Help please.....in the UK

[Nite nite]

Thank you for your reply. I had a prong on my nose for the c02 measurements clamp on my finger for the oxygen sats chest strap for heart rate plus collecting data. I normally sleep on my sides. Waking up for the toilet, feeling tired all the time I taped myself breathing one night then played it back in the morning listen to myself struggling to breath so went to doctors for sleep study. I am 55 years old , I will sent over the information you require in about 15 mins many thanks

[Nite nite]

Okay....no centrals noted on the sleep report.
It also appears that this was a type 3 home sleep study and did NOT measure sleep status.

Did you wear any sort of belt or restrictive device around your chest or abdomen? Important to know so please answer.

One thing to note is that the AHI when supine (on your back) was significantly higher but apparently you didn't spend much time on your back during the sleep study.

What position are you sleeping now primarily????

Have you watched the videos here
http://freecpapadvice.com/sleepyhead-free-software
to try to figure out if the centrals (clear airway on the OSCAR reports) were real asleep flags or awake/arousal related?
This HAS to be done.

It's quite obvious that a sizable chunk of the flagged centrals are awake related.
The cluster of OAs at approx 2:15 also coincide with a break in therapy where we know you were awake.
So we can discount those.

Some house cleaning....turn off the pie chart. It doesn't help anything and prevents needed statistics from being viewed.
Also add the flow limitation graph to the graphs shown on the right.
See these examples.
viewtopic/t158560/How-to-post-images-for-review.html

So....what can be done to help you sleep better? Right now the sleep quality overall is making for a difficult evaluation because we don't know how much of that ugly mess is real asleep flagging or just a bunch of false positives from the crappy sleep quality.

I wanted to limit the max to see if by chance the pressure going up (probably from flow limitations which is why we need to see the FL graph) was causing the centrals. I don't think the centrals are related to increases in pressure.

Why such a hard time sleeping? Is this something you had prior to starting cpap? What caused you to end up getting the sleep study in the first place?
Do you have to go pee often during the night? How old are you?

Get a screen shot of last night including the flow limitation graph please.
Then tonight try these settings.
Minimum 8 cm
Max 15
and this time add in EPR at 3
Should be fairly comfortable....if you have any sort of OTC sleep aid in your house that you can safely take....take it.
Some how or other we have to get more solid blocks of sleep to evaluate.
Use the mask that you like the best and is more comfortable and stands the greatest chance of your sleeping better with it.

Right now we need to target getting some sleep first before we can really try to zero in on pressure tweaking.

At least we know that you didn't have centrals prior to starting cpap.

Hi Pugsy, thank you for the suggestions.

I’ve tried to clean on the charts and squeeze them in, I think this is right:
https://gyazo.com/d489b0f1da11d373a8b7af9a88603593

Thanks again

[Pugsy]

Thanks for the clean up. Pretty much as I expected.

Tell me...are you experiencing any nasal congestion at all?

[Nite nite]

No nothing at all . The only thing that happens quite a lot is the nasal pillows mask the prongs feel like the push shut a bit in the nose I find myself repositioning them quite a lot so I can feel the pressure more clearly hope that makes sense

[Pugsy]

The nasal pillows aren't really prongs because prongs actually go up inside the nose and actually touch the insides of the nostril.
Pillows don't have any part of the pillow or inner cone actually touching anything inside the nostril at all.

If you are feeling the pillows up inside the nostril then I suspect either too small a pillow or too tight with the straps or maybe both.
So try a larger size nasal pillow if you can and/or just a little bit less tension on the straps.

The nasal pillow should rest GENTLY against the out skin of the nostril opening. Not too tight and shouldn't try at all to crawl up inside the nostrils.

[chunkyfrog]

The p10 pillows do have a double wall; the inside of which can invert and block airflow.
When this happens, the inner cone can be returned to normal position
with a small plastic crochet hook.

[Nite nite]

Ok great thank you both for your reply’s I have an f30i full face mask I will give that a try tonight. I used to be in the fire brigade and when I used the breathing apparatus I used to gulp down the air quite quickly I haven’t tried this mask much but as a mouth breather it might be better suited

[Pugsy]

When you have time please go back to my reply earlier this morning (bottom of page 2) and answer all the questions that I have changed to red text color.

Every little bit of information can be useful in figuring out a plan of attack.
Example...the question about the chest/abdomen belt during the sleep study. If you didn't wear anything to measure effort to breathe then the lack of centrals noted on the report doesn't really mean much. Just a little detail that helps us know if the sleep study data reported is accurate. Right now I am going on the assumption that it is accurate but I want to make sure that they were collecting the type of data that would or would not flag centrals on that home study.

So please take the time to answer the nosy little questions.

[Nite nite]

Good morning top of page 3 I did reply to your questions watched some of the videos will watch rest today. Full face mask did not really get on with changed back to my pillow mask seemed to sleep better last night feel better this morning will send over last nights report later many thanks for all your help

[Pugsy]

My apologies. Totally missed your reply with the answers to the questions.
Old eyeballs I guess.
Thank you.

[Nite nite]

No worries appreciate your time trying to help me . Will send over last nights report shortly will be interesting I felt a lot better today

[Nite nite]

My apologies. Totally missed your reply with the answers to the questions.
Old eyeballs I guess.
Thank you.

