OSCAR data check, UARS?

Hi all,

I've been browsing the helpful posts here for a while and have learned a great deal from all of you about how to interpret my data with Oscar. I have been diagnosed with OSA with an AHI of around 12. I've had a few sleep studies done and this was a pretty consistent result. My symptoms are waking up tired and waking up early, consistently at around 5am, even if I go to bed quite late.

I was prescribed APAP therapy and have been using a Airsense 11 AutoSet for about 2 months. The care provider set the range at 4-11 and has not been helping to titrate any further. They will only look at the data a month from now, and probably only at the AHI.

In the mean time I have been experimenting with different settings. I did initially experience an improvement in symptoms and I can attribute this to there being far fewer obstructive events. However, I still wake up early and feel unrefreshed.

Looking closer at my data I think there are still quite a few flow limitations. Some small ones are picked up by the machine, but I reckon there are quite a few more that lead to awakenings. However, I'd like to get a sanity check on that; maybe the breathing pattern is entirely normal.

Here are some screenshots from two days ago, which was a pretty typical night as far as the last few weeks go.

https://www.ibb.co/ScM4Ptx - overview
https://www.ibb.co/N2JMBvQ - arousal 1
https://www.ibb.co/zFvKSGw - arousal 2
https://www.ibb.co/Qp8xJVF - arousal 3
https://www.ibb.co/7W3gwBR - arousal 4
https://www.ibb.co/HG7jXSs - waking up

There's a screenshot of the overview, and then several zoomed in screenshots showing what I think are arousals due to flow restrictions. These tend to go together with a gradual rise in pulse rate. I would be grateful if someone could interpret these and tell me whether they're indicative of a problem or whether it's innocuous.

I should also mention the leaks are not typical. I had that under control, but adjusted my mask slightly with leaks as a result. I also tape my mouth and have no mouth leaks.

Please note that the data includes oximeter and pulse rate values. I've tried to line up the data temporally, but I'm not sure it's completely correct. There was definitely a large shift that needed to be corrected.

What is this data indicative of?

Thanks!

Welcome!

Arousals are a normal part of sleep. When all goes well, most of them will be very short and will not interfere with sleep architecture. (That's the normal progression through sleep stages multiple times during the night.)

I'm not seeing your arousals emerging from flow limitations, though there are FLs flagged for features of your arousal breathing. Overall, your FL data don't indicate a problem.

Did your sleep studies note respiratory-related arousals and/or spontaneous arousals?

Just curious: how early do you think you could go to bed? Early enough to get a decent amount of sleep before your 5 a.m. wake-up? Also, how dark is your bedroom? Are there other things that change in your environment around 5 a.m., e.g., the heat turns on?

Any chance you could sign up for a free account at SleepHQ and post their links to your data? It's a lot easier for us to look at FLs and arousals using their platform.

Thanks for helping Miss Emerita!

I have uploaded my data to sleephq: https://sleephq.com/public/teams/share_ ... 029cf97500

I think generally at lower pressures I have more flow limitations, but at higher pressures I get aerophagia and it becomes too uncomfortable. Perhaps I've overdone it with the pressure lately.

The sleep study data report didn't report RERAs as far as I know. I've requested the full report and data, but I've not received it yet.

Generally when I go to bed earlier my wake-up time shifts to be earlier as well. My bedroom is pretty dark, temperature is good, I'm decent at keeping good sleep hygiene and bedtime routine. I can't really think of anything happening around 5am. This morning it was 4am, so it's not that regular, just too early. However, I feel like the problem generally is bad quality sleep rather than just early waking.

I hope the sleephq data helps spot something!

Thanks

WinnerFieldman wrote: ↑

Fri Sep 20, 2024 11:24 pm

I think generally at lower pressures I have more flow limitations, but at higher pressures I get aerophagia and it becomes too uncomfortable. Perhaps I've overdone it with the pressure lately.

There is often a balance that has to be struck between allowing some events and/or flow limitations to happen, pressure, and aerophagia.

In other words, it is unreasonable to expect that you will find a magic pressure setting that gives you an AHI = 0.0, no flow limitations, and no aerophagia night after night after night.

