can't find my fixed pressure, varied results (positional?)

[palerider]

because videos from TheLankyLefty27 talked about how apap should be used to find yourself a fixed pressure, and the algorithm doesn't work well enough to set a proper range.

He has his opinion on that respect, many of us don't agree.

His opinion doesn't take into account the fact that your sleep varies from night to night, and leaving the machine set to a fixed pressure cannot accommodate your changing needs.

[tempuser]

So aerophagia is the big issue

As I previously said, aerophagia is nonexistant when using MAD device. Since I've started to use my cpap device and try to make it work (before I didn't know about it much and didn't even use OSCAR).

Yesterday I wanted to see if MAD could cause those arousals that I've uploaded recently and decided to ditch it for one night while increasing the fixed pressure and the epr. I took "The 0.8 AHI perfect 2:30 hour sleep" as a baseline, and increased the pressure to from 9 to 11.6 but also increased the EPR to 3 from 1. While removing the Mandibular advancement device.

Now that I've read what palerider, pugsy and you have said, I think I should've went with APAP with a range as I have no idea how much MAD was helping me.

Nonetheless I have got a 4 hour usage last night, and the reason for this usage time(I was a sleep for 8:30 hours) IF I recall correctly I woke up to go to the restroom and forgot to put the mask back on(unfortunate).

with 11.6 pressure and EPR at 3 I recall no aerophagia wake-ups and in the morning my intestines and stomach was very normal.

The first picture is overview, and I have added 2 close-ups to some of the clustered events.
The overview:


Messy events:


Possible obstructive event?:




Now by taking consideration what you folks have said. I have decided to set a range to see if I'm in a similar case as Pugsy where I need different pressures for rem sleep, I will set my last 11cm pressure as my minimum and put a max pressure of (maybe?) 15 or 16 (with EPR on 3 for aerophagia reasons).

I also try to not eat before going to sleep as a general rule but sometimes I don't pay attention and eat, I will also try not eat before going to sleep to avoid experiencing the old aerophagia in my attempt to increase the pressures. I will also start the sleep log like you have said, I think it can help with stress through minor victories as you said. Thank you

Thanks to you all in general

(sorry if the language of my oscar deems any problems to you, I hoped it wouldn't cause any problems because I assumed you are familiar with the application)

[Pugsy]

Do you happen to remember if you were awake around the time of the "messy events" cluster?
From your flow rate graph it doesn't appear you were sound asleep.
See that big gulp of air right before the first flagged at 01:56???? We don't breath like that when asleep.
I really think all those flagged events are SWJ or sleep/wake/junk false positive flagging. You can't fix arousal/awake flagged events with more pressure...you need to fix the cause of the arousal instead and that's not always so easy to do even when we know what is causing the arousals.

Remember these machines can't tell if you are awake or asleep. They only measure air flow and our awake/arousal breathing is often very irregular when compared to asleep breathing and the machine can and will make mistakes and flag arousal breathing as some sort of apnea event. We can have false positives or SWJ in all apnea event categories as well. It's not limited to central apnea false flagging which is very common.
Remember also that the machine will respond to SWJ with more pressure (when in auto adjusting mode) because that is all it knows to do.

[tempuser]

Do you happen to remember if you were awake around the time of the "messy events" cluster?
From your flow rate graph it doesn't appear you were sound asleep.
See that big gulp of air right before the first flagged at 01:56???? We don't breath like that when asleep.
I really think all those flagged events are SWJ or sleep/wake/junk false positive flagging. You can't fix arousal/awake flagged events with more pressure...you need to fix the cause of the arousal instead and that's not always so easy to do even when we know what is causing the arousals.

Remember these machines can't tell if you are awake or asleep. They only measure air flow and our awake/arousal breathing is often very irregular when compared to asleep breathing and the machine can and will make mistakes and flag arousal breathing as some sort of apnea event. We can have false positives or SWJ in all apnea event categories as well. It's not limited to central apnea false flagging which is very common.
Remember also that the machine will respond to SWJ with more pressure (when in auto adjusting mode) because that is all it knows to do.

no I don't remember unfortunately. is it possible that I switched from nasal breathing to mouth? since I don't know, could it be that I gasped for air because previous breathing pattern was limited? hopefully tonight with a small range in apap and a full nights sleep I'll finally nail down the pressure

[Pugsy]

no I don't remember unfortunately. is it possible that I switched from nasal breathing to mouth? since I don't know, could it be that I gasped for air because previous breathing pattern was limited? hopefully tonight with a small range in apap and a full nights sleep I'll finally nail down the pressure

Well I suppose anything is possible but the leak data doesn't support it.
It just as easily (and more likely) that what you see in terms of those flagged events is a symptom of poor sleep and not the cause of the poor sleep.

