Help! I am not sure my therapy is working

[Beeckbeck]

Hello All,

Pleasant day. I am going on six months now on CPAP and a major crucial symptom still persist: Nightly rapid heart rate waking me almost hourly. The rapid heart rate was what led to my diagnosis with UARS. I was experiencing other symptoms such as insomnia which is a little better but the heart is not slowing down and I am still not getting consistent undisturbed sleep.

I tried some self titration by gradually adjusting the minimum pressure from the preset 5 up to 6, even went 7 one night but had to reduce it some time during the night. My lungs and stomach felt like a balloon. None of these settings worked.

I also need help interpreting my OSCAR data. According to the sleep doctor the rapid heart rate and frequent arousals are due to reduced oxygen level caused by flow limitation (FL) as a result of narrowing of the air passage. He assured me that CPAP will correct the problem by keeping the airway open. Now looking at the data I assume flow limitation can be seen on the flow rate graph. Can someone explain how to interpret this please. I also noticed a trend on the pressure graph; my arousals occur when the pressure is rising.

I also noticed that when I have these arousals there are no flags. My sleep study said my AHI was 11.8 but since being on CPAP my AHI has passed 4 only three times.

For an example, the images below, for your scrutiny, shows a screen shot, a 10 minute flow rate graph and a 1.5 minute flow rate graph, which shows what happen minutes before I awoke at 01:23. In the 10 minutes graph the shape at 01:17 is close to zero and different from that at 01:20. '01:20' appears to look like when I am awake but I was definitely asleep and dreaming. In the 1.5 minutes graph which shows more details at 01:17, I am wondering if this is the point of FL.

Also, in threads here I am seeing where it was suggested on many occasions that the Resmed Aircure 10 Vauto is more suited for UARS that the AirSense 10. Any comments?
Thanks a lot.

[Beeckbeck]

Sorry I intended to show this view.

[Pugsy]

Can you include the flow limitation graph in the big non zoomed in detailed nightly report? I suspect if we see it we will see why the pressure goes up and we don't see much of anything else being flagged. Flow limitations are early signs the airway is trying to collapse. They might not grow up to be full grown apneas but they can still disturb sleep and the machine's auto algorithm will increase the pressure just for FLs even if not many OAs or hyponeas are present.

What is your EPR set at? from the statistics it looks like set to 1 but from the graph it looks like set to more than 1.

Are those leaks waking you up?

Are you still waking often during the night?

Do you take any medications of any kind? If so, what?

Unfortunately more pressure can cause belly issues in a lot of people. It's called aerophagia
wiki/index.php/Aerophagia
It sucks because we might need more pressure to deal with airway issues and more pressure can cause belly issues which in turn can mess with our sleep and make us feel like crap. Damned if we do and damned if we don't kind of thing.

The zoomed in sections do seem to point to some flow limitations happening. The breaths don't look like normal rounded breaths.
We could maybe try more EPR and see if it helps both the breath shapes and the aerophagia issues.

[Miss Emerita]

Just to add to Pugsy's post: to benefit from EPR of 3, you will need to set your minimum to 7, since 4 is the lowest pressure the machine can generate.

[Beeckbeck]

Hi Pugsy,

Please see graphs below.
The EPR is currently set at 3. I also tried 2 to see if I could see a charge but no.
The leaks do not affect me. I do wake up often during the nights. The fist half I would sleep through and then phase in and out frequently with palpitations.
I am not on any medications at this time. I was taking zopiclone in June.

[chunkyfrog]

Have you seen a cardiologist?
I would be concerned the heart rate is not being corrected by cpap.
Medicine is so specialized that mistakes can be made . . .
You don't want to be the example.

[Pugsy]

Don't assume that because you don't remember being awake that you didn't have some sort of arousal. The 01:20 flow rate...that's arousal breathing. You maybe were half asleep briefly and just didn't form a memory of the arousal. If we dream...we don't remember them unless we wake up during or immediately after. So remembering dreaming means waking up and that's not a good thing.
Now why the arousal....million dollar question.

EPR at 3 but starting pressure minimum is 5.4 so you aren't getting the full benefit of EPR until you hit 7 cm and that's why the pressure graphs look a bit weird. You barely maxed out at a little over 8 cm. Most of the night is spent well below.

Unfortunately you already have found out that more pressure minimum creates belly problems for you.

Have you had one of those heart monitor things that record heart rate for 24 hours or whatever the parameters are?
Holter monitor or similar?

If this UARS that is the problem you probably need more minimum pressure but more minimum may create the belly issue problem.
At this point I don't know if the auto bilevel is the next step or not. If you can't tolerate 7 inhale and 4 exhale then it is doubtful that the setting options on the bilevel to maybe help with UARS is going to be tolerable from the belly aspect.

[Beeckbeck]

...we don't remember them unless we wake up during or immediately after... Intresting fact. didn't know that.
Have you seen a cardiologist? Yes and Pugsy I did wear a holter monitor and also did two ECGs with my GP before going to the Pulmonologist. All was normal.
I ride bicycle almost every day and I still do sports sometimes (badminton and table tennis) and I don't have an issue to suspect heart problem.

So I am not getting the benefit of EPR. Since I cannot tolerate a min of 7, should I turn off EPR (never tried that before) or set min to 6 and EPR to 2? Pugsy / Miss Emerita your take?

The 01:20 flow rate...that's arousal breathing Thanks for that information. The spikes on the flow limit graph, are those the times when the airway tend to close?

[Pugsy]

Are you experiencing any nasal congestion?
Sometimes nasal congestion will show up as an increase in the flow limitation graph. When that happens the answer isn't more pressure but instead to address the nasal congestion in the normal nasal congestion reduction ways.

[Beeckbeck]

Hi,

Yes I do have nasal congestions but I have treatment for it. At some point I was also wondering of the nasal congestion was a problem but now that I am treating it I have ruled that out,

[Pugsy]

When you get a chance edit your equipment profile. You have the wrong machine chosen....probably because you couldn't see your model up in the AirSense choices.
Look down in the R section...your AutoSet is down in the R's.

[chunkyfrog]

Since a heart problem has been "ruled out", I suspect anxiety.
After six months, most have gotten comfortable with cpap, but you might need help.
Also, leaving the lowest setting at only 4 would give me panic attacks every night,
due to insufficient airflow.
Get the manual, and fix that sucker!

[Beeckbeck]

I hardly think anxiety. Can anxiety be triggered while one sleeps? I remember awaking from some scary dreams but even when I had pleasant dreams I still get rapid beats.
I am in the process of purchasing the Contec oximeter to do and oxygen pule comparison.

...probably because you couldn't see your model up in the AirSense choices That was definitely the case

[ChicagoGranny]

Can anxiety be triggered while one sleeps?

Sleep apnea (sleep-disordered breathing) is a major cause of anxiety. Some reading for you - https://doctorstevenpark.com/?s=anxiety&submit=Search