New to the forum, wanted to share my Sleepy Head data

[cisne0224]

Hello everyone,
I have been a lurker on this forum for a few weeks and finally registered today. Have been using CPAP for almost three years now, have used it virtually every night. The first couple of months on CPAP were great, I had never woken up so refreshed in my life. Then for some reason, I began to not feel refreshed anymore. My AHI has always stayed below 5 yet I still feel very tired upon waking and I go through the day feeling sleepy, groggy, moody just feeling like I am sleep deprived.

I wanted to share my sleepy head data with you all, it would mean the world if someone could offer any insight into something I may be missing.

First attachment is from last night. I realize its fragmented, in the middle of the night I awoke for some reason and was able to resume sleep about an hour + later.

Second attachment: is a close up of my flow chart. This is what my flow chart has always looks like. I am concerned about the flat line that always happens right after expiration. Is this indicative of an airway collapse? if so how can I prevent, reduce these. Could this be indicative of UARS, flow limitation?

Third attachment: also my flow chart. I see this happen a lot as well mostly as I get deeper into the night. It just doesnt look like what a normal flow chart, curve should look like. Wanted to get your thoughts.

Hopefully I attached the images correctly, I have updated my signature and profile with my equipment.

Thanks,

[zonker]

welcome to the zoo!

please read the link below to find out how the experts here want to see your charts.

please note- i ain't one of the experts!

viewtopic/t158560/How-to-post-images-for-review.html

good luck!

[Pugsy]

Welcome to the forum.

I think you chose the wrong machine and humidifier in the profile equipment.

Your machine choice should be PR System One 60 Series Auto CPAP...except there is no longer a choice for that machine...so leave it blank and just put it in the comments section.

Humidifier choice should be PR System One 60 Series humidifier with heated tube (even if you aren't using the heated hose).
There is a choice for that in the equipment menu.

[cisne0224]

Updated my equipment on my profile and also followed the guidelines on graph image posting. Thank you for the help.

[Pugsy]

Any special reason the extremely tight auto/apap range of pressures?

Your pressure line on the full detailed image looks weird...do they all look like that?
Do you have night where the sleep was more solid and not fragmented with the stoppage in the middle of the night?
Is this a typical night for your in terms of when you go to sleep and get up the next morning?

Off hand without seeing more examples...looks like crappy sleep....the AHI isn't that bad but if you add to the AHI the FLs and the RERAs it all points to sub optimal therapy and crappy sleep.
Crappy sleep will give you crappy daytime feelings every day of the week.

[cisne0224]

Any special reason the extremely tight auto/apap range of pressures?

Your pressure line on the full detailed image looks weird...do they all look like that?
Do you have night where the sleep was more solid and not fragmented with the stoppage in the middle of the night?
Is this a typical night for your in terms of when you go to sleep and get up the next morning?

Off hand without seeing more examples...looks like crappy sleep....the AHI isn't that bad but if you add to the AHI the FLs and the RERAs it all points to sub optimal therapy and crappy sleep.
Crappy sleep will give you crappy daytime feelings every day of the week.

Pugsy,
Thank you for your input I appreciate it much. I have been feeling crappy for over 2 years now. My sleep doctor always says that everything is fine because my AHI is low. I have been doing quite a bit of research on this forum and I think I may have some things that I can point out to my sleep doctor when she gives me that justification.
Anyways, regarding your questions.

-Re tight auto/CPAP settings: I want to keep my minimum value around 9 to possibly treat UARS. I want to keep my max value no higher than 11 because anything higher and in the middle of the night I get the most painful burning sensation in my sinuses and soft palate. Not sure if its due to dryness or I just cant tolerate higher pressures. I do use both a humidifier on the machine and the heating tube both at their maximum settings.

-Mostly when I set my pressure to auto is when my pressure lines look like that.

-Yes almost all night I do sleep a full night. Below I have included graphs for the night before. You will notice that I have the settings at CPAP 8 pressure. I did this because the night before I have set it to auto on a 13 max pressure and I experienced that burning sensation.

-No, this is not a typical night for me. I usually go to bed around midnight and get up around 7. I have been averaging 7 hours of treatment for the last 3 years on cpap.

Let me know if you want to see more of my data history.

[Pugsy]

How many time do you think you might wake up during the night?
Take any medications even OTC? If so what?

We can't spot UARS on these graphs anywhere. The machine simply can't do that for us. I sure wish it could.

[cisne0224]

How many time do you think you might wake up during the night?
Take any medications even OTC? If so what?

We can't spot UARS on these graphs anywhere. The machine simply can't do that for us. I sure wish it could.

I wake up quite frequently each night but I quickly go back to sleep.
I dont take any prescribed medications at all. I take Afrin and Flonase every now and then. Not sure why but Afrin seems to help out in my therapy, however cant take it too often.


