Tired567 wrote: ↑Wed Nov 16, 2022 6:18 pm
Hi robysue1! Thanks for the very detailed response!
1) Why did you increase the pressure? What was your goal for doing so? How much did you increase the pressure? Did you increase, decrease or leave PS the same when you increased the pressure?
I increased the pressure because the 95% pressure was usually between 11.8–12. I also noticed that many nights I would get out of bed after a pickup in pressure (marked in OSCAR as a reset in pressure due to power on/off), indicating either the pressure ramp was waking me up, or I was having events causing me to wakeup, and the machine was not treating them quickly enough.
So you increased the minimum pressure in an effort to minimize the pressure increases you are seeing in Oscar and that you think may be what is causing you to wake up a lot or at least arouse a lot at night.
On paper that's not a bad idea, but because you are also dealing with the air bubble problem that seems to kick in around IPAP = 11, you also need to ask yourself whether reducing Max IPAP might not have been just as effective in eliminating the pressure increases.
Here are two charts (
link) that are representative of nights when I awake when the pressure ramps up.
First, there's not much
obstructive going on in these charts, but that's not a surprise since you say your diagnostic sleep study showed UARS, not OSA. (In UARS, you arouse or wake up
before the obstruction in the upper airway is significant enough to cause a hypopnea or an apnea.)
Second, the pressure increases are being triggered by fairly mild flow limitations.
Third, while the number of CAs is not alarming, it's still noteworthy that they are what's making up the majority of your events on both nights. That begs the question, "Is PS = 4 causing some problems with hyperventilation leading to blowing off too much CO2?"
Fourth, you've got those pesky air bubbles that bother you once IPAP reaches 11.
All of that needs to be taken into account when you are trying to figure out what to do next.
2) I appreciate your suggestion to decrease pressure back down. My concern is, if I am sensitive to the nighttime pressure increases, or the auto mode is not adequately treating my minor breathing events, I actually need to increase the minimum pressure. I spent about 6-7 months at a lower minimum pressure on auto mode and slept awfully.
As I said in the previous post, I think you may need to decrease Max IPAP while either keeping min EPAP at the current level OR you may want to decrease Max IPAP and increase min EPAP, which will effectively tighten the pressure range. If you really are sensitive to the pressure increases, a tighter range may help you sleep better even if there winds up being a bit of activity in the flow rate graph.
Alternatively, you could try fixed pressure mode: No pressure increases eliminates "sensitivity to pressure increases" as one of the things that could be negatively affecting your sleep. While the vast majority of people on this forum do use Auto mode, there are a handful who use fixed pressure mode
by choice because they find they sleep better when the pressure is not changing al night long.
3) Are you scrolling through the Oscar flow rate data zoomed in close enough for you to see the times you think you are awake? Or are you guesstimating that you're waking up 8-10 times based on what you remember about the night when you get up in the morning?
Yes I am. I am looking for awake breathing where the flow signal goes crazy. Also, my internal estimate is that I have 2-3 major awakenings per night, and 8-10 awakenings where I'm awake, turn over, and fall right back asleep.
Several comments all tied back to sleep hygiene and CBT-I stuff:
Wakes where you turn over and fall right back asleep are not a serious problem in terms of sleep quality: They're comfort related---for many people sleeping in the same position all night long can actually lead to some soreness, particularly if they fell asleep in an awkward position.
Focus on trying to eliminate the 2-3 major wakes that you sort of remember rather than the 8-10 places in the flow rate where you think the "signal goes crazy", particularly if the "crazy" only lasts 30 seconds.
For the 2-3 wakes that you sort of remember, it may be worthwhile to train yourself to turn the machine off and back on when you find yourself consciously awake in the middle of the night. That will give you some data about whether you are remembering the number of wakes with some degree of accuracy.
Also keep this in mind: Breathing in REM cycles can be much more irregular than sleep breathing in non-Rem sleep. It's possible that some of the "crazy" is indicating the start of a REM cycle rather than a wake.
And again, you could consider getting something like a FitBit that tracks sleep and see if there is a correlation between the "wakes" in the FitBit data and the crazy stuff in the flow rate graph.
4) How long do you think you are actually awake during these periods? Do you remember any of the wakes when you get up in the morning? And do you remember having serious problems getting back to sleep after any of them?
Ranging from 30 seconds to 30 minutes.
A few 30 second wakes during the night is not something to be overly concerned about.
But even one 30-minute long middle of the night wake can be pretty significant in terms of consolidating the sleep cycles. Since you say you've done sleep restriction therapy, you probably know this drill as well: If you find yourself lying in bed in the middle of the night for more than what you think is 15 or 20 minutes, it's useful to get out of bed and go into a different room. Do something quiet and relaxing and sleep inducing (getting on line isn't a good idea) and only go back to bed when you are feeling sleepy enough to get back to sleep in about 15 minutes or less. The idea is you need to reacquaint your brain and body with the notion that "being in bed" means "being asleep".
6) You wrote that: "you may have been leaking a small amount of air through your mouth without the chinstrap. And with the chinstrap, that air is getting caught in the upper airway somehow."
Yes, I often have chipmunk cheeks in the middle of the night without the chin strap.
Sounds like air from the xPAP is getting into your mouth. The problem might not be that your mouth is opening---if your mouth were hanging open the excess air would escape through the open mouth.
The problem might be that your tongue is relaxing and not staying in its normal position touching the top of your mouth with the tip touching the upper mouth just behind and above your top teeth. When the tongue moves out of that position, it can allow air to enter through the back of your throat from the nasal passage. And the result is chipmunk cheeks.
You might try focusing on where you put your tongue when you are awake and not talking or eating or drinking. If it's not where it's supposed to be when you are relaxed and awake, there's a good chance it won't be where you want it to be when you are asleep.
7) One final note regarding my increasing the pressure to combat breathing events. If you look at last night's chart, you will see a leak spike at 2:48. I took the mask off for a second to mark my awakening. Here is a zoomed-in chart about 10 minutes before I awoke at 2:48(
link). Looking at the flow rate, it appears there are multiple small flow limitations prior to awakening. Thoughts on whether these types of flow limitations could trigger an awakening?
Did this pattern continue all the way to the 2:48 wake? Or did it resolve several minutes before that wake? If the pattern resolved into more normal, more regular sleep breathing before you woke up at 2:48, then I'd say this was probably not the cause of the wake. But if it continues all the way to the wake, then yeah, it might have caused the wake.
But that snippet of flow rate data may have more going on than the flow limitations: There's a bit of a waxing and waning pattern to the whole snippet. And given that both of the nights you posted have some CAs, it could be that this is a place where PS = 4 is triggering a bit of instability in your breathing, causing you to hyperventilate slightly, followed by smaller breaths while your body waits for the CO2 concentration in your blood to increase to the normal level to trigger a regular inhalation.
It may be worthwhile to scroll through the whole night and see if this kind of a pattern precedes a lot of the CAs. If you see a lot of stuff that looks like this, particularly in the minutes immediately before a CA, it's worth experimenting with reducing PS for a night or two. See if using PS = 3 with your current settings results in less of this kind of pattern (and potentially fewer CAs.)
Joined as robysue on 9/18/10. Forgot my password & the email I used was on a machine that has long since died & gone to computer heaven.
Correct number of posts is 7250 as robysue + what I have as robysue1
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