Struggling

[Becksta]

I'll give it a run:

- Is there a reason you are on CPAP mode and not Autopap? There is really no right or wrong answer.
- May I ask how old you are?
- Seem your therapy improved as your pressure was increased.
- Your leak rates are acceptable.

Many folks search for an "ah-ha" moment in cpap therapy and some folk's improvement is so gradual and occurs over many years of therapy, they feel that no improvement ever existed. It may take many years to repair the damage sleep apnea has done to your body. We all (including me) want to feel better as we do it.
To me, there seems to be other issues you may have with fatigue and the "barely lift my arm" thang'. I'd see the doctor on those things. There's something else going on here.

Sheriff

I had no idea about auto/ not auto, how do I change that?
I will be 60 in April
Only changed pressure two nights ago so will wait a bit before cheering
I think I am due for a new nose mask anyway as I have had this one for 9 months

[chunkyfrog]

When you get into the clinical menu, mode is the first item under therapy.
If you do not already have the "real" users manual, it is free for download from another website.

[Pugsy]

First thing I'd do is switch over to autoset mode, min 7, max 20 on the pressure, and see what the machine can do to reduce your AHI.

My current AHI is less than 1 (see first two charts) the third chart with AHI of 4+ was from September last year (dates on the bottom of the chart) I popped that one in as a comparison to now, so was thinking my AHI is not too bad currently?

I see no need to change anything based on your most recent report. Can't get much better than consistent AHI less than 1.0.

Maybe PR missed the most recent report or maybe was wondering what apap mode might do.

[palerider]

First thing I'd do is switch over to autoset mode, min 7, max 20 on the pressure, and see what the machine can do to reduce your AHI.

My current AHI is less than 1 (see first two charts) the third chart with AHI of 4+ was from September last year (dates on the bottom of the chart) I popped that one in as a comparison to now, so was thinking my AHI is not too bad currently?

There's nothing wrong with your ahi as is, ahi isn't all there is to sleep problems, you might not need as much min pressure as you have now.

[Pugsy]

Have you ever used any mode except cpap mode?
The reports you shared all are cpap mode settings.

If unsure you can look on the main Statistics page in OSCAR and down at the bottom it should show past settings under "changes in prescription".

If you are sleeping great and feeling great....there's no urgent need to change to apap mode (if you have never used it) unless you just want to or are curious.

[Becksta]

Ok, so I had a go on APAP mode, two horrible nights, unbelievably dry mouth..
Data for 26 Jan is last night on CPAP mode pressure set at 9. Previously had been 7, increased to 8.
Data for 27 & 28 Jan is two nights on APAP min 9 max 20.
On 27/1 I woke up from a dream (so in REM) with horrible dry mouth (curious as to what the grey stripes down the report at this point are). Was also aware of dreaming before waking at 4.49am when I think i ripped my mask off...
28/1 Not a whole lot better, woke feeling puffy, eyes were bloodshot, did not feel refreshed.

Need some advice, do I have another go at APAP tonight or is 2 nights of yuk enough?

thanks

[Pugsy]

The gray stripe sections are when you went into large leak territory (went over 24 L/min) in terms of excess leak.
See the LL line on the events graph at the top? That's Large Leak events.

Either mouth breathing most likely since you complain of dry mouth or mask movement.

Refresh my memory...why did you decide to try apap mode?

Could you do me a favor please and omit the mask pressure graph and put the flow limitation graph in its place and redo the report that shows the large leaks. I don't need to see the others as I can tell by the statistics they have less FLs.

[Pugsy]

Ahh....I went back and read your prior posts.

Low AHI but still complaining of extreme fatigue....is that correct?
Strong need to nap during the day???? I don't remember if you mentioned this or not.
Any other unwanted daytime symptoms that you were hoping cpap would fix?

Do you take any medications for any reason...if so, what?
Any other health issues?
Has thyroid been checked?
How many times do you think you wake up during the night?

[palerider]

Need some advice, do I have another go at APAP tonight or is 2 nights of yuk enough?

You can certainly go back to a fixed pressure of 9 all night long, but...

consider this, every time that pressure went up above 9, it's because you're having breathing problems that are very likely disturbing your sleep, and the machine is trying to stop those problems.

If all you needed was 9 to alleviate your breathing problems, then the machine would not have gone higher.

[Becksta]

So, when I originally posted I was not having great days. Almost as soon as the ink was dry (so to speak) I started feeling better. Murphy’s Law. But as I was on a track, I stayed on it.
I came off anti depressants in early December, and now am wondering whether by early January they were finally out of my system and so I was sleeping better. My charts from that time look pretty good, AHIs below 1, few mask leaks etc.
Before CPAP (May 2019) I was getting up 2-3 times a night for a pee, now it is rare.(well it was before APAP).
I am aware of waking maybe once or twice a night. I haven’t remembered dreams for some time, until the other night (27th).
I am having some computer issues just now (working on tablet right now) so might be a day or two before I can get the data Pugsy is after.

