Trying to Understand Waking

[jdougc]

Can you zoom in about 3 minutes on your wake ups on the flow rate chart? have the wake up be on the far right so we can see what proceeds them.

Attach 3 of them and maybe do another post with the rest.

The wave forms may say what is happening, but maybe not.

Arousals are tough to deal with, they are a normal part of sleep, we may never go to zero, but if you can roll over or shift your position and fall back to sleep that would be normal.

[Cruisin4Snoozin]

Here's last night's data.  More of the same.  I adjusted the pressure settings per advice on another source but kept EPR at 1.  Tonight, I'm adjusting EPR to 2 to see what that does.  (I only wanted to adjust one variable at a time to try and get a "clean" view of what each change does.). I'm also adding zoomed in views of the few minutes before each arousal to see if we can spot any anomalies that are leading to me waking up.  To my uneducated eye, I don't see any specific reason I'm waking up....the few minutes before each arousal look the same to me....

[jdougc]

You got nailed by flow limits restrictions in your breathing, ugly ones that probably woke you up.
At 1:32:30, those were not nice rounded breaths.
At 2:23:30, also they look bad.

You should use EPR of at least 2, but 3 would be better, you might have to increase your minimum pressure by 0.6 or 1.0 cm to 7.6 or 8.0 cm whichever is more comfortable. 
Exhaling might feel easier, but your CAs might increase as your body gets used to them, so no worries.

You might move your flow limits chart under your flow rate for a few days, as you monitor these changes, this will show the correlation easily.

[Cruisin4Snoozin]

You got nailed by flow limits restrictions in your breathing, ugly ones that probably woke you up.
At 1:32:30, those were not nice rounded breaths.
At 2:23:30, also they look bad.

You should use EPR of at least 2, but 3 would be better, you might have to increase your minimum pressure by 0.6 or 1.0 cm to 7.6 or 8.0 cm whichever is more comfortable. 
Exhaling might feel easier, but your CAs might increase as your body gets used to them, so no worries.

You might move your flow limits chart under your flow rate for a few days, as you monitor these changes, this will show the correlation easily.

Yeah zooming in helps a lot.  I’m curious about both of those situations tho….I woke up a minute or so after the anomalies.  Why wouldn’t I have woken up during those periods?  I had bad luck raising EPR last weekend but I was also adjusting pressure at the same time.  I’m gonna bump up to 2 tonight, keeping the pressure where I had it last night, and see if we can isolate that variable.

[super7pilot]

Cruisin, The resmed machines have a slow EPR system. It has quite a slow response to add pressure after your exhale. So when I went from EPR2 up to 3. I added .4cm to my minimum.
And yes. Adjusting too many things at once is bad. Hard to tell what worked or made you worse.

I see that your median pressure was 9 and went up to 11.3. So why are you at 7cm? I would try going to 10 over even higher and put in EPR3 and see what happens. You can always back off the EPR to 2. By raising the pressure and adding more EPR. Your flow limitations should subside.

You can use the "notes" section just above the AHI readout to document when and what changes you made. Then look at the next few days treatment results. Then you can refer back to the day you changed to modify those changes if you need to. I wish I would have done that.

[Cruisin4Snoozin]

Interesting that last night I didn’t have any RERAs and only a couple of hypopneas. Maybe that’s progress. Also what super7pilot says about slow response time on the ResMed lines up with what someone elsewhere said too….that the pressure was “chasing” the events and not keeping up. So instead of being out ahead of them, it’s trying to adjust after and not catching up, which may be why they’re waking me up. That matches up with the slow response time comment I think.

In the spirit of only changing one thing at a time, tonight I’ll turn EPR up to 2 and leave the pressure alone, and see what happens. Then tomorrow I’ll up the pressure setting again….and keep walking those up alternating until something looks different!

[super7pilot]

Here is an interesting talk on the resmed EPR compared to other machines. And is why a lot of Resmed users end up going to a Vauto model. Resmed could fix this with a programing up date. But why do that when Resmed could force you to buy the upgrade for min $1k more than the AS11.

resmed EPR 

I'm fortunate that Resmed's EPR has worked in my case. However, A BIG BUT would be this. Might be nice to be at 11-12cm instead of 13.4 to use EPR3.

[Cruisin4Snoozin]

OK here's my update....still chasing these multiple wake-ups.  Last night I kept pressure at low 7 high 12, EPR at 2.  My flow limit has dropped down to 0.06 at 95%, so that's an improvement.  But I'm still waking.  I'm also attaching a couple of zooms on my flow rate and finally starting to see some "triggers" for the waking.  My pattern at each wake up looks pretty consistent until a minute or so before, and then all hell breaks loose and my breathing gets super erratic.  If we can figure out what's causing the shift from smooth consistent breathing into those erratic segments and adjust for them, then we might be on the right track?

I"m only going to change one variable at a time.  So, should I adjust pressure tonight?  Or jump the EPR up to 3 tonight and see how that goes?

[jdougc]

You should up EPR to 3. This is to lower flow limits even more, the goal is under 0.02 which indicates low number of restrictions of your breaths.
But you really should increase the minimum pressure to at least 8.0 cm, to prevent being air-starved at start up.

Flow limitations the breaths did not cross the 0 line around 1:51:25 , probably led to an arousal.