Setting advise request

[SleepyPaolo]

Hi,
Can you please provide some setting advice for me?
There were no CAs present in my sleep study, only hypopneas at 29.1 per hour.
The AHI was about 75% higher in REM stage and in supine position, 35 vs 20 and averaging at 29.1.
I wear a cervical collar and have been focusing on side sleeping as best I can.
So far I've been on auto 8-20cmH2O with EPR3 which was showing CAs in 3CAI range. Last night I tried EPR2 and still have a similar amount of CAs.
My graph for last night and a previous night is below.
What advice would you offer please?

[Pugsy]

Your last night report shows EPR at 3 and not 2. Are you sure you made the change and it stuck or is SleepyHead reporting the setting wrong?
I would suggest just turning EPR off and see what happens. Going from 3 to 2 isn't much of a change anyway.

Is there any chance that when you have some central apneas that you were awake?
Please watch all the vidoes here
http://freecpapadvice.com/sleepyhead-free-software

[SleepyPaolo]

Thanks for your help!
The top graph is last night's one. It's definitely at EPR2. Sorry, I probably should have had earliest first followed by latest.

Oddly, the CAs increased with the reduction in EPR, which is not what I expected at all, having researched it on this forum.
I've attached some samples for you to look at. This first one is from the green period. Based on what I've learned, I think some are SWJ, but other seem to be genuine CAs.
I'd appreciate your thoughts.

[SleepyPaolo]

CA samples two.jpg (172.71 KiB) Viewed 1364 times

CA sample three.jpg (183.9 KiB) Viewed 1364 times

[Pugsy]

I think the bulk of what is shown looks like SWJ to me. A handful of maybe asleep but most look like SWJ ...IMHO.

The fact that the centrals increase with the reduction in EPR doesn't mean much especially if EPR isn't the cause of the centrals.
I think awake/arousal breathing is probably the primary cause of the centrals.
Could have just been a coincidence that they increased last night because maybe you didn't sleep as well with the reduction in EPR because it is different.

[SleepyPaolo]

Thanks again Pugsy.
So back to EPR3 and give it more time?

What would typically cause all these awakenings from your experience? There doesn't seems to be many obstructives events so maybe it's not apnea related?
Could changing pressure cause the awakenings? Is it worth trying fixed pressure to test that or is it best to just give it more time?

[Pugsy]

Medication side effects is usually the first thing we look at when someone has poor sleep quality.
But sometimes people just don't know what is causing the arousals.
See this thread
viewtopic/t178231/PSG-shows-increase-in ... -CPAP.html

Can changing pressure cause arousals...even small changes...maybe...but you are experiencing a bigger change just from using EPR than the slow upwards or downwards trend of the pressure line.
Is fixed cpap mode worth trying?....anything is worth trying in my book.

And yes...not all arousals are related to airway or breathing issues.
I have first hand experience in that regard but in my case I know the culprit....low back and pelvic pain. I can't lay in any one position very long or it starts hurting really bad and I wake up to change positions and I remember waking often tossing and turning and changing positions...and when I end up on my back it hurts extra bad....so bad sometimes it's all I can do to muster up the ability to turn over.
It hurts to move and it hurts to stay in one position....talk about being between a rock and a hard place.

If you want to use EPR...use whatever settings feel the best to you.
If you want to see if EPR is a factor in the centrals...turn it totally off...don't mess around with tiny reductions.

[SleepyPaolo]

Ok, thanks very much.
Wow, your back troubles don't sound like much fun...

I'll turn EPR completely off and leave pressure 8-20 for 3 or 4 night and see what the new average looks like. At least it might eliminate EPR as a potential cause.

For medical info, if it helps:
I'm not on any meds, including the recreational variety. Don't drink much at all.
I'm pretty healthy, exercise regularly and eat well, resting heart rate is usually around 40, BMI is 24.6 (192cm and 91kg/16%BF)
ECG shows normal heart function, brain MRI is all clear. I know because I has a bike accident two years ago where I broke my arm. The MRI was done to eliminate any head trauma from the accident and the ECG testing was done because my low resting heart rate triggered all these alarms at A&E. At that time I was put on a lot of Oxycodone while my arm healed which sent me a bit lala. I stopped taking it after three weeks. I've had nothing like that since.

