Quite an adventure

So two nights ago in the middle of the night I was not sleeping well, and woke up not breathing/snoring heavily. I found my face to be itchy and drooly so I wiped it off and could not get comfortable with the mask again. I took it off and "slept" the rest of the night without it. Man did I feel like crap yesterday morning. If I wasn't sure if cpap therapy was working, I was sure yesterday.

Today I feel okay, I tried changing up the pressure a little bit because I thought I needed some more to keep me from snoring so hard and having my ahi go crazy around 2-3 AM. Here is my graphs, I'm still not sure how to interpret them. I noticed my AHI isn't high but the snores are (not sure what that means). (Also I was told to get rid of the pie chart but I can't seem to figure out how to do that).

http://imgur.com/a/cDfCS

Please help me out with any info you have. I am waiting until Tuesday to have my appointment with the ENT doc to go over my home sleep study results, and I figure the more info I have to throw at him, the better.

Your pie chart isn't keeping us from seeing what we need to see but if you want to turn it off go to Preferences/Appearance tab and just remove the check mark for "show pie chart".

You still need a little more pressure to better hold the airway open to prevent the snores better.
The snores aren't growing up to earn OA or hyponea flags...but they are trying to. Snores usually mean the airway tissues are trying to collapse and vibrating...need just a little more pressure to hold the airway tissues open better.

To remove the pie chart, go to File - Preferences - Appearance - then uncheck Show Event Breakdown Pie Chart.
Your snores and hypopneas need a little more pressure.

Thank you guys so much, I know it's not quite right yet, I can just tell. Also, this morning I woke up with a sore throat (like I used to before I started using CPAP). I get the feeling that what's upsetting my sleep may not be picked up by Apnea/Hypopnea because it may not be lasting 10 seconds or more, but it's enough to disturb my sleep. I guess I'll know more on Tuesday but the more you know [swoosh]

Each time I have increased the pressure, even just a little, I would have a sore throat and lungs for around a week. Maybe the same is happening for you.

New day, new graphs!

http://imgur.com/a/yXzfz

My ahi around 12:00 is insane and my snores are still pretty high. What gives?

My first thought is sleep position.
Were you on your back?

No, most likely side or stomach. I prefer to fall asleep on my sides and will alternate between them and face down style throughout the night. I was probably on my right side at first.

I almost never will sleep on my back unless I have to

Well during that time frame the pressure wasn't sufficient to prevent the apnea events.
Why part of the night and not all of the night?
The 2 most common reasons for differing pressure needs are Supine Sleeping and REM Stage Sleep.
In both of those it is common for our OSA to worsen and/or require more pressure than other times of the night or other sleep positions.

This particular cluster comes a little too soon the think it is REM related. We don't normally go into REM so soon after sleep onset. Usually it takes a little longer but it wouldn't be totally impossible for it to be REM related.

Something changed during that particular time frame in your OSA where that pressure just couldn't get the job quite done optimally. We don't know how much more pressure you might have needed. We just know that this pressure didn't do the best job. Now the rest of the night this pressure did a bang up great job.

Your PR System One PRO model 460 is mainly a fixed pressure machine but unless the apap mode nights have been used up you might want to think about switching over to auto mode and setting a little range of pressures and let the machine decide where it wants to go for situations like this where the 9 cm just doesn't quite get the job done.

I have never been one to worry to much about the "why it happened" except to maybe explain the mechanics of why.
I have always been more of a "let's just fix it no matter the cause" type of person. I think people should be able to sleep in any position they want to and of course we can't control REM anyway. Even if it is supine sleeping it's not that easy to avoid back sleeping.

There's really no way to know for sure exactly why this happened or what changed to make the pressure of 9 not the optimal pressure. We can guess but we just don't know for sure...but we do know we don't like it and if it happens often we probably want to prevent it.