Anytime you see a big gulp of air (or irregular breathing like you see with those clusters) immediately preceding any flagged events it usually means some sort of arousal.
Maybe something as simple as turning over in bed and not remembering it.

Last year I had a night with an AHI of 9.4...sounds horrible for a 14 year cpap veteran doesn't it?
Sure got my attention but when I looked at the flow rate up close it was very evident that I slept poorly and 90% of the flagged events was SWJ stuff. Then I had to factor in the fact that I knew I slept horribly because of back pain issues.
I had overdone things working outside in my garden and I paid for it with an increase in back/pelvic pain since it is known that I have significant arthritic issues. I already knew that I was tossing and turning almost all night due to pain.

Now I don't know what might have triggered your arousal that in turn caused the SWJ flagging....but I would bet my last dollar that you weren't sound asleep with that first cluster you shared.
The second image...it's zoomed in a little to close to know for sure but what is shown isn't 100% sure fire asleep breathing either.

You are fairly new to cpap therapy and it wouldn't surprise me at all if you have some evidence of awakening (you may or may not remember them but they happened) show up on your reports. It took me probably 3 months of cpap use for my brain to stop waking me up just to tell me "hey dude...do you know that there is an alien on your face" ....it just comes with the newness of cpap therapy even when we aren't having actual therapy issues.

And remember...the machine will increase the pressure when it sees this sort of clustering going on because it doesn't know if those flagged events are real asleep events or just SWJ events.

[tempuser]

no I don't remember unfortunately. is it possible that I switched from nasal breathing to mouth? since I don't know, could it be that I gasped for air because previous breathing pattern was limited? hopefully tonight with a small range in apap and a full nights sleep I'll finally nail down the pressure

Well I suppose anything is possible but the leak data doesn't support it.
It just as easily (and more likely) that what you see in terms of those flagged events is a symptom of poor sleep and not the cause of the poor sleep.

Anytime you see a big gulp of air (or irregular breathing like you see with those clusters) immediately preceding any flagged events it usually means some sort of arousal.
Maybe something as simple as turning over in bed and not remembering it.

Last year I had a night with an AHI of 9.4...sounds horrible for a 14 year cpap veteran doesn't it?
Sure got my attention but when I looked at the flow rate up close it was very evident that I slept poorly and 90% of the flagged events was SWJ stuff. Then I had to factor in the fact that I knew I slept horribly because of back pain issues.
I had overdone things working outside in my garden and I paid for it with an increase in back/pelvic pain since it is known that I have significant arthritic issues. I already knew that I was tossing and turning almost all night due to pain.

Now I don't know what might have triggered your arousal that in turn caused the SWJ flagging....but I would bet my last dollar that you weren't sound asleep with that first cluster you shared.
The second image...it's zoomed in a little to close to know for sure but what is shown isn't 100% sure fire asleep breathing either.

You are fairly new to cpap therapy and it wouldn't surprise me at all if you have some evidence of awakening (you may or may not remember them but they happened) show up on your reports. It took me probably 3 months of cpap use for my brain to stop waking me up just to tell me "hey dude...do you know that there is an alien on your face" ....it just comes with the newness of cpap therapy even when we aren't having actual therapy issues.

And remember...the machine will increase the pressure when it sees this sort of clustering going on because it doesn't know if those flagged events are real asleep events or just SWJ events.

Thank you. I'll be listening to you, and If I understood correctly you say that this does not look like pressure related issue. so I'll have another go with the same settings tonight.

[palerider]

So, what I recommend is to use autoset mode (which you're on) but set the max pressure to 20.
Set the min pressure high enough to prevent *most* of your events, and then let the machine respond if you temporarily need higher pressures. (like if you normally sleep on your side but roll onto your back, or when you're in REM sleep).

So if it were me, I'd leave your minimum where it is, set max to 20 and see what your data looks like tonight.

Jason has a lot of good ideas, but not all of his views are good. For instance, until recently, he was "a big fan"™ of respironics machines, saying that they were "better" in some nebulous manner than Resmed machines. ... of course, now all respironics machines from the last 13 years have been recalled... so he's switched to Resmed. Something I did 9 years ago.