First night

[Pugsy]

Did you by chance end up on your back during that last half of the night where things got a bit ugly?

Where's your pressure graph?

[Daydream Believer]

I woke up on my side.... i very seldom sleep on my back (as far as I know at least)... hmmm...
Is this the pressure you asked about?

[Daydream Believer]

Just so you know - the graphs look very similar the past two nights. I've noticed the hypopneas and centrals for a year or so but didn't know what it was. Almost like I just forget to breathe. But I'm not waking up with them on cpap so that's better.

[Pugsy]

Yes, that's the pressure graph I was wondering about. I was wanting to see if the pressures changed very much in response to all that ugliness the second half of the night.

Assuming you were asleep for the bulk of this night something changed during the second half of the night that caused the pressures used to be suboptimal and allowed a good number of apnea (OA and Hyponea) events and related (snores and FLs) to airway collapse events to sneak past the defenses.

The 2 main culprits... when we see half the night as really good (your first half) and the other half not so good ...are either supine sleeping, REM stage sleep or both. It's common for our OSA to be worse with either or both and sometimes we just need more pressure to do a better job preventing the airway collapse.
People think that auto adjusting pressures will automatically go up as high as they need to be and as quickly as needed but the reality is that the machine doesn't/can't work that quickly.

The minimum pressure setting is the most critical pressure setting. It has to be set high enough to start with to do a better job of holding the airway open in the first place so that if the airway starts to collapse it can get to where it needs to be in a more timely fashion and it can't get there quick enough when starting out at 4 cm. The airway collapses and reopens long before the machine can get to where it needs to be to do a better job.

If you look at your reports and the bulk of your reports look like this one with half the night being ugly then you might want to re-evaluate that minimum of 4 cm pressure.
If you look at your reports and the bulk of them look like the first half with not much going on then the pressure is probably fine as it is.

It all depends on how much of the night is ugly and how often it happens. If this were the only ugly night...I wouldn't do anything. If you see this pattern often and prolonged then that minimum pressure could stand to be a little bit higher to help the machine have a better head start in preventing the airway collapse (whatever the reason be it supine sleeping or REM sleep).
Something changed from the first half of the night to the second half to cause such a difference.
Fluke nights we ignore....when we consistently see the same pattern then we pay attention.

[Daydream Believer]

I'll keep an eye on it the next few days. It was likely REM cause I felt like I slept deeply last night

[Pugsy]

REM is where my OSA really acts up and documented in my sleep study. I had some initial ugly sections on my reports when I first started therapy that were pretty much textbook where we would expect to see REM stages. I was also using APAP mode....a little more minimum pressure fixed it right up. I didn't strive for total eradication during REM but was happy with random events here and there. In the wee hours of our sleep sessions right before we wake up for the day is when people tend to have more frequent changes into REM sleep and the REM stage lasts longer...which is prime conditions for REM related events to pop up that are a little more difficult to prevent.

We don't normally have REM last from 11 PM to 5 AM though and that's why I asked about supine sleeping.

Just keep an eye out on things and if the uglies persist....consider a little more minimum pressure no matter what the cause...can't control REM anyway and I don't control sleeping position so great either.
If you do elect to change the pressure on your own I would suggest go up slowly in 0.5 cm increments. It will be an easier adjustment in the first place and you might get lucky and not need as much minimum to get the job done as one might think by looking at these reports and stats.

[Daydream Believer]

Last night felt a bit rough... but mostly because I woke once and thought I might not be able to get back to sleep. A few minutes watching tv reminded me that I was still tired. heheh I'm still having events all through the night...

[Daydream Believer]

A couple thoughts... I've been napping 2-3 times a day for months. Yesterday I pledged to stay awake. Now sometimes I have what I call "involuntary naps" where i fall asleep in my chair and don't realize I've slept till I wake up. That happened yesterday morning - so my pledge didn't work out so well. But i kept myself awake the rest of the day and was exhausted at bedtime. Maybe I shouldn't stop my naps for now. Let myself ease into this without forcing things. I just get so tired of my days being slept away. :p

[Pugsy]

Next time you do your report image can you make it wider...doesn't have to be so tall as we don't really need anything past the leak graph anyway.
When it is scrunched up so small horizontally it is a bit difficult to eyeball the event graph in relation to overall hours of sleep. You had 8 hours of sleep last night but the horizontal dimensions kinda make a not so pretty graph in the first place..look worse.

If we mentally remove the Clear airway index from the evaluation (we don't treat those anyway with this machine real or not) your AHI is still really close to 5.0 which is the upper limits of where we like to see therapy results.
So while technically not horrible...it is a bit ugly in terms of what I call "clutter" and I think that an increase in the minimum pressure of 4 would very likely help clear up the "clutter". Still more events in the last hours of the sleep session...might be REM.

If you are sleeping soundly and feeling quite decent and your AHI (minus the CAs) is between 4 and 5...no real need to do anything about it unless you just want to.
There's no guarantee that getting rid of a bit of the "clutter" will improve on things anyway. Some people just want to try though....and no harm in it. I found that with my AHI of 4 to 5 (back then we didn't have CA flags to mess with results) I still had a little bit of "clutter" clustering a little and when I got those clusters broken up so that the AHI was less than 3.0 I noticed that I slept better and felt better. Sometimes a little change can make a bigger difference than one might think.

Naps...try to avoid them after 3 or 4 PM if you can.

The urge/need to nap...could be habit but also could be that your sleep quality isn't quite to where it needs to be yet. Meaning you may not be sleeping as well as you think....that one awakening that you took some time to get back to sleep last night...it messes things up a little in terms of sleep architecture and % of time in each of the sleep stages we have to go through.
Now that you mention the "need/urge to nap"....I would look at reducing the "Clutter" a little stronger. Might help and a change from 4 cm minimum to 5 or 6 minimum is unlikely to cause issues.

[Daydream Believer]

OK I've increased the min pressure to 5. we'll see how that goes tonight.
I'm using a windows 8 tablet. Some of the slide bars aren't working for me in the Sleepyhead software... but I see what you mean by scrunching those graphs. I did today's in portrait mode. I'll go back to the landscape going forward.

[Daydream Believer]

Well, this was weird night. Even though the machine didn't record arousals, I woke a couple times - aware that air was being rushed into my nose, but also aware that I wasn't breathing. When I realized it, I took a breath and went back to sleep. But these didn't last long... the longest central was 20 seconds. I can tell you that when I woke each time it was scary. What was happening before apap? That's really scary!

[Daydream Believer]

Closing out this post which now should be titled "First WEEK" heheh

Ending with a high note - last night I slept nearly 8 hours with AHI of 3.94. I feel good today. Now onward.

[Nick Danger]

Wonderful! Keep at it. You've worked hard at this and I'm happy that you are seeing some positive results.