One Month Later...

[Sunnymuffins]

Just over 1 month into therapy, and I had my follow up with the sleep doctor this morning. I've been 100% compliant since starting, and he's happy with my progress. AHI is averaging right around 5, though the last 2 consecutive nights have seen the best numbers ever (2.5 and 2.6). I haven't uploaded the new data to Sleepyhead in a couple weeks though, so I still need to do that and review. I was able to get a copy of my sleep study results though and found some interesting info:

552.4 minutes total study time
371 total apneas/hypoapneas
40.3 AHI overall
-- 41 AHI for supine position
-- 69.5 AHI for nonsupine position (left side for 9.5 minutes)
-- 33.3 AHI for nonsupine position (right side for 72 minutes)
72% lowest SpO2
60.4% snore rate

Everything I've seen/read seems to indicate that sleeping on one's back generally causes higher numbers. I know everyone is different, but does the info recorded in the HST seem plausible, or could it just be a one-off situation? Has anyone else had higher numbers in a nonsupine position?

Also the HST didn't mention anything about REM vs non-REM sleep. I'm guessing the only way to know if REM sleep requires more pressure is via a full in-lab PSG?

[Julie]

You can look into REM through Sleepyhead... someone more familiar with how should show up soon. And I can't explain the positional stuff, but maybe someone else can.

[Pugsy]

It's plausible that your OSA is worse on one side and not another or even when supine. It's possible that the home sleep study caught a fluke on off night.
It's possible that when on your side that you had more REM sleep when might have made the OSA worse and that maybe you just spent more time on your side to increase the chances of more OSA period.

Lots of possibilities and plausibles and yes, the only way to know if REM events might need more pressure is with a sleep study in a lab and even then it's a one off night where needed data might not be available if you didn't get enough REM to accurate test the pressures.
I had it happen to me and I had in lab sleep studies both for the diagnostic portion and the titration portion.

Other than satisfying a curiosity itch there's not all that much to be gained by knowing for sure anyway.

Sometimes we can get a decent idea about REM and pressure needs by watching the pressure graph respond through the night from the software data available from a machine using auto adjusting (apap) pressures...sometimes we can't.
My OSA was documented 5 times worse in REM (supine vs side sleeping was no real difference) and sometimes I can see probable REM cycles by the change in pressure and sometimes I can't. When the pressure is sub optimal they are fairly easy to spot though because of the clustering of apnea events during what would be normally a REM cycle.
If you google "sleep stages" and look at the normal hypnograms you can see when REM normally occurs and get an idea where your REM cycles might be if you look at the data your machine gathers (assuming your machine offers the data).
It's not perfect but it will get you pretty close in your estimations of REM cycles happening.

[Sunnymuffins]

Lots of possibilities and plausibles and yes, the only way to know if REM events might need more pressure is with a sleep study in a lab and even then it's a one off night where needed data might not be available if you didn't get enough REM to accurate test the pressures.
I had it happen to me and I had in lab sleep studies both for the diagnostic portion and the titration portion.

Other than satisfying a curiosity itch there's not all that much to be gained by knowing for sure anyway.

Sometimes we can get a decent idea about REM and pressure needs by watching the pressure graph respond through the night from the software data available from a machine using auto adjusting (apap) pressures...sometimes we can't.

Endless possibilities ftw LOL!!

I've always had a curious personality--love to learn! If I could be a full-time student and not have to work, I think I'd be in heaven. I used to get on teachers' nerves because I'd always be the one asking "why?" even after they thought they'd sufficiently explained something (just not to my satisfaction). I'll definitely take a look at my data a little closer in the next few days and see if I can pinpoint any instances of what looks to be REM and the corresponding data, if nothing more than to try and satisfy my own curiosity.

Thanks as always for the info!

[Pugsy]

I will dig around and see if I can find a good example of REM and pressure changes.
I used to have a lot of them but they are over in Photobucket and being held for ransom so I can't link to them like I used to and I haven't had time to move them over to imgur yet.

Let me see what I can find.

[Pugsy]

Here's one sort of example. Main pressure increase in the wee hours of the morning where we have more REM.
It's the only image that I seem to have handy.

[Sunnymuffins]

Thanks--I'm not really seeing anything like that in mine. My higher spikes lately seem to be more towards the middle, but on the earlier half of the night. I guess it'll remain one of my great unsolved mysteries for now lol. On a side note, the last 3 nights have been my best ever, so maybe I'm hopefully, finally full adjusted. Hoping it stays like that or drops even a little more!

[Pugsy]

I used to see my biggest spikes in pressure about 90 minutes after sleep onset which is about when the first REM cycle would happen.
I tried to find a good example of one of those but couldn't. I used to call it my witching hour. Most of those old reports are on a long since dead computer.

[Sunnymuffins]

Witching hour--I like it! Maybe I'll start telling people that's when the aliens abduct me LOL! Omg, maybe they ARE!

[aspen]

I have awful apnea when sleeping on left side. I do have a chronic condition that contributes, however. But yes, if I could stay on my back all night my AHI would be substantially lower, which is somewhat odd.