As someone who has suffered significantly from aerophagia in the past, in my opinion, aerophagia messes with your sleep a lot more than the last few residual events do. In other words, I find that I do best at a pressure that gives me decent (but not perfect) control of the obstructive stuff while being low enough to not trigger the aerophagia.

Also worth keeping in mind: Aerophagia can trigger unwelcome arousals when it's bad enough. And then you can get trapped in a very nasty feedback loop of "more aerophagia leads to more arousals which leads to more aerophagia which leads to more arousals which leads to ..." all night long.

So how bad is the aerophagia at the pressure you are currently using?

Generally when I go to bed earlier my wake-up time shifts to be earlier as well. My bedroom is pretty dark, temperature is good, I'm decent at keeping good sleep hygiene and bedtime routine. I can't really think of anything happening around 5am. This morning it was 4am, so it's not that regular, just too early. However, I feel like the problem generally is bad quality sleep rather than just early waking.

Some questions and comments:

1) How much sleep do you think you need for a good night's sleep? And how much sleep do you think you actually get during a typical night?

2) Have you always been an early riser? In other words, are you a morning person? Is there a problem with just getting out of bed at 5 am and starting your day if that's when you typically just wake up on your own?

3) You've been using your AirSense 11 AutoSet for about 2 months. While that may seem like an eternity, it means you are still pretty new to CPAP therapy. And it's possible that your body is still learning how to sleep with the machine. In other words, your body may be arousing more than normal just because it hasn't yet fully decided what stimuli coming from the machine are normal and can be ignored and what stimuli from the machine warrant "an arousal" to figure out if there is something wrong before going back to sleep. Also before you started CPAP, your brain had become accustomed to the need to arouse frequently just to open up your collapsed or collapsing airway so that your breathing would return to normal. And it's possible that your brain has not yet figured out that it doesn't need to arouse every few minutes just to make sure you are still breathing. In time, your brain will figure that out.

4) Is there something else that might be causing the bad quality sleep? What I mean here is this: Your data indicates that the CPAP has eliminated your sleep disordered breathing problems for the most part, but you self-report the sleep quality is still bad. Bad sleep can be caused by a whole bunch of things in addition to sleep disordered breathing, and it's possible that before your diagnosis the OSA was only one of multiple things causing your sleep to be bad. Fixing the OSA through CPAP fixed one of the problems, but not all of them. And so your sleep continues to be of poor quality.

Now of course the big question is: What else could be messing with your sleep? Which leads to a whole bunch of other questions:

A) Do you have any medical conditions other than OSA? Both daytime fatigue and bad quality sleep are symptoms of lots of different medical conditions.

B) Are you taking any medication on a daily basis? If so, are any of them known to have the potential to mess with your sleep?

C) Any chronic pain issues? Pain messes with sleep.

D) Any use of caffeine, alcohol or marijuana or other recreational drugs? They can all mess with sleep.

I hope the sleephq data helps spot something!

Thanks

I'll post again with my analysis of your sleephq data.

WinnerFieldman wrote: ↑

Fri Sep 20, 2024 12:23 am

Here are some screenshots from two days ago, which was a pretty typical night as far as the last few weeks go.

https://www.ibb.co/ScM4Ptx - overview

Here's what that data looks like:


There is nothing in this overview that screams "FIX ME! by changing the settings on the Autoset!"

Yes, there is some evidence of arousals and there are at least two or three periods of what looks to be pretty restless sleep. It looks like it took you 30-40 minutes to fall into a decent sleep. There's a period between 0:40 and 1:15 that looks pretty restless. And there's another restless stretch between 2:45 and 3:00. And then everything 3:40 looks to be pretty restless.

The thing is: None of that restlessness appears to be tied to anything respiratory related. You don't have any OAs or Hs scored for the whole night, and your flow limitations are actually quite small.

Since you are worried that the flow limitations might be a problem, it's worth talking about why I'm saying your flow limitations are actually quite small. So here's what you need to know about flow limitations: The flow limitation graph's full scale runs from 0.0 to 1.0, but your OSCAR screen shot has Oscar choosing a much more narrow vertical range of 0.0 to 0.25 which makes every little "blip" in the flow limitation graph show up. Your flow limitations are also quite short lived and overall there really aren't that many of them. Moreover there is not a close correlation between your most restless periods and activity in the flow limitation graph. Typically when people are having enough residual flow limitations for them to be a problem, we see almost constant activity in the flow limitation graph over long periods of time AND many of the flow limitations are peaking well above 0.33 or 0.4.

