Need help

After 3 weeks of therapy it has become obvious to me that most of my events are hypopneas. They usually make up about 75% of my events and sometimes even 100% of my events. My AHI is always under 2.0 and is usually at or under 1.0. On some mornings I wake up feeling good but on others, like this morning I still feel tired. I am wondering about the following:

1. How do hypopneas affect oxygen levels? Could my oxygen level be dropping off severely with these events, especially the ones that last 30 seconds?
2. Maybe these events are occurring during REM sleep and are kicking me out of REM? During my sleep test my AHI was 65.7 during REM sleep.

Is there anything I can do to reduce these hypopneas? Any advice would be greatly appreciated. I am going to try to insert last night's SleepyHead report below in case looking at it is helpful in giving me some advice. I apologize if it shows up as a link and doesn't show the report here. I have tried and tried to get it to work and even with following the directions I was given by helpful members, it still doesn't seem to work for me.

http://s743.photobucket.com/user/Sharry ... sort=3&o=0

Here's your image below.
One single or even 2 hyponeas close together are unlikely to affect O2 levels even if they last 30 seconds. You can hold your breath totally longer than that and not see a drop in O2 levels if you were wearing a pulse oximeter.
Now it's possible that they are occurring in REM sleep and kicking you out of REM...it's also possible that other minor flow reductions that don't meet criteria for an event flag might be happening and also kicking you out of REM or sleep in general.
What does your Flow Limitation graph look like?
Your Hyponea count doesn't really merit a pressure increase but that is what is usually done for hyponeas...just a little more pressure. Same thing if the flow limitation graph shows a lot of activity..at little more pressure.
Since you are using APAP mode with auto adjusting pressures..those increases in pressure are likely from Flow limitations and the minimum pressure is what would be increased in an effort to better prevent the flow limitations and/or the FLs from growing up to be a hyponea or OA.

Also..there's a rather wide range going on with your pressure...from the 5 up to looks like around 12. The pressure changes themselves can be a disruptive factor to sleep quality (causing arousals that you may or may not remember). Some people can sleep through big changes in pressure and do quite well but others find that even small changes disturb sleep and they find that they do better with a small range of pressures or even cpap mode with a fixed pressure.

You might tighten the range with more minimum. It should help with any FLs and/hyponeas and with those better prevented the upper range of pressure may not go so high. I see it all the time. Increase the minimum a little bit and the upper range drops because the machine doesn't have to go to "fix it" mode as much of the time.
If you want to increase the minimum pressure (and are comfortable doing it) I would go slow with a 1 cm increase for a few days and watch the reports and then another 1 cm increase and watch the reports. It will be an easier adjustment process if you go slow and you might not need as much as first thought. Often people think they need that 95% pressure number if using a tight range or cpap mode and sometimes they do but sometimes they don't because often the 95% number (which just means you were at OR BELOW that number for 95% of the time) will drop and not be nearly as high if the minimum pressure does a better job preventing events in the first place.

Sorry, I guess I forgot to adjust the size of the graphs so the Flow Limitation graph would show. Here's the link to it:

http://s743.photobucket.com/user/Sharry ... sort=3&o=1

Pugsy, thank you for taking the time to explain all of that to me. If my oxygen level isn't dropping with these events then the next logical cause would be my sleep being disturbed either by the event or by the increase in pressure but I don't know which. I was thinking a bump in the bottom number on my pressure might be the next step but wanted to get the opinion of someone with more experience with this. I am currently at 5 to 12. If it were you, how much would you increase that 5? Bump it to 6 or would you go higher? Thank you!!!

Your flow limitation graph isn't horrible ( I have seen much worse) but compare yours to mine (which is pretty much non existent) and I think you will see what I mean. Yours could stand for some improvement based on symptoms you are reporting. Images below.

Yes, I would start with 6 cm minimum and see how it goes. 2 reasons...1 being it's easier to adjust to and 2 being sometimes we see remarkable improvement with as little as 1 or 2 cm increase. I see no reason to use more if not needed so I tend to be conservative with increases but it wouldn't hurt to try 7 if you are comfortable with it starting out.
I can't guarantee it will help with what you are having symptom wise. It's possible though and thus worth a shot to try it.
You might have just had a bad night (and we all have them from time to time) and you are still new to therapy and there is some truth to "give it time". I understand the need to look for a solution in the software reports and sometimes there is a solution in there when something screams out "fix me" but sometimes there isn't. We feel we NEED to do something to fix it...and sometimes we can't fix it but it doesn't hurt to try.

So on paper you look good in terms of therapy but the flow limitation line might stand for a little improvement and it wouldn't be impossible for those FLs to be impacting how you feel or sleep. I can't guarantee it though. There's so much more to getting good sleep and feeling better than just what we see on these reports.
Heck, it might be the variable pressures themselves and a tight range or even cpap mode might be a better choice.

I don't think your symptoms are related to low O2 unless you have something else going on. You aren't having enough hyponeas to impact O2 without some other complicating factor in your health. You could get one of those overnight pulse oximeters to check it though. For peace of mind if nothing else. DMEs will also often do an overnight pulse ox test for you...but need a doctors order to do it. Usually easy to get though.

Here's a couple of my FL graphs from back when I was using the S9 VPAP Auto...99% of the time this is what I got. Pretty boring.

Thank you Pugsy! Looking at your FL graph was helpful. Mine may not be horrible but there is definitely more going on with mine than there is with yours. I think I'm going to up my lower pressure and see if that makes a difference. I'm going to have to give some thought to whether I should try 6 or 7.