[SleepyPaolo]

I realise that one night is not statistically significant.
However, I thought I'd share this as an initial result.

The whole night OSCAR view is below.

Observations from me:
Pressures went higher, maxing at 12.3
Flow limits increased over my previous 4 day average
Hypopneas increased over my previous 4 day average
Tidal Volume decreased while the respiratory rate remained constant with 12 being the median. The max is RR is 27 which is assume is the awake periods?
CAs reduced significantly from an average of 3.5CAI to 0.86CAI. Higher pressures don't seem to produce any more CAs.


I went through each CA event and they all look like the two samples I've provided. Erratic breaths followed by stop, followed by return to 'normal' breathing patterns. From my research on here this looks like I'm either awake or rolling over and temporarily stop breathing.
Do you agree?
The previous 4 nights has some CAs that look like this, but many of them looked like I just stopped breathing.

My guess is that I should wait a week at these settings to see these results settle and become statistically significant, then add 1cmH2O EPR back in per week or two while observing CAs. After a month of two I'd be back to EPR3. Do you agree with this assessment?

[palerider]

Unless your CAI is over 5-8, just ignore them completely.

People give CAs WAY more significance than they warrant.

[SleepyPaolo]

That's interesting.
I've found over the last three months that the time in Apnea is a far better indicator of tiredness the following day than just the AHI number itself.
I've had nights at 5 AHI, but felt fine, and I've had nights at 2AHI where I felt exhausted. Looking at the event list it seems to correlate more to the duration of the events and not the amount.
The night before last my CAI was 5, but I felt totally exhausted.
When I looked the CA event list (see below) there were 45 events in total, but many of them were longer than 30s as you can see below.

Is there anyway to get OSCAR to multiply the AHI by the 'total event duration/sleep time' to give a 'time in Apnea' figure? I'd love to test the theory.

[palerider]

That's interesting.
I've found over the last three months that the time in Apnea is a far better indicator of tiredness the following day than just the AHI number itself.
I've had nights at 5 AHI, but felt fine, and I've had nights at 2AHI where I felt exhausted. Looking at the event list it seems to correlate more to the duration of the events and not the amount.
The night before last my CAI was 5, but I felt totally exhausted.
When I looked the CA event list (see below) there were 45 events in total, but many of them were longer than 30s as you can see below.

Is there anyway to get OSCAR to multiply the AHI by the 'total event duration/sleep time' to give a 'time in Apnea' figure? I'd love to test the theory.

Doesn't your Oscar show the Total time in apnea?

[raisedfist]

Why do you want to add back in EPR? Without it looks pretty good. I would probably raise the min pressure to at least 9, as you spent practically no time at 8 and those ups and downs may be effecting your sleep quality.

[SleepyPaolo]

EPR3 was reducing the flow limits and hypopneas to almost nothing, as you can see in the previous charts.
When the machine was at EPR3 it used lower more consistent pressures, but it also seems to have been causing excess CAs.
I turned off EPR last night to check if that was the case. It seems to be as the CAs reduced significantly (although it is only a one night test).
I'm hoping that my body will become accustomed to the increased ventilation at EPR3 over time and reduce the CAs. Then I think I can have better controlled hypopneas and flow limits at lower pressures.
Does that make sense or am I going wrong?

[SleepyPaolo]

That's interesting.
I've found over the last three months that the time in Apnea is a far better indicator of tiredness the following day than just the AHI number itself.
I've had nights at 5 AHI, but felt fine, and I've had nights at 2AHI where I felt exhausted. Looking at the event list it seems to correlate more to the duration of the events and not the amount.
The night before last my CAI was 5, but I felt totally exhausted.
When I looked the CA event list (see below) there were 45 events in total, but many of them were longer than 30s as you can see below.

Is there anyway to get OSCAR to multiply the AHI by the 'total event duration/sleep time' to give a 'time in Apnea' figure? I'd love to test the theory.

Doesn't your Oscar show the Total time in apnea?

It does as a total, but not a per hour value like AHI is. It's not too hard to do that manually, but it would be nice to have there in OSCAR.