Given your flow limitation graph on this night as well as the one you posted to SleepHQ, I see no reason to worry about them. And there is certainly no need to increase the pressure in an attempt to wipe out these last few flow limitations, particularly since you have also stated that you do get aerophagia if you increase the pressure beyond what you are currently using.

arousal 1

Here's a marked up image:

Yes, there's some very minor flow limitations, but the arousal itself? It looks to me like the arousal was triggered by the need to move around in bed. I would not blame this arousal on sleep disordered breathing. And, in fact, I would consider this one a normal arousal simply triggered by the need to move around as long as sleep breathing starts back up shortly after the arousal. (The snippet doesn't show what happens after the arousal.)

arousal 2

Here's the marked up image:

Again, there's some very minor flow limitations before the arousal. But the arousal itself? It looks like a perfectly normal arousal triggered by the need to turn over in bed. (I've seen the respiratory pattern in the blue box as labeled as "turning over in bed" in other sites, but I no longer have the references at hand.) Again, if sleep breathing immediately resumes after that arousal, it's nothing to worry about. But again, we don't have enough of a snippet to see if normal sleep breathing resumed after the arousal.

arousal 3

Again here's a marked up image:

While it's clear there is an arousal, it's less clear exactly where the arousal starts. Everything in the blue box and only the blue box is clearly after you first aroused and it looks to me like you're really awake here. But what's in the red box? I can't tell if the problem is that a "wannabe" hypopnea woke you up or if you started to arouse and as a part of the arousal process you simply had a bit of ragged breathing. In other words, it is possible, but not certain, that this arousal may have been respiratory related. How much to worry about this particular arousal? Well that depends on two things:

1) Did you get back to sleep shortly after the arousal? Again, the snippet of data doesn't go on long enough for us to answer that important question.

2) Are there lots and lots of arousals that look more like this one than like what you labeled arousal 1 and arousal 2? From the overall data, I would suspect the answer is no.

arousal 4

Here is the marked up image:


Again, there's some ambiguity in this one: Yes, the stuff in the blue box is clearly an arousal/wake. The large inhalation in the red box might be an arousal, and if it is, it is clearly not respiratory related. The stuff in the purple box? The question is whether that's a bit of sleep disordered breathing that is not severe enough to get labeled as a hypopnea or a flow limitation, but caused the wake OR is it a bit of sleep transitional breathing in an effort to get back to sleep after the possible arousal in the red box. And there's just no way to tell that from the CPAP data alone. (On an in-lab sleep test, the tech would be looking at EEG data to see when you were actually asleep.)

And again, what we can't tell from this snippet of data is whether you got back to a decent sleep shortly after this arousal or not.

So of the four arousals: Two are (in my opinion) clearly not related to sleep disordered breathing. Two are questionable---as in they might be related to a UARS type response to some very minor flow limitations, but they might be spontaneous arousals. And we just can't tell for sure.

But what's missing in all four of the snippets of data is what happened after the arousal? Did normal sleep breathing quickly resume? Or did you get trapped in a bunch of what's called "SWJ" or Sleep-Wake-Junk breathing where you're not really soundly asleep, but you aren't fully awake. Rather you're drifting in and out of sleep and the breathing is ragged because of the wake breathing and the sleep transition breathing are mixed in with short snippets of sleep breathing. (Neither wake breathing nor sleep transition breathing is anywhere near as regular as normal sleep breathing is.)

WinnerFieldman wrote: ↑

Fri Sep 20, 2024 12:23 am

My symptoms are waking up tired

I learned from this forum not to rate your sleep upon waking up. Judge it near bedtime. "Was I energetic today? Did I have excess sleepiness? (Some sleepiness is normal, especially after lunch.) Near bedtime, am I fatigued, but not stressed?"

WinnerFieldman wrote: ↑

Fri Sep 20, 2024 11:24 pm

I have uploaded my data to sleephq: https://sleephq.com/public/teams/share_ ... 029cf97500
I hope the sleephq data helps spot something!

