New New guy needs some clarification

[Lambo915]

So this was last nights recording. It basically looks the same as the others LOL, most of my CA and OSA happen early in the night, while drifting off, or soon after. Machine wise, is there anything else I can do to get those down early on?

Just turn up the pressure a tick alone with my ramp pressure. Currently my ramp pressure is at 6 and my range is 8-20.

[Pugsy]

If that first cluster is real and you were actually asleep....yes maybe increase that minimum from 8 to 9 and lets see what happens.
You can leave ramp at 6 if you wish...but see if you can cut it really short like 5 or 10 minutes.
If you weren't quite really asleep that cluster might just be SWJ sleep/wake/junk and not real and more pressure won't do much to make it go away.

Can you zoom in on that first beginning of the cluster at around 21:05 when the first OA and first CA got flagged?
Maybe a 10 minute segment and make the first OA and first CA be on the right side of the graph. I want to see the flow rate preceding the first flagged events. Looks like 3 or 4 OAs...1 hyponea and a couple of CA/centrals.

The bulk of your AHI is CA/central and more pressure won't fix it and if those first obstructive events (OAs and hyponea) are SWJ....more pressure won't fix those either. To fix SWJ we just have to fall asleep faster and stay asleep.

[Lambo915]

SH 3-10 zoom.PNG (98.53 KiB) Viewed 572 times

[Lambo915]

Thats the zoomed in for that stretch of time.

That stretch of time was definitely while falling asleep, and its interesting I dont have much in the way of CA's the rest of the night, so you are likely right, I need to fall asleep faster, and not linger in that half in/half out state for as long as I do.

[Pugsy]

Sleep onset or sleep stage transition centrals are normal but what you seem to be doing is bouncing in and out of sleep so you get more chances for sleep onset centrals to pop up.

Kinda hard to tell for sure if the OAs are real and then if they are real...are they playing a factor in the bouncing in and out of sleep....or is it just bad sleep quality for unknown reason.

The rest of the night you are fine and things look great.

You could try the 1 cm more minimum just to see if it reduces the OAs any....and as a by product see if any centrals get reduced.
If no reduction...then I would assume that the OAs are probably also SWJ and shrug my shoulders and just adopt a "give it time" approach to see if you can eventually fall asleep a little faster. Easier said than done I know....I had big time visit from the insomnia monster myself last night. He wasn't unexpected though...he always comes visiting with the change to DST.

[Lambo915]

LOL I am in AZ so we are the only ones who do not change, and so I slept like a baby!!!!

I totally agree with your thoughts. Either the rise in pressure helps me stop "bouncing", or they are SJW, and I am sleeping like a dead body the rest of the night, so I should focus on THAT and not get too caught up in the pure AHI number, since my OPA was under 1 for the night, including the bouncing. Maybe that is as good as it gets!


As always, I appreciate your help and insights!

[Pugsy]

Here's the deal...even if every single one of those centrals were the real deal (as in your were fully asleep) and not a normal sleep onset central you aren't having enough of them to be a cause for alarm.

When I first started cpap therapy my reports always were a bit ugly that first hour to hour and a half. Back then we didn't have flow rate on the graphs to evaluate asleep vs awake...so I didn't know that what I was seeing might not even be real. I just always called it my witching hour and since the rest of the night wasn't ugly I just shrugged my shoulders and moved on.
Though one time I did try the more pressure thing just to see if things changed...took 6 weeks but I started with my usual 10 cm minimum and increased by 0.5 cm increments (1 week at each new setting) up to 13 minimum...just to see if the AHI changed or my sleep quality changed or if I felt any different. Nothing changed...not one thing. So now I know that what I was seeing was probably SWJ and more pressure doesn't fix SWJ that isn't related to airway issues. I went back to my original 10 cm after that experiment.

Your choice as to how you want to proceed. If you are sleeping good and feeling good then maybe just adopt the give it time thing.
If not then you can always try a little more minimum...won't hurt a thing to try.

[Lambo915]

As usual, you are probably right!

Even if they are legit CA, 1.6 an hour isn't really significant ( complex apnea is considered >5 per hour ), especially when I am so clear for most of the night. I might try more pressure, as you said it can't hurt, but in reality, I should be happy with what I got because prior to getting the machine, I was at 50+ an hour so........ No question I am in a better position than ever with my apnea!

[Lambo915]

SH Week.PNG (27.17 KiB) Viewed 565 times

Especially when I look at the totality of my week, the numbers look pretty damn good!

[Lambo915]

SH 3-12.PNG (110.5 KiB) Viewed 546 times

[Lambo915]

Hey All,

Just for clarification, when I watched some of the sleepy head videos suggested here, one of them talked about how to read if an apnea was real or not, based on flow rate. So last night I had a good night, very few OSA and few CA, but looking at the CA's I narrowed them down to look at flow rate, and saw the up and down flow prior to the CA, which if I understand correctly, usually means its not real, but SWJ. I know that 1.42 is not significant for CA, I am just trying to learn how to understand the readings better. So the image above looks like NOT a real CA and the one below DOES, based on that flow rate.

Also I turned my ramp time down, as suggested, and that obviously helped the OSA, I know 1 night it not data but it seems to work.

[Lambo915]

SH 3-12 CA.PNG (117.44 KiB) Viewed 546 times

THIS looks like a real CA as opposed to the previous one which looks like SWJ.

[Pugsy]

I would tend to agree with you on those 2 centrals. Remember it's normal to have an occasional "real" central anyway.
The only thing that troubles me is the bottom "real" central is flagged during a time of large leak. Now, it isn't a massively huge large leak but it is up there in an area where the machine could possibly be having a little trouble with sensing stuff.
Only around 30 L/min from the looks of it which isn't horribly high but it might be enough to affect the sensing. Can't say for sure....we know that sensing, recording and responding ability deterioration gets worse the higher above 24 L/min you go. I would think that if it was having a problem we might see unknown apnea first...but we just are never given exactly when, why and how much large leak can mess with the data.

This is one of those situations where I would say "iffy" just because of the large leak being present....because I don't know for sure if the machine is having trouble sensing stuff or not.
"Iffy" gets treated as "real" in my book ...just because I don't know what else to do with them and it's always better to err on the side of caution IMHO. If I see a lot of "iffies" then I start wondering what is going on...random "iffies" I shrug my shoulders and move on because I know that sometimes I can't always have a clear cut black and white answer to my question and I can't do much about it anyway.

[Lambo915]

Ya I saw that as well, but like you I shrugged it off. There was one stretch with really high leak, I must have shifted in my sleep and jostled my mask or something, so I know that areas are suspect, but like you said, if you dont know, you dont know.

Also if you look at the large spot of leakage, the start and finish coincide with an UA and a CA, so likely that was me waking a bit and jostling around. I am starting to learn how to read the pressure, flow, and leak to better understand the flags.

SH 3-12 leak.PNG (134.95 KiB) Viewed 539 times