New user looking for some feedback

Hello!

I've been working on trying to optimize my therapy and am at a point where I'm looking for some guidance.. I'm hoping you all may be of help - as the forum has been for me (as a guest) up to this point - thank you!

I was diagnosed with mild sleep apnea and got a dreamstation machine (one of the recalled ones). I had used it off and on for awhile, and then when the recall news hit I stopped. I never had much success with the therapy anyway. AHI was > 5 most nights and I didn't feel great. I started with the APAP 9-12 cm with the flex mode on using nasal pillows. Attached is a screenshot from a typical day during this time.
Thankfully I am able to restart therapy now and have been trying my hand at dialing in the settings. Currently I've made quite a few changes - running in cpap mode with pressure at 10.5. Also using a few extra things to help out, including fixodent and the soft cervical collar. I was hoping to fix mouth leak with these and I do think that was accomplished. However, I'm still trying to reduce events and get a higher quality of sleep. Here is another screenshot after these changes:
The main concern I have (maybe not warranted?) is the form of the flow rate... it seems kind of erratic to me. When I zoom in I see this waveform, which I'm not sure how to interpret:
Anyone have any advice? I see the two peaks on the inspiratory portion of the flow rate which doesn't make a lot of sense to me. Also the areas where there are a few bigger breaths in a row are puzzling to me as well. I appreciate any help and thank you for your time!

Just curious if you're a back or side sleeper, and why your max pressure is where it is vs higher and why you went to a fixed pressure. Someone else will address the flow rate, etc.

mopared wrote: ↑

Mon Jul 04, 2022 9:57 pm

I started with the APAP 9-12 cm with the flex mode on using nasal pillows. Attached is a screenshot from a typical day during this time.

You need more minimum pressure and/or maybe less flex exhale relief back then. It's no wonder you didn't feel so great.

Since you changed to fixed cpap and at a higher pressure without flex exhale relief you obviously increased the minimum and you turned off flex...both of which effectively increases the baseline. This will usually result in the airway being stented open more optimally and less chance for the airway to collapse.

How are you sleeping with this setting?

Julie wrote: ↑

Tue Jul 05, 2022 4:30 am

The main concern I have (maybe not warranted?) is the form of the flow rate... it seems kind of erratic to me. When I zoom in I see this waveform, which I'm not sure how to interpret:

It is indeed erratic but from the fact that you most likely weren't sound asleep. You were awake and our awake breathing is very irregular when compared to asleep breathing. It just looks weird and sometimes the machine flags those irregularities as some sort of apnea event. You have to mentally disregard this sort of flow rate except to note that it points to awake breathing and if you see a lot of it then it means you aren't sleeping well.

I am reasonably certain that those 3 flagged OAs point to awake breathing false positives.

Now for this question

mopared wrote: ↑

Mon Jul 04, 2022 9:57 pm

I see the two peaks on the inspiratory portion of the flow rate which doesn't make a lot of sense to me. Also the areas where there are a few bigger breaths in a row are puzzling to me as well.

I think the second little tiny peak in inspiration looks a lot like cardioballistic artifact. Been discussed often here.
It doesn't mean much except the machine is sensing your heartbeat. You can search the forum for past discussions.

Bigger breaths in a row at any time...very likely awake breathing. Asleep breathing is nice regular smaller breaths that don't vary. We don't take be gulps of air when we are asleep.
This may help you...watch all the videos
http://freecpapadvice.com/sleepyhead-free-software
It's mainly talking about centrals flagged by mistake but it can be other events as well or even no events.

Julie wrote: ↑

Tue Jul 05, 2022 4:30 am

Just curious if you're a back or side sleeper, and why your max pressure is where it is vs higher and why you went to a fixed pressure. Someone else will address the flow rate, etc.

Generally I fall asleep on my side or stomach. Sometimes I do wake up on my back though, so I bet I sleep on my back some percentage of the time. The 9-12 range was set when I got the machine from the sleep clinic. I was working with them for awhile to get things set up and they had been upping my min pressure for awhile until I stopped using it. I went to the fixed pressure after watching a few youtube videos on the subject, it seemed to make sense to me to keep a consistent flow all night if I was still comfortable enough.

