New, Severe, Really Concerned

I started at about 930 but I was awake for awhile with the mask (couldn’t sleep) so I didn’t include that part in the graph I posted.

I believe I feel asleep / was asleep during the first session on the graph.

See if you can change the scale on your pressure graph. It's sort of messed up. Your machine won't go to 25 and I don't know why it is showing 25.
Right click your mouse on the word "pressure" on the graph and then click on y axis and change the scale.

You need more minimum pressure if you were for sure asleep when all these flags happened.
Don't know how much more at this time but I suspect at least 10 cm minimum...maybe more.
If you can't handle another big jump in minimum either make use of the ramp feature or just go up slowly in small increments.
Monitor the OAs, hyponeas, FLs along the way. We don't expect CAs/centrals to change with more pressure.

I changed the settings on my Oscar graph, that worked right away to made it more readable.

What do you mean by don't expect the Centrals to change? Can they ever change?

I will keep pushing the minimum up if you think that will help. Its at 8 now, maybe I'll try 8.5 or 9. I was for sure asleep for atleast 8/9 hours of these 10+ listed. Is there any danger with having too high of a minimum pressure?

Is it odd that my sleep doctor couldn't seem to care less or have any suggestions besides getting a sleep lab?
He pushed aside my original concerns about having sleep apnea - coming suddenly, about it maybe being central/complex, and the machine settings not being right at first.
He also didn't seem to know what Oscar or Sleepy Head was when I mentioned it to him.

Also with the data saying Clear Airway and and Periodic Breathing does that mean I have Central/Complex Sleep Apnea? And is Automatic CPAP enough?

I'm sorry I have so many questions, I just don't get anything from my sleep doctor. I am trying to get pulmonologist appointments as I type this.

Also, is a Soft Cervical Collar recommended or is it too early for that?
What about a special pillow? I prefer to sleep on my side (Fetal type position)

Clear Airway/Central apneas ....we don't treat them with more pressure because the airway is already open. You just aren't making an effort to breath. A few centrals are normal and no big deal. Hold your breath for 10 seconds...that's essentially a 10 second central apnea.

You don't have enough centrals/CAs at this point to be anywhere near making the criteria for a diagnosis of complex or central apnea.

I do expect that some of your flagged centrals are probably related to an arousal (you may or may not remember waking up) that is happening and I do expect that once those obstructive events (OAs, hyponeas) get reduced and the arousals get reduced then the centrals will reduce.

Ignore the centrals for now...nothing we can do about them anyway.

There is no danger in having a minimum pressure 'too high"....now sometimes higher pressures can trigger centrals but your machine is already going higher than the new minimum suggested and you aren't having a boatload of centrals pop up. The most common problem with higher pressures relates to aerophagia or air in the belly discomfort.
Lots of people use a lot higher pressure minimums than you are using without any problems. Heck, some people start out the night with pressure minimums in the high teens.

I quit trying to second guess doctors a long time ago...sorry. I don't know why they do what they do or don't do most of the time.

Your periodic breathing isn't enough to be a problem and it's not chocked full of central apneas.
Periodic breathing is just a waxing and waning of the air flow that lasts at least 2 minutes.
Now if your PB was prolonged and chocked full of central apneas we worry about Cheyne Stokes Respiration but I don't think yous is.
Most of the time there are no events at all during the PB flagged time.

If your PB looks like this...no big deal.



If it looked like this we would have a different discussion.



Fix the problems that we know about now with the tools available now....and then we worry about anything left over that might need fixing.
Right now the only thing really needing fixing is the too many OAs and hyponeas.

Wow - thank you so much! That is so informative. Really helpful. I am going to increase the pressure a bit and hope for the best tonight.

I also purchased a CPAP pillow - https://www.amazon.com/RespLabs-CPAP-Pi ... B07TTPZ5LZ

Finally talking to a Pulmonologist tomorrow.

O man, last night was not a great night. But maybe some silver linings somewhere. Any help / advice is always appreciated. Working hard to get through this.

I didn't include the first two "sessions" of the night. Set the Pressure the same as the night before min 8.5 / max 18 with 2 Aflex. Both were about 10 mins where I was falling asleep but immediately woke up with my heart feeling as it skipped a beat.

****
1st session on graph: Bumped pressure to 9.5 min lasted 35 mins before waking up, kept 2 AFlex.

2nd & 3rd Sessions: Bumped up to 10 min, kept flex, did not sleep much during it.

