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so im trying to keep an eye on my ahi and have had logts of great help here, especially from pugsy trying to understand the graphs, last few nights have been quite ugly on the graphs, las night getting a 4.8, i woke this morning feeling quite refreshed i thought, so i took a look at the results. my sleep study i did at home showed an ahi of 15 when i first started my cpap therapy 4 years ago, i lost alot of weight which brought it down to 8, as i have af i kept up with therapy as to be honest it dosent bother me.
ive since put weight back on, and since april ive noticed my ahi has incresed quite dramatically, from 0.3 to.1.5 up into the 4's and 5's
below is a period from last night where i had a few episodes of which look false to me, but there is no change in the pressure, im due to go get my machine yearly checked soon is it a casde the machine needs changing perhaps?

Other people will have more expertise than I do, but I'd say these events are SWJ. The breathes with the greater flow-rate amplitude are the give-away, I think. At least on my graphs, that's a sure indication that I've experienced an arousal, maybe waking all the way up, maybe just moving out of deeper sleep into shallower sleep. The problem for this kind of stuff is less the events themselves and more the fact of the frequent arousals.

Your machine is set with a fixed pressure, so it's not going to go up in response to events. I'm not sure whether your particular machine has an auto mode, though from what you say it sounds as though it does.

Even with an auto mode, a PAP machine isn't going to increase pressure after a CA event, because more pressure won't fix CAs. And even with an auto mode, PR machines can be quite conservative about responding to obstructive events.

Bottom line: you could try increasing the pressure incrementally. Given your weight gain, that might be what you need at this point. Take it slowly, though: .5 at a time, with at least a few days at each new setting.

Keep us posted, would you?

Miss Emerita wrote: ↑

Fri Jul 24, 2020 10:34 am

Other people will have more expertise than I do, but I'd say these events are SWJ. The breathes with the greater flow-rate amplitude are the give-away, I think. At least on my graphs, that's a sure indication that I've experienced an arousal, maybe waking all the way up, maybe just moving out of deeper sleep into shallower sleep. The problem for this kind of stuff is less the events themselves and more the fact of the frequent arousals.

Your machine is set with a fixed pressure, so it's not going to go up in response to events. I'm not sure whether your particular machine has an auto mode, though from what you say it sounds as though it does.

Even with an auto mode, a PAP machine isn't going to increase pressure after a CA event, because more pressure won't fix CAs. And even with an auto mode, PR machines can be quite conservative about responding to obstructive events.

Bottom line: you could try increasing the pressure incrementally. Given your weight gain, that might be what you need at this point. Take it slowly, though: .5 at a time, with at least a few days at each new setting.

Keep us posted, would you?

So are the arousals as bad as the apnea events themselves then, also when checking most if not all of the centrals seem to be false

Arousals point to crappy sleep...We can have an AHI of 0.0 and still feel like total crap if we have a truckload of arousals.

There is a good description of how and why we need the nice normal progression of sleep in the various sleep stages and percentage of each sleep stage at the link below. Arousals mess with the nice normal progression of the sleep stages. Think of them as sort of resetting things so we don't get the nice normal progression of the sleep stages.
Now I know it is talking about how alcohol affects the sleep stages but just substitute the word "anything" for alcohol because the end result is the same....doesn't matter what is the disturbing factor the end result is the same.
https://www.sleepfoundation.org/article ... tity-sleep

A few arousals are normal and not a big deal. Like did you know it's normal to wake up after the completion of each REM cycle? This is normal. Most of the time we aren't awake long enough to form a memory of the wake up but on occasion we remember a few of them. Likely explains why we remember dreaming sometimes..just happened to wake up at the end of a REM cycle though we can also dream in other sleep stages. Remembering a lot of dreams...not a good thing at all. Remembering an occasional dream...sort of normal.

It's when we have a LOT of arousals that is when we worry. It means we aren't getting good sleep quality and likely not getting the needed amount in each sleep stage that the body needs for the restorative powers of sleep to work their magic. I have this problem myself and my arousals aren't related to sleep apnea at all. I do not know how many arousals are "acceptable" and how many are "bad news"....usually your body will let you know though. I do know that on the nights I see probably 25 to 35 arousals and a nice low AHI...I feel like crap and the nights I might see a dozen arousals I will feel better in general. A lot of it will depend on how quickly you can get back to sleep and back into the progression of the sleep cycles.

