Newbie Self Diagnosis - In Denial - AHI Question

[Pugsy]

Sleep maintenance insomnia...what you have when you can't stay asleep...can be caused by a long list of suspects and sleep disordered breathing is but one item on that list.
I had a particularly bad case of it last night myself. Pain issues again....weather change and a front moved in and I tossed and turned all night long because I just couldn't get comfortable. Looked at my flow rate...looks like about 15 arousals in a 6 hour period. Half of them I probably remember.

We need to get you to sleeping more soundly...less wake ups but you need to try to figure out what is causing them.
A problem can't be fixed until you know what is causing the problem.

Can you get me a new screen shot of last night...and include the Flow Limitation graph...let's look and see if there's anything there that might be a factor in your wake ups. Make sure pressure graph and flow limitation graph show up...need to see what the pressure is doing at the time of any FLs.
Do hide the calendar and turn off the pie chart because I also what to see the statistics that are hidden right now.

Maybe your wake ups are because therapy is not yet optimal...maybe not but lets look to make sure.
There's more than AHI involved in good sleep or therapy.

[marktheshark]

Sleep maintenance insomnia...what you have when you can't stay asleep...can be caused by a long list of suspects and sleep disordered breathing is but one item on that list.
I had a particularly bad case of it last night myself. Pain issues again....weather change and a front moved in and I tossed and turned all night long because I just couldn't get comfortable. Looked at my flow rate...looks like about 15 arousals in a 6 hour period. Half of them I probably remember.

We need to get you to sleeping more soundly...less wake ups but you need to try to figure out what is causing them.
A problem can't be fixed until you know what is causing the problem.

Can you get me a new screen shot of last night...and include the Flow Limitation graph...let's look and see if there's anything there that might be a factor in your wake ups. Make sure pressure graph and flow limitation graph show up...need to see what the pressure is doing at the time of any FLs.
Do hide the calendar and turn off the pie chart because I also what to see the statistics that are hidden right now.

Maybe your wake ups are because therapy is not yet optimal...maybe not but lets look to make sure.
There's more than AHI involved in good sleep or therapy.

You mentioned insomnia, that's really what brought me here, I dealt with 2-3 years of very stressful time with my wife's health and I dealt with sever insomnia for that time frame, things are much better now but I can't get out of the sleep rut.

How's this?

[Pugsy]

That's better, thank you.

It's easy to see what is driving the pressures for the most part...see the correlation between the activity on the FL graph and the pressure increases?

You are still having some flow limitations and they may or may not be a factor in the wake ups.

Are you having any nasal congestion? Sometimes the machine will mistake nasal flow reduction because of congestion with airway OSA flow reductions and try to increase the pressure in an effort to reduce the FLs....only if it is nasal congestion it won't work so great.

How to fix flow limitations that aren't nasal in origin...more minimum pressure.
Will it help your fragmented sleep issues...unknown but it might and is of course worth trying.

[marktheshark]

That's better, thank you.

It's easy to see what is driving the pressures for the most part...see the correlation between the activity on the FL graph and the pressure increases?

You are still having some flow limitations and they may or may not be a factor in the wake ups.

Are you having any nasal congestion? Sometimes the machine will mistake nasal flow reduction because of congestion with airway OSA flow reductions and try to increase the pressure in an effort to reduce the FLs....only if it is nasal congestion it won't work so great.

How to fix flow limitations that aren't nasal in origin...more minimum pressure.
Will it help your fragmented sleep issues...unknown but it might and is of course worth trying.

Yes, I have sinus problems at night, I forgot to mention I use sinus spray nightly before bed which helps keeps me open. I bad habbit I need to kick.

[Pugsy]

Afrin or similar habit?
Try using it on one nostril for a few nights and let the other side heal up and not be dependent on chemicals....once it is free from dependency then do the other nostril.

In the meantime use LOTS of something like Simply Saline. All day and at night. Will help the nasal mucosa get back to a non dependent on chemical state.

Been there and done that Afrin rebound thing. It's not pleasant to kick that habit.

[marktheshark]

Afrin or similar habit?
Try using it on one nostril for a few nights and let the other side heal up and not be dependent on chemicals....once it is free from dependency then do the other nostril.

In the meantime use LOTS of something like Simply Saline. All day and at night. Will help the nasal mucosa get back to a non dependent on chemical state.

Been there and done that Afrin rebound thing. It's not pleasant to kick that habit.

You are correct, it's one of those names and I get rebound during the day almost daily but I know I have to stop, will try what you said

[Pugsy]

You might also try adding Flonase/Nasacort (or whatever it is called now that it is OTC). It will help get things back in balance but there's no dependency effect with using it. It won't immediately clear or reduce the swelling like Afrin does...so don't expect that kind of result.
Added in with lots of simply saline and even oral decongestants and doing the one side at a time thing...it can make the withdrawal a bit less ugly and go faster.

[marktheshark]

That's better, thank you.

It's easy to see what is driving the pressures for the most part...see the correlation between the activity on the FL graph and the pressure increases?

