Another bad night according to sleepyhead

My sinuses are doing better. And I don't feel too bad as I awake from a "nap".

One time I rolled over last night (i'm in a hotel) and the tug of the hose pulled the machine off the bedside table.
Luckily, it seems to be OK....guess the hotel bed is larger then mine. Live and learn. Sleep closer to Cpap machine.

Another high AHI....I slept on a split schedule as I'm on the road and had a good long nap today.
But had tons of OA's during it according to sleepyhead (found a newer version of sleepy head too).

I scrolled some of the graphs so I could get screen shots of what seems like the important ones (leak rate, though
I'm not sure what I'm looking at but you can see where it spikes)

edited to add first and second image....more experimenting and I'm getting a more thorough screen shot.

It would be useful to see the flow rate zoomed in to show the period between about 9:30 and 10:00 when that nasty cluster happens.

Where you pretty much sound asleep the whole period? If so, it's possible that the cluster might be REM related.

Thank you for your reply.

I am going to work on zooming in on that time frame.

I felt like I was asleep the whole time AND I even remember a dream (it was a bit unrealistic).

I will post the new image below

can you redo that one (just edit the post) with a full screen (so the trace is spread out more) and zoom in just a bit more so there's less non icky stuff on each side? also, right click on the flow rate chart and turn off the vs2 flags, pls.

Done

NMchop,

That's one nasty chain of events. Do the two clusters between 17:00 and 18:00 look similar?

I hope Morbius stops by to take a look at that last screen shot. It's NOT scored as periodic breathing, but there's a certain amount of repeating pattern here: Large, quick inhalations (possibly leading to blowing off too much CO2?), followed by inhalations of decreasing size, followed by the apnea (leading to blowing off too little CO2?), followed by another set of large, quick inhalations. And a few of those apneas are indeed scored as CAs. It would also be useful to clearly see the very beginning of this cluster: Can you make another screen shot that starts about 2 minutes before the very first OA in this chain and continues to about 2 minutes after the chain ends? Select JUST the Event Flags table and the Flow Rate graph for the screen shot; we don't need anything else since you are using fixed pressure at 14cm.

And even though your fixed pressure of 14cm is not sky high, it is high enough to warrant being cautious with any further pressure increases in my opinion. Me? I'd be very reluctant to add more pressure at this without having a professional have a look at that close up of the flow rate. While the apneas are mostly scored as "obstructive", it's possible that this kind of thing might be a chain of pressure induced centrals. That's why I'd really like to see what Morbius says about this snippet of your flow rate graph.

Thank you. I'll work on another screen shot!

I don't know what I'm looking at as I review the data, but knew this was
too clustery.

here's a zoom in on the second cluster at 17:35 that day (the second bad cluster)

NMchop,

Those clusters are very concerning. They're very long clusters---the first one lasts almost 30 minutes and the second one lasts around 40 minutes. And there's a periodicity about both these clusters that is very troubling. In the second one, the machine is flagging some of the periods as "Periodic Breathing." (SleepyHead calls it CSR, but CSR is only one type of periodic breathing, and this does not look like real Cheney Stokes respiration patterns.) And both the clusters start with some big, quick breaths that happen before the first apnea. Those big breaths just before the clusters start might indicate a spontaneous arousal at the start of the cluster, but they are NOT caused by an apnea event. And you're already at 14cm of pressure.

I do wish that Morbius would stop by and look at these close ups of your clusters. Because they look to me like they just might be a long chain of pressure induced centrals that have been misscored as obstructive events. In which case, adding more pressure is not going to fix them. You might want to post those last two screen shots of the close ups to a new thread with a subject line like: Calling on Morbius---are these OAs possibly pressure induced centrals? That might get his attention. Provide a link to this thread so you don't have to write everything down again.

Has this kind of clustering of events been present in your data since you started PAPing? Or is it a new thing in your data? And did your titration study say anything about central apneas at higher pressure levels?

This is a situation where I would be very reluctant to self-treat by adjusting the pressure. If these are pressure-induced centrals being misscored as obstructives, then you need some advice from your sleep doc. So I think once you're home you need to let your sleep doc know that there's a troubling pattern in your data. And you need to show the doc the close up of the Flow Rate data for some of these clusters.

Thanks for looking at this.

Things were going really well initially....MY AHI's were 4 and under.

then last week, these spikes were noticeable.

I did have some "sinus" distress last week which maybe contributed. I thought it was allergies, but it might have been
a cold or a sinus infection or something.

I'm feeling better today.

It does seem I have a couple of clusters like that every night lately? One theory was it is REM sleep at those times? I don't know as I said.
I'm on like my third week of therapy.

Would lowering the pressure be the answer if you are right?

This is yesterday...Sunday night

Have you tried wearing a soft cervical collar that would keep your head up better and your airway open, allowing a more consistent flow that might otherwise be periodically blocked by your head scrunching down into your chest? Here's something from a member about that -

Soft Neck Brace Reduces Flow Limititations
by Jay Aitchsee on Sun Sep 07, 2014 9:04 am

Lately, I've been getting some mask leaks after I fall asleep, I assume due to my jaw dropping as I relax. I decided to try something new, a soft neck brace I made from some 1'' foam I had. I made a piece that was about 3 1/2 inches tall that wrapped a little more than half-way around my neck and held it in place with one of those stick to itself ace bandages wrapped around the outside of the foam.

The surprising result is depicted below. My Flow Limitations, which I most recently became aware of with the purchase of a new S9, have almost disappeared! This has been a consistent result since I using started using the brace, about 6 days ago. I notice my pressure average, in auto, has dropped and all obstructive apneas and hypopneas have virtually disappeared as well.

I think what is happening here is that the brace is not only keeping my jaw from dropping, but it is also helping to keep my airway open by keeping my head from tipping forward.

I'm not sure the long term implications of this, but it seems, at the very least, I will be able to lower my pressure settings. I wish I could say I felt significantly better, I don't, but then I was feeling pretty good already, with a sub 1.0 AHI. Needless to say, I ordered a real soft cervical collar and should get it tomorrow.

I post this in the hopes it may help someone with their therapy.

These are not pressure induced centrals. These are plain old Obstructive Events. Your airway collapses gradually in every breathing wave cycle from top to bottom, till it collapses fully and you don't breathe for 10+ seconds. Then your body wakes up and you take a large breath. And then the cycle continues again and again.

This is either happening because you get in the supine position; or in REM or SWS; OR both.

You have multiple options here:
1) If you are using Cflex+, Eliminate it. Make its setting to zero. See the effect for the next 3 days.
2) Keep using Cflex+ but raise the pressure in 0.5 cm increments for 3 days each and see the effect. This may reduce OAs but increase CAs.
3) If not using Cflex+, raise pressure in 0.5cm increments like in step 2.
4) Get an APAP machine. Set it to 12-16cm range and evaluate.

Other things you can try independent of machine settings:
1) Cervical collar.
2) Tennis Balls to ensure you never sleep on your back.
3) Nasal rinses 1 hr before going to bed.