Reading data from Oscar - Hypopnea's

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TehMonkeh
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Reading data from Oscar - Hypopnea's

Post by TehMonkeh » Thu Oct 14, 2021 7:40 am

Good Morning,

I am hoping somebody here may have some additional insight for me. I recently was researching some side effects I was experiencing and learned that every single one of them were signs of my CPAP pressure being too high, I was on CPAP at 18cm and was having a horrible time with dry mouth, mask leaks, aeropaghia and more. During this research I found a video by Nicko at CPAP reviews about how the clinics often give you a higher pressure than what may be needed and he went into some details of how to adjust APAP settings etc. I reached out to my sleep diagnostic clinic and talked to them about it first and they confirmed it was ok to make adjustments on the settings in order to get better comfort and sleep so I changed my resmed 10 to APAP and set it on 8-20 the first night. I found my 95% mark around 13.75 so second night I adjusted down to 9-14 95% was about the same but the low end of 9 was still not comfortable felt like not enough air so last night I moved it to 10-15. I'm sleeping better, aerophagia is gone, haven't working up 5-10 times a night with horrific dry mouth or needing to adjust my mask as mask leak is virtually non-existent now (6 month average was 6% large leak, and last 3 nights it's been .5 or lower).

With all that said, my AHI has gone up but not do to CA's or OSA's, those are still in line with my 3 and 6 month averages; it appears to only be coming from Hypopnea events. I know CA's can read false positives if you're sort of awake and moving in your sleep and I've had those for a while, but when I look at the data they are 99% false positive events. I've looked through the data in Oscar, and im not sure if it's false positives like the CA's or if they are actual hypopnea events. I'm hoping somebody with more experience or insight may be able to guide me / point me in the right direction?

Screenshot of around 2 minutes of data where it looks all normal and the same but there's a random hypopnea event in the middle?
https://www.dropbox.com/s/y6nyxususdzu9 ... 0.png?dl=0

full screenshot of last nights data
https://www.dropbox.com/s/nnpctg7fg8rwp ... n.png?dl=0

I really don't wanna go back to the super high 18 CPAP pressure since I was miserable much of the time with mask leaks, horrible aerophagia, dry mouth and more. But I am not sure if this rise in hypopnea is A: something to even worry about or B: if these are accurate real hypopnea events and C: if they are real I am not 100% sure what to do to address them, do I need to increase my low end of the range? or should I try to go back to CPAP but with a lower pressure like just 14 maybe?

Any help or insight would be greatly appreciated.

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Julie
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Re: Reading data from Oscar - Hypopnea's

Post by Julie » Thu Oct 14, 2021 8:20 am

Do you sleep on your back most of the time?

The 90-95% reading is about being UP to those numbers, not sitting at the high point the whole time which worries people unnecessarily.

TehMonkeh
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Re: Reading data from Oscar - Hypopnea's

Post by TehMonkeh » Thu Oct 14, 2021 8:28 am

No I’m a stomach sleeper. The 95% was 13.75 and the max I hit was like 14.5 maybe 15.

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Pugsy
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Re: Reading data from Oscar - Hypopnea's

Post by Pugsy » Thu Oct 14, 2021 8:34 am

The report you shared with all the hyponeas was with 8 cm minimum from the 11th
Do you have one with minimum of 10 cm?

Sometimes we sit here scratching our heads over why a hyponea gets flagged because we can't see any change in air flow at all. Looks like the one you zoomed in on falls into that category.
Doesn't look like you were awake to me either.

In general to deal with hyponeas or better prevent them we need more minimum pressure and most often not huge amounts more.

Did you ever add EPR into things to help with aerophagia?

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TehMonkeh
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Re: Reading data from Oscar - Hypopnea's

Post by TehMonkeh » Thu Oct 14, 2021 8:49 am

Pugsy wrote:
Thu Oct 14, 2021 8:34 am
The report you shared with all the hyponeas was with 8 cm minimum from the 11th
Do you have one with minimum of 10 cm?

Sometimes we sit here scratching our heads over why a hyponea gets flagged because we can't see any change in air flow at all. Looks like the one you zoomed in on falls into that category.
Doesn't look like you were awake to me either.

In general to deal with hyponeas or better prevent them we need more minimum pressure and most often not huge amounts more.

Did you ever add EPR into things to help with aerophagia?

sigh, I grabbed the wrong one on accident, here's the correct one here's last night with 10-15 range.
https://www.dropbox.com/s/2mucm96oa2fkr ... 3.png?dl=0

I had my EPR at max from day one, I actually tried turning it off at one point (based on I Think it was your advice actually) and I couldn't do it, I had to turn it back on with the 18 pressure. I didn't have the air swallowing issues as bad at first but now that ive gotten used to it and im sleeping better it's gone crazy especially with all the other side effects going on to. I was shocked by how much better it was when I turned down my pressure.

I can try upping the min pressure in small increments if that may help, my median has been 11.3-11.5 on all 3 nights so I have some room to increase the bottom end I think?

