Quality of Sleep Question

[Brian_H]

I can wake up one morning and feel great, and then the next morning I feel like crap. All statistics from OSCAR are very similar, but the quality of my sleep is significantly different. Does anyone know which of the measured data displayed in Statistics in OSCAR has the most impact on your quality of sleep? I rate my quality of sleep on a scale of 1-10. I put all of the statistics into a spreadsheet next to my sleep scale to try and figure it out, but there doesn't seem to be any correlation. I also looked at my Flow Rate. Whenever I go to sleep the Flow Rate is Normal. Then after about 30 minutes it looks like the second graph for the rest of the night until just before I wake up in the morning.

What is the purpose of all of this data if none of it can be correlated to your quality of sleep? All the sleep docs worry about is the AHI, but there's more to it than that. Any suggestions?



I followed the instructions from Zonker for posting images but it doesn't seem to work.

https://imgur.com/PMMN30d

[Miss Emerita]

Welcome!

The first step toward better-quality sleep is to make sure sleep apnea is well-controlled, and the Oscar data are very helpful for people who aren't there yet. This is especially true given how little effort many sleep clinics make to fine-tune patients' settings.

How well-controlled is your apnea? What is your average AHI looking like, and what is your usual breakdown into OA, CA, H? Do you have a lot of flow limitations or snores? (I think there's a problem at Imgur's end, so it might be worth trying to link to your chart again later.)

One important datum is how long you are sleeping each night. Is it generally about the same?

Another is how many times you wake up. This is tricky, because we don't remember a number of the short arousals we experience during the night, and we may even not remember some of the longer periods of wakefulness. It is normal to wake up from time to time during the night, but frequent wake-ups can disrupt "sleep architecture" -- the succession of sleep stages we should cycle through around four or five times per night. These include light sleep, deep sleep, and REM sleep.

You can teach yourself to recognize arousals and wake-ups by zooming in on your flow rate and scrolling through the night. Arousals are marked by at least several successive breaths that are irregular and messy or ratty looking.

Finally, there are variables that affect the quality of sleep that you won't find in an Oscar chart. Examples include what you've had to eat and drink, or how quiet your room is.

Oh, and I wasn't sure about this: what do you mean by the "second graph"?

[Brian_H]

My Sleep Apnea is well controlled. My cmH2O was 4.2 - 8.6 for a long time. In the process of experimenting with settings, my cmH2O is now 4.6. Increasing the pressure made things worse. I even experimented with EPR. AHI is always less then 1.00. Total number of Events is almost always less than 10. I don't have a breakdown by event type, but I looked at about 2 weeks worth of data and the number and type of event varied but didn't correlate with sleep quality.

I usually sleep from 7.5 to 9 hours per night. Events are pretty obvious on the Flow Rate graph, but I don't know how to identify arousals or sleep cycles. I assume each bump on the Flow Rate is a breath. If I were to figure out how to identify arousals, then what? How do you prevent them from happening? I also monitor the other variables. I don't eat or drink for at least 5 to 6 hours before I go to bed. I live in the suburbs so my room is quiet (no TV either).

The second graph is the one in the link labeled "Night Time Flow Rate."

Thanks

[zonker]

I followed the instructions from Zonker for posting images but it doesn't seem to work.

well, that'll teach ya!


not sure what instructions so i don't know how i led you astray. in the end, though, we're only seeing one graph. if you'd like to try again, let me know what steps you're taking and i'll see where i can give you the correct steps.

[Brian_H]

Sorry for the confusion. I originally had 2 separate graphs (files) but then I combined them into just one graph (file) before attempting to post.

[ozij]

Any suggestions?

Please post OSCAR data as explained in the very first post on this forum.

It's the charts that teach us what is going on during the night, not the statistics.

If I were to figure out how to identify arousals, then what? How do you prevent them from happening? I also monitor the other variables.

You look at what is happening on the other charts at the same time.

[Brian_H]

Not sure what you're asking? Are you talking about the actual data from my spreadsheet? The Flow Rate Charts are linked in the original post. I'll post a link to the entire night.

https://imgur.com/YehaDH1

[Julie]

What you posted on Imgur is exactly the format wanted for a given night for people here to help interpret for you... no more, no less, but please don't do what a couple did recently and post 10 nights all at once! A couple, sure, but not more. And really an overview (few nites vs one or ten) is usually just as helpful.

[ozij]

Looking at the entire night I can say:
I get woken up by leaks far smaller than yours -- that's a sleep quality issue.
It's also possible that your sleep is disrupted by the flow limitation - sometime they're higher when the lead is higher. Try to track that on other nights
You write:

"My Sleep Apnea is well controlled. My cmH2O was 4.2 - 8.6 for a long time. In the process of experimenting with settings, my cmH2O is now 4.6. Increasing the pressure made things worse."

