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Re: APAP user with an AHI that's all over the map.
Posted: Sun Nov 03, 2019 10:44 pm
by SmallCityDave
Pugsy wrote: ↑Sun Nov 03, 2019 10:34 pm
Is your OSA worse on your back or in REM? --
I've been working on not sleeping on my back or my left side that's when I seem to get a good snore in and my pressure spikes and hangs and perhaps that's what wakes me.
Spend much time on your back some nights and not other nights?
I think I do but it's inconsistent.
How was your sleep quality with the increase? Did you find yourself waking up during the night more? Spend much time awake with mask on?
It doesn't seem to be quality sleep, I do wake up a good amount and I try to go back to sleep with my mask on and yes it's a good amount of time.
Re: APAP user with an AHI that's all over the map.
Posted: Mon Nov 04, 2019 8:47 am
by Pugsy
The machine doesn't know if you are asleep or not. All it does is measure air flow and our awake/semi awake breathing is irregular when compared to asleep breathing and the machines can and will flag awake breathing irregularities by mistake. They also respond to awake breathing if it thinks the irregular breathing means some sort of airway collapse is going on.
So....REM sleep or back sleeping can cause higher OSA pressure needs but also not being asleep can cause higher AHI and pressure needs in some people.
If you know you aren't sleeping well and are having a significant amount of time being spent awake with mask and machine on...and tossing and turning and sighing because you can't sleep...there's a good chance that the higher numbers you see some nights and not others are nothing more than nights where your sleep quality is worse than usual.
You can learn to distinguish awake vs asleep breathing. OSCAR is base off SleepyHead so these instructions and information will apply to OSCAR as well.
http://freecpapadvice.com/sleepyhead-free-software
If it were me I would concentrate more on figuring out what I can do to improve sleep quality right now and less on pressure tweaks unless the pressure itself was part of the problem (causing aerophagia or leaks or whatever).
Re: APAP user with an AHI that's all over the map.
Posted: Mon Nov 04, 2019 9:41 am
by Dog Slobber
SmallCityDave wrote: ↑Sun Nov 03, 2019 10:30 pm
Can you guys take a look, it seems like when I went from 8 to 8.5 as my minimum my AHI got worse.
41 day average at 7.5 minimum pressure AHI was 2.86
7 day average at 8 minimum pressure AHI was 2.79
6 day average at 8.5 minimum pressure AHI was 2.73
Your AHI did not get worse as you increased your pressure.
Is it "normal" to be anywhere from under 1 to over 4 for the AHI, it seems like I have 3 good days than 2 bad days (4 really isn't bad).
Volatility is normal for a lot of people. Especially when we are not sleeping well.
Re: APAP user with an AHI that's all over the map.
Posted: Mon Nov 11, 2019 8:41 am
by SmallCityDave
Thank you both for the feedback, I take it my pressure settings look okay?
Re: APAP user with an AHI that's all over the map.
Posted: Mon Nov 11, 2019 8:57 am
by Pugsy
I suppose you could try a little more minimum pressure if you just want to experiment and see if it helps or hurts things but I don't see any urgent need to change anything.
Awake flagged stuff will be flagged no matter what the pressure is because it's not related to pressure or sleep apnea. You have to be asleep for it to count or be related to therapy.
Now if a little more pressure helps a person sleep better then that might help reduce the awake flagged stuff but because the person is reducing awake times and thus reducing chances for awake flagged false positives.
Way back in the dark ages with I first started therapy (and I think was around 6 months into therapy and after I had dialed into a 10 cm minimum as giving the the most consistent results) I decided to conduct an experiment to see if more minimum helped or not.
Over a period of 6 weeks I increased the minimum 0.5 cm a week until I had spent a week at 13 cm minimum.
I tried to keep good records during those 6 weeks of how I slept, felt, energy levels, AHI and compared those results to what I was seeing with the 10 cm minimum.
Nothing really changed in any of my parameters. Back then we didn't have flow rate to evaluate and determine if flagged events were real asleep events or awake false positive events...I now know that it's very probable that my 1 to 2 AHI that I had at 10 cm minimum most likely was primarily made up of awake false positives. I have other health issues that impact my sleep quality...I had those same issues back when I first started cpap therapy.
I did that experiment more as a learning experience and not because I really expected much but I figured you never know for sure until you try so that's why I tried. You can do that same experiment if you wish and you get to decide if it helps or not and how far you want to take it. I aborted the experiment at the 13 cm point because nothing changed. I saw no reason to continue it.
Re: APAP user with an AHI that's all over the map.
Posted: Mon Nov 11, 2019 10:45 am
by Miss Emerita
Your numbers are pretty good, and as others have remarked, your focus should be on feeling more rested. Still, there's clustering in your charts that might be worth addressing. Others have mentioned back-sleeping and REM sleep as possible culprits. Another possibility is chin-tucking, where you move your head so your chin tucks toward your chest. You might consider using a soft cervical collar or an anti-snore collar to see whether that gives you a smoother ride through the night and a more rested feeling during the day.
Re: APAP user with an AHI that's all over the map.
Posted: Mon Nov 11, 2019 5:58 pm
by SmallCityDave
Pugsy wrote: ↑Mon Nov 11, 2019 8:57 am
I suppose you could try a little more minimum pressure if you just want to experiment and see if it helps or hurts things but I don't see any urgent need to change anything.
Awake flagged stuff will be flagged no matter what the pressure is because it's not related to pressure or sleep apnea. You have to be asleep for it to count or be related to therapy.