Thanks

Here's my analysis of this night's worth of data. Note: I've only included screen shots when there's something that I want to talk about at some length.

You didn't really fall asleep until about 9:35, and the first CA that is scored is clearly a normal sleep transitional central that would not be scored on an in-lab sleep test.

Your first major arousal occurs around 10:23. It looks like this:

I don't think it's respiratory related. The CA scored at 10:25 is a false flag---it's a normal sleep transitional central that would not be scored on an in-lab sleep test.


Unfortunately you have another clear arousal shortly after getting back to sleep. That arousal looks like this:

Yes, there's some questionable breathing in that red box. But the arousal doesn't immediately follow it, so I'm not sure you can "blame" the second arousal on bad breathing. It is just as likely that you were only in a very light sleep after the first arousal and that you didn't fully transition into a more "real" sleep until after the second arousal was over. In that case the stuff in the red box could just be a bit of more obvious sleep transitional breathing that didn't last long enough to be labeled as a "CA" by the machine.


More arousals occur around 11:00. They look like this:

The first potential arousal is exceptionally short, but the thing of importance is that it occurs before the flow limitation is scored. The most likely means the arousal is NOT respiratory related and the flow limitation is being scored on sleep transitional breaths.

The second and third arousals? They're clearly not respiratory related in my opinion. The temporary drastic reduction in airflow is part of sleep transition breathing and when you see this kind of pattern it sometimes gets labeled as a "hypopnea", but that kind of a "hypopnea" would most likely not be scored as a real hypopnea on an in-lab sleep test.


A bit later you've got a leak related arousal that looks like this:


At the beginning of this snippet is a bit of flow limited breathing that shows that sometimes there is an offset between the flow rate graph and the flow limited graph. But in any case, I don't think the first arousal is respiratory related. You clearly woke up enough to fix the leak at the end of this snippet, but unfortunately the fix didn't last very long, because this is what show up next in scrolling through your data:



The stuff between the two leak related arousals? Most likely it's sleep transitional breathing. In other words, I don't think the CA is real. Rather you were just about back to a real sleep when the leak popped up again and woke you back up.


A bit later you have another leak related arousal:


The first "arousal" in this snippet may or may not be a real arousal. It if is, it is very short and does not appear to be respiratory related. The thing in the second box looks like a real arousal, but again it's not respiratory related. The third arousal? It's clearly related to waking up enough to fix that leak. Now the stuff between the arousals? It looks pretty much like sleep breathing, but it might have a bit of sleep transition stuff mixed in. In other words, I would not be overly worried about the first two arousals---they're spontaneous and we don't know what caused them. The third one was caused by the need to fix the leak which somehow started as you were transitioning back to sleep after that second arousal.


A bit later on there's another leak related arousal:


Notice how the leak starts to grow when you are clearly asleep. At some point, you wake up and fix the leak. But this time you don't get back to sleep quickly. What follows is a bunch of SWJ breathing. Those CAs in the purple box are most likely not "real" CAs and the flow limitations being scored are also most likely the machine misinterpreting your SWJ breathing as abnormal sleep breathing.

Worth noting that your SleepHQ data ends at about 2:48 AM. So it's also worth asking: What did you do after you turned the machine off around 2:50? Did you get up for the day? Or did you go back to sleep without the mask on?


General conclusions about this night's data:

There is little or no evidence that flow limitations are causing you to wake up on this night. There is some real evidence that you were having problems with leaks that were annoying enough to wake you up even though these leaks mostly stay below Resmed's red line definition of "Large Leak" at 24 L/min. In other words, Mr. Green Smiley Face showed up on the machine's LCD and MyAir would say your leaks were "ok" on this night.

You only used the machine for a total of 5 1/2 hours and you turned the machine off at roughly 2:50 AM. In other words, this brings up the question of whether you are using the machine all night, every night. If you just got out of bed at 3:00 AM, then no wonder you would have felt tired the next day. But if you went back to sleep for 2-3 more hours after taking the mask off, that would also be enough to make you tired the next day: Even 2 or 3 hours of sleep disordered breathing can be problematic for a lot of folks.