By "well controlled" are you referring to your AHI? Because your breathing pattern is far from nice and stable.
Which experiments made you decide on 4.6? And what do you mean by "made things worse"?

Information for you to keep in mind:
Flow limitations can disrupt sleep.
For some people, the changing pressures of Auto mode disrupt their sleep.
The "leak redline" only refers to the machine's functioning at higher leaks. It has nothing to do with how the leaks affect your sleep - that's a very individual thing, you may be sleeping bad because you are a person who can't sleep deeply and restfully through those leaks.

What did your sleep study say? Why were you prescribed a CPAP machine?

[Miss Emerita]

To answer your question about the flow rate graph: above the 0-line is inhalation, and below is exhalation. Often there will be a pause between an exhalation and the next inhalation; the flow-rate trace will be on the 0-line during the pause.

Zoom in and take a look at some of your flow limitations. You'll probably see an inhalation curve that is flat on top, or has a dent in it, or has a hump, or some combination of those features. This tells you that something was preventing a smooth inhalation. The limitation might be in your nose, or it might be further down in your pharynx. Do you have a stuffy nose?

Ozij has mentioned that flow limitations can be disruptive to sleep. That's because they can make you work harder to inhale, which can prevent you from sleeping peacefully. Are you seeing any correlations between good nights and lower FLs?

[Brian_H]

Background information: I have been using CPAP for over 25 years. My initial sleep study prescribed 10 cm H2O pressure. I was on that for a long time and always complained to my sleep doc that I still didn't feel rested. Of course her answer was basically your AHI is really good so you're being treated. Then I got an Auto Sense CPAP and they set it to 10-12 cm H20 and I was on that for a long time. Still didn't feel like I slept well. At some point I was given another overnight sleep study, and then a few years later I was given a home sleep study and that confirmed my pressure requirement. Then a couple years ago I changed my diet and lost over 50 lbs and that pressure got very uncomfortable. So the doc changed my pressure to 6-12 cm H2O. That was around the time I discovered OSCAR and noticed that my pressure rarely went above 8.4. So I changed settings to 4.2-8.4 cm H2O. I still didn't feel any better. I just looked at some of the Flow Chart graphs for that setting and they're pretty ugly. But the Leak Rate graphs look pretty good.

Maybe I need to try a new mask. Right now I use Resmed Swift FX Nasal Pillows and tape my mouth. So I'm pretty certain that the leaks aren't coming from my mouth. On the night of the screen shot I felt pretty good the next morning. But, on the day before the leak rate was very similar but I felt much less rested.

By "well controlled" I mean AHI, Total Events, and Sleep Quality. I know that even people without sleep apnea experience events during sleep, just not as many. Prior to this experimentation I was on 4.2 - 8.4 cmH2O (Auto Mode) for a long time and felt just "okay" in the mornings. From what I've read my Flow Rate Charts indicate some sort of flow limitation. So I tried increasing the pressure to see if it would improve my breathing. I tried pressures as high as 11 cmH2O (CPAP) and different EPR settings. Higher pressures made me really feel like crap in the morning. So I gradually lowered the pressure along with different EPR settings. Between 7 and 8 cmH2O with EPR=1, I felt just okay. Between 6 and 7 cm H2O with EPR=1 I felt pretty good most days. Between 5.2 and 6.0 cm H2O with EPR=1 I felt pretty good most days. At 4.6 cm H2O I felt pretty good most days. It doesn't matter what pressure I set to, the AHI, number of events, and the leak rate are pretty much the same. But my sleep quality is not consistent. So 4.6 cm H2O is almost the same as higher pressures so why use a higher pressure if you get the similar results from lower pressure?

[ozij]

At 4.6 cm H2O I felt pretty good most days.

I'd try to set the pressure where I feel good, and there are less flow limitations, or at least, the flow limitations are stable.
As we all know, some sleep problems are not necessarily caused by disrupted breathing. And, unfortunately for us when looking for cause and effect, we can't always tell if it's wakefulness disrupting the breathing you shou see when you sleep, or sleep causing breathing interruptions. I wish I could say something more helpful...

[Brian_H]

Thanks. I'm going to try a new mask and see if that makes a difference, and then go from there.

[Miss Emerita]

For what it's worth, EPR is the "go-to" setting to help with flow limitations. Don't be afraid to try an EPR of 3. Be aware that you won't get its full benefits if your pressure is less than 7. That's because an EPR of 3 drops your pressure by 3, and 4 is the lowest the machine can go.

[chunkyfrog]

Apnea is only one factor affecting sleep quality.
Many of us realize within a short time of starting cpap that we also need a new mattress.
Who knew?