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My week-long experiment (that was suggested by RobySue1 on 12/5/22) is now finished.
robysue1 wrote: ↑Mon Dec 05, 2022 10:47 am
The thing that most catches my attention from the data you posted is this: Your flow limitations disappear almost completely once your pressure is 12cm. In other words, you may need to bump the min pressure up a bit.
As for whether the CAs are something to be genuinely worried about:
1) While I know that you didn't have any CAs on your sleep tests, the number of CAs on this night is not particularly alarming---particularly since you say there might be some SWJ mixed in.
2) In an ideal world, your xPAP ought to be able to use enough pressure to prevent obstructive events even when you are sleeping supine. But since your OSA is positional, the question is how much additional pressure might be needed and can you tolerate it in terms of aerophagia and the number of pressure induced CAs.
I'll also add this: Sound sleep on your back at a higher pressure beats sleep interrupted by attempts to keep yourself from sleeping on your back, particularly if pain issues are a problem when you are trying to sleep on your sides.
My suggestions, such as they are, are these:
1) Try bumping min pressure up to 11 and see if there's no aerophagia. Leave your max pressure where it currently is set and leave EPR = 2.
2) For the next several nights, don't worry about trying to keep yourself off your back. Let yourself sleep in whatever position seems most comfortable. Make a note of whether you wake up or fall asleep while on your back. Don't worry about a temporary increase in AHI. The point of the experiment is to see where the machine wants to go if you are on your back and just how much the AHI increases when you are on your back.
After you have several days of data, then reevaluate what to do based on the answers to these questions:
A) How bad did the AHI get during the experiment? And what was the distribution of events?
B) Subjectively is sleeping on your back easier, more satisfying, and in any sense more "restful" than trying to focus your attention on keeping yourself off your back?
C) What problems with aerophagia and/or mask leaks happened because the machine was running at a higher pressure for longer periods of time because you were on your back for longer periods of time?
Here are my OSCAR Daily Views for each night (with stat summaries):
12/5/22
https://imgur.com/JP8F4CN
- AHI 4.4 [Supine @half night]: "Reported" OA 3.07, CA 1.16, H 0.21 . . . 95% FL 0.06, 95% P 15.32 // 99.5% P 15.98, % LL 5.06
12/6/22
https://imgur.com/KeoFMF9
- AHI 4.43 [Supine @half night]: "Reported" OA 3.05, CA 0.98, H 0.39 . . . 95% FL 0.08, 95% P 15.78 // 99.5% P 16 (set at 16), %LL 4.16
12/7/22
https://imgur.com/dq4toLI
- AHI 9.25 [Supine 3 hrs]: "Reported"
OA 5.27, CA 3.23, H 0.75
[CSR 2.83] . . . 95% FL 0.08, 95% P 14.94 // 99.5% P 15 (set at 15), %LL 0.02
12/8/22
https://imgur.com/0FyPdUl
- AHI 3.35 [Supine 1-1/2 hr]: "Reported" OA 1.95, CA 0.65, H 0.54 . . . 95% FL 0.07, 95% Pressure 14.06 // 99.5% P 15.70, %LL 1.90
12/9/22
https://imgur.com/Dg3TKFn
- AHI 3.98 [Supine 1 hr]: "Reported" OA 1.16,
CA 2.83, H 0.00
[CSR 2.46] . . . 95% FL 0.07, 95% P 13.76 // 99.5% P 15.90, %LL 0.01
12/10/22
https://imgur.com/OoHKFAc
- AHI 5.84 [Supine 2-1/2 hrs]: "Reported" OA 0.80,
CA 4.24, H 0.80 . . . 95% FL 0.08, 95% P 13.64 //99.5% P 14.54, %LL 0.01
12/11/22
https://imgur.com/NlDDlQY
- AHI 1.75 [NON-Supine night]: "Reported" OA 0.22, CA0.66, H 0.87 . . . 95% FL 0.10, 95% P 12.46 // 99.5% P 13.36, %LL 0.04
To Zoom in (Z) on any graphs in SleepHQ, see MY NEXT POST (I was limited to 10 URLs per post).
I did make some adjustments during the week:
1. On 12/7, I decreased the MAX P from 16 to 15 in the middle of the night (poor move), so first half was 16, last half was 15. I thought this "might" stop the "runaway pressure" when I was supine . . . but all it did was INCREASE THE EVENTS (whether real or false) while supine. The next morning I returned it back to 16 as before.
2. Since RobySue1 mentioned that she thought I should increase the MIN Pressure even more . . .I did after 2 nights go from 11>11.2 MIN P . . . and the last 2 nights from 11.2>11.4. At no time did the increase in Min pressure make me uncomfortable. I believe I can still increase the MIN P even more, as long as I do it gradually.
I'm eager to hear any observations or conclusions that RobySue1 and the Forum experts have to say.
Here is what I noticed, concluded, or wonder about:
1.
My Supine sleeping is here to stay, no doubt about that! I need to figure how to deal with it re EPR, Pressure, a different machine that may serve me better . . . in order to reduce the time I spend all during the night with arousals and poor sleep. I AM functioning quite well during the day w/o needing naps most days. But at my age & CV issues (high PVCs & moderate TriCuspid valve leakage) I need as much refreshing sleep as I can manage!
2. When I look at ZOOMED views of my Flow Rate & "reported" events . . . what "I" see is an awfully lot of arousals all through the night . . . and a significant amount of SWJ around ugly clusters of events when Supine (see 12/7 and 12/9) that appear to me as "unreal" events since I was either awake or in a S/W period. --
I added a link to my SleepHQ charts hoping someone would either confirm this, or see something else going on.
3. At no time was I bothered by aerophagia or pressure that was uncomfortable (at least while I was at some point of wakefulness to notice.). Nor were Large Leaks much of a problem (even though there was a fairly large one on 12/5, probably just a mask leak from tossing & turning.)
4. With regard to whether "subjectively" it seems easier or more restful when I am Supine, it's hard to say. When my hips hurt, I don't hesitate to give in to rolling over to my back. But I enjoy sleeping on my side, otherwise. I've also discovered this week that I can be very comfortable on my stomach (or nearly so, with one leg pulled up). However, I don't always get to make the decision, and my body goes Supine for a period of time during what seems "most" nights.
5. Using my O2 Ring, at no time did my O2 drop below once at 88. The low was usually 92-93.
6. One question I have (since increasing EPR beyond 2 causes increased CAs for me, assuming they are "real"):
Other than increasing EPR, what will reduce things that may be causing so many arousals like Flow Limitations . . . will increasing my MINIMUM pressure (and to what amount) be enough to take care of OAs, Hs, & FL when I am SUPINE? It seems like, with EPR at 2, I'd have to increase my MIN P to at least 13 to accomplish this? Am I right?
7. And should I increase my MAX pressure in order to cover nights when I may be Supine most of the night, ie, 18, 19, 0r 20 cmHOH?
8. Am I a possible candidate for ResMed AirCurve 10 VAuto Bipap machine, with regard to my high pressure needs when Supine, and need to more effectively reduce frequent arousals? Or would the ability to use even greater PS do the same thing as EPR in increasing Centrals??
Looking forward to some feedback. Thanks!
Joy
wouldn't be the first time someone didn't see the big orange box on the main forum page that says "Post a new topic".