Setting Min Pressure referencing OSCAR Data

[Mguitar]

Greetings.

I just got my Resmed 11 APAP 4 days ago and it has already made a HUGE improvement in my quality of life. I got it through Lofta and at first it was at 4-20 but I have been looking at my OSCAR data and see that my Flow Limit causes a pressure increase to between 6 and 7. Does that mean I should raise min pressure to around 6 or 7?

I have arousals indicated by an increase in Flow Rate, usually following a Flat Topped Inspiration (maybe imediately or maybe a minute or so after). I have a camera recording me at night and every 10 to 60 minutes I twitch awake and then rub my eye or head or mask. I did this before getting the machine and I do this no matter if I sleep on my side or my back. These awakenings coincide with the flow rate spikes in OSCAR. My goal is to get them to stop happening. And to be clear, I am not aware of these happening in the moment. I didn’t even know I was doing this until I recorded myself with a camera two weeks ago.

I have attached my May 8th OSCAR data. The first bit is a 1.5 hour nap I took in the evening, and the second bit is my 4.5 hour sleep from 3am to 7am (that usually happens on friday nights). The nap min pressure was 4.8, the sleep min pressure was 5.4.

EPR is on 3 Full Time, Ramp was off but I think if I have to put min pressure on 6-7 I'll have to use ramp. I'm seeing that the first Flow Limit on the nap and the sleep both happen within 10-15 minutes of me turning on the machine so I'm assuming that's right when I fall asleep. The second spike to around 7 must be when I hit REM.

Even with all these arousals, 4.5 hours with the machine feels like 10 hours without (actually way better).

Edit: Actually looking at it I realize I only slept 2.5 hours last night lol

Thanks guys. I appreciate that there's people here willing to help!

[ChicagoGranny]

We can tell more if you get a free account at SleepHQ.com and post the link in this thread.

[Mguitar]

We can tell more if you get a free account at SleepHQ.com and post the link in this thread.

Thank you, Granny.

Like this? https://sleephq.com/public/teams/share_ ... f2dd17545a

That website is cool.

The only useable data is Wednesday and Friday. For some reason Thursday didn't write the data to the SD card.

[Pugsy]

Are you having much (if any) nasal congestion at night?

[Mguitar]

Are you having much (if any) nasal congestion at night?

No I don't think so. I mean my nose does the thing where one nostril is 90% clogged but it switches every 30-60 minutes so I think that's normal.

Also just to be clear, I am not aware of the arousals while they are happening. I didn’t even know I was doing this until I recorded myself with a camera two weeks ago.

[Pugsy]

Your Flow Limitations aren't quite as ugly as we might first think because of the scale involved. Your scale for FLs is only 0.5 which can give the illusion that it is worse than it is. Most of the time the scale goes to 1.0 so having it go to 0.5 makes for bigger looking spikes but really not all that big.

Nasal congestion can make the FLs look worse and the machine will try to kill them with more pressure but more pressure doesn't help with FLs caused by nasal congestion.. You aren't experiencing nasal congestion so we won't worry about that side of things.

So we assume the FLs are early warning signals the the airway is trying to collapse (into Obstructive Apnea or hyponea) but since you don't have many OAs or hyponeas to speak of then those FLs aren't growing up to be something that needs flagging.

If you are sleeping good and feeling quite decent I don't know that there is anything that urgently needs to be done at this point.
Your choice....give things a bit more time since you are so very new to this therapy or increase the baseline minimum pressure a little bit.

[Mguitar]

Your Flow Limitations aren't quite as ugly as we might first think because of the scale involved. Your scale for FLs is only 0.5 which can give the illusion that it is worse than it is. Most of the time the scale goes to 1.0 so having it go to 0.5 makes for bigger looking spikes but really not all that big.

Nasal congestion can make the FLs look worse and the machine will try to kill them with more pressure but more pressure doesn't help with FLs caused by nasal congestion.. You aren't experiencing nasal congestion so we won't worry about that side of things.

So we assume the FLs are early warning signals the the airway is trying to collapse (into Obstructive Apnea or hyponea) but since you don't have many OAs or hyponeas to speak of then those FLs aren't growing up to be something that needs flagging.

