I'm a dentist treating myself! CPAP Results... Advice please?

[Pugsy]

didn't note any events where I got woken up by the CPAP going crazy with increased pressure to get me out of obstructive apneas,

The machine will NOT respond at all during any sort of apnea event with more pressure. When an apnea event is happening the machine sits by and just twiddles its little thumbs waiting for the apnea event to cease and then it tries to figure out what it needs to do to best prevent another apnea event from happening.

So it won't/can't try to get you "out of an apnea"....none of the auto adjusting machines have algorithms where the machine will actually increase the pressure during the actual apnea event.

Lots of times people think that when the machine is finally increasing the pressure that it is the increase that causes the wake up but most of the time the wake up was from the apnea event and not the change in pressure. The change in pressure is so slow that it really is unlikely to be the cause of the wake up. The difference between inhale and exhale when using exhale relief is going to be a bigger change in pressure over a few seconds than the very gradual increase that the machine might decide to instigate to better hold the airway open and we don't wake up with each exhale and inhale do we?

These machines don't really go "crazy" doing anything within a short period of time...they can't.
It cannot or will not try to blow past an obstruction. It twiddles its little thumbs instead.

[ChicagoGranny]

last night I turned it down to 2.0 and I used the cervical collar. I woke up feeling pretty good,

That's great that you woke up feeling better. But, you changed two variables (EPR and collar) on one night and therefore can't tell which (if either) caused the improvement. (In my experience, a cervical collar makes for a much bigger improvement than a one-notch change in EPR.)

I had dreams as well!

That means you were awakened - not a good thing. Dreams that are slept through aren't remembered. However, waking up from a dream after you have slept a quality full night is a good thing.

[nee]

didn't note any events where I got woken up by the CPAP going crazy with increased pressure to get me out of obstructive apneas,

The machine will NOT respond at all during any sort of apnea event with more pressure. When an apnea event is happening the machine sits by and just twiddles its little thumbs waiting for the apnea event to cease and then it tries to figure out what it needs to do to best prevent another apnea event from happening.

So it won't/can't try to get you "out of an apnea"....none of the auto adjusting machines have algorithms where the machine will actually increase the pressure during the actual apnea event.

Gotcha! I just note that, from my results, the pressure keeps increasing and increasing along with my clusters. I find myself waking up with a lot of pressure (>18 cmH2O) blowing at me.

Correct me if I'm wrong, but is this what happens? One apnea event > Machine twiddles its thumbs > another apnea event shortly after > Machine starts increasing pressure > another apnea event shortly after > Machine ramps up the pressure more... etc etc. And the reason why the apneas don't cease is perhaps due to being badly positioned, which increased pressure cannot overcome, and which cervical collars aim to correct?

[nee]

last night I turned it down to 2.0 and I used the cervical collar. I woke up feeling pretty good,

That's great that you woke up feeling better. But, you changed two variables (EPR and collar) on one night and therefore can't tell which (if either) caused the improvement. (In my experience, a cervical collar makes for a much bigger improvement than a one-notch change in EPR.)

I had dreams as well!

That means you were awakened - not a good thing. Dreams that are slept through aren't remembered. However, waking up from a dream after you have slept a quality full night is a good thing.

You mean, one indicator of good sleep is only remembering the last dream, in the morning, as one is waking up? Interesting.

[Pugsy]

You are sort of correct about how the pressure thing works except you forgot to factor in snores and flow limitations.
FLs are probably the most commonly used driving force for pressure increases.
I get the pressure question all the time...."help, my pressure is going way up but I don't see many flagged OAs or hyponeas".."what's going on, is my machine crazy"...
Snores and flow limitations are the early warning signs that the airway is trying to collapse and the machine will react more to FLs than anything else. Remember the algorithm was written with prevention in mind and not fixing after it's broke thing.

I don't know how many OAs have to be close together or occur during what time frame but the machine will work harder when it sees FLs than it does for random OAs or hyponeas.

[ChicagoGranny]

You mean, one indicator of good sleep is only remembering the last dream, in the morning, as one is waking up? Interesting.

This is because dreams will not be recalled unless one awakens. The awakening may be only briefly, and you may not remember the awakening.

A good sleeper may have lots of dreams and not remember any. If you hear someone say, "I dreamed all night long," it means they had to have had many awakenings during the night.

Correct me if I'm wrong, but is this what happens? One apnea event > Machine twiddles its thumbs > another apnea event shortly after > Machine starts increasing pressure > another apnea event shortly after > Machine ramps up the pressure more... etc etc. And the reason why the apneas don't cease is perhaps due to being badly positioned, which increased pressure cannot overcome, and which cervical collars aim to correct?

In the second paragraph here, https://www.resmed.com/us/en/healthcare ... ology.html , is a brief description of the AutoSet algorithm.

[palerider]

- Pressure must be maintained while exhaling to continue stenting the airway open.

