luciferin wrote: ↑Mon Feb 27, 2023 3:08 pm
Would anyone be able to take a few minutes to look over my data and provide any suggestions for optimization?
For some information on my case, I was diagnosed a couple of weeks ago with severe SA in lab. My AHI was 33, and my REM AHI was 60. I have a total of 16 minutes of REM sleep during the study, which lasted a total of over 7.7 hours.
So your untreated OSA is really bad. And it's really, really bad in REM. Probably bad enough to make it difficult for your body to get into REM and stay there long enough for the REM sleep to be beneficial.
Higher than 13 and I wake up frequently during the night, and never reach the high respiratory rate moments that I associate with REM sleep. I have tried 8 CPAP mode and I also never see the elevated REM and I feel noticeably worse.
What exactly do you mean here? And how are you attempting to quantify a "high respiratory rate moment" that you "associate with REM sleep".
Given the charts you posted over at SleepHQ, it doesn't surprise me that straight CPAP @ 8cm could make you feel worse than APAP @ 8-13cm: Your charts indicate that whenever the pressure drops close to 8cm, there are enough flow limitations for the machine to start increasing the pressure up towards the 12-13 cm range, and that most likely means that
if the pressure were held at 8cm for any length of time, some (many) of those flow limitations would in fact deteriorate into hypopneas and apneas.
Some things that stick out to me that I'm hoping for feedback on:
- Respiratory rate seems really high periodically. I feel much better on days where I have the high respiratory rate more often, so I've been associating it with increased REM sleep. I don't know how to anylize the data to tell if it's real.
Again, it's not really clear what you are talking about here. While Oscar shows a respiratory rate graph, SleepHQ does not. Yes, if you zoom in on the data in SleepHQ to show maybe 1 minute of flow rate data at a time, you can get a good estimate of the (moving) respiratory rate by counting inhalations. But I'm not at all sure that's what you are doing when you say you are looking for "high respiratory rate" periods.
While it's known that in a typical person's (decent) quality sleep, the respiratory rate is more variable and often a bit higher in REM, it's not like there's a dramatic increase in the number of breaths per minute. For example, on all of my various sleep studies over the years, my non-REM respiratory rate is listed as being in the 12-14 and 14-16 breaths per minute range and my REM respiratory rate is listed as being in the 12-18 12-16, and 14-16 ranges.
The upshot of this is: It's kind of difficult to definitively identify REM periods just by looking at the respiratory rate in xPAP data, but if you see periods of higher variability in the respiratory rate at roughly 90 minute intervals, then that can point to probable REM periods.
But you also have to add in this: Breathing in REM can also look sort of like wake breathing since wake breathing is also more variable than normal non-REM sleep breathing. And then any time you arouse enough to turn over in bed, that also can cause some variation in the respiratory rate as well the size of the individual inhalations. So trying to tease out so-called "Sleep-Wake-Junk" breathing (SWJ) from possible REM is another problem.
If you are genuinely interested in whether you are getting into REM, you may want to think about getting a smart watch or fit-bit type device that claims to be able to detect sleep stages. While these devices are far from 100% accurate, they do monitor changes in the heartbeat and lack of movement to attempt to flag REM; some of them also factor in measuring the oxygen concentration and skin temperature and potentially use that data as well in trying to measure the quality of sleep. If you investigate in a smart watch/fit bit type device that claims to measure sleep stages, you can attempt to correlate the periods the device says you are in REM with what you see in the flow rate data recorded by your APAP.
- The 2/25 data shows a cluster of OA events start at 4:55 AM despite being near my max pressure already. Any advice on if anything should be done to control events like this?
Here's a screen shot of that cluster with a moderately zoomed in view:
I'll first observe that this cluster happens about 3 hours after you turn the machine back on and go back to sleep after your family woke you up for a non-therapy related reason. That timing (3 hours after going to sleep) points to this cluster of events as quite probably being REM related.
And unfortunately, the fact that your machine was not allowed to raise the pressure beyond 12cm on this night, means that once you hit REM and your apnea got really bad, the machine was not able to respond by increasing the pressure to a level that would splint your airway open and allow you to keep breathing.
- Is my flow limit at all an issue that something should be done about?
In zooming in on some random areas in your data that have been flagged as "flow limited"---i.e. that correspond to high areas on the flow limitation graph---my conclusion is that you do in fact have some real flow limitations that are likely indicative of your airway not being "stable" and in danger of collapsing. Moreover, many of these severe flow limitations occur when your pressure is at or near the max pressure setting of 12 cm or 13 cm indicates that you may need more pressure at some points in the night in order to give your airway the support it needs.
It is also worth pointing out that very often when your pressure drops to close to your current min pressure setting of 8cm, the flow limitations start. This indicates that you might want to bump your
minimum pressure up a bit.
In other words, you might do better using a range of 9cm-14cm than you are doing with 8cm-13cm. If you really are struggling when the pressure gets above 13cm, you might want to try a range of 10cm-13cm.
Good luck!
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