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Pugsy
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Re: Reading data from Oscar - Hypopnea's

Post by Pugsy » Thu Oct 14, 2021 9:03 am

Did you have a lot of central apneas at first and that is maybe why I suggested turning EPR off?

About half your AHI is central and half hyponea.
Some of the central clusters are obviously awake breathing false positives but some may be real.
Give me a bit of time as I need to go review your past posts and what was talked about. I need to refresh my memory a bit.

If you never saw these reports......how would you describe how you slept in general and how you feel during the day?
How many times do you wake up during the night? Why?

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TehMonkeh
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Re: Reading data from Oscar - Hypopnea's

Post by TehMonkeh » Thu Oct 14, 2021 9:19 am

Pugsy wrote:
Thu Oct 14, 2021 9:03 am
Did you have a lot of central apneas at first and that is maybe why I suggested turning EPR off?

About half your AHI is central and half hyponea.
Some of the central clusters are obviously awake breathing false positives but some may be real.
Give me a bit of time as I need to go review your past posts and what was talked about. I need to refresh my memory a bit.

If you never saw these reports......how would you describe how you slept in general and how you feel during the day?
How many times do you wake up during the night? Why?
I had a lot of false positive CA's before when you suggested it, I was trying to learn to determine if they were false / real at the time. the nI go through almost all of my CA's are very obviously awake. over time I learned they mostly appeared when I would wake up cause my mask was leaking and driving me crazy. My CA's now are on par with the average over the past 6 months as well, those didn't change with the APAP change (6 month CA average = 3.57, 30 day CA average = 3.89, last night CA was 3.57)

ALl in all the last 3 nights have been a lot better I believe. I was waking up a ton due to the Sahara desert level dry mouth, or the insane mask leaks, and the aerophagia OMG I would have to get up and take gas-x to go back to sleep. with all that gone the only times I can recall waking up the last 3 nights was to roll over and fall right back asleep maybe to use the restroom once per night. no noticeable mask leak, zero dry mouth, and no gas / aerophagia issue. as for day to day I feel about the same as I did before, I never felt the massive improvement to energy levels everybody talked about, I just stopped feeling like I was going to fall asleep driving and what not after I started CPAP

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Pugsy
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Re: Reading data from Oscar - Hypopnea's

Post by Pugsy » Thu Oct 14, 2021 10:26 am

So for the past 3 nights some improvement in overall sleep quality??? No miracles but somewhat of a daytime improvement with a reduction in drowsiness during the day??? No aerophagia issues?? Safe assumption??

With your history of bad aerophagia issues at higher pressures I am very hesitant to suggest to try more minimum at this time just to try to kill off some hyponeas that don't look all that scary on the flow rate if most are like what you zoomed in on.

I think I would run with the new minimum for a couple of weeks and see how it goes.
Give your body a chance to adjust to the new settings.

This may be one of those situations where you have to choose between 2 less than optimal options.
The thing is we don't know how critical it is to get those hyponea numbers down but we do know that most likely more pressure is going to cause aerophagia issues which in turn disturb sleep and make us miserable.

I am of the opinion that we have to get some decent sleep first and worry about needed tweaks later when we are faced with 2 not so optimal choices.

You made a fairly substantial increase in the minimum pressure....lets see what happens in terms of sleep quality and aerophagia abatement and results after a couple of weeks.

3 hyponea per hour average and sleeping more soundly and maybe feeling a little better and no aerophagia may be an acceptable compromise.

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Miss Emerita
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Re: Reading data from Oscar - Hypopnea's

Post by Miss Emerita » Thu Oct 14, 2021 1:36 pm

Please follow Pugsy's advice!

I would add one thing: you have some significant flow limitations along with the hypopneas. The FLs may be bothering you some at night -- or not. For some people, they are no bother at all.

EPR can help with flow limitations, and I've seen knowledgeable people on other forums also recommend EPR for hypopneas. The potential downside of adding EPR is increasing CA events.

No reason to pay any attention to this now, while you do as Pugsy has recommended. But it's something to tuck away in the back of your mind as an option down the road.
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TehMonkeh
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Re: Reading data from Oscar - Hypopnea's

Post by TehMonkeh » Thu Oct 14, 2021 1:45 pm

Pugsy wrote:
Thu Oct 14, 2021 10:26 am
So for the past 3 nights some improvement in overall sleep quality??? No miracles but somewhat of a daytime improvement with a reduction in drowsiness during the day??? No aerophagia issues?? Safe assumption??

With your history of bad aerophagia issues at higher pressures I am very hesitant to suggest to try more minimum at this time just to try to kill off some hyponeas that don't look all that scary on the flow rate if most are like what you zoomed in on.

I think I would run with the new minimum for a couple of weeks and see how it goes.
Give your body a chance to adjust to the new settings.

