Breathing disturbances still causing awakenings?

[Rob K]

Some more strange breathing before shutting off machine in morning. Maybe that's awake breathing. Possibly gasping.

Chart #12

[Rob K]

That's enough charts. It's hard to convey all that is going on in a single night. I'll go back and label them for easier reference.

[Rob K]

Here's a zoom in of strange breathing near end of sleep. Looks like deep inhale with shallow exhale. All I can think is gasping for air. That doesn't look deep enough inhale for gasping.

Chart #13

[Pugsy]

Chart #12....the irregular breathing at approx 06:19....arousal...you were waking up. Nothing really exciting in terms of the airway prior to that arousal.

Chart #11....iffy...5:53:15 to about 05:54:40... More arousal looking than asleep looking. The probably asleep breathing but it's a bit weird looking and the 05:57:30ish reduction but no flag followed by definite gulp for air. I think that one is airway related and I think you were asleep. The big gulp of air is often seen after an obstructive event of some sort. I don't think that one lasted the 10 second minimum and that's why no flag. Probably real close to 10 seconds but if it doesn't last 20 seconds..no flag

Anytime I am iffy about something....I put it in the asleep basket...it might still be iffy and might be arousal and I could be wrong but I would rather err on the side of caution.

Chart #10.....looks like asleep and then a little flow reduction and then the arousal jagged stuff after it for about a minute and then you fell back to sleep.

Chart #9....real asleep OA flagged and foll0wed by the normal few gulps that is common to have after the event passes..then you went back to sleep.

Chart #8.....the flagged hyponea...a little iffy for that hyponea but I am thinking arousal related mainly because of the big gulp at around 01:16:00.
Arousal breathing at 01:19:00 to approx 01:19:30. Since it appears you were asleep briefly prior to that time frame....and I don't see anything restrictive happening right before the sudden irregularity. Very brief and no real reduction in air flow...so the 01:19 short spurt...arousal.

Chart #7.....a bit iffy but I am leaning towards an airway reduction that was extremely brief and it was followed by an arousal....and the arousal didn't last very long ...maybe a little over a minute is all

Chart #6.....it's irregular for sure until the big gulp at approx 00:10:30 then the big gulp maybe 2 of them and then they start smoothing out...and by around 00:11:15 or so back to sleep. I am leaning towards a 2 to 3 minute arousal until you fell asleep at around 00:11:05 or so.

Chart #5,,,,,,breathing but much smaller breaths for some reason the ending with a flat line that didn't earn a flag followed by obvious big gasps.....this one is one of the iffy one that I put in the real basket.

Chart #4....Pretty much the first half of that graph is arousal/awake breathing.....I don't think the OAs are real.
Actually this entire segment looks more arousal related than it looks asleep related. 23:19:00 to 23:23:00 maybe asleep ....then followed by the obvious big gulp at 23:24:00...big arousal breath.

Chart 3.....the spikes/big gulps of air....arousal related. Asleep we don't normally take big deep breaths.
This image is a little bit not zoomed in enough though...just a little bit too scrunched together. Roughly a 12 minute segment....you can see the breaths better if you stick to around 4 or 5 minute segments. No need to redo this one though. Just remember don't scrunch thing together too much.


Chart# 13.....06:00:00.....looks like asleep and then reduction in air flow but not long enough to earn a flag or not enough reduction...followed by a big recovery breath or gulp of air.....another iffy one but I tend to lean real and not awake.

[Rob K]

The charts I posted are just a small sample from the night of Jan 28 which is an average night. There is a lot of arousal activity that I could not show, just to much of it which is sort of visible in all the spikes in chart 1 or 2. Most nights are similar, maybe a little better or or worse.

AHI has been real low for a long time. The flag chart looks squeaky clean. The devil is in the details though from what I am finding out.

I'm so glad I was able to watch those videos that were recommended here. It's an amazing and precious thing to be able to find tune therapy and just as precious is the help a person gets on this forum.

Pugsy, thanks so much for taking so much time to help. Big thank you hug
Thank you everyone. Hugs for everyone. lol

[Rob K]

The next two charts from the last two nights I tried to turn the machine off when I would wake up. Unfortunetly is was way to much to deal with. Both nights were not typical I woke many times. Up to late studying and thinking about to much sleep apnea stuff. I was only able to turn the machine off maybe 1/4 to 1/3 of the times I woke. Sleep was so unrestful that I dreaded reaching over to turn off the machine choosing to go back to sleep instead.

I notice right where the machine is off it is followed by a cluster of deep breathing. I think these clusters indicate when a person is typically awake. You can see there are quite a few even if I did not turn the machine off.

I think I need to give it a few days to get back to an average nights sleep and then zoom in and look at breathing at the points where I shut the machine off. Right now it looks like some are breathing arousal and others are just waking up from something else.

Charts 14 & 15

[Pugsy]

Back off a bit and don't worry overly much about trying to remember to turn the machine off when you wake up.
Don't do anything that is going to add stress and worry because that feeds the already present insomnia monster.
You and I have something called sleep maintenance insomnia. Insomnia doesn't mean just a problem falling asleep (that's sleep onset insomnia) but sleep maintenance insomnia is when we either wake up often during the night and/or when we do wake up during the night we have trouble going back to sleep (which sometimes turns into sleep onset insomnia). We can't stay deeply asleep like we want to or need to.

We just either have arousals we don't remember or wake ups/arousals that last long enough for us to remember them and we have a lot of other stuff going on in terms of our life or our health that can cause us to wake up more than we want to or is normal.

Yes, you probably do have a few arousals/wake ups related to airway issues but I suspect they are well in the minority and the bulk of your arousals are probably spontaneous and not related to the airway.