If this little cluster is a one off cluster and doesn't happen more often during the night or every night AND you are sleeping good and feeling good then I don't know that it is all that urgent to break up little clusters like this with more pressure especially if more pressure ends up causing more problems than this little cluster might cause.
In CPAP mode you would have to use more pressure all night (and at this point we don't know how much more) to cover whatever is changing in this cluster situation. More pressure all night might (stress the might) cause some aerophagia symptoms and there's always the remote chance of centrals but that doesn't really happen all that often.

I think you are a good candidate to try apap/auto mode just to see where the machine wants to go and then decide if you want to try to totally prevent these clusters with more pressure or just let them slide if/when they might happen.

Thank you for the information, and I agree with trying the auto mode. How does it work? I know I can toggle it on in the settings, but will it automatically detect the amount of pressure I need during an apnea episode and just adjust?

I'm sleeping okay and waking up feeling better than I did before cpap therapy, but I still am not satisfied that I feel rested or good in the morning, so still more to tweak, and I may have come off as trying to figure out why, but what I really want is to eliminate the apnea episode for a nice clean sleep. I'm getting closer I think.

jwood0087 wrote:How does it work? I know I can toggle it on in the settings, but will it automatically detect the amount of pressure I need during an apnea episode and just adjust?

Pretty much that is how it works but you do have to help the machine out by giving it a good enough head start on the pressure so that it can get to where it needs to be in a timely manner. It can't make changes very fast...it goes up in stages and comes down in stages. It can't make a big change in the blink of an eye.

If it were me I would start with 8 cm minimum and maybe set the max to 12. I suppose you could set it higher but I would wait to see if it wanted to go there first because you might need to make some mask fitting adjustments if it goes higher.
Preemptive leak control. I would be surprised if it even goes to 12 but it wouldn't be impossible.
My OSA is worse in REM and sometimes I need around 6 cm more to deal with REM events (my OSA is documented worse in REM).

If you set the minimum to 4 cm it can't get to where it needs to be fast enough and we already know that 9 cm isn't doing the job during the cluster. Start with something closer to where we know you need more and the machine can then hopefully get there soon enough to prevent the collapse.
It can't get from 4 to 9 that fast.

I guess I can start with 9 or 10 with a max of like 14 or 15. I don't wanna do too little, I wanna make sure it ramps up to catch it. Does that sound reasonable?

I don't think you need to start with 9 and for sure don't need to start at 10...at least until we see where the machine wants to go.

The machine can get a good head start with an 8 cm starting point and I am thinking you might be surprised at how well 8 will do for the bulk of the night.
Your choice though...I always tend to recommend the conservative side of things until I see what is actually needed because often conservative works out just fine.

The max...doesn't really matter. The machine won't go anywhere without what it thinks is a good reason.
My idea about limiting the max was mainly for leak control so that big leaks aren't as likely to wake you if they should happen. When you fit the mask for the 8 or 9 cm pressure starting point it's going to have some leeway in pressures before that seal is compromised with more pressure. If the machine happened to go to say 14...that fitting for 8 or 9 isn't going to hold and could wake you up. I was just trying to eliminate a potential reason for you to have a wake up.
Heck, you could be like me and set the machine to 20 and if it leaks bad you could sleep right through it. I do it all the time. But not everyone can sleep through big leaks...some people wake up with teeny tiny leaks.

Since you were on a fixed mode of 9 cm and it controlled most of your events, when you switch to an auto mode you can actually begin with a lower minimum because you probably didn't need that 9 cm all night. That's why the suggested 8 cm might work as a starting point.

Thank you, I will try 8 or 9 on auto and see what happens. I am excited at the prospect of sleeping through the night. Most nights I wake up (and don't remember it). The same was true before I started cpap therapy, I would wake up many times and not sleep through the night although if they were really severe, I would wake all the way up and have to pee.

I can't wait to see how my throat and brain feel if I actually sleep through the night. And then like do that more than once. I have a lot of sleep to catch up on from the last like 10-15 years so I don't expect to feel better right away, but I'm looking forward to seeing how much better I can feel.