If you are sleeping good and feeling quite decent I don't know that there is anything that urgently needs to be done at this point.
Your choice....give things a bit more time since you are so very new to this therapy or increase the baseline minimum pressure a little bit.

Ok. Thanks for the info about the nasal congestion. I'll keep that in mind.

I know the FL's are relatively low, I'm just trying to figure out why I "wake up" at least once an hour. Every time I do that there's always a flow limit somewhere before the wake up so I figure they are related. Before I started APAP, my arousals were more frequent. Now they are about 50% less frequent and less violent. I used to completely change positions and now I don't and the initial twitches are less violent. I noticed even the first night on APAP that something was working even though that night I barely slept because I wasn't used to it. And when I increased from 4 to 4.8 it got better, and then to 5.4 it got better.

Tonight I'll raise minimum to 6 and see what happens.

I do feel MUCH better, but I think getting rid of these arousals would make it even better.

[Mguitar]

Last night I upped the min pressure to 6 and I took EPR off (used to be 3). My theory was that taking EPR off would keep my airway more open during exhalation, and also I find EPR makes it so I can't really sleep because it goes out of sync with my breathing. Surprisingly I fell asleep great but my jaw kept dropping all night. I have a lot of leak spikes leading to arousals.

I had mouth tape on but the problem is my jaw drops, my tongue loses seal to my front teeth and then air gets in my mouth and wakes me up. So I ordered a chin strap and it'll be here tomorrow.

Tonight I'll keep min pressure on 6 but put EPR back on and see what happens.

My new hypothesis for the arousals in my original post is that it could be due to my jaw dropping. Since my mouth puffing happened even when I didn't have my CPAP machine I think it could hold some water. If that is the case, it would make sense that turning off EPR would lead to worse sleep because now instead of no pressure (no CPAP), I'm trying to exhale against 6 pressure. So maybe this chin strap will be the missing piece of the puzzle!

[Pugsy]

Please review the graph formats in this thread and when you post your reports to share you can try to include the most useful graphs on that right side.

http://www.cpaptalk.com/viewtopic/t1585 ... eview.html

Your tidal volume thread isn't particular useful but the events graph (which you omitted) is much more useful

In general we like to see (on the right side) these graphs

Events
flow rate
Pressure
Leak
Flow Limitations
Snores ....only if very active

Of course include the usual stuff on the left side as well.

[Pugsy]

Oh...one more thing...when you make a change in anything try to limit your changes to just one.
Remember Science 101...when experimenting try to keep your changes to a minimum because if you make more than one change and the results are really good or really bad you won't know which change caused whatever result.

[Mguitar]

Sorry about that! I’ll do better next time!

Yeah I know I should have just changed one thing but I was confident in my theory so I got impatient.

[Pugsy]

I got impatient.

Been there and done that myself and wouldn't you know it.....something happened and I couldn't tell what/who to blame.
I think that's a subset of Murphy's Law.
Also unless a result is just plain horrible with the results....don't go changing stuff every night.
Give your body some time to adjust to the change(s).

[Mguitar]

So last night was a big success!

I had practically no events and less flow limits. This is with 6 pressure 3 EPR, on my back (how I like to sleep).

I can't wait to try out a chin strap tonight to see if that stops all these arousals from happening. Because at this point I don't have any "apnea" events. I really think the only problem now could be my jaw and tongue relaxing which wakes me up upon exhale. But who knows.

I learned yesterday that my sister does the exact same thing as me. Every 15-30 minutes she changes position. Could be the same thing, her jaw relaxing. Since we have the same jaw.

[Mguitar]

I have been raising pressure 1 every night, trying to get arousals to go away. I have gotten to 9/6 last night and flow rate looks decent but still getting arousals. Going to try 10/7 tonight. How does the FR look before arousal?

I'm noticing a pattern. On basically all my nights, the first arousal is 40-50 minutes after falling asleep. I am guessing that this is me transitioning to N3 sleep (deep sleep). I wonder why I get an arousal doing that?