Help with MyEncore data/charts

OK, here's last night - set at 16.5-17.5 cm.

It looks good, right? But I still woke up feeling like crap. I was very conscious of that REM thing going on in the last 2 hours. There might have been a little aerophagia late, but nothing major.

I just don't know what the deal is - can there be Centrals that aren't being picked up (I know, that's an involved question)? If not, then I have to conclude that I have some non sleep-related issue, I guess. We'll see how it goes this week - if I get up after only 6-7 hours, maybe I'll feel better. I'm going to try a straight 16.5, no range tonight.

Funny thing is, even on weeknights I sometimes get the REM thing for the last hour.

cby1 wrote:OK, here's last night - set at 16.5-17.5 cm.

It looks good, right? But I still woke up feeling like crap. I was very conscious of that REM thing going on in the last 2 hours. There might have been a little aerophagia late, but nothing major.

I just don't know what the deal is - can there be Centrals that aren't being picked up (I know, that's an involved question)? If not, then I have to conclude that I have some non sleep-related issue, I guess. We'll see how it goes this week - if I get up after only 6-7 hours, maybe I'll feel better. I'm going to try a straight 16.5, no range tonight.

Funny thing is, even on weeknights I sometimes get the REM thing for the last hour.

Pretty good.
You might try a slightly lower pressure setting (I see you're planning to try straight 16.5).
You didn't have any centrals and it appears only one or two obstructive apneas flagged at the very end.
And, if it didn't flag a central as either a "NR" or an obstructive, then there weren't any.


Den

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Yeah...looks good on paper anyway.
Give the fixed 16.5 a trial and see what happens...your pressure variations are tiny with the above settings but it wouldn't be impossible for tiny variations to mess with sleep quality.
Actually I suggest not using cpap mode though...mimic cpap mode by setting apap mode so that minimum equals maximum.
The reason I suggest it is that in cpap mode we lose FL flagging (it's turned off in cpap mode) and while your FLs aren't horrible...it is a data point that is potentially useful and I don't see any sense in losing it just in case something might show up.
FLs are something the machine will increase the pressure in response to so you may not be seeing them much with the range of pressures but some might pop up if you go to a single pressure and would have maybe needed more to deal with them and if using a single pressure the machine can't respond to prevent.

I doubt that centrals are involved...if they were we would most likely see them dumped in either the OA or hyponea bucket or maybe the Non Responsive bucket. Your machine doesn't flag centrals separately but it usually can sense something but not know what to call it and thus it goes in one of the other buckets.

Also, yes, it's entirely possible something else is going on that is messing with your sleep quality that we can see on these reports and that the best cpap therapy in the world can't fix.
Example...even with optimal cpap therapy I would have frequent awakening due to pain and discomfort from the arthritis issues I have in my spine. So while I can effectively prevent apnea related arousals with cpap therapy my cpap doesn't help with the arthritis so I have a separate issue that has to be resolved or worked on separately. Also one of my pain meds causes insomnia so I am doomed if I do and doomed if I don't in that regard...so I have to figure out something else to help with the pain. It's a war I never totally win but my battle success rate points to at least winning some of the battles.
I still may not feel like running a marathon when I wake up but at least I don't wake up feeling like I just ran a marathon.

Take a hard look at anything that affects good sleep hygiene and dig deep in your detective work for things that might affect your sleep quality and causing the arousals that affect sleep architecture..sleep maintenance insomnia. It's hard work for sure.
Often it is any one single thing but a combination of things that compound a problem.
Using a single pressure instead of a range of pressures will at least eliminate the pressure variations themselves as being part of the problem and it may or may not help you.
Fixed pressures didn't help me but they did help Den....maybe it will help you and is sure worth investigating.

I would use 16.5 though if your belly can handle it...the reason I suggest it is that you already have OA clusters pop up and a documented need for more pressure when using the 16 minimum and a small range.
If you use 16 single pressure...those clusters will return..might not be every night but they will return.

OK, thanks both of you.

> I still may not feel like running a marathon when I wake up but at least I don't wake up feeling like I just ran a marathon.

That's what I'm going for - I want to wake up not feeling like I fought a battle all night - and shakey anxious. I also take pain meds too, but have been on them at the same dosage since 2008 (failed back surgery). No issues until recently.

OK, here are the data from last night at 16.5-16.5. I did leave it in APAP mode per Pugsy's instructions. Very suspicious (although I did feel decent this morning). FYI, MyEncore reports total flow limitations of 10, with an FLI of 1.64, % of night in variable breathing = 25.4% - but no other events, just like the Details report below. All the breaks in time are because I'm coming down with a URI, and had to keep getting up to expectorate and blow my nose. Figure that one out.