Pugsy wrote: ↑

Tue Jul 05, 2022 6:03 am

How are you sleeping with this setting?

Better than with the APAP, but still overall I feel pretty lousy.

Pugsy wrote: ↑

Tue Jul 05, 2022 6:03 am

It is indeed erratic but from the fact that you most likely weren't sound asleep. You were awake and our awake breathing is very irregular when compared to asleep breathing. It just looks weird and sometimes the machine flags those irregularities as some sort of apnea event. You have to mentally disregard this sort of flow rate except to note that it points to awake breathing and if you see a lot of it then it means you aren't sleeping well.

I am reasonably certain that those 3 flagged OAs point to awake breathing false positives.

Now for this question
mopared wrote: ↑Mon Jul 04, 2022 8:57 pm
I see the two peaks on the inspiratory portion of the flow rate which doesn't make a lot of sense to me. Also the areas where there are a few bigger breaths in a row are puzzling to me as well.
I think the second little tiny peak in inspiration looks a lot like cardioballistic artifact. Been discussed often here.
It doesn't mean much except the machine is sensing your heartbeat. You can search the forum for past discussions.

Bigger breaths in a row at any time...very likely awake breathing. Asleep breathing is nice regular smaller breaths that don't vary. We don't take be gulps of air when we are asleep.
This may help you...watch all the videos
http://freecpapadvice.com/sleepyhead-free-software
It's mainly talking about centrals flagged by mistake but it can be other events as well or even no events.

Makes sense to me. Scrolling through a couple of the nights I see a lot of those events where they are marked as apneas but right before hand the flow rate goes wild. In one of those videos they were talking about being able to put a straight edge to the top of the flow rate line. I rarely see any areas where I would be able to do that. All that makes sense as to why I wouldn't be feeling great.

So I wonder why all the arousals? Maybe I'm tossing n' turning? Pressure too low to help with the real apneas? I appreciate the insight, thank you both.

mopared wrote: ↑

Tue Jul 05, 2022 9:24 am

overall I feel pretty lousy.

Define lousy in more detail?

Do you take any medications of any kind? If so what?
Any other physical or mental health issues that might be a factor in sleep quality or how you feel during the day??

mopared wrote: ↑

Tue Jul 05, 2022 9:24 am

So I wonder why all the arousals? Maybe I'm tossing n' turning? Pressure too low to help with the real apneas?

Don't know why. It could be any number of things. When we wake often during the night (and we may or may not remember those arousals/awakenings) it is called sleep maintenance insomnia and if you google it there is a miles long list of potential culprits and OSA or airway issues is but one item on that very long list.
Tossing and turning...very possible but that begs the question "why the tossing and turning so much".
I have a problem with arthritis pain...so I toss and turn a lot and I know I wake often during the night. The best cpap settings in the world don't help with arthritis pain.
Even if we know the cause for the arousals (and most of the time we don't know for sure) it isn't always so easy to fix anyway. Have to do a lot of detective work first to figure out the cause and then work on the fix.

To fix any problem we first have to identify the problem.

Pugsy wrote: ↑

Tue Jul 05, 2022 9:33 am

Define lousy in more detail?

Main issue I face is fatigue, a lack of focus & wanting a nap in the afternoon which I find annoying. I'll also have headaches fairly frequently, but they go away by mid day usually.

Pugsy wrote: ↑

Tue Jul 05, 2022 9:33 am

Do you take any medications of any kind? If so what?
Any other physical or mental health issues that might be a factor in sleep quality or how you feel during the day??

Nope, none that I can think of. Occasionally NSAIDs.

Pugsy wrote: ↑

Tue Jul 05, 2022 9:33 am

Have to do a lot of detective work first to figure out the cause and then work on the fix.

Makes sense, I'll see if there is something obvious I can figure out.

mopared wrote: ↑

Tue Jul 05, 2022 4:48 pm

Makes sense, I'll see if there is something obvious I can figure out.

see if it's a matter of sleep hygiene-
https://www.sleepassociation.org/about- ... iene-tips/