Technically, pressure must be maintained at the end of expiration, since the airway won't close during exhalation, that's why the professionals refer to it as "PEEP' Positive End Expiration Pressure.

. It's a balancing act, and everyone is different. I'm most comfortable with a pressure difference of 4.4 and can tolerate a lot more than that, but my wife can't go over 2 without getting centrals.

I'm running at a PS of 6, have been up to 8 at one point without any sign of centrals, like you said, different people, different settings.

[palerider]

and I had dreams as well!

Dreams aren't necessarily a good sign, since the brain doesn't form memories while asleep... the only time you remember dreams is when you're waked up during, or just after a dream.

Remembering something when you're waking up normally, or with your alarm is fine, but remembering you had a lot of dreams during the night, probably means fractured sleep.

Sorry for seeming to toss a bucket of cold water on things

[palerider]

Gotcha! I just note that, from my results, the pressure keeps increasing and increasing along with my clusters. I find myself waking up with a lot of pressure (>18 cmH2O) blowing at me.

Yes, but if you zoom in, you'll see it increases pressure *after* each event, trying to prevent another one, and keeps going up until it does so.

https://www.youtube.com/watch?v=4GW97Xk06N8

Correct me if I'm wrong, but is this what happens? One apnea event > Machine twiddles its thumbs > another apnea event shortly after > Machine starts increasing pressure > another apnea event shortly after > Machine ramps up the pressure more... etc etc.

No, it starts increasing after the first breathing event, whether it's an obstructive apnea (but not a central), hypopnea, snore or flow limitation.

Now, Respironics machines do sit on their hands a lot more.

https://www.youtube.com/watch?v=lzCCgNLya_g

[nee]

and I had dreams as well!

Sorry for seeming to toss a bucket of cold water on things

Gah. Okay. It was a dream about King Kong fighting Godzilla so, while I'm disappointed that I remembered it, I'm also happy I remembered it. It was amazing.

Thanks for further clarifying how the machine works, etc etc. You guys are tremendously helpful and it's really going to benefit my patients the more I get into this.

[ragtopcircus]

The machine does not ENTIRELY twiddle its thumbs DURING an event. Both Resmed and Respironics will use short pressure pulses during a pause to measure the airflow resistance. This is done to determine whether the potential apnea will be classified as obstructive or central. The implementations differ - I think Respironics uses a single impulse and Resmend uses low amplitude, relative high frequency oscillation - so they look a little different in Oscar, but they idea is similar. Pressure will then be increased after an obstructive event, but not a central event.

[palerider]

and I had dreams as well!

Sorry for seeming to toss a bucket of cold water on things

Gah. Okay. It was a dream about King Kong fighting Godzilla so, while I'm disappointed that I remembered it, I'm also happy I remembered it. It was amazing.

Thanks for further clarifying how the machine works, etc etc. You guys are tremendously helpful and it's really going to benefit my patients the more I get into this.

I do love seeing someone that's in a position to help even more people eagerly accepting the information to help themselves, and then others.

[palerider]

The machine does not ENTIRELY twiddle its thumbs DURING an event. Both Resmed and Respironics will use short pressure pulses during a pause to measure the airflow resistance. This is done to determine whether the potential apnea will be classified as obstructive or central. The implementations differ - I think Respironics uses a single impulse and Resmend uses low amplitude, relative high frequency oscillation - so they look a little different in Oscar, but they idea is similar. Pressure will then be increased after an obstructive event, but not a central event.

Resmed doesn't use a pressure pulse, they use FOT. https://www.youtube.com/watch?v=4GW97Xk06N8 which is a 4hz ongoing vibration (which isn't high frequency at all).

Resmed blowers can change speeds fast enough to generate that, Respironics can't, which is why they have the 1 second pressure pulse.

[chunkyfrog]

With well-treated OSA, I remember very few of my dreams, which previously
were numerous, unpleasant and alarming--I don't miss nightmares,
though a little entertainment night be nice.

[kteague]

I had to look up scalloping on tongue and I have that. Is that related to sleep apnea?

Remembering bits of a conversation on here about this topic from several years ago. It mentioned thyroid dysfunction as being suspect when the tongue is enlarged. In the absence of thyroid dysfunction, there was speculation that with snoring, swelling can be an inflammatory response, possibly to the vibrations of snoring. I may have butchered that. If so, hopefully someone will interject with a clearer picture. My snoring before CPAP was obnoxious, or so I was told. Over time my tongue kept getting thicker, overfilling my mouth and pressing against my teeth causing me to bite it often, especially when clenching down during sleep. Rude awakening! Within months of getting my sleep apnea resolved with CPAP, my tongue returned to its normal size. So I am convinced experientially there is a relationship, just am not sure the exact mechanisms involved.

You know what would be an interesting question to pose here - Are those whose sleep apnea did NOT include snoring spared the enlarged tongue symptom?