Thoughts? I suspect it didn't capture the data right, but hey...

cby1 wrote:OK, here are the data from last night at 16.5-16.5. I did leave it in APAP mode per Pugsy's instructions. Very suspicious (although I did feel decent this morning). FYI, MyEncore reports total flow limitations of 10, with an FLI of 1.64, % of night in variable breathing = 25.4% - but no other events, just like the Details report below. All the breaks in time are because I'm coming down with a URI, and had to keep getting up to expectorate and blow my nose. Figure that one out.

Thoughts? I suspect it didn't capture the data right, but hey...

Well, see if the next several nights produce similar data. Since it was recording "events" on previous nights, it probably "ain't broke". If the non-events situation continues, drop the pressure settings a bit and see what happens. You may not have needed the pressures you've been using all this time.


Den

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So things look decent at fixed pressures in the 16-17 cm range - but I still don't feel well when I get up.

I'd like to get a pulse oximeter that can record while you sleep (and/or flag low O2 sat and the time it occurred) - there's got to be a thread(s) on this somewhere here, but having some trouble finding. Do either of you know of any brands you'd recommend?

Thanks.

The CMS 50 D Plus and above models
http://www.coopermedical.com/overnight-pulse-ox
Make sure it says recording overnight.
Many, many threads here about the various models and member input as to their preference as well as sources that are the least expensive.

cby1 wrote:So things look decent at fixed pressures in the 16-17 cm range - but I still don't feel well when I get up.

Can you clarify "don't feel well" a little more?
Also..how many hours of sleep are you averaging? And do you wake up often during those hours and if you do any known reason?
Also..do you take any meds of any kind? If so, what?
Also..do you have any other health condition that might impact things?
Also..any issues with pain, arthritis, bed comfort, mask comfort, etc?
Unfortunately often people have other reasons that impact how they feel and/or sleep that are unrelated to OSA and the best reports in the world can't fix stuff unrelated to OSA.

Thank you very much, Pugsy. On the Pulse Ox - would you buy from Cooper, or would Amazon be OK? I saw someone complaining there about it being a "knock-off" - but that was only one review. It's about 1/2 the price on Amazon.

http://www.amazon.com/CMS-Finger-Pulse- ... +recording

Then again, it's not sold by Amazon directly - so that makes me wonder. To your questions:

Can you clarify "don't feel well" a little more?

> When I do finally haul myself out of bed, I feel anything but rested. I am a bit dizzy, a little disoriented, anxious, sometimes a little weak and shaky. I feel like I have cognitive issues for the first 2-3 hours I'm up. It's not unlike what happened back in 2005, although not quite as bad - thankfully. So you'd think I (and my doctor) could figure it out.

Also..how many hours of sleep are you averaging?

> 6-7 weeknights, 8-9 weekends - but after about hour 5-6 it's kind of a waste, as I have that REM issue that (I think) really messes me up. If I could just drag myself out of bed at that point - makes me think things would be better - but I just *can't*.

And do you wake up often during those hours and if you do any known reason?

> Usually only once or twice to use the bathroom. Right now I have "Walking Pneumonia" (I haven't been sick like this in years) which is complicating things - but this issue pre-dates that by months.

Also..do you take any meds of any kind? If so, what?

> Vicoprofen (Since 2008 for back pain from failed surgery in 2008; but no problem there either in the past)
Lunesta for sleep maintenance - I have used that on and off since 2005.
Cozaar for high BP for the last year, Benicar before that. I was originally DX'ed for OSA in 2005, although I'm pretty sure I had it since my 20s (53 now).
Benadryl from time to time for post-nasal drip that causes coughing. That might not be helping.

Also..do you have any other health condition that might impact things?

> Think I covered that above - back pain is controlled; doesn't bother me much. Now, the current job I have is the highest stress (for me) job that I've ever had. I'm sure that plays no small part in all this. I'd like to rule out O2 Sat issues, however. If CPAP data and O2 Sat both look good, then I look elsewhere.

Also..any issues with pain, arthritis, bed comfort, mask comfort, etc?

