Newbie Self Diagnosis - In Denial - AHI Question

[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.

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

Thanks for your input. That video is very informative! Felt like I was watching myself there for a minute.

[ChicagoGranny]

marktheshark

Afrin (active ingredient oxymetazoline) causes trouble with sleep in many people. (It bothers Gramps and me.) It could be causing your frequent awakenings. Also, be very careful about caffeine.

Afrin

If experienced, these tend to have a Severe expression:

Chronic Trouble Sleeping

https://www.webmd.com/drugs/2/drug-1230 ... ideeffects

[marktheshark]

marktheshark

Afrin (active ingredient oxymetazoline) causes trouble with sleep in many people. (It bothers Gramps and me.) It could be causing your frequent awakenings. Also, be very careful about caffeine.

Afrin

If experienced, these tend to have a Severe expression:

Chronic Trouble Sleeping

https://www.webmd.com/drugs/2/drug-1230 ... ideeffects

Thank you for sharing!

[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.

One thing I wanted to ask you about sinuses and flow limitations, wouldn't that NOT be the cause of the flow limits if the nasal spray makes me incredibly clear all night long?

[Pugsy]

One thing I wanted to ask you about sinuses and flow limitations, wouldn't that NOT be the cause of the flow limits if the nasal spray makes me incredibly clear all night long?

Correct...if using the spray keeps the nose open all night then nasal congestion isn't the cause of any FLs you see.

[marktheshark]

One thing I wanted to ask you about sinuses and flow limitations, wouldn't that NOT be the cause of the flow limits if the nasal spray makes me incredibly clear all night long?

Correct...if using the spray keeps the nose open all night then nasal congestion isn't the cause of any FLs you see.

Got it. So I have looked back thru the data for the last 60 days, and every night is filled with FLs from start to finish. The only real change I notice in the data is when I went from an EPR setting of 3 to 1, the Clear Airways dropped down to almost none and my AHI is always at or below 1.0. My instincts make me feel like those FLs are my problem because I can't say I have ever dealt with full on apneas with gasping etc. I came into this thinking if I have a problem, its more mild in terms of what happens to me at night but still having horrible daytime tiredness issues. I've read quite a bit about UARS, and now I'm really wondering if that's more in line with what I am dealing with. I also noticed I've become very sensitive to my pillow getting worn out, I found a cheap pillow that works, but as soon as it starts getting flat I know my sleep is getting worse and worse and I have to go to the store and replace it. So I've become sensitive to the pillow being flat as well as my positions that I'm sleeping in seem to worsen things if I lay on my back or my stomach.

[Pugsy]

I have also wondered about UARS in your situation.
If that is what is going on then you are going to have to play with the minimum pressures and rely on how you feel more than the numbers you see the machine reporting for any sort of evaluation or validation.
UARS people don't normally have a high AHI to start with...so we can't use AHI as a marker for evaluation of effectiveness it's already going to be low in the first place.
Instead we have to rely on how we feel in general and how we sleep and that's subjective and very hard to measure.
Need to keep a diary of sorts and log every little thing...and then be able to refer back to see if you are getting anywhere.

[marktheshark]

I have also wondered about UARS in your situation.
If that is what is going on then you are going to have to play with the minimum pressures and rely on how you feel more than the numbers you see the machine reporting for any sort of evaluation or validation.
UARS people don't normally have a high AHI to start with...so we can't use AHI as a marker for evaluation of effectiveness it's already going to be low in the first place.
Instead we have to rely on how we feel in general and how we sleep and that's subjective and very hard to measure.
Need to keep a diary of sorts and log every little thing...and then be able to refer back to see if you are getting anywhere.

That's what I read up on as well about minimum pressure, I will keep tweaking!

[marktheshark]

So I understand that clear airways can be sleep wake junk, but what about apnea's and hypoapneas, can those also be missing leading on sleepyhead software?

[Pugsy]

So I understand that clear airways can be sleep wake junk, but what about apnea's and hypoapneas, can those also be missing leading on sleepyhead software?

Yes...OAs and hyponeas can also be SWJ.
It's the machine doing the flagging...not SleepyHead. Remember that.

[marktheshark]

So I understand that clear airways can be sleep wake junk, but what about apnea's and hypoapneas, can those also be missing leading on sleepyhead software?

Yes...OAs and hyponeas can also be SWJ.
It's the machine doing the flagging...not SleepyHead. Remember that.

I figured, thanks.

[marktheshark]

Here is last nights data, still about the same? I raised the minimum to 10.0 and its seems I never dipped down to the lowest of 10.0 all night. Maybe I should raise it again.

The first shot I zoomed in more, I always notice the ups and downs on the Flow Rate that don't trigger a flag, not sure if it matters, the rhythm just seems to vary a lot.

[palerider]

Here is last nights data, still about the same? I raised the minimum to 10.0 and its seems I never dipped down to the lowest of 10.0 all night. Maybe I should raise it again.

The first shot I zoomed in more, I always notice the ups and downs on the Flow Rate that don't trigger a flag, not sure if it matters, the rhythm just seems to vary a lot.

Do this, would you... right click the 'pressure' and change the y scaling from 'auto' to override, and set a min of 9, max 15... it'll make the pressure line more meaningful, cuz the ramp start pressure is causing the chart to be pretty squished up where you're spending your time.

(don't forget to change the override pressure if you end up raising your max).

[marktheshark]

Here is last nights data, still about the same? I raised the minimum to 10.0 and its seems I never dipped down to the lowest of 10.0 all night. Maybe I should raise it again.

The first shot I zoomed in more, I always notice the ups and downs on the Flow Rate that don't trigger a flag, not sure if it matters, the rhythm just seems to vary a lot.

Do this, would you... right click the 'pressure' and change the y scaling from 'auto' to override, and set a min of 9, max 15... it'll make the pressure line more meaningful, cuz the ramp start pressure is causing the chart to be pretty squished up where you're spending your time.

(don't forget to change the override pressure if you end up raising your max).

Like this?

[palerider]

Like this?

Yes, that's better on the pressure line... instead of looking all flat and having half of it taken up by the ramp (which doesn't tell us anything) we can see more of what the pressure's doing. I'm thinking a minimum of 12 *may* help with the bouncyness.

However, the flow rate chart is missing, LL flags (at least) are turned off (lower left corner of the graphs), and you don't need the snore chart, since it's blank. Could you arrange the sizes of the charts so that

Event Flags
Flow rate
Pressure
Leak Rate
Flow Limit

Neatly fill the space... and turn off the calendar.