What do you see in my data for the full night. Is that also a crappy night? What cpap settings would you recommend to improve? What do you make of that flat line that occurs in my flow rate each time immediately after expiration?

[Pugsy]

I don't know that I would make anything of that little bit of a flat line that doesn't have a flag. If you are waking often maybe they are causing some arousals you may or may not remember and the arousals are messing with the necessary sleep architecture percentages in each stage and the progression into each stage so that the restorative powers of sleep can work their magic.

Have you considered doing the user custom control thing on SH so you can set SH to flag those flow reductions that don't earn a flag so you can see just how many of them.
Preferences...CPAP tab...lower left corner. It won't change the AHI but you can more easily spot flow reductions that don't meet the criteria for an event flag...
Criteria...certain amount of flow reduction that we can't easily spot with our eyes and at least 10 seconds in duration.
Even if you had a full 100% obstruction but the flow rate reduction only lasted 9 seconds...no flag.

You might also when you wake up during the night reach over and turn the machine off and then right back on again.
This will give you some markers when you know you were awake and any events happening close to one of those markers probably aren't real...
also will let you have an idea just how many times you are waking up.

This recent full night...not real exciting. One known wake up where the machine was turned off so we know at least one wake up.

If you want to use fixed pressures don't use cpap mode....instead used apap mode with the minimum and maximum equaling each other.
Flow Limitation flagging is turned off in cpap mode so we don't know if you had any Flow Limitations or not when in cpap mode.
Flow Limitation flagging is only available in apap/auto mode. So if you wanted to use cpap fixed at 8...do apap mode but set minimum to 8 and maximum to 8. You get fixed pressure but FL flags are turned on.

[cisne0224]

While doing some research on this forum re flow line charts someone mentioned that lines like these might be indicative of a collapsed airway? Tonight I will be turning off my Cflex to see if it helps any. Although I beleive I also read that on RemStars cflex should not be an issue because it stops the relief slightly before expiration is over?

I will also go in and set SH to flag those flow reductions for tonight.
Will also follow your recommendation on always using auto even if I want both pressure values to be equal.

I will post my results tomorrow morning.

What do you make of the burning sensation I describe? It really is a painful feeling, literraly like my upper airways are getting fryed. I was thinking of setting up a stand alone humidifier in my bedroom to add more moisture to the air. I see a lot of people here with pressures way above 12 who dont report this symptom.

on a side note, I did have my tonsils taken out a couple weeks ago, on 10/14/18, very painful recovery but I am at the point where I am desperate. I still have some swelling from the surgery so that can explain some of the issues I am having now.
I expect that the swelling should be gone in a week or two.
I have however had bad night sleep on a nightly basis for the last two to three years.

Below is my data from the night right before the surgery. Do you see anything here?

[cisne0224]

Looks like my attachment didnt come over. This is the data from the night before my tonsillectomy.

[Pugsy]

I have no idea what might be responsible for the burning sensations you are describing. The only time I have ever had any such sensation was when the nasal pillow got sort of sideways a bit in my nostril and for me right inside the nostril was the only place that I felt the burning. I repositioned the pillow and the burning immediately went away. And it didn't happen very often when it did occur.
Have you tried a different mask or a different size nasal cushion?

And definitely wait until you no longer have any swelling from the surgery before putting much worry into what you see on the reports.
Same goes for if you catch a cold or the flu. The least little swelling or illness can really mess up the data from the machine.

[cisne0224]

I have no idea what might be responsible for the burning sensations you are describing. The only time I have ever had any such sensation was when the nasal pillow got sort of sideways a bit in my nostril and for me right inside the nostril was the only place that I felt the burning. I repositioned the pillow and the burning immediately went away. And it didn't happen very often when it did occur.
Have you tried a different mask or a different size nasal cushion?

And definitely wait until you no longer have any swelling from the surgery before putting much worry into what you see on the reports.
Same goes for if you catch a cold or the flu. The least little swelling or illness can really mess up the data from the machine.

Pugsy,
I just thought, could this burning sensation be caused by GERD? I dont really exhibit any heartburn though, can probably even say I've never had it and Im 35. However there is silent GERD.
This could explain why I have so many flow limitations which are under 8 seconds (i added manual flags on SH as you recommented above). See screen shot below. I'm thinking GERD could be narrowing my airways decreasing air flow and causing me arousals to breathe "harder" to compensate.


See my data below from last night which includes manual flags for airway reductions of 30% or more and 50% or more of at least 8 seconds. If these were included in my AHI it would be well over 5.

Flag#2 is anytime my airflow decreased by more than 50% for at least 8 seconds. If Im comprehending this correctly this would take my AHI into the 20s?

A lot of my User Flags #2 do correlate with mask leaks though. I will try to fix the leaks tonight and see how it looks.