BiPap settings - double check and one question

[Pugsy]

I have thought all along you needed more minimum EPAP so I agree with keeping the 10 cm EPAP (you might end up needing even more especially if you can't stay off your back).
Obviously there is a strong positional component to your pressure needs. Normally I tell people to sleep in any position they want and let the machine sort it out but sometimes the pressure needs are so much higher when supine that it makes a drastic impact on sleep quality when those really high pressures are used and it makes more sense to just try to avoid supine sleeping.
Now I know it's easier said than done sometimes. I also try to avoid supine sleeping but not because of how it affects my sleep apnea or pressure needs. I have some back and pelvis issues where supine sleeping simply causes a lot of pain and that pain wakes me often but I can't always stay off my back.

I don't know if having more PS would help or not. Something to consider is maybe trying PS of 5 at some point especially if you see a predominance of hyponeas. Don't go above PS of 6 though...Too much PS can trigger centrals.

[Dog Slobber]

As I expected, increasing my max pressure to 25 just meant I followed that up (e.g. the chart on the left shows I was at 24.58 for 95% of the time, but I really was there only about 1.5 hours).

The 95% number does not mean you were at 24.58 for 95% of the time. It means that for 95% of the time you were at 24.58 or less.

[Pugsy]

Ignore the 90/95% pressure numbers....it's just a number that is easily skewed upwards by a relatively short period of time at higher pressures.
Does NOT mean that you need that amount of pressure all night.
Same comment about 90/95% leak numbers.

90 (Respironics)/95 (ResMed) percent number just mean like DS said...you were at OR BELOW that number for 90/95 % of the night.
The "or below" part of the definition is often missed or forgotten but it is critical to the definition.

[Norma45]

Dogslobber, Pugsy,
Thanks re the 95% number. I am slowly figuring out what to pay attention to and what to not really put attention to in Oscar.
Since things seem significantly better at EPAP 10 and IMAP 20 ish, I am going to try that for a few days before changing anything.
Pugsy I will keep in mind potential SP changes but to really watch cause/effect.

[Norma45]

I am doing diagnostics and trying to figure things out.
Not changing any settings.
I actually got an AHI of 2.8 last night so making progress (my lowest before that was closer to 6).

However, I am finding that sometimes I sleep on my back with very low AHI and sometimes I have high AHIs on my back.
So last night I tried 2 phones with somnopose, one strapped to my chest and one to my forehead, so I can account for head tilt direction on my back. I have been trying to sleep with my head turned to the side instead of straight up as that seems like my IPAP pressure lowers in that position, but since I shift around in my sleep I have no idea how my head is really tilted (or not).
Unfortunately no bad back sleeping last night (the night before had several hours of back sleep plus right side sleeping was great, another chunk of back sleeping was high AHIs, but I only had the chest somnopose on at that atime).
So I will try 2 somnopose - head and chest - again (and again) until I have some clues why some back sleep is much worse than other back sleep.

I am still have some fine tuning to do after I figure out this one big element.
For now I am making detailed notes on my sleep each night as well as gathering oscar information, to have enough info to tease out issues.

[Pugsy]

Don't forget about REM stage sleep and its effect on OSA and how the airway behaves. It can also worsen OSA and cause someone to need more pressure.
REM worse OSA....just as common as supine sleeping making OSA worse.

[Norma45]

Pugsy, I am ruling out REM (at least until after I have fully ruled out position) as the bad sleeping on the back lasts for 1-2 hours straight with significantly higher AHI the entire time (apneas spread out evenly). That doesn't sound like REM to me (if I remember right we do shorter chunks of REM, 20 min or so).
So I am looking at position also, hoping I will find some clear positive evidence... (maybe wishful thinking, but I am optimistic ).

I will post either way, in another day or two, after I have enough charts to cover several days (I do change some day to day).

[Pugsy]

REM cycles through the night. First REM cycles are typically rather short but in the wee hours of the morning we have more frequent REM and the cycles will last longer.

Just offering something to consider. I don't know if your OSA is worse in REM or not but it might explain why sometimes you are on your back things aren't so bad and other times it is bad. Something changed. REM is a possible factor. So it chin drop as well.
Something changed though.