Now if a little more pressure helps a person sleep better then that might help reduce the awake flagged stuff but because the person is reducing awake times and thus reducing chances for awake flagged false positives.
Way back in the dark ages with I first started therapy (and I think was around 6 months into therapy and after I had dialed into a 10 cm minimum as giving the the most consistent results) I decided to conduct an experiment to see if more minimum helped or not.
Over a period of 6 weeks I increased the minimum 0.5 cm a week until I had spent a week at 13 cm minimum.
I tried to keep good records during those 6 weeks of how I slept, felt, energy levels, AHI and compared those results to what I was seeing with the 10 cm minimum.
Nothing really changed in any of my parameters. Back then we didn't have flow rate to evaluate and determine if flagged events were real asleep events or awake false positive events...I now know that it's very probable that my 1 to 2 AHI that I had at 10 cm minimum most likely was primarily made up of awake false positives. I have other health issues that impact my sleep quality...I had those same issues back when I first started cpap therapy.
I did that experiment more as a learning experience and not because I really expected much but I figured you never know for sure until you try so that's why I tried. You can do that same experiment if you wish and you get to decide if it helps or not and how far you want to take it. I aborted the experiment at the 13 cm point because nothing changed. I saw no reason to continue it.
I will try to tweak it a bit but it seems that I need to address the issues that are causing me to sleep poorly, I took a sudafed 12hr (because I was congested) it appears to have cleared me up my AHI was better but the quality of sleep isn't good.
Aerophagia seems to be more tolerable.
Re: APAP user with an AHI that's all over the map.
Posted: Mon Nov 11, 2019 6:02 pm
by SmallCityDave
Miss Emerita wrote: ↑Mon Nov 11, 2019 10:45 am
Your numbers are pretty good, and as others have remarked, your focus should be on feeling more rested. Still, there's clustering in your charts that might be worth addressing. Others have mentioned back-sleeping and
REM sleep as possible culprits. Another possibility is chin-tucking, where you move your head so your chin tucks toward your chest. You might consider using a soft cervical collar or an anti-snore collar to see whether that gives you a smoother ride through the night and a more rested feeling during the day.
You and Pugsy have both mentioned Rem Sleep can either of you expand I thought that I wanted rem sleep, looking at that data it looks like after a few hours of sleep (when I go into rem sleep?) I get a big spike with the AHI.
Re: APAP user with an AHI that's all over the map.
Posted: Mon Nov 11, 2019 6:50 pm
by Pugsy
Your body needs and wants all the sleep stages and that includes REM.
It's unfortunate that for some of us REM stage sleep markedly worsens our OSA but it's a fact of life we deal with.
I just make sure that my minimum pressure is optimized so that the machine can get to where it needs to go to deal with REM stage sleep OSA events that need more pressure.
We can't do anything about REM anyway. We need it and want it so might as well accept it and deal with it if needed.
FWIW...my OSA is 5 times worse in REM than in non REM and sometimes I see some substantial increases in pressure what I assume is normally REM sleep.
If you google sleep stages and look at the normal hypnograms you can get an idea when REM will happen during the night unless someone has a lot of wake ups to mess with the cycles.
Re: APAP user with an AHI that's all over the map.
Posted: Mon Nov 11, 2019 9:47 pm
by SmallCityDave
Pugsy wrote: ↑Mon Nov 11, 2019 6:50 pm
Your body needs and wants all the sleep stages and that includes REM.
It's unfortunate that for some of us REM stage sleep markedly worsens our OSA but it's a fact of life we deal with.
I just make sure that my minimum pressure is optimized so that the machine can get to where it needs to go to deal with REM stage sleep OSA events that need more pressure.
We can't do anything about REM anyway. We need it and want it so might as well accept it and deal with it if needed.
FWIW...my OSA is 5 times worse in REM than in non REM and sometimes I see some substantial increases in pressure what I assume is normally REM sleep.
If you google sleep stages and look at the normal hypnograms you can get an idea when REM will happen during the night unless someone has a lot of wake ups to mess with the cycles.
Great information, thank you.
Re: APAP user with an AHI that's all over the map.
Posted: Sun Dec 01, 2019 9:49 pm
by SmallCityDave
I just checked my filter and wow, I've seen it slightly discolored after 2-3 months but never like this.
The odd thing is that my washable filter was a clean as ever.....
Re: APAP user with an AHI that's all over the map.
Posted: Sun Dec 01, 2019 10:34 pm
by Julie
If you have a fireplace or even burning candles they could account for the problem.
Re: APAP user with an AHI that's all over the map.
Posted: Mon Dec 02, 2019 8:21 am
by SmallCityDave
Julie wrote: ↑Sun Dec 01, 2019 10:34 pm
If you have a fireplace or even burning candles they could account for the problem.
Thanks you are spot on we just installed a wood burning stove.
Re: APAP user with an AHI that's all over the map.
Posted: Mon Dec 02, 2019 11:46 am
by zonker
SmallCityDave wrote: ↑Mon Dec 02, 2019 8:21 am
Julie wrote: ↑Sun Dec 01, 2019 10:34 pm
If you have a fireplace or even burning candles they could account for the problem.
Thanks you are spot on we just installed a wood burning stove.
<ding><ding><ding>
winner,winner, chicken dinner!
Re: APAP user with an AHI that's all over the map.
Posted: Mon Dec 02, 2019 11:54 am
by Pugsy
Just make a mental note to change your filter more often when using the new wood burning stove.
At least check it more frequently and watch the color change.