[Pugsy]

Don't fret about redoing that one FL report I was curious about. It's not a critical issue...it would have been the worst looking FL graph and it was only max at .3 which isn't much.
The FLs will drive the pressure up but they may or may not be a for sure airway issue. They can be nasal congestion as well.
How's the nose in terms of nasal congestion. More pressure doesn't usually help nasal congestion.

We all can have bad nights from time to time for no known reason no matter what mode we use.

It might be that since you used cpap mode for so long that the body is going to take a little time adjusting to auto mode.
It might be that you simply do better in terms of how you feel with cpap mode. Killing off every little FL with more pressure sometimes creates more problems than the little bit of FLs was causing.

The anti depressant side effects....probably a big factor in how you felt during the day. Fatigue and messing with sleep architecture (and that means messes with REM because it suppresses REM) mean we just don't get good sleep and we feel like a bus ran over us during the day. And yes...they can take a long time to get out of our systems and depending on how you went off them just the withdrawal effects can act just like, or worse, the side effects.

We don't remember dreaming unless we wake up during one or right after and we are awake long enough to form a memory (like it's normal to wake after REM but normally we aren't awake long enough to remember it).
Don't assume that it just had to have been REM though....we can actually dream in any stage but of course more common in REM.

The night of Tues the 28th....one wake up at around 03:00...the pressure increase right before the wake up....I would bet that it was REM related. The pressure increases at 22:40 on that same night.....my bet is the first REM cycle of the night. Normally the first happens about 90 to 120 minutes after sleep onset. There is another increase at around 00:20 and I suspect another REM cycle.
It is quite normal for our OSA to worsen in REM...sometimes just a little worse and sometimes a lot worse. Mine happens to worsen a lot in REM...in REM my AHI is 5 times worse than in non REM and sometimes needs a LOT more pressure to deal with it.
I can often pretty much pick out my probable REM cycles just by eyeballing the pressure increases.

If you look at your FL graph and you see more activity (higher) during the times when the pressure goes higher...probably your OSA is at least somewhat worse in REM which we know is common.
Same thing can be said about supine sleeping though...so this all could be related to being on your back.
But since the pattern sure looks like a typical REM pattern..makes me really suspicious of it being REM.
Google "sleep stages" and take a look at the normal hypnograms...look for when REM normally occurs. First REM typically at around 90 minutes after sleep onset and as the night progresses REM comes on more quickly and last longer each time with the biggest part of REM happening in those wee hours of the morning right before we get up for the day.

Your ugly report in terms of large leak on the 27th....again most like in REM with higher pressures when the leaks happened.
You can change the leak graph to auto scale and insert a red line on the reports so you can see the leaks better. Right now with the scale fixed at 120 you don't get the full effect of the leaks. Put your mouse cursor over the words "leak rate" and right click the mouse and you get a menu that drops down...double click the mouse to see if the scale changes...if it doesn't go change it to auto scale and also go down to where the menu says something about "dotted lines" and click on that and then put a check mark in the last line that says "leak rate upper threshold".

I suspect it was the large leaks that probably disturbed your sleep at 00:40.. the pressure went up probably because of REM and for some reason the leaks happened either because the mask fit couldn't hold at the higher pressures or maybe some mouth breathing happened.
A slight adjustment at the beginning of the night fitting the mask at higher pressures (mask fit option on the machine) might help anticipate the higher pressures you probably need because of REM related stuff happening.

So....most likely your OSA is worse in REM and you are going to need more pressure in REM.
You have some options and some might not be very appealing but you have options.
1...continue with fixed pressure of 9 and just let whatever happens during REM happen. It's not bad enough stuff to earn an OA or hyponea flag but it is bad enough to probably show on the FL graph. Your airway gets somewhat restricted in terms of air flow.
2...use a fixed pressure that is higher than 9 all night long to deal with the REM stuff...around 11 probably would be a decent compromise...would need to see the FL graph at 11 fixed to see how much activity is happening during probable REM to get an idea.
3...use auto adjusting mode with current settings...and come to grips with it and like it.....maybe increase the minimum to 10 cm in hopes that maybe the pressure won't need to go up as much during REM and if it's the pressure changes that bug you then maybe with less changes not so disturbing to you.

The bulk of your Clear Airway/Central apnea events I chalk up to arousal related...SWJ sleep/wake/junk. The first cluster of 4 or 5 CAs at 03:20 on the 28th happen about 20 minutes after a known awake time. Either you weren't asleep yet or they are sleep onset transitional centrals and in either case they don't really matter. Random centrals through the night...normal to have them so we ignore them.