Finally, I'll add this: You say that you are dealing with some aerophagia. Your pressure settings on the nights that you've shared data for are 15-20 cm (the night for the data you posted at https://www.ibb.co/ScM4Ptx) and straight 16cm for the night you posted at https://sleephq.com/public/teams/share_ ... 029cf97500). Both nights have an obstructive AHI equal to 0.0. In other words, all your scored events are CAs, and the bulk of them appear to be post-arousal, sleep transitional centrals that would not be counted as real events on an in-lab sleep test.

All of this means: If you wanted to experiment with lowering the pressure setting, you might very well be able to lower the pressure setting and give your stomach some relief from the aerophagia while still preventing most of your obstructive events from happening. And that just might allow you to sleep better with fewer arousals.

ChicagoGranny wrote: ↑

Sat Sep 21, 2024 10:16 am

WinnerFieldman wrote: ↑

Fri Sep 20, 2024 12:23 am

My symptoms are waking up tired

I learned from this forum not to rate your sleep upon waking up. Judge it near bedtime. "Was I energetic today? Did I have excess sleepiness? (Some sleepiness is normal, especially after lunch.) Near bedtime, am I fatigued, but not stressed?"

Just want to second this observation of ChicagoGranny. Not all of us wake up feeling bright eyed and bushy tailed even when we're sleeping well. But we do have enough energy to get through our day without excessive sleepiness. And it is also worth repeating what she said about some sleepiness during the day being normal, especially after lunch.

And worth adding: There is a difference between feeling sleepy and feeling fatigued/tired. Ideally you want to feel like you're getting very sleepy close to bedtime.

Many thanks for the SleepHQ link. After browsing your charts, I agree 100% with robysue1's thoughtful analysis.

I want to underscore her observation that you can try lowering your minimum pressure. I'd suggest dropping it by one every 3-4 nights until you start seeing bothersome obstructive events crop up. Then edge the pressure back up just high enough to control the OAs. This should help with aerophagia.

Sometimes people who experience a lot of arousals benefit from using a single pressure all night. (By that I mean max = min; EPR fine.) When you find the lower pressure that works for you, you might consider trying max = min. I caution against making several changes at the same time; that makes it hard to discern what was or wasn't helpful.

First of all thanks to everyone for these incredibly thoughtful replies. I'm very grateful and I feel it gives me a new perspective and a lot of insight.

So how bad is the aerophagia at the pressure you are currently using?

At 16, with EPR 3, I was waking up quite bloated. I dialed it back a bit last night, and at 13 I had no aerophagia issues, although I think flow limitations slightly increased. I've updated SleepHQ's data as well now.

1) How much sleep do you think you need for a good night's sleep? And how much sleep do you think you actually get during a typical night?

If I get 5 hours or less the next day is pretty much a write-off for doing any cognitive work, and I'll be in a bad mood. Six hours is typical and I can function, but I'll feel fatigued throughout and I have to manage my mood in the morning and evening. There are rare days where I get 7-8 hours, and those days feel pretty amazing: I take a lot more initiative, my thinking is more creative and sharp, and I am more empathetic.

2) Have you always been an early riser? In other words, are you a morning person? Is there a problem with just getting out of bed at 5 am and starting your day if that's when you typically just wake up on your own?

No, I distinctly remember starting to suddenly wake up at 5am more and more regularly about 8 or 9 years ago. I started looking into my sleep about 3 years ago.

3) You've been using your AirSense 11 AutoSet for about 2 months. While that may seem like an eternity, it means you are still pretty new to CPAP therapy. And it's possible that your body is still learning how to sleep with the machine.

This is a helpful perspective! I should give myself more time.

4) Is there something else that might be causing the bad quality sleep?

I cannot think of anything apart from that my daughter was recently diagnosed with dust mite allergy. The last 3 weeks I have been really on top of cleaning the bedrooms, changing the sheets, and encasing the mattresses and duvets with anti-allergy covers. My daughter stopped sneezing at least, but I haven't noticed a difference.

Another thing I've tried and discounted (but keep coming back to now and then) is general stress management. I've picked up a few techniques for being more aware of stress and managing it, and I feel I generally manage well. There's nothing that's continually stressing me out at the moment. It's hard to know what a normal level of zen is though.

A) Do you have any medical conditions other than OSA?

No, I could lose a few pounds, but my BMI is 24.

