It's been a while since I've checked in - a couple of pieces of context here:
1. I am most comfortable on my back falling asleep, although I move a lot in my sleep so it's anyone's guess what position I am at any given moment. I believe I spend a significant amount of most nights on my back (I really wish there was a good way to monitor body position, that would be worth a lot to me) so if this is positional apnea, I think it must be something more specific than just "on my back"
2. I use a full face mask because when I did the fittings, my ears hurt a lot with the nasal pillows. The DME said that would happen less with FFM. I don't have any evidence that I do much mouth breathing *except* if I have a bad cold, flu, sinus infection, etc. That was also quite a while ago and it was literally the first moments that I encountered CPAP - if switching might help I'd be willing to try (I use the Dreamwear FFM, I assume I can just get the nasal pillow cushion and attach it to existing headgear?) I suspect the massive jumps in leaks are related to body position changes and perhaps that might reduce or eliminate that problem?
3. My professional says I'm doing well because my average RDI (we use RDI because I didn't qualify for treatment on AHI alone, but had enough RERAs to qualify under RDI) is well under 5. Looking at the past 90 days, I would say about 8% of nights exceed 5, most only barely. But, I think I could still do better and I am stuck on what, especially given there are nights that are really good and some that are really quite bad (relatively speaking) and I can't find anything obviously all that different.
4. I used to get tons of clear/central events (treatment emergent, didn't have them on testing). They have gone way, way down over time, but now I have lots of RERAs instead. I can post trends for anything if requested.
5. Although I tolerate the mask fine and the only time it comes off unintentionally is when I do things like pull the whole machine off the nightstand or pull the tube out at the headgear connector (happening a lot less frequently recently, each thing has happened at least 10 times) anything else I try to do like sleep in a particular position is very temporary. I always wake up in a different position than I fell asleep, including on my front (I absolutely hate sleeping on my front and would never intentionally do it). I move pillows around, kick sheets off, etc - basically if it's in arm or leg length (ironically, testing never saw any of this) it's fair game that I'll push it away or move it around with no memory. I'm not saying I won't try stuff that would involve positioning or whatnot, but it's not terribly likely to be successful.
Anyway, here are three charts - one from a good day (which I think is pretty optimal), one from a day that's generally pretty good but had a big cluster of events, and one that was pretty bad (worst day in the past 90 days). I cannot tell you anything specific that was different among these days (other than the one where you see I tried to take a nap later - I don't normally nap but I had a moment and tried, and failed).
Is this clearly positional? My testing did show REM as being much worse (like 4 times worse) than non-REM, so I am also wondering if it is possibly sleep stage related instead?
I've been on fixed pressure for a while and rarely get aerophagia anymore (on variable at the larger swings I got tons) - does my data indicate a variable pressure might be better? Or changing the EPR (currently zero)? I'd need to know why I'm changing something.
Any other thoughts? Anything to try?
Bad night:
Obvious cluster:
Good night: