UGH, 2 episodes yesterday night

[nicholasjh1]

Yesterday night I woke up to this feeling of tremendous pressure. I checked the machine and it had ramped up to 19.6, and was showing an AHI of 9, this was after 1hr 22 minutes of sleep. I was having trouble going back to sleep and reset it to 16.2, went back to sleep and an hour and half later was at 19.2 pressure with an AHI of 9 still. meaning that I had 27 Apneic events that night so far. I decided to stay at 19.2, went back to sleep and woke in the morning with total AHI of 4, and the machine had ramped back down to 16.2. feeling a slight apnea headache this morning and wondering what set me off. sigh. Feel free to share your experiences and what you did. Hopefully it's just a quirk. though It makes me wonder if I should raise my pressure, but I have no idea what had it happen. Whether I have some kind of inflamation, or I just went into a deeper sleep then normal.

[nicholasjh1]

to give some context my average is usually around .5 AHI

[Pugsy]

You don't really have much more room to increase the pressure with your machine.

Two most usual reasons for needing more pressure....supine sleeping or REM stage sleep or a combination of both.

Can you post an image of the detailed report for the night in question? Let's see just how bad the cluster is and what it is composed of.

[nicholasjh1]

Sure. I'll probably get a chance tomorrow to download the info. and to answer your implied questions, I was sleeping on my back (because I sleep much better on my back, I have a certainly level of arthritis that usually causes me to wake up when on my side) , but at my current starting pressure (16.2) that usually doesn't bring my AHI above .8 . Thanks for the offer.

[Pugsy]

If you normally sleep on your back then probably supine sleeping isn't the culprit for the clustering (assuming the cluster is obstructive and not central which is why it is important to always note what kind of events we are seeing clustered and not just the number) then that leaves REM and sometimes it just happens. My OSA is 5 times worse in REM and not really any different when on my back than when on my side.
Sometimes in REM we just need more pressure than at other times no matter what the sleeping position.

Let's look at the cluster itself and what it is composed of first...then see what could be done to maybe reduce the likelihood of them happening again.

Also...just how many events in just how long of a time frame are we talking about...not that AHI number per hour on the AHI graph???
Go to the Events tab and then click on the event category of that cluster...then go to the time where there were flagged and just exactly how many happened clustered in a close proximity time wise to each other.

[nicholasjh1]

almost solely obstructive is what my usleep.umbian.com site says. of the whole night .4 was hyponea, 3.7 apnea. 9.6 AHI during the first 1 1/2 hours, 9.2 during the second 1 1/2 hours. I'll still post that graph tomorrow hopefully. I have to take the card out and bring it to my Brother in laws in order to get it onto sleepy head.

[nicholasjh1]

I can report that during the first 1 1/2 of an hour my AHI was definitely 9, so about 13.5 events, mostly OSA (no CSA, few HSA), so it certainly does sound like an REM issue. Maybe the the graph will tell us more. It's too bad we can't fine tune our machines to have different pressures based on time of night/length of sleep.

[Pugsy]

Yeah well even if we could pre program specific pressures at specific times we have no idea when we might get into REM nor how long we are going to stay there...and that's assuming REM is the culprit.

It's funny but my REM dependent OSA was almost always worse with the first REM cycle as evidence by sometimes clustering and/or the machine's response with more pressure. Almost always I would see it about 90 minutes after sleep onset which is of course when the first REM stage is most likely to happen. Now sometimes I would also see the response in the wee hours of the night when we typically would have more REM and have it last longer but it was much more common for me to see it "worse" about 90 minutes after sleep onset.
I saw it so much that I just referred to it as my "witching hour".

About the best we can do is adjust the minimum so that it has the best chance of preventing whatever it is that is causing the ugly clusters (assuming it is obstructive in nature).

You are caught between a rock and a hard place since your minimum is already pretty high. You are fast approaching maybe needing to think about bilevel depending on what kind of events and is your machine maxed out when you see those events clustered.

[nicholasjh1]

Yeah, this conversation makes me think of an apnea machine with ECG. one that pre-responds to what you will need and has pattern recognition. bring the apnea machine into the 21st century!

[ajack]

get some charts up to see if it's just when you go to sleep. the rest of the night may be fine. There are a few adjustments that can be made.