*4th Session: Kept pressure 10-18 but turned off the flex. This did not go well at all. Up to almost 50 AHI at that point. Obviously need the flex.

*Following sessions - put it back down to 8.5 / 18 with Aflex 2. And seemed better.

Spoke to a Sleep Dr / Pulmonologist today and she said to just keep going at that 8.5/18 with Aflex 2.

Any other suggestions? As always, thank you so much!

First of all let's learn how to figure out awake vs asleep flagged events.
http://freecpapadvice.com/sleepyhead-free-software
While the above talks mainly about ClearAirway/Central apneas....false positive/arousal flagged events aren't limited to just centrals.
It can happen with any flagged event. Remember the machine only measures air flow. It has no way to know if we are asleep or not but it still responds like we are asleep even if we are awake.

I am reasonably certain that a sizable chunk of your AHI is related to false positive/arousal/awake flagged breathing events due to your overall poor sleep last night. It only matters if we are asleep....awake/arousal flagged events don't count.

My suggestion since you are in contact with your doctor....do what the doctor says for a period of time and work on sleep quality and give yourself some time to establish trends and patterns at these settings once your body gets adjusted and is actually sleeping soundly for the most part.

I am new myself but the leak rate seems to be quite high? Does your mask fit ok? May have to tighten a bit?

mike2020 wrote: ↑

Tue May 12, 2020 11:49 am

I am new myself but the leak rate seems to be quite high? Does your mask fit ok? May have to tighten a bit?

You are using a ResMed machine and if you had those leak numbers it would seem quite high but the OP here is using a Respironics machine and it reports leaks differently and it has a different line in the sand where large leak territory begins....and that line varies depending on pressures used and the mask used. Much more complicated.

The OSCAR software is basing the large leak statistic off a ResMed baseline number and that makes the statistic percentage falsely inflated.
In reality...there were no large leaks flagged at all....see that top LL line in the events graph? That's large leak per the machine and the machine's reporting trumphs OSCAR software calculations.

So to the OP here....let's fix that little error so that your time over red line statistic isn't so incorrect and potentially alarming.
Go to Preferences/CPAP tab and adjust the 24 L/min red line threshold to something more suitable for your machine which is a bit difficult since the red line varies...but something around 80 L/min would be a nice conservative red line number to use or better yet just turn off that particular statistic and rely on the LL line on the events graph for leak monitoring. That's the real marker anyway.
If you don't see any large leak flagged gray areas...you didn't have any leaks that made it to large leak territory and the machine is very capable of compensating for any minor leaks.

Ah..thanks. Learning new things every day on this forum.

After looking at some data and realizing how it matches up with how I feel - I think a big issue is the RERAs. Those times seem to corespond with the feeling I have of waking up gasping for air with my heart hurting. These usually happen immediately upon fall asleep - which is why they are so troublesome. It's so demoralizing to finally fall asleep only to be jolted up moments later. I find that the period of sleep where I have the RERAs are the most tiring and frustrating. Does that make any sense?

Is there any specific way or tips to stop them?

Thanks!

Were you ever really asleep prior to the RERA flagging? This is where the zooming in on the flow rate needs to be done to establish awake breathing and asleep breathing.

I’m just going by how I feel. This was the original problem - and the thing that still bothers me the most. The many times I fall asleep and immediately gasp. My wife watching me says it’s only a few seconds after I appear asleep.

In terms of the flow chart I have no idea. Still trying to do research to try to figure it all out.

Do you know how to zip/compress an entire SD card contents in one step?
If you can do that and would like for me to take a look at the flow rate since you aren't yet comfortable with that level of analyzing....I would let you send me that zipped SD card folder and I can unzip it and take a look using my software.
It has to be an exact mirror copy though because I can't take bits and pieces and put them all together and make it work.
So the SD card itself has to be compressed in one step. Then you can email it to me as an attachment.

Here's the deal...the RERAs could be happening while asleep and causing the arousal...or the arousal can come first and cause the RERA flagging. We can't tell without looking at the breath by breath flow rate...one breath at a time.
What to do to try to reduce them depends on what is causing them.

You are very, very new to this therapy and it would be extremely common for a lot of what you see flagged to be related to arousals that you may or may not remember.

Do you take any medications? If so, what?