Hi again Pugsy,

Here’s last nights data
https://gyazo.com/0fe6ac9f315c22567d51faca2dca6ee9

Thanks again

[Pugsy]

You feel better today...that's important.
Pretty sure some chunks of those central clusters are again awake related.
The little bit of OA clustering....could be related to being on your back for a short period of time.

Question....do you have to pee with each wake up? As in a full bladder kind of thing?
Do you have to pee a lot during the day as well?

Lets keep these settings for now and get a few nights without changing anything...that includes masks...each time you change something it introduces a new variable into the mix.
Again....primary goal right now is simply getting to sleep and staying asleep.
Not enough prolonged real sleeping yet to get much of an idea but I am thinking that these settings at least deal with the obstructive stuff quite well.

The central stuff....we can't do much about it anyway except hope that they go away with better, more solid, sleep quality.
Not ignoring the centrals at this point. Just putting them on the back burner for now while you target getting more solid blocks of sleep.

[Nite nite]

Ok great yes will be good to get a comparable.no don’t wee lots in the day . And I used to wake up a lot and pee each time but now I don’t seem to as much at night. I don’t recall waking up much last night I don’t tend to dream much if that helps

[Pugsy]

Needing to pee often during the night (official medical term is nocturia) is a common symptom of sleep apnea.
I had it myself and it was the first symptom to go away with effective treatment. I always said that even if nothing else got better that the no more peeing every hour on the hour was well worth it.
Now of course there are other reasons that people might have nocturia issues...over active bladder for male or females as well as for the guys that are a bit older the old prostate causing problems is another.

Then there's the "habit" thing....people get used to waking up needing to pee and once the sleep apnea takes care of the nocturia the people may have developed the "habit"....you know wake up for some reason and decide "I am awake so I might as well go pee" but maybe the bladder isn't full. I know when I had it prior to starting cpap....my bladder was painfully full causing the wake up. Big difference between having to pee and just "I might as well go pee".

Your OSA is much worse on your back and if you need to sleep on your back we may need to re-evaluate the pressure settings but for now just sleep in any position that you can sleep in and don't worry about it.
Your main priority right now is to decrease the wake ups. If at all possible try to figure out what might be causing them.
Now it is normal to wake up after the end of a REM sleep stage cycle but most of the time we aren't awake very long and don't have a memory of the awakening....but if you do wake up 2 or 3 times a night....it could be REM related and we just accept it. What we don't want to go doing is starting more sleep problems by worrying about waking up.

The lack of dreaming...doesn't mean much really.
We can dream in any sleep stage and not just in REM and not remembering them doesn't mean they didn't happen.
All it means is you didn't wake up during the dream which is actually a good thing. We want to keep the wake ups at a minimum.

Also...sometimes we just wake up and don't really know why and can't find anything comfortwise that we can maybe blame the wake up on. Sometimes it's just the newness of it all and the brain wanting to alert its human that there is an alien plastered on the face and blowing air up the nose. I had this happen to me for at least 3 months when I started therapy.
I was happy with the mask and the therapy and doing very well but I still would have these wake ups 8 to 10 times that I couldn't figure out why except my mind seemed to be on the therapy. Once I got used to the pressures a lot of times I would wake up wondering if the machine was on because I didn't notice the pressure anymore.
Eventually the brain does adjust and comes to see that alien as its human's new best friend.

There is a lot of truth to the old adage of "give it time" as well. Time for the body and brain to adjust to the new way of doing things. This is why once we get settings that give us decent results that we say to just keep those settings for a while and lets see how things go. Don't go changing things without a really good reason. Give the body and brain a chance to adjust. I like to have at least a weeks worth of data without any changes before I consider changing anything unless there is a huge problem with a new setting.

I am reasonably certain some of your central apneas are related to arousal/awake breathing false positives but I can't say for sure that the majority are. There are people who have centrals pop up just from starting cpap therapy. I don't know yet if you fall into that category or not. It's about 10% of the people who start cpap that end up having this happen.
Sometimes if it does happen the centrals will fade away on their own....sometimes people need a different machine.
So for you...we don't know for sure how many of the centrals are the real deal and even if the bulk were real....the most common thing done about them is to sit back and just watch them because sometimes they will go away on their own.
In the meantime you learn how to identify real vs awake centrals.

So...work on sleep quality itself. Continue the on/off button thing so we know for sure when awake times are happening...and do whatever it takes for you to get to sleep and stay asleep.
Google "good sleep hygiene habits" and see if there is something you are doing that can be improved upon to facilitate sleep.
If you can safely take some sort of OTC sleep aid...try it and see if it helps or not.

We need a night with maybe only 2 or 3 wake ups to best evaluate your pressure needs as well as those centrals.
3 or 4 hours of solid sleep would be a big help.

Don't obsess over it though. There are 2 kinds of insomnia...sleep onset insomnia which is trouble falling asleep and sleep maintenance insomnia which is where we wake up too many times during the night or wake up and can't go back to sleep which sort of turns into sleep onset insomnia. The insomnia monster feeds on worry though. So try not to worry about it because most of the time it just makes things worse.

You are reporting feeling better though...which is another reason I tend to think those centrals are arousal related.
If they were the real deal asleep centrals I think with that many we are seeing that you would feel like total crap...and not feeling better.

Your assigned homework....read up on good sleep hygiene....work on identifying real vs awake/arousal centrals...and just get some sleep any way you can.