We can't really do anything about it though if it is REM because we don't really have control over REM.
It's just something we can say might be a factor and explain a marked difference in results.

[Norma45]

I have not posted for a while. I tried to gather some "standard" oscar reports, but my reports are all over the place with no consistency so each night looked really different (big mask leaks one night, low AHI or high AHI - both on back sleeping nights, etc.). I didn't want to chase something that happened only occasionally, I wanted to focus (at this point) on the big problem causers.

I took a break for a week or two because I was spending way too much time on it.
However, I have figured out a couple more things. So this is an update.

Looking at patterns over time, using the diagnostic tools, I figured out:
-- I got AHIs from 0 to 2 if I sleep on my side.
-- I got AHIs from 0 to 2 if I breath thru my nose – even if I was sleeping on my back all night long with my head in line with my body. However, most nights (4 out of 5) I breath thru my mouth.
-- When I am sleeping on my back, the pressure will at times (short periods or long periods) rise quickly and stay at the max IPAP.

So:
-- I focused more on what it felt like to be on my back vs my side (wide awake but relaxed). When I was on my back and even fully awake, my throat is more closed when it is in line with my body (my head straight and not turned to the side). This is true regardless if my chin is tilted to my chest, tilted way to the ceiling, or my chin is not tilted at all (that tilting seemed to make no difference at all). However, if my head is turned to the side (45 degree or 90 degree angles), my throat is much much more open.
-- I tried to sleep only on my side but I shift positions while asleep so that didn’t work - even if I tried to block that path.
-- I tried training myself to sleep with my head tilted to the right if I was on my back, but this worked sometimes but not others.
-- I did a test with a somnopose on my head and another on my chest, it seemed to confirm that my events went up when my head and body were aligned (both prone), but I was only in that position for 30 minutes that night so I was not certain.

I had watched a couple videos on bi-pap that someone has posted somewhere on this site and decided to play with ventilation (outbreath) and inhalation and my responses (specifically if I felt oxygen hungry and was trying to get more air in/co2 out).
-- I lay on my right side and adjusted the PS to find a sweet spot where I was no longer oxygen hunger – e.g. short forced exhale bursts did not make me feel less oxygen hungry. Using 4 was a big difference better than 3, fine tuning showed 4.2 was a sweet spot.
-- However, with PS at 4.2 now, I felt a little oxygen hunger that short exhale bursts didn't help. I then adjusted the EPAP up a little to 10.2 which got rid of the last bit of oxygen hunger. Note: I never find that sweet spot on my back, it just doesn't feel the same at all as my throat is never fully open, even with my head tilted to the side.

Thinking that I really needed to do sleeping on my back with my head tilted to the side...
-- I started testing with a pillow under my left shoulder blade. It seemed to help so I constructed something I could attach to a shirt - I started with a knee pillow, taller so even squished it was still a couple inches high. I put it inside a king size zippered pillow case and attached the bottom with a belt (that could hold my somnopose also) and the top I tied the corners to the top of a tank top shirt.
Big improvement - my AHIs were 2.48, 1.90, and 2.59 always in the 3s or below - a big improvement from the 6-15 AHIs I was consistently getting before. I even got an AHI 0 for a nap.
But my back muscles were stressed in the morning because I was doing a twist (hip flat, shoulder tilted).
So I tried two knee pillows in my pillow case and that was much better on my back, though it was harder to attach with my temporary methods so it didn't stay on the entire night. However, AHIs were still lower (3.47, 3.68).

So I am working on a contraption (taking a chunk of foam that goes from my shoulder to my lower hip and from the middle of my body to the outside of my body, making a slant, and putting it inside a large pillow case using snaps, etc. so I can attach it to a couple night tank tops I bought for this purpose.
It will take me a couple of days to put it together and test it all out - I will attach pictures of it when I get it put together.

I am encouraged by this. I know there is some fine tuning still to be done, but getting my AHIs under 3 or even 4 consistently will be a huge step forward.

[Norma45]

Just a quick update - it makes a huge difference for me to have my head to the side if I am on my back.
I am consistently getting AHI under 3.5, rarely high AHI and rarely very low AHI.

Still working on some fine tuning, other things in life came up that took up my time/effort.