Can you explain this part more? Not sure what that means I guess.

[marktheshark]

That's better, thank you.

It's easy to see what is driving the pressures for the most part...see the correlation between the activity on the FL graph and the pressure increases?

Can you explain this part more? Not sure what that means I guess.

Here is Tuesday night, I wanted to find another night with Flow data.

[marktheshark]

And here is a recent might I had it set fixed at 9.6 pressure.

[Pugsy]

Flow Limitations are part of what the auto adjusting algorithm will try to kill with more pressure.
They will drive the pressure upwards even if those FLs don't grow up enough to earn the OA or hyponea flag.
They can disturb sleep...cause arousals that a person may or may not remember and frequent arousals or awakenings will trash sleep quality or architecture and lessen the effectiveness of the restorative powers of sleep working their magic because the sleep architecture isn't as good as it needs to be.

Are those FLs causing the wake ups....maybe.

[marktheshark]

Flow Limitations are part of what the auto adjusting algorithm will try to kill with more pressure.
They will drive the pressure upwards even if those FLs don't grow up enough to earn the OA or hyponea flag.
They can disturb sleep...cause arousals that a person may or may not remember and frequent arousals or awakenings will trash sleep quality or architecture and lessen the effectiveness of the restorative powers of sleep working their magic because the sleep architecture isn't as good as it needs to be.

Are those FLs causing the wake ups....maybe.

Got it, I still have the EPR set at 1, think that matters in this area?

Also, the Flow Limitations are also telling a story about limited flow, as in another thing for me to recognize in being a part of some sort of sleep apnea?

[Pugsy]

There's a video somewhere (I don't have it handy) that explains how Flow Limitations can impact our sleep and they can be a part of the whole sleep disordered breathing thing.
There's so much more to it than just AHI.

Using EPR reduces EPAP (exhale pressure) during exhale and allows a little drop in pressure and sometimes that little drop allows the airway to try to collapse. Might not collapse to the point of earning the OA/hyponea flag but it might collapse enough to disturb sleep.
It can happen when someone is at the minimum needed to hold the airway open and that little drop using EPR allows the airway to try to collapse. Not always...but sometimes...it all depends on where the line is in terms of above the line the airway stays open and below it it can try to collapse. Not everyone will be using the bare minimum to have it happen.
If you like EPR...use it...just increase your minimum to offset that little drop.

All this is assuming it's the airway that is collapsing that we are seeing on those FL graphs and not nasal congestion.

See if this video helps clear up things.
https://www.youtube.com/watch?v=-gie2dhqP2c

[marktheshark]

There's a video somewhere (I don't have it handy) that explains how Flow Limitations can impact our sleep and they can be a part of the whole sleep disordered breathing thing.
There's so much more to it than just AHI.

Using EPR reduces EPAP (exhale pressure) during exhale and allows a little drop in pressure and sometimes that little drop allows the airway to try to collapse. Might not collapse to the point of earning the OA/hyponea flag but it might collapse enough to disturb sleep.
It can happen when someone is at the minimum needed to hold the airway open and that little drop using EPR allows the airway to try to collapse. Not always...but sometimes...it all depends on where the line is in terms of above the line the airway stays open and below it it can try to collapse. Not everyone will be using the bare minimum to have it happen.
If you like EPR...use it...just increase your minimum to offset that little drop.

All this is assuming it's the airway that is collapsing that we are seeing on those FL graphs and not nasal congestion.

See if this video helps clear up things.
https://www.youtube.com/watch?v=-gie2dhqP2c

Makes sense. Thank you again for all your help, and everyone else here that has chimed in.

I will continue to tweak things and work on the sinus alternatives.

[palerider]

There's a video somewhere (I don't have it handy) that explains how Flow Limitations can impact our sleep and they can be a part of the whole sleep disordered breathing thing.
There's so much more to it than just AHI.

Using EPR reduces EPAP (exhale pressure) during exhale and allows a little drop in pressure and sometimes that little drop allows the airway to try to collapse. Might not collapse to the point of earning the OA/hyponea flag but it might collapse enough to disturb sleep.
It can happen when someone is at the minimum needed to hold the airway open and that little drop using EPR allows the airway to try to collapse. Not always...but sometimes...it all depends on where the line is in terms of above the line the airway stays open and below it it can try to collapse. Not everyone will be using the bare minimum to have it happen.
If you like EPR...use it...just increase your minimum to offset that little drop.

All this is assuming it's the airway that is collapsing that we are seeing on those FL graphs and not nasal congestion.

See if this video helps clear up things.
https://www.youtube.com/watch?v=-gie2dhqP2c

Makes sense. Thank you again for all your help, and everyone else here that has chimed in.

I will continue to tweak things and work on the sinus alternatives.

For what it's worth, I second what Pugsy's saying.. more pressure typically helps resolve flow limitations, and FL's are basically like breathing through a straw... you can take a full breath, you just have to work harder for it, and that results in less rest.

to understand them better: https://www.youtube.com/watch?v=-gie2dhqP2c