Google "sleep stages" and look at the normal hypnograms showing all the cycles. It's quite complicated and we cycle through several repeated cycles in a good night. On a bad night we don't. We will feel it on those bad nights in terms of fatigue and being sleepy the next day because we just don't get enough "good" sleep quality. Sometimes it's short hours that is also a factor and sometimes it's simply crappy sleep even if we get 8 hours of sleep. If it's not good sleep we aren't going to feel good.

So arousals are a big factor and that's why we watch for them and when we see a lot of them and we still fill like crap we go do some more investigating to see what we can do to reduce them because we want to feel better.

OSA therapy and sleep....there's a whole lot more to it than just getting nice low AHI numbers. I wish it was as easy as that because getting the nice low numbers is the easy part. Feeling them is a whole different story sometimes..

Here below is an example of a software report that shows the flow rate in a much bigger picture and makes it much easier to evaluate asleep vs arousal breathing and flagged events.
It is Respironics machine and Encore software report which is why it looks so different and it's actually the only thing I like about Encore.

This guy doesn't have OSA....documented with an in lab sleep study....his AHI was less than 2.0 during the in lab study and he slept fairly well (for him) but he still felt like crap so he wanted to give cpap a try...thinking maybe UARS or something like that.
No matter what we did...couldn't make him feel better but bear in mind he was having some mask comfort/leak issues AND he was also taking a medication that was also well known to cause sleep maintenance insomnia.

It doesn't take a rocket scientist to see that his sleep quality is/was in the toilet. Pretty much all of the flagged events were SWJ and there were a lot of them. I don't know what finally happened to him. He fell off the map.

So how do you differentiate between UARS and OSA??

Juggsy75 wrote: ↑

Sat Jul 25, 2020 5:39 am

So how do you differentiate between UARS and OSA??

Not sure what you mean. Are you talking about the data available from the cpap machine and the software?
Or are you talking more about in general?
We can't see UARS on the data that a cpap machine gathers for the most part. We can maybe see evidence with arousal flow rate breathing but that's not always a given or easy.

UARS is all about Respiratory related arousals. We can have any number of reasons for having arousals or poor sleep but unless they are related to some sort of airway issue...it's not UARS. I wake up frequently during the night but it's from pain. That means it's not UARS.
There are tons of reasons out there to have arousals unrelated to the airway. Heck, just plain old sleep maintenance insomnia or spontaneous arousals with no known cause or medication side effects or the dog barking or cat walking across a person. You get the idea.

To know for sure that UARS is the problem the best way is to have an in lab sleep study using a Pes device because a person has to be asleep first...and then have some sort of airway related event (that doesn't meet OSA criteria) that causes an arousal and the arousal is for sure seen with the sleep status data. It's not an easy for sure diagnosis to make. Not all labs do sleep studies using the Pes device and most doctors just will go ahead and say "it sounds like or looks like UARS and since the treatment is the same, which is cpap, lets go ahead and give it a try"...

Pugsy wrote: ↑

Sat Jul 25, 2020 7:54 am

Juggsy75 wrote: ↑

Sat Jul 25, 2020 5:39 am

So how do you differentiate between UARS and OSA??

Not sure what you mean. Are you talking about the data available from the cpap machine and the software?
Or are you talking more about in general?
We can't see UARS on the data that a cpap machine gathers for the most part. We can maybe see evidence with arousal flow rate breathing but that's not always a given or easy.

UARS is all about Respiratory related arousals. We can have any number of reasons for having arousals or poor sleep but unless they are related to some sort of airway issue...it's not UARS. I wake up frequently during the night but it's from pain. That means it's not UARS.
There are tons of reasons out there to have arousals unrelated to the airway. Heck, just plain old sleep maintenance insomnia or spontaneous arousals with no known cause or medication side effects or the dog barking or cat walking across a person. You get the idea.

