Strange snoring issue

[palerider]

Here is the OSCAR data from the moment I first went to bed up to the first group of hypopneas.

https://www.dropbox.com/s/cggdxyt0wlcs1 ... 3.png?dl=0

You were certainly moving into what the machine registered as snoring and flow limitations, Without zooming in and looking at individual breath shapes, all we can do is trust the machine's interpretation of the airflow.

[palerider]

The highest I've set my min pressure to was 7 a few nights ago. I had a decent AHI but I know that doesn't tell the whole story. Should I set my pressure to 10 or should I go from 4 to 10 over the course of a few days?

If you can fall asleep with a min of 10, then go for it, If it gives you trouble, then you can use the ramp to start at a lower pressure (6? 7?) and let it ramp up to 10.

The only reason to spend days raising the pressure if you can't get to sleep initially with the pressure, but all that does is delay your getting to where your airway stays open.

[ChicagoGranny]

Here is the link to my OSCAR data for the first group of hypopneas. Hope it works. I was in bed at 21:42.


https://www.dropbox.com/s/8nweoezhutiti ... 4.png?dl=0

Can you post the entire night?

[davewalsh]

If you can fall asleep with a min of 10, then go for it, If it gives you trouble, then you can use the ramp to start at a lower pressure (6? 7?) and let it ramp up to 10.

My understanding of the Autoset 10 is that I can have it ramp up from min to max, but not from 6 or 7 to 10, and from there to a max of 20. Are you saying that 10 should be my max, or that 20 should still be my max and that 10 should be my min?

[davewalsh]

Can you post the entire night?

I can, but will it be readable by you?

[ChicagoGranny]

20 should still be my max and that 10 should be my min?

Minimum 10.0/maximum 20.0. The machine will go no higher than it senses it needs to. From what I see so far, I don't think your needs will be above 15.0 pressure. The machine is unlikely to raise the pressure to near 20.0.

A comment on definitions, ramp is different from min/max pressures. Ramp allows the starting pressure to be set very low and slowly rise to the min pressure. For example, you could set your ramp pressure to 7.0 and ramp time to 10 minutes. The machine would slowly increase to the min pressure over 10 minutes. After that, the machine will not go below the min pressure the rest of the night unless you turn the machine off and back on again. Then it resets to the ramp pressure of 7.0. Some people like to use ramp to fall asleep at a lower pressure. Many don't use ramp.

I can, but will it be readable by you?

Don't know/could be. I'm more used to seeing screenshots posted on imgur.com.

[davewalsh]

A comment on definitions, ramp is different from min/max pressures. Ramp allows the starting pressure to be set very low and slowly rise to the min pressure. For example, you could set your ramp pressure to 7.0 and ramp time to 10 minutes. The machine would slowly increase to the min pressure over 10 minutes. After that, the machine will not go below the min pressure the rest of the night unless you turn the machine off and back on again. Then it resets to the ramp pressure of 7.0. Some people like to use ramp to fall asleep at a lower pressure. Many don't use ramp.

Got it. Thanks. Here's the link to the whole shootin' match. https://www.dropbox.com/s/qvju8jfnfgqvo ... 4.png?dl=0

[palerider]

If you can fall asleep with a min of 10, then go for it, If it gives you trouble, then you can use the ramp to start at a lower pressure (6? 7?) and let it ramp up to 10.

My understanding of the Autoset 10 is that I can have it ramp up from min to max, but not from 6 or 7 to 10, and from there to a max of 20. Are you saying that 10 should be my max, or that 20 should still be my max and that 10 should be my min?

I'm saying your Min should be 10, your max 20, and your ramp whatever you need.

You can set the ramp start pressure anywhere from 4 to your min pressure, and the time anywhere from 5 to 45 minutes or 'auto' where it will increase pressure when it thinks you're asleep based on breath shapes.

Note, when I say "ramp" I mean the RAMP setting, not the normal operating min/max. (check the manual)

[davewalsh]

I'm saying your Min should be 10, your max 20, and your ramp whatever you need.

You can set the ramp start pressure anywhere from 4 to your min pressure, and the time anywhere from 5 to 45 minutes or 'auto' where it will increase pressure when it thinks you're asleep based on breath shapes.

Note, when I say "ramp" I mean the RAMP setting, not the normal operating min/max. (check the manual)

Thanks for the clarification, and my thanks to you and everyone else who has responded for being my Resmed 101 instructors.

Any suggestions for EPR? On? Off? Level?

[ChicagoGranny]

As a first step, I would change the settings to min 8.0/max 20.0. Leave EPR on at 3. After a night of this, post the full night chart.

Which position do you start out sleeping in? Any changes in position during the night?

Ramp setting - your preference. After getting accustomed to CPAP, many of us no longer use ramp.

[davewalsh]

As a first step, I would change the settings to min 8.0/max 20.0. Leave EPR on at 3. After a night of this, post the full night chart.

Will do.

Which position do you start out sleeping in? Any changes in position during the night?

I start on my left, and for those times that I can remember waking up during the night I am on my back. I can't stay that way for very long without feeling uncomfortable, so I usually turn over on my right side. For the reset of the night it's probably some variation of the above.

Ramp setting - your preference. After getting accustomed to CPAP, many of us no longer use ramp.

I've been on CPAP since 2017. I'll see what tonight brings me and decide about EPR based on that.

What's been bugging me is why has this suddenly started happening when I never experienced this before? The problem solving part of me wants to analyze and come up with a solution. The pragmatic part of me realizes that that may not be possible.

[palerider]

Any suggestions for EPR? On? Off? Level?

The important thing to understand about EPR is that it *lowers* your pressure between inhalations, and it's that pressure between inhalations that keeps your airway open so that you can take another breath.

For each number you set EPR to, it reduces your pressure by 1cmH₂O, and if you get the pressure below the level of pressure you need to alleviate breathing problems, you'll have more things disturbing your sleep.

So, the pressure that suggested took your current EPR settings into consideration, if you lower your EPR, you're effectively raising your pressure, which may have an effect on your sleep and AHI... but the best thing to do is keep all that in mind, and experiment... make *one* change, and wait a few days, because your sleep isn't the same every night, when you're 'fine tuning' you have to work on averages.

[davewalsh]

Here is the link to my OSCAR data from last night. What does the brain trust think?

https://www.dropbox.com/s/cmbkg6y3odn1q ... 1.png?dl=0

[ChicagoGranny]

Here is the link to my OSCAR data from last night. What does the brain trust think?

https://www.dropbox.com/s/cmbkg6y3odn1q ... 1.png?dl=0

The brain trust is currently logged off, so here is my opinion.

That's a fairly good night. Very good leak line. The clear airway apneas near your wakeup time were most likely apneas happening during the transition of drifting in and out of sleep - nothing to be concerned about. Subtract those out and your AHI is acceptable.

Look at the marked (blue) events just before 1:00 p.m. Notice the flow limitation line increases. The machine raises the pressure to compensate. Around two-ish the flow limitations decrease and the machine lowers the pressure. I'm wondering whether you rolled onto your back about 1:00 a.m. and stayed there for an hour. OSA is often more severe when sleeping on the back where gravity has a direct pull on the tongue and soft palate - directly toward the airway.

At the end of the day, make a note of how you felt during the day. Energetic? Any excess sleepiness?

Raising the min pressure to better handle the back-sleeping periods is not out of the question. You don't seem to have objections to higher pressures. If it were me, I would raise it to 10.0.

[ChicagoGranny]

BTW, OSCAR: you can click on the Events tab for a list of each event and the length of the event. If you click on any event, your line graphs will zoom in on the event.