> Mask can be a bit of a challenge, but has been since 2005 - I use a FFM (and I need to - 3 sinus surgeries which helped, but did *not* fix my deviated septum). Respironics ComfortGel Blue - best I've found for me. I sometimes have small leaks at the bridge of the nose, and they will wake me up. The best solution I've found is to tie the mask down with a chinstrap wrapped front to back right around that area, with sticky velcro on the mask. Works well, but can also irritate the bridge of the nose. Wouldn't mind trying a hybrid mask one of these days - would get nose and mouth without the nose bridge involvement.

cby1 wrote:Thank you very much, Pugsy. On the Pulse Ox - would you buy from Cooper, or would Amazon be OK? I saw someone complaining there about it being a "knock-off" - but that was only one review. It's about 1/2 the price on Amazon.

http://www.amazon.com/CMS-Finger-Pulse- ... +recording

Then again, it's not sold by Amazon directly - so that makes me wonder. To your questions:

that's the same oximeter, just cheaper. however, consider that the cms50F model has a number of advantages, it's wrist mounted, with a light grippy fingertip probe, so it stays on much better throughout the night.

it also timestamps the recordings, AND, it doesn't eat batteries like the D+ does. (you get about 24 hours, or 3 nights, out of a set of alkaline batteries with the D+

you can find it much cheaper on aliexpress.com (which is sort of the chinese version of amazon) I myself have the I version, which is like the F, but records multiple sessions.

I would buy the pulse ox model (whatever model I chose) from the cheapest place I could get it.
Check your results and then if those look okay then start looking elsewhere for potential culprits causing your unwanted symptoms.
Your meds don't scream loudly as being a potential culprit.
Cozaar...Losarten...mentions dizziness as a possible side effect but usually dizziness should decrease as the person gets used to the meds.
Your pain meds...hydrocodone and of course the typical opiate side effects go with it.
I doubt that your meds are the primary cause of your unwanted symptoms. They might contribute in a small way though.
Take some time and read up on them in great detail and look at more than one reference when you do.
I was just asking because sometimes people are on meds that just scream out "if you take me you will feel like crap"
Yours don't appear to be in the class that screams out.

I will say this and I am speaking from experience....back pain (or really any pain) and the underlying cause of the pain can and will mess with our sleep architecture and that will directly affect how well rested we feel and how we feel during the day.
Sometimes the pain meds sort of make us draggy and dopey feeling but we would feel worse (and sleep worse) if the pain wasn't addressed. Damned if you do and damned if you don't sort of thing.

Thanks all.

FYI - I had another one of those mornings this morning with OA clusters in the last 30-60 minutes at the constant 16.5 cm setting. The clusters line up pretty much exactly with the "REM" period I describe. Then again, they don't always show up - maybe 1/2 the time.

Were you for sure asleep during that last cluster and do you remember if you woke up on your back or your side?

Always on my side.

It is a weird state - it's in-between sleep and waking - it's as if I transition in and out of sleep during that time, but don't fully wake up - or if I do, I slip back into this horrid thing. Maybe it's some kind of REM rebound. I forgot to mention that I have been on an SSRI (DX'ed as secondary Anx/Depression to OSA) since 2005. Same one, same dose. So I tend not to place the blame there either.

The quick and dirty fix is obvious - as soon as you sense it - WAKE UP AND GET UP! No matter how hard. But it is hard. Or go to bed late enough that the alarm time forces you up - no choice. But that has it's own issues.

At this point, I'm worried about O2 Sat. I'll tell you what - let me scan in my last sleep study, which was WAY less than satisfactory - but I'm not a sleep professional - BUT IT WAS. If I black out all personal info and facility/MD info, will it be OK to post? i.e., not violating forum rules?

Yes, you can post your sleep study results. No rules against it.

I wonder if that ugly cluster is some awake/semi awake breathing irregularities sort of confusing the machine.
It's possible it is REM but it's odd to have only that one ugly spot and blame it on REM when I assume you also had other REM cycles throughout the night.
That's why I asked about sleeping position because I was wondering if maybe you were on your side.

You may be like me...In REM sleep I sometimes need substantially more pressure and some nights when I was using APAP mode the pressure never changed and I know I hit REM some of the time.
I even did an experiment where I built a wall to make sure I was on my side all night and thus eliminate supine sleeping as a factor.
I still would see nights with not much, if any, increase and some nights I would have clusters like you are showing and the pressure would go up accordingly. If it's not supine sleeping causing the change in pressure needs then that pretty much leaves REM as the remaining culprit.

In your situation I don't know if I would attempt to do anything about those clusters at the end of the night if more pressure creates issues or auto adjusting pressure create issues.
It's short lived and doesn't happen often. Clinical correlation would need to be done.

Oh...those SSRIs...look them up...they scream out ...we mess with sleep and how you feel during the day.
Again..probably not the entire problem but they sure will mess with things...and don't assume that just because they didn't cause a problem in the past that they won't start causing one now.