Oscar stat review and help.

[Miss Emerita]

Sounds like a plan! One question I have. Is it fairly normal to still feel pretty tired? First two nights had me waking a lot easier than normal, but feeling tired later in the day as per usual.

Yes, this is normal. Improvement in daytime functioning may come somewhat unevenly or gradually, but it will come. You're doing very well.

If you wake up with the mask off repeatedly, we can offer some tips.

Another potential cause for clustered events is tucking your chin down toward your chest, whether on your back, side, or stomach. If you have a high pillow, you might want to switch to a fairly low, firm pillow. Persistent clustered events may call for a soft cervical collar, but I wouldn't bother trying that at this point.

[masterpkpk]

Does this cluster look like Sleep wake junk or like real events? I think it will be a while before i can tell on my own.

[palerider]

It's a little too squished to tell for sure, and there's not enough "before" anything happened, and too much "after", ie the events in question should be over to the right of the chart, so that we can see more of what led up to them.

that said, it looks like there was some non-breathing related disturbance to the smooth breathing, and that resulted in a bit of restlessness, possibly movement, repositioning, before getting back to sleep.

[Pugsy]

I lean towards arousal related...I can see asleep breathing then the obvious arousal breathing and then the junk but I don't see asleep breathing until after the junk.

[masterpkpk]

I'm also feeling more exhausted than usual. Is there a worse before better period for some people? Thanks for all the help by the way ya'll.

[khauser]

I'm also feeling more exhausted than usual. Is there a worse before better period for some people? Thanks for all the help by the way ya'll.

Most definitely, depending on how well you adopt. Some people don't sleep so well at first (have to get used to machine, mask, new routine, etc). You were already sleep deprived so this doesn't help. But as you acclimate, you begin to sleep better and start to feel accordingly.

[zonker]

I'm also feeling more exhausted than usual. Is there a worse before better period for some people? Thanks for all the help by the way ya'll.

Most definitely, depending on how well you adopt. Some people don't sleep so well at first (have to get used to machine, mask, new routine, etc). You were already sleep deprived so this doesn't help. But as you acclimate, you begin to sleep better and start to feel accordingly.

+1

[masterpkpk]

Increased pressure to 7.2 last night and lowered per to 2. Got an ahi of 0.6! Feeling pretty well rested today, but unfortunately it appears that I ended up with some aerophagia. Pretty painful morning. I have a deviated septum that makes it pretty hard to breathe through my nose. Any advice on how to alleviate this? Epr back to 3? Lower minimum a bit?

[Pugsy]

Try going back to EPR of 3 first. See how the belly feels with that relief first.
If that doesn't do the trick then small reduction in pressure.

[masterpkpk]

Aerophagia seems to be a lot better after setting the epr back to normal. last night i was woken up by the pressure being at 20. I think thats the first time ive hit that. my 95% was also really high. does my minimum pressure need to be higher? It also seems like for a lot of these events i might be awake, but im not experienced enough to tell yet. thoughts?

[Pugsy]

It wants to go higher because of the Flow Limitations. Were you maybe on your back when the pressure went so high?

The 95% pressure number is where we were at OR BELOW for 95% of the night. That or below part is real important.

If you raise your minimum then that means a greater chance of belly issues from a more constant minimum pressure and I am not so sure that you need more minimum or if you do.... very much. I wouldn't do it just because of this one night though.

[masterpkpk]

Good to know about the 95% its definitely possible that i was on my back during those moments. Is there a way to deal with flow limitations? Try to sleep on my side more often?

[Pugsy]

It is common for OSA to worsen when we are on our backs....also when in REM stage sleep. From the timing of when your FLs increase and the pressure went up...you might also have some REM involvement.
So yes...we try to stay on our sides as much as possible when we see evidence of OSA being worse when on our backs.

Normally I just tell people to sleep in whatever position they sleep best in and let the machine sort it out but for people who have supine sleeping cause higher pressure needs and those higher pressure needs cause belly issues then we have to rethink things a bit.

Flow limitations are very early warning signs the airway is trying to collapse and the machine will try to increase the pressure in an effort to prevent further collapse. It's doing a good job in your case because we don't see full grown OAs or hyponeas in any great numbers real or not.
Your FLs aren't horrible. I have seen much worse on some reports. If it were me and I was having belly issues....I am not so sure I would go trying to kill the FLs with more minimum pressure. I would try side sleeping as much as possible first. Sometimes the belly issues from more constant pressure with a higher minimum ends up causing a bigger problem than the FLs (that aren't growing up to be OAs) are causing.

Now if your FLs are worse because of REM worsening OSA (which is what I have) not much you can do about limiting REM. We need REM anyway. Sometimes we just have to make a compromise and accept the fact that a few FLs will just have to happen so that we can avoid the aerophagia issues that can come with higher pressures.

You could try a little more minimum but just bear in mind that there may be a fine line where if you cross it the belly issues cause more of a problem than the FLs are causing. I don't normally have belly issues but I have had them twice in my time on cpap and it was ugly.
Made me sick the entire next day. Pain and nausea both. A lot more than just a little belching and farting. It was miserable and I don't think people should accept that result just to kill a few FLs that the machine wants to kill that aren't growing up to be full grown OAs or hyponeas.

Your choice...if last night was a one off rarity....I wouldn't do anything. If it becomes a habit I would first make an effort to stay off my back if at all possible. If that didn't work out then maybe a very small increase in the minimum and give myself a lot of time.
Pay no attention to the 95% pressure number...it's easily skewed to the high side by a relatively short period at higher numbers.
The median average is the one I pay the most attention to and as long as I can keep my minimum around 3 below that median average...I am good. That gives the machine time to respond as needed and we already know your OA and hyponea count is low so it's doing a good job there. The CAs/centrals we ignore. They may or may not be real but if even they are real we can't fix them with more pressure anyway. The machine isn't responding to them anyway. The machine only responds to obstructive related stuff...like the flow limitations or OAs or hyponeas.

[Pugsy]

I just saw where you posted in the thread where deviated septum was mentioned.
You know your FLs might be in part from your septum issues. No way to know for sure but the machine only measures air flow.
It can't do much about nasal restricted air flow...except think it is in the airway and needs to be fixed.
More pressure in the nasal area won't help FLs that are from a deviated septum. The machine will want to give it but it won't fix the problem. But it can sure make your belly issues worse while trying.

[masterpkpk]

hmm thats interesting. Thanks for taking the time to be so thorough with your responses! I do one day intend to get my septum dealt with, but for now I suppose I'll have to just give it more time and see how things change as I adjust to the machine/mask life.