This may be one of those situations where you have to choose between 2 less than optimal options.
The thing is we don't know how critical it is to get those hyponea numbers down but we do know that most likely more pressure is going to cause aerophagia issues which in turn disturb sleep and make us miserable.

I am of the opinion that we have to get some decent sleep first and worry about needed tweaks later when we are faced with 2 not so optimal choices.

You made a fairly substantial increase in the minimum pressure....lets see what happens in terms of sleep quality and aerophagia abatement and results after a couple of weeks.

3 hyponea per hour average and sleeping more soundly and maybe feeling a little better and no aerophagia may be an acceptable compromise.
Yeah, for the most part im staying asleep (at least to my knowledge) for longer than I was before as I'd wake up every hour or so with some sort of issue most nights. Still not "energetic" really, but im not falling asleep 10 minutes after waking up like I was before either.

ill give it a shot like this for a bit and see how it goes, but I have no issues raising the minimum to try it etc. I mean I've been dealing with those issues for a while ill know if they come back and can adjust what I ddi etc. but ill wait a bit and see what happens. Im ok with how things are going right now to be honest, I am more just concerned about interpreting data properly for both now and future reference. I figured if it was a situation like with the false positive CA's that was easy to identify then if it said I had 3 an hour but when I look at them it's only "actually" like 4 3 total and the rest are false then I'd know it's no big deal (much like I do with CA's now).

like I said, ill give this a week or two and see if there's any long term issues or if everything adjusts down and if not, then ill up the minimum slowly to see if / where it improves. thank you again!

TehMonkeh
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Re: Reading data from Oscar - Hypopnea's

Post by TehMonkeh » Thu Oct 14, 2021 1:49 pm

Miss Emerita wrote:
Thu Oct 14, 2021 1:36 pm
Please follow Pugsy's advice!

I would add one thing: you have some significant flow limitations along with the hypopneas. The FLs may be bothering you some at night -- or not. For some people, they are no bother at all.

EPR can help with flow limitations, and I've seen knowledgeable people on other forums also recommend EPR for hypopneas. The potential downside of adding EPR is increasing CA events.

No reason to pay any attention to this now, while you do as Pugsy has recommended. But it's something to tuck away in the back of your mind as an option down the road.
im do not fully understand what the flow limitations are, or why that is significant, if you have any insight or anything that would be great (ill also be researching this when I get off work so if not I should hopefully find something later). Do these have to do with exhaling though, my understanding is EPR is only to help you get some relief when exhaling. my CA events are already happening, but as I've noted the vast majority are not actual CA events and are occurring when im actually awake / stirring a bit to move around etc. out of the like 31 listed last night, only like 3 were really possibly an actual CA and those may not even be CA's.

I don't have a problem with the EPR being on, I HAD to have it when it was at 18 full blast all night, I tried it for 30 minutes without and was a non-starter lol

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Re: Reading data from Oscar - Hypopnea's

Post by Pugsy » Thu Oct 14, 2021 2:02 pm

Are you experiencing any nasal congestion at night?

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TehMonkeh
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Re: Reading data from Oscar - Hypopnea's

Post by TehMonkeh » Thu Oct 14, 2021 2:20 pm

Pugsy wrote:
Thu Oct 14, 2021 2:02 pm
Are you experiencing any nasal congestion at night?
24/7/365 for like...20 years.

it was never a really bad thing, but with CPAP it's been an issue so I've started seeing an allergist and likely will be sent to an ENT in 4-5 weeks when I do my followup. recently learned I have asthma (just got put on a control inhaler for asthma) no serious allergies, but I have had post nasal drip and had issues with smell and getting air through my sinuses for as long as I can remember.

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Re: Reading data from Oscar - Hypopnea's

Post by Pugsy » Thu Oct 14, 2021 2:40 pm

Flow limitations have 2 potential points of origin
1...airway related and we might think of them as baby hyponeas and sometimes they can mess with sleep and be important to kill
2..nasal congestion as possible origin

Remember these machines measure air flow only. They have no way to know if a reduction in air flow is from the airway below the nasal cavity (which is where OSA happens) or in the nasal cavity because of swollen nasal mucosa causing the reduction in air flow.

Unfortunately the highest pressures in the world won't do much to help reduce nasal congestion and any increased FL activity on that FL graph. Also little tweaks that will maybe help reduce FLs that are airway related won't help with nasal related FLs. Sometimes adding EPR into the mix will help reduce airway related FLs but won't do anything for nasal related FLs.

Something you might consider adding later but don't be surprised if the FLs on the graph don't change much.

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TehMonkeh
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Re: Reading data from Oscar - Hypopnea's

Post by TehMonkeh » Thu Oct 14, 2021 2:45 pm

I didn’t think about it till you asked
About congestion but I have noticed a reduced amount of gunk being coughed up every morning the last couple days. I’m wondering if the previous high pressure was pushing some of that back into my throat and the new pressures are not and may be causing the additional limitation or hypopneas etc.? I don’t know what I’m talking about so I’m just guessing based off of what you just noted above.