Can't seem to break 4 AHI barrier

[captain556]

I do wake up feeling good, like I slept better when I first started. Now that you mention it, the sleepiness later in the day, its hard to compare, but I feel it could be better.

My ahi today was 0.4, and looked exactly like the chart just above. So EPR 2 ramp only seems to produce that. I think I'll try epr 1 all the time and post results.

Its amazing how the CAs just disappeared.

Eta: what's the relation of flow limitations? Did some googling but was curious.

[Miss Emerita]

About the CAs: your body may simply have done a good job of adapting to a bit less CO2 in your blood, due to your changed breathing on PAP. At first, that can mean the "breath now" signal to the brain is delayed, resulting in CAs, and it sometimes takes a bit of time for your body to adjust. I hope the CAs will stay away, but don't be perturbed if they sometimes pop up again.

Flow limitations are restrictions in your airway that usually result from the relaxation of the tissues lining the airway. They can make it harder to complete an inhalation. You start inhaling, the FL slows the inhalation down, and you need to inhale harder to complete the breath. Over time this can be tiring, and for some people, it can also disrupt normal sleep cycles.

If you zoom in on your flow rate, you will see FLs in the part of the trace that is above the zero line. Instead of a nice rounded curve up and then down, you'll see a pointy peak or two, a plateau, or a dent. Take a look and see if that's what you can observe.

[captain556]

Yup, I see what you mean on the zoomed in chart of a higher flow limitation. Not a nice rounded curve, was pretty jagged and irregular.

So I did toy with with epr to see if it would affect that, but inconclusive so far. Just CAs go way up with EPR is off. Been consistent that way, pretty interesting

Another question:
I've noticed when going to sleep that occasionally when I breathe in, there's like a quick blip in my inhale where it's like the air quickly pinches off half a second. Sort of comes from the back of the throat, like a hiccup but not. Like the airway closes and opens quickly. Happens with epr on or off. Is that normal? I can post a chart zoomed in to when I'm going to sleep if that helps. Every single night I've noticed that.

[captain556]

I've noticed flow limitations and H's/RE's seem to be the main driver of my pressure lately. I've read that EPR can help reduce those, so I turned that back on full time at 3 as a test to see how I'd feel.

As expected, CAs came back, but I felt that I slept and felt a little better despite that. How bad are CAs considered? I don't recall waking up for those, and I swear a lot of those were from when I was going to sleeep.

Any thoughts on the differences between the EPR FULL 3 vs EPR ramp only charts?

8-15-20-EPRFULL3.png (102.37 KiB) Viewed 413 times

8-10-20-EPR-RAMP.png (102.66 KiB) Viewed 413 times

Close in view of the 8/10 RE:

8-10-20-RE.png (97.12 KiB) Viewed 413 times

So despite the AHI different, I really only seemed to have 1 OA and 1 H on 8/15. How bad are the CAs considered?

[captain556]

This was a 5 min view of the 8/15 cluster of CAs:

8-15-20-CA-5min.png (94.61 KiB) Viewed 410 times

Some others looked like SWJ like this cluster (8 min duration)

8-15-20-CA-8min.png (94.17 KiB) Viewed 410 times

Not quite where where to fine tune from here.

[Pugsy]

CAs are clear airway apneas or central apneas.
If they are real asleep apneas they matter just as much as the obstructive apneas or hyponeas. The stress on the body or potential for oxygen desats are very real. They matter a lot.

Now an occasional real asleep central apnea isn't a big deal but a lot of them can be just as much of a problem as OAs.

BUT if those flagged CAs/centrals are awake breathing flagging or false positives they don't mean anything except you were awake and they won't/can't hurt you.

So you need to learn how to figure out if you were asleep when they were flagged or if you were awake or semi awake (which you may or may not remember). You can learn to distinguish awake/arousal related vs asleep by examination of the flow rate up close.
Go here and watch all the videos and start zooming in on the flow rate and manually counting real asleep flagged events vs arousal related flagged events.
http://freecpapadvice.com/sleepyhead-free-software
It can be done but takes some work.

If 80% of the flagged centrals are arousal/awake related false positives then you can just ignore them.
If the bulk of them appear to be asleep related...you have a potential problem.

I had an AHI of 9.4 a month or so ago...about half central and half obstructive but 85% of everything flagged was false positive and awake breathing related. I didn't sleep well that night. Had more back pain than usual because I over did things working outside that day. So the high AHI was more of a symptom of poor sleep than the cause of the poor sleep.

Your first cluster of CAs/centrals....probably a safe bet you weren't asleep. Don't know about the other clusters later but you can look and see what you think unless you know for sure you were awake. The random lone flagged CAs...they aren't really a problem even if real. We all can have a few random centrals that are real and they won't hurt anything especially if they are of short duration.
Hold your breath for 10 seconds...not a big deal and that is essentially a 10 second central apnea. The airway is open but no air is moving. Now if you did that every minute for 10 minutes ...it could cause a problem.

[Pugsy]

The obvious SWJ stuff...toss out the window.
The stuff that is iffy...I can't always tell either but I will "count" them as real if for no other reason than to err on the side of caution.
I get a pencil and paper and manually mark...asleep or awake column and count them up and figure percentage.

What I don't see on your first zoomed in image that looks more "iffy" is a recovery breath at the end of the flagged event.
Most of the time with a real asleep apnea you take a big breath after the event and it's usually seen right after the noted flag.
I would lean more towards arousal related than asleep because of the lack of the recovery breath but they are "iffy".