounds with a normal neck circumference (15”). I don’t drink or smoke, nor do I take illicit drugs or prescribed opiates or sleep aids of any kind. I’m being treated for high BP and I have heart disease (myocardial infarction 20 years ago). I have Bradycardia with a night time HR in the high 40s - low 50s. A recent echocardiogram revealed an ejection fraction of 60-65 with no abnormalities other than ‘trivial’ valve leakage. I exercise regularly.
My apnea had gone undiagnosed until a few months ago after seeking help for a mixed bag of nocturnal arrhythmia which includes premature contractions, runs of the same, some tachycardia and rare epochs of A-fib/ atrial flutter (A-fib burden of 1%). An In-home sleep test diagnosed "Severe Apnea" with an AHI of 34.
Since starting APAP with a Resmed Auto-sense 10, my arrhythmia burden is near zero. The exception are relatively rare arousals from a dream with a steady elevated HR that ceases within a minute upon awakening. I have yet to have an in-lab sleep study but one is being scheduled.
I just installed Oscar and transferred the Resmed data to it. Here is today’s screen and the summary data.
05-29-2025, 03:51 AM (This post was last modified: 05-29-2025, 03:51 AM by 2farfromshore.)
RE: New user intro with Oscar screens
I neglected a few things in the intro. A recent appointment with an ENT revealed a deviated septum; large turbinates and something about a flap. I was also advised I have a smaller than average airway in my throat.
The in-home sleep test (34 AHI) was all obstructive. Consequently, my sleep therapist believes the CA is treatment emergent, but I tend to think I've always had some degree of CA. I base this on noting occasional gaps and shallow breathing while napping or falling asleep for many years.
Welcome to the forum,
How did you feel during the day?
Try not to chase numbers, but how you feel.
Can you post a copy of your sleep report with your personal info redacted?
Are you on any medications that may affect your breathing or your sleep?
Do you have any health issues that may affect your breathing or your sleep?
Are you a side sleeper? If you sleep only on your back consider an inclined pillow or an adjustable bed to raise your head.
Your minimum pressure is too low for an adult, you need at least 8 cm of pressure.
Raising the minimum may also help stop some obstructive events and your hypopneas.
Your flow limits are very high, you need EPR to deal with that, use a setting of EPR of 3
If you feel airstarved with EPR on, don't turn it off, but raise your minimum to 9 cm.
Try these settings for a few nights and see how you feel.
You have positional apnea,clusters or groupings of events, where you are tucking your chin to your chest or you are on your back and gravity is pulling your soft palate and collapsing your airway.
You may need a soft cervical collar
I'm not taking anything that would interfere with sleep. I feel generally OK during the day --better than before I started therapy. I did notice, though, that the few times I had an AHI less than 10 I felt better. The increase in pep in my step was noticeable. Also more alert. I occasionally still wake up with a headache, but it's gone after breakfast and coffee. I don't have caffeinated drinks after 12 noon.
I'm a back sleeper but I was a side sleeper. I trained myself to sleep on my back after realizing that the nocturnal arrhythmia primarily occurred when side sleeping. I do turn over in the night but revert without knowing it.
I can't make changes to the machine without my sleep therapist knowing it. I did turn on EPR and set it to 1. She asked about it at the very next appointment and implored me to contact her to discuss changes. I'll mention the min flow rate and EPR to her.
Also, I'm just learning the terminology involved with all of this, so I'm still in novice mode :-)
Here is something to study about Flow limitations. Many sleep doctors/therapists might say that your AHI is fine.
Flow Limitation Is Associated with Excessive Daytime Sleepiness in Individuals without Moderate or Severe Obstructive Sleep Apnea https://pubmed.ncbi.nlm.nih.gov/38530665/
Talk to your "sleep therapist" about you having positional apnea,clusters or groupings of events, where you are tucking your chin to your chest or you are on your back and gravity is pulling your tongue or soft palate and collapsing your airway. No therapy increase of pressure can open the airway, usually you have an arousal and move to open up your airway, this fragments your sleep and makes your tired.
Thank you! I'm waiting for a collar. The sleep therapist is an NPC within a hospital pulmonology dept. I've had 2 appointments so far with only one at-home sleep study which I can't find the paperwork for. I do recall it diagnosed me with severe apnea (mid 30s AHI) that were all obstructive and with a lowest 02 saturation reading of 88. It was a device that strapped around the forehead with sensors and a cannula. I used it for 3 consecutive nights. There was no chest strap. I did discuss position with the sleep specialist, as they are officially called, and advised them I currently slept on my back. No recommendations were made. I bought a wedge pillow soon afterwards that I struggle with -- it hurts my back after a few hours. I'll post back after I use the collar for awhile. I did raise the starting pressure to 7. I'm still reading about EPR. It seems hit or miss and patient dependent in that some are worse with higher EPR while some are better.
Sleeping on your side is prefered for sleep apnea patients if possible.
When you sleep on your back, gravity is pulling your tongue or soft palate and collapsing your airway. You would need very high pressure to keep your airway fully open and not restricted. EPR probably would not be any help and it might make the issue worse, as it lessens the exhalation pressure, which is needed to maintain the open airway.
You may need help to force yourself to side sleep if you decide to go that way. Wearing a T-shirt backwards with a tennis ball in the pocket could be an inexpensive device to try
Another solution for a back sleeper is to purchase a child-size pillow with a raised front. That's what I use. It tips my head back a little and solves positional apnea completely. My pillow is no longer made, but some on Amazon look like they would work in the same way. Here's a link to one:
2far, several things. If you look at your info on the left. You will see that you spent most of the night at 12.8 CM. I would say that in addition to using EPR 3, set your minimum pressure to 12 CM and the max at least 16cm if not a bit higher. The ResMed machines use the Flow Limitations figure as a trigger to up the pressure.
Big changes in pressure is not a CPAP users friend.
You might also be a good candidate for a procedure I had done. It's called VivAer and it greatly increased the flow of air through my nose. It's a quick in office procedure. No cutting. I highly recommend it.
05-31-2025, 05:59 AM (This post was last modified: 05-31-2025, 06:09 AM by 2farfromshore. Edited 1 time in total.)
RE: New user intro with Oscar screens
Thanks - I tried sleeping on my sides more last night with no big changes in the graphs. The hypopnea was a little lower, as was Rera.
What I'm really taking note of is (a) how the pressure shoots up at :45m to an hour and (b) how that 1 hour mark was when I used to have heart palpitations that would wake me up; the palpitations that started me on CPAP. Also, the period of, say, :30 before that 1 hour mark, I'm not asleep and CA is rising. I mentioned to the specialist that I've been aware of shallow breaths and pauses in breathing while going into a nap or falling asleep for years, but it didn't get much of a reaction.
Also again, I woke up at 2am under no respitory distress and tried to get back to sleep for about an hour. During that hour, looking at the readout, the events and flow were banging at the top of the graph and I know I was awake/semi-awake because I recall looking at the clock several times.