To know for sure that UARS is the problem the best way is to have an in lab sleep study using a Pes device because a person has to be asleep first...and then have some sort of airway related event (that doesn't meet OSA criteria) that causes an arousal and the arousal is for sure seen with the sleep status data. It's not an easy for sure diagnosis to make. Not all labs do sleep studies using the Pes device and most doctors just will go ahead and say "it sounds like or looks like UARS and since the treatment is the same, which is cpap, lets go ahead and give it a try"...

starting to be at a loss as to why my nights are so bad lately, im taking citalopram for anxiety but have been for a while, ive gone through this night and found alot were false, giving me a ahi of 1.5, however it wasnt a great nights sleep so cannot understand why im having so many arousals, also my machine was set by hospital at 6, ive increased it to 8 but the flow rate stays around 6 it says epap is 6.21, should i increase or turn off the epap?

last nights

You appear to be using C Flex exhale relief set at 2. So the pressure does drop during exhale and gives you that lower EPAP pressure average on exhale. It's fixed at 8 on inhale. Flex relief isn't a 2 cm per setting drop for exhale like ResMed machines. Instead it is based on how forcefully you breath. Using Flex is giving you the EPAP average you are seeing but you are having 8 cm on IPAP or inhale.

Do you know if you were awake at the roughly 01:00 to 02:00 when the dense cluster of OAs got flagged?
On your back maybe???

Do you know if you still have some auto trial mode capabilities available on your Pro model machine?
Meaning if you go to the clinical setup menu area can you access the auto trial feature at all or is it greyed out and you can't engage it.

citalopram...it's in the SSRI class of drugs and they are well known to mess with sleep quality and don't assume that because it maybe didn't seem to be a factor before that it isn't now. Our bodies can change and our reactions to meds can change as well.
Google SSRI meds and sleep and start reading. It suppresses REM stage sleep for one thing. Trouble sleeping is a common known side effect. It's not doing you any favors in the sleep department.

You know I am thinking that with the increase in weight and maybe just our old friend Mother Nature of getting older you just need more pressure than you are getting to deal with your original problem of mild OSA and maybe it isn't so mild now.
Maybe your problem isn't UARS but just plain old OSA not being well treated.

Do you know if in your original sleep study they ever mentioned the OSA being worse in REM sleep? Do you know if you even got much REM sleep? I know it's quite common to have OSA be a lot worse in REM and if we don't always get much REM it doesn't always show up on a sleep study. Especially true if either the REM events bounce us out of REM every time we get to REM or if we are taking a medication that suppresses REM.
My own OSA is 5 times worse in REM and documented in the in lab sleep study. My non REM OSA was a mere 12 per hour but in REM it figured out to be 53 per hour. A bit hard to figure out because pretty much as soon as I hit REM then the apnea events started happening fast and furious and I would find myself bounced out of REM because the apnea events caused arousals.
And I wasn't on any meds that mess with sleep or REM.

So when I went to the sleep lab for the titration study....I had trouble sleeping and didn't get much sleep and came out of there with a prescribed setting of 8 cm but I had a grand total of 6 minutes in REM during that awful night. They never really got to test me during REM to find an optimal pressure for the REM related events. It didn't come as a big surprise that 8 cm fixed did a lousy job during REM.
It did do a good job during other non REM sleep stages. Now I don't know that this is your problem but if you were asleep for sure during that first ugly cluster last night...that's just about at the time we would expect the first REM stage to kick in. I used to see patterns like that on my reports. I called them my witching hour. Which is why I asked if you were asleep at that time.
Your report looks like what I used to see when I first started therapy and my pressure settings weren't yet dialed in.

Maybe we need to go back to square one and think that it's OSA that is your problem and not UARS and go from there.
And maybe having the minor complicating factor of the medication also impacting sleepy quality....between apnea events potentially causing arousals and the medication itself causing problems...then you situation has worsened. It wouldn't be impossible I suppose.

Pugsy wrote: ↑

Sun Jul 26, 2020 6:29 am

You know I am thinking that with the increase in weight and maybe just our old friend Mother Nature of getting older you just need more pressure than you are getting to deal with your original problem of mild OSA and maybe it isn't so mild now.
Maybe your problem isn't UARS but just plain old OSA not being well treated.

