CPAPer since '12, new questions

Hi,

When I was originally diagnosed in 2012 I found this board very helpful. I thought I had an account but my password manager doesn't remember it, so here's a new account.

My diagnosis is severe OSA. My last sleep study was over a year ago. About August of '17 I was having so many sleep problems I went from a Resmed S9 to Resmed S9 Autoset for Her and I really think it made a huge difference. Maybe even saved my life. I will never go back to a single pressure machine. About January '18 I upped the range from 4 to 20 to 14 to 20 - that also made a huge positive difference.

About June or July of this year I felt like my nasal pillow mask was leaking regardless of headgear settings and I was waking up with dry mouth so I went in and got a full nasal mask. That has worked out well. Since October I've been on a decline in many ways - mental and physical health - many physical and life changes so I figured it was an adjustment period. Also, when sleep stops working my brain stops working right.

3 days ago I finally was clear-headed enough to realize that some of my symptoms are a repeat of the times when I've had really bad sleep issues and needed to up the pressure, change machine, change mask, etc. So I googled and must have read something (foggy brain) that made me go and turn the pressure range on my machine down from 16-20 to 12-20. I woke up from the next time I slept after that feeling really good. (Only ever previous time that happened was when I woke up from a titration study that upped my pressure to where it needed to be.)

I'm here today with a few questions:
1) It seems like my flagged events are more and more centrals. Do I need to go to my sleep doctor to discuss this? (It would be in January - I have learned you can't get a sleep doctor appointment in December because everyone has already paid their deductible and wants to get in all treatment by the end of the year.) Is there anything I can try or adjust or test on my own?

2) Any other insights on what I could try to start getting sleep that's restful again?

Any help is so appreciated.

Here's my last full day of data: Here's the last 6 months of data:

You don't have enough centrals to worry about doing anything about them even if they were all real and with the history of bad sleep quality and frequent awakenings I am better most aren't real anyway. Instead I am betting most are SWJ or sleep/wake/junk false positive events flagged because of awake/semi awake breathing irregularities getting flagged by mistake.
Go here and watch the videos to learn how to zoom in and see the actual flow of each breath to see awake breathing vs asleep breathing.
http://freecpapadvice.com/sleepyhead-free-software
The machine can't measure sleep status...all is measures is air flow. It can and will flag awake/arousal breathing by mistake.

As to why your sleep quality has worsened....that's a tough one to figure out sometimes.
Start with the obvious...any changes in your life that might cause sleep disturbances?
Added a new medication? Changed a dosage on an old medication? Any new stressors in life? Any new health issues? Change in pain levels for some reason?
You've got what is termed sleep maintenance insomnia...you probably go to sleep just fine but wake up too many times in the night or sooner than you wish and then maybe have trouble going back to sleep.
The list of potential culprits is a mile long with sleep disordering breathing being just one item on that mile long list.


Any idea what is causing the wake ups?

Oh...your AHI is low but your Flow Limitation graph is fairly active...any chance you are having nasal congestion issues?

Thank you for your reply @Pugsy.

My nasal congestion isn't more or less than normal. But would an enlarged left thyroid with planned nodular FNA biopsies on Monday count? Or maybe only if there invasion/constriction of the airway? It was an undetectable enlargement ~5 months ago, but ~1 month ago was large enough to feel and send me for an ultrasound.

Changes in my life: So many it feels like. Moved from running my own business to full-time W2 with a client.

I did add a new medication 2.5 months ago - but it would really suck if it was effecting my sleep because it really helped me otherwise. I will say I've taken more xanex in the last 2 weeks than the entire rest of my life combined. A few times it's the only thing that's allowed me to get to sleep at all.

In terms of wakeups - it's less wakeups (which I've had for years for 1-3 times a night - mostly about going to the bathroom) and now more a nap, awake, nap, awake, etc. cycle. You can see on the session times how I went from having a consistent 8-12 hour awake time to having sleep go throughout my day. In terms of what causes me to wake up I don't know if it's not being able to breathe or something else. Recently I always wake up with sweat on the top of my back and neck.

I will also say - I'm not getting as much sleep as the numbers would say. Years ago I had a bad habit of falling asleep before I could put the mask on so now I put it on whenever I lay down to make sure I never sleep without it. In terms of breathing it's great but in terms of knowing whether I slept 3 hours or 12 hours in a day it's hard-impossible to tell.

People don't always understand that sleep quality if often more important than "quantity"....10 hours of highly fragmented sleep is likely to leave us feeling just as crappy as a meager 4 hours of sleep.

There's an article I read a while back that really explains the impact of sleep architecture in detail and easy to understand language.
While it is addressing alcohol and sleep...substitute anything for alcohol in terms of impact on sleep architecture.
https://www.thesleepdoctor.com/2017/11/ ... hol-sleep/
Doesn't matter if it is alcohol, pain, medication side effects, nasal issues, mask issues...whatever issues....the harm that fragmented sleep does to our sleep architecture is the same.

The other night I had a bad night because of back issues...got a measly 5 hours of sleep and I went through the flow rate and had at least 15 arousals during those 5 hours. I probably remembered half of them. My AHI was nothing...something like 1.2 or whatever and maybe one event was real...the rest being SWJ. I felt like crap because not only did I not get enough sleep...it was crappy quality sleep too.
Not every sleep problem in the world is caused by sleep apnea and thus can't be fixed with the best therapy in the world. I wish it were that easy.

The reason I asked about nasal congestion is that sometimes the machine will sense nasal congestion reduction in air flow and the FL graph is really active.
When the FL graph is ugly from nasal issues more pressure isn't likely to help but if it's in the airway down behind the tongue area...sometimes more pressure will help and if those FLs are affecting sleep quality and causing wake ups/arousals...people can feel better if the FLs get reduced a bit if those FLs are affecting sleep quality (and they can).

Adding some EPR full time may help the flow limitations but may also increase your centrals but until we try we won't know.

alison985 wrote: ↑

Sun Dec 16, 2018 6:30 am

1) It seems like my flagged events are more and more centrals. Do I need to go to my sleep doctor to discuss this?

Your centrals are completely insignificant. I wouldn't even raise an eyebrow on them till you're way over 5 an hour.