B) Are you taking any medication on a daily basis? If so, are any of them known to have the potential to mess with your sleep?

None.

C) Any chronic pain issues? Pain messes with sleep.

Also no.

D) Any use of caffeine, alcohol or marijuana or other recreational drugs? They can all mess with sleep.

I generally don't drink caffeine after 10am. Daily caffeine intake is 2-3 cups of black tea. I drink a coffee or two on the weekends. DNA does indicate I'm a slow metaboliser of caffeine though.

I haven't had any alcohol in the last two months, although I have had periods in the past where I drank 4-5 units a day. Recreational drugs, maybe twice a year and the last time has been a while now.

robysue1 wrote: ↑

Sat Sep 21, 2024 9:34 am

There is nothing in this overview that screams "FIX ME! by changing the settings on the Autoset!"

Yes, there is some evidence of arousals and there are at least two or three periods of what looks to be pretty restless sleep. It looks like it took you 30-40 minutes to fall into a decent sleep. There's a period between 0:40 and 1:15 that looks pretty restless. And there's another restless stretch between 2:45 and 3:00. And then everything 3:40 looks to be pretty restless.

The thing is: None of that restlessness appears to be tied to anything respiratory related. You don't have any OAs or Hs scored for the whole night, and your flow limitations are actually quite small.

Since you are worried that the flow limitations might be a problem, it's worth talking about why I'm saying your flow limitations are actually quite small. So here's what you need to know about flow limitations: The flow limitation graph's full scale runs from 0.0 to 1.0, but your OSCAR screen shot has Oscar choosing a much more narrow vertical range of 0.0 to 0.25 which makes every little "blip" in the flow limitation graph show up. Your flow limitations are also quite short lived and overall there really aren't that many of them. Moreover there is not a close correlation between your most restless periods and activity in the flow limitation graph. Typically when people are having enough residual flow limitations for them to be a problem, we see almost constant activity in the flow limitation graph over long periods of time AND many of the flow limitations are peaking well above 0.33 or 0.4.

Given your flow limitation graph on this night as well as the one you posted to SleepHQ, I see no reason to worry about them. And there is certainly no need to increase the pressure in an attempt to wipe out these last few flow limitations, particularly since you have also stated that you do get aerophagia if you increase the pressure beyond what you are currently using.

Thanks so much for doing this in-depth analysis and marking up the screenshots. I had been obsessing with the flow limitations, but I realise now I should be more relaxed about them and that these minor limitations very likely don't cause the arousals. I had read somewhere to try and eliminate the flow limitations but now I can back off a bit on the pressure.

So of the four arousals: Two are (in my opinion) clearly not related to sleep disordered breathing. Two are questionable---as in they might be related to a UARS type response to some very minor flow limitations, but they might be spontaneous arousals. And we just can't tell for sure.

But what's missing in all four of the snippets of data is what happened after the arousal? Did normal sleep breathing quickly resume? Or did you get trapped in a bunch of what's called "SWJ" or Sleep-Wake-Junk breathing where you're not really soundly asleep, but you aren't fully awake. Rather you're drifting in and out of sleep and the breathing is ragged because of the wake breathing and the sleep transition breathing are mixed in with short snippets of sleep breathing. (Neither wake breathing nor sleep transition breathing is anywhere near as regular as normal sleep breathing is.)

This is a good question, what happened after? It's perhaps worth zooming in on this stretch of sleep that starts at 23:10 and ends at around 23:40 of the night of the 18th September.

https://sleephq.com/public/teams/share_ ... _id=YVDPZj

There are ~5 arousals in that stretch and there's some periodicity in between those stretches. The very stable breathing pattern resumes again after. Pulse is higher and I move throughout. This type of stretch happens pretty much every night 30-40 minutes after falling asleep, and its similar in characteristics to the other restless stretches of sleep. Is it just REM sleep? It seems too long. Could this be related to being on my back or on my side? I could set up a camera to see what my position is during these stretches.

Last night is another good example.

https://sleephq.com/public/teams/share_ ... _id=YVDPZj

Please note that the sleephq data is out by an hour. Everything actually happened an hour later.

