Newbie struggling after 4 weeks

[Ghostrider08]

I was diagnosed with 'mild apnea' with a AHI of 13. Due to having problems sleeping in the lab, they only acquired just over 3 hours of sleep time requiring me to go back for the titration study. Once again, I had trouble falling asleep and once again they recorded just over 3 hours sleep time. It was found that I responded well at the starting 6cm, but they titrated up to 12cm due to residual snoring. I did have I remember waking up to this pressure and felt I was struggling to breathe. My script setting is 11cm fixed, but it took me weeks to (thanks to learning how to change my settings and absolutely no thanks to the DME tech) to get into that range without that 'struggling' feeling.

So here's where I'm at now ... Last night's Sleepyhead was an extreme version of what's been happening. After watching the tutorial how interpret 'what's an event and what's an arousal' by looking at the breath flow waves, it looks like I have very few events and mostly arousals. You can see when the pressure goes up to 12cm, it doesn't prevent events and almost seems to exacerbate arousals to the point where you can see I just took it off for awhile. I showed the results to my prescribing primary care doctor, but it was way over his head. I'm in the process of getting a sleep specialist referral.

Ok enough of that, here's my questions ..

1. Can those shorter periods of sleep in the lab really give accurate results ?
2. Are my pressures really just causing a positive feedback loop of more arousals, arousals due to other disordered sleep ? My sleep study did show several other clusters of arousals along with unresolved CA's.

Here's a few graphs that hopefully illustrate my thoughts .. Thanks !

[Pugsy]

Welcome to the forum.

Can you zoom in a little closer on the cluster of OA events shown happening around 1 to 1:30?
Maybe just a 15 to 20 minute segment instead of an hour.

Do you think you were asleep when this got flagged?

[Ghostrider08]

Thanks for the quick feedback! I can't say I was 'fully awake', but I do feel I'm in and out all night so it's hard to tell for sure.

[Pugsy]

Those close ups look more like arousal or post arousal flagged events to me. You weren't sound asleep.

Now do me one more zoom in picture but this time put the first couple of flagged events of the cluster to the far right of the graph and not so much in the middle. I want to see the flow rate that preceded the first couple of flagged events.
So that first CA flagged at about 1:11:15 is more on the right side of the graph and not the left side.

[Ghostrider08]

Sure thing. I'll post as many shots as you need lol

Yeah, arousal/post arousal is my arm chair working theory. Feels like a 'chciken or egg' situation

[Ghostrider08]

Oops .. I'll try again

[Pugsy]

I wonder if the hyponeas were real and the rest of the stuff was post arousal. What does it look like in the flow rate preceding that first hyponea in that time segment?
I have trouble with figuring out if hyponeas are real or arousal related. When in doubt I tend to lean towards real though. If I am going to err I want to err on the side of caution.

We really do get in a chicken and the egg situation sometimes. To make matters worse since the machine doesn't know if we are asleep or not it responds to everything like it is the real deal. I have seen my machine do it myself.

When someone tells me that they know they slept poorly and there AHI is ugly...we know that there is a good chance that some of the ugly AHI is arousal sleep/wake/junk and while we don't ignore it...we have to take it with a grain of salt.
Figuring out what is causing the arousals isn't always easy so sometimes we have to try several things. If there is a chance that the arousals are preceded by some real events then we increase that minimum baseline pressure a bit.
When it doesn't help sleep quality then we look to other potential culprits.

[PatriotPartner]

I wonder if maybe you should sleep maybe only 3 hours the night before a sleep test, and
that day do at least a 4 mile walk or workout.

Its incredibly frustrating not getting the data you need

[HoseCrusher]

With your pressure slammed into 12 cm for extended periods of time, perhaps a little higher pressure may help.

On question 1...

No. BUT they give an important data point from which to start guessing from.

On question 2...

It appears you have limited your up side pressure. That may cause a feedback loop in that there isn't quite enough pressure to keep the airway open.

[Ghostrider08]

Thanks for all your input ! I’ll take the next 4 weeks to just relax and continue to adjust to this whole experience (and get a specialist referral while I wait) .. some nights are definitely better than others and I’ll try to bump up my minimum to 11 and potentially experiment with letting that upper boundary drift up in ‘auto mode’