Do you know if in your original sleep study they ever mentioned the OSA being worse in REM sleep? Do you know if you even got much REM sleep? I know it's quite common to have OSA be a lot worse in REM and if we don't always get much REM it doesn't always show up on a sleep study. Especially true if either the REM events bounce us out of REM every time we get to REM or if we are taking a medication that suppresses REM.
My own OSA is 5 times worse in REM and documented in the in lab sleep study. My non REM OSA was a mere 12 per hour but in REM it figured out to be 53 per hour. A bit hard to figure out because pretty much as soon as I hit REM then the apnea events started happening fast and furious and I would find myself bounced out of REM because the apnea events caused arousals.
And I wasn't on any meds that mess with sleep or REM.

So when I went to the sleep lab for the titration study....I had trouble sleeping and didn't get much sleep and came out of there with a prescribed setting of 8 cm but I had a grand total of 6 minutes in REM during that awful night. They never really got to test me during REM to find an optimal pressure for the REM related events. It didn't come as a big surprise that 8 cm fixed did a lousy job during REM.
It did do a good job during other non REM sleep stages. Now I don't know that this is your problem but if you were asleep for sure during that first ugly cluster last night...that's just about at the time we would expect the first REM stage to kick in. I used to see patterns like that on my reports. I called them my witching hour. Which is why I asked if you were asleep at that time.
Your report looks like what I used to see when I first started therapy and my pressure settings weren't yet dialed in.

Maybe we need to go back to square one and think that it's OSA that is your problem and not UARS and go from there.
And maybe having the minor complicating factor of the medication also impacting sleepy quality....between apnea events potentially causing arousals and the medication itself causing problems...then you situation has worsened. It wouldn't be impossible I suppose.

My sleep study was quite poor I thought, it was a home study and I noticed during the study the oxygen level whilst walking around was 93, my wife who is a nurse questioned this as it should be higher, so I told them when taking the equipment back, they just shrugged and said it’s not the number it’s how many time’s it drops into a low level, made no sense to me as if it was low to start then it would dip into low levels quicker‍♂️‍♂️


I was told at initial appointment that due to the answers I’d given and my neck measurement that they would be very surprised if I had osa, following home test it was discovered I’d had 15, that’s literally the only information I’ve ever had,

Due to having Afib I’m under a hospital in London, after a procedure they did another overnight sleep study at home, I wore what looked like a watch, I’d lost about 2 stone since first test and it came back as ahi of 8, since then I’ve put weight on, I was having low scores in jan and feb it seems to have gone higher since March, I have had and still am having some anxiety issues over my heart issues hence the vital Oprah

Ahhh...you are in the UK. They do things a bit differently over there compared to here in the US.

I am going to change your topic to get the attention of a UK forum member to help out. Get his input as to your potential options.

And you had a home study. Did you just wear a little gadget on your finger? Or did you wear something else along with it?
Did you wear anything around your chest? Did you have a little cannula thing sitting at your nostrils.
I know these seem like weird questions but it helps me figure out what kind of home study you had and I am betting there were no leads on your face and head to measure sleep so we have no idea what went on during sleep or actually if you even slept much.
You already know that the O2 levels dropped just walking around awake.

Again....were you asleep when that first dense ugly cluster of OAs got flagged?

Just read about narcolepsy aswell, which involves waking a lot through the night

Pugsy wrote: ↑

Sun Jul 26, 2020 8:22 am

Ahhh...you are in the UK. They do things a bit differently over there compared to here in the US.

I am going to change your topic to get the attention of a UK forum member to help out. Get his input as to your potential options.

And you had a home study. Did you just wear a little gadget on your finger? Or did you wear something else along with it?
Did you wear anything around your chest? Did you have a little cannula thing sitting at your nostrils.
I know these seem like weird questions but it helps me figure out what kind of home study you had and I am betting there were no leads on your face and head to measure sleep so we have no idea what went on during sleep or actually if you even slept much.
You already know that the O2 levels dropped just walking around awake.

Again....were you asleep when that first dense ugly cluster of OAs got flagged?

Furst home study was finger, a tube that sat just around nostrils but not inserted and some bands around chest and stomach I believe, second one was from what I recall on finger fitted to a watch type device, the oxygen wasn’t correct as I have it tested regularly and it’s never below 98% so think the equipment they have was either impaired or not fitted properly, that’s only two studies I’ve had,I also asked recently if I suffered osa or central sleep apnoea and was told osa they can tell by info‍♂️‍♂️

I won’t lie after having pretty decent ahi over last 4 years this has me really worried now