ChicagoGranny wrote: ↑

Sat Sep 21, 2024 10:16 am

WinnerFieldman wrote: ↑

Fri Sep 20, 2024 12:23 am

My symptoms are waking up tired

I learned from this forum not to rate your sleep upon waking up. Judge it near bedtime. "Was I energetic today? Did I have excess sleepiness? (Some sleepiness is normal, especially after lunch.) Near bedtime, am I fatigued, but not stressed?"

That's helpful! I'll try to take the whole day after into account rather than just how I feel in the morning.

robysue1 wrote: ↑

Sat Sep 21, 2024 10:53 am

Here's my analysis of this night's worth of data. Note: I've only included screen shots when there's something that I want to talk about at some length.

Thanks!

Worth noting that your SleepHQ data ends at about 2:48 AM. So it's also worth asking: What did you do after you turned the machine off around 2:50? Did you get up for the day? Or did you go back to sleep without the mask on?

It's worth noting that the clock is an hour late, so I actually turned off the machine at 3:50. That morning I took the mask off and tried to sleep, but couldn't. I lay in bed for probably an hour trying and then got up. Waking up at 4am doesn't happen all that often though.

There is little or no evidence that flow limitations are causing you to wake up on this night. There is some real evidence that you were having problems with leaks that were annoying enough to wake you up even though these leaks mostly stay below Resmed's red line definition of "Large Leak" at 24 L/min. In other words, Mr. Green Smiley Face showed up on the machine's LCD and MyAir would say your leaks were "ok" on this night.

You only used the machine for a total of 5 1/2 hours and you turned the machine off at roughly 2:50 AM. In other words, this brings up the question of whether you are using the machine all night, every night. If you just got out of bed at 3:00 AM, then no wonder you would have felt tired the next day. But if you went back to sleep for 2-3 more hours after taking the mask off, that would also be enough to make you tired the next day: Even 2 or 3 hours of sleep disordered breathing can be problematic for a lot of folks.

This night wasn't representative in terms of using the machine. A normal night is using the machine from around 22.30, falling asleep at ±23.00 and waking up at 5.00, with 6 hours of sleep. There are typically 2 arousals per night where I'm consciously awake, but it typically doesn't take me long to fall back asleep unless it happens after 4am.

Leaks have been an issue the last week. Before that I had a pretty good fit and had quite some nights without significant leaks. I might have to try a different mask that's a little more reliable. I'm thinking of getting some nasal pillows.

All of this means: If you wanted to experiment with lowering the pressure setting, you might very well be able to lower the pressure setting and give your stomach some relief from the aerophagia while still preventing most of your obstructive events from happening. And that just might allow you to sleep better with fewer arousals.

Thanks for this advice; it makes sense. I will reign back the pressure and try to see what this coming week of sleep looks like.

robysue1 wrote: ↑

Sat Sep 21, 2024 10:56 am

And worth adding: There is a difference between feeling sleepy and feeling fatigued/tired. Ideally you want to feel like you're getting very sleepy close to bedtime.

Yes, that's a good note. I wake up tired, but not sleepy. Actually the rare night where I get a decent sleep is one where I wake up still a little sleepy!

A while back I did a melatonin saliva test, measuring melatonin every hour for 5 or 6 hours. No problems there, and luckily I can always fall asleep just fine at bedtime.

Miss Emerita wrote: ↑

Sat Sep 21, 2024 12:08 pm

Many thanks for the SleepHQ link. After browsing your charts, I agree 100% with robysue1's thoughtful analysis.

I want to underscore her observation that you can try lowering your minimum pressure. I'd suggest dropping it by one every 3-4 nights until you start seeing bothersome obstructive events crop up. Then edge the pressure back up just high enough to control the OAs. This should help with aerophagia.

Sometimes people who experience a lot of arousals benefit from using a single pressure all night. (By that I mean max = min; EPR fine.) When you find the lower pressure that works for you, you might consider trying max = min. I caution against making several changes at the same time; that makes it hard to discern what was or wasn't helpful.

Thanks for browsing the charts!

I think setting a single pressure is a good idea, and effectively with a high minimum that's what I get now. I found that at lower pressures the AirSense would be very tardy in increasing the pressure and it would not do anything with small but consistent flow limitations. Higher pressure also feel more comfortable now that I'm used to them to be honest.