Now what you could do if you want to is just systematically increase the minimum pressure in stages over a period of time just to see if your sleep quality improves any.
More pressure is what we use to deal with the airway issues.
I did this experiment a long time ago. At that time I had settled on a minimum of 10 cm with max of 20. AHI was running 1 to 3 and I was sleeping and feeling fairly well I guess considering my other health issues. Back then we didn't have flow rate details to look at though on our reports.

So I increased the minimum pressure 0.5 cm and kept it for 1 week...each week I would increase that minimum 0.5 cm more.
Over a period of 6 weeks I worked my way up to 13 cm minimum.
Then I sat down and reviewed my notes that I kept along the way about hours of sleep and quality of sleep and the AHI.
Nothing really changed other than minor normal variations in AHI an hours slept. AHI never really went any lower...and my sleep quality never changed and I really never noticed any change in how I felt during the day.

Now that I know more about flow rates and sleep/wake/junk SWJ...I suspect the bulk of my AHI back then was SWJ and more pressure won't fix arousal related SWJ false positives. My AHI was probably mostly false positives like it is now. The false positive flagging being more of a byproduct of the crappy sleep from pain, etc...and not the cause of the crappy sleep.

You can try the same experiment if you wish. Won't hurt you to use more pressure than you might technically need if just going by AHI kind of thing. The worst thing that might happen is you get some aerophagia from the higher pressures and if you do all you have to do is abort the experiment.

Spontaneous arousals are a bitch....not always easy to identify the cause and sometimes even harder to fix them.

Finally...you always have the option of aiding a sleep aid and let it help you maybe sleep a little sounder. Between you and your doctor if you want to make it an RX sleep aid but there are some OTC sleep aids that are fairly benign. Sometimes I do take a little bit of plain Benardryl (common drug in OTC sleep aids) when I anticipate a bad night (rain and cold weather always makes my pain worse)....and it does help some and doesn't leave me with too much of a morning hangover.

[Rob K]

Last night Feb 1. I still see quite a few instances where breathing is normal and flat lines for a short period of time, not long enough to get flagged. May have something to do with sleeping position or REM. Also there are a fair number of flow limitations and increases in pressure. I think this means my airway is collapsing a little to often and I maybe should increase minimum pressure. Sound right?

I'm realizing that the industry standard of 5AHI is a very weak standard. Both of the sleep doctors I went to in the past were very focused on this number and said all looks good. I'd be surprised if they looked very hard at the breathing patterns. For me the hospital/sleep lab/DME were small and all the same staff. I talked to them many times and they helped a little more than the doctor, but basically said the same things, that all looked good. That's why this forum is incredible. My guess is the percentage of good sleep apnea staff is low. On the bright side it will improve, eventually.

Chart 16

[Rob K]

It seems like I'm around the point of getting false positives and sleep wake junk. I think it makes sense to bump up the minimum pressure to see if things improve at all. Like you say I can always decrease again if there isn't significant improvement, which there likely will not be at this point, but might as well try.

Now that I think about it the increases in pressure and flow limitations could be from sleep wake junk, correct? So I would need to study that flow rate chart closer to make a determination in each instance. Then I will get a better picture of what's really happening. So the best thing right now is for me to study flow rate waveforms, sound right? Really wish there was a source for studying and interpreting these waveforms more in depth. A sticky with waveforms posted and what they mean would be awesome. Maybe we could work on that as a community.

[palerider]

MinEPAP 11, MaxIPAP 25, see what that does.

Might try bumping the PS, depending.

Any reason your PS is only 2?

Also, when you're doing those zoomed in looks at individual breaths, the Mask Pressure trace is better than the Pressure trace.

[Pugsy]

Yes...sometimes the increases in pressure you might see are a response to false positives...SWJ stuff.
The machine can't tell sleep status and it only does what it knows to do based on the algorithm.

So it's very possible that the machine will respond to awake breathing but I would rather have it do that then not respond to asleep airway issues.

By all means....give that experiment that I did a try and see if more pressure helps or not. You can always reduce it if you want to and you will at least have an answer to some of your questions. Might not be the answer you want but you will have an answer.

Be patient though...don't get in a rush...allow at least one week between setting changes when increasing the pressure.
You need to let the body adjust.
Make lots, and lots and lots of notes about how you feel and slept and maybe what you see when you zoom in on the flow rate.
Don't trust yourself to remember anything because you won't.

[Rob K]

Will proceed as advised.

Palerider. Was using Phillips apap for 5-6 years. I decided I wanted a newer machine and have a back up so I bought a Resmed bilevel to get more pressure relief on exhale. You all helped with the initial settings. PS was set to 2 because that was close to what my Phillips provided. Turns out the Resmed machine seems to work much better with my breathing and I never felt the need to change the PS setting. With the Phillips the pressure can be annoying and it's seems to be a struggle to breath against. With the Resmed and very similar settings breathing seems much easier.

I think you are telling me to swap the pressure and mask pressure traces?

[palerider]

I think you are telling me to swap the pressure and mask pressure traces?

When you're zooming in and looking at some of the individual breaths like you are, it can help to see what the machine is doing with the pressure, If you have a small breath, was it enough to trigger the machine to go to IPAP? If not, you can adjust the trigger settings, a few possible other things too.

[Rob K]

I read the manual about trigger and cycle settings. It's all very foreign to me at this point. It will take some more studying to understand why and how I would adjust these settings.

I did bump the PS to 3 for last night. Also moved the mask pressure up so it's visible when posting screen shots.

Chart 17

[Pugsy]

Mask pressure isn't really all that exciting unless zoomed in to see the very subtle stuff.

Start making a log of all your changes and how you slept and feel....including the recent increase in PS.