1 year on CPAP, looking for advice

[manacles]

Hello everyone,

I've been on CPAP for about a year now, but I'm still having trouble with my sleep. I'll wake up 3 or 4 times in the night, sometimes with aerophagia, and feel very unrested even after 9 or more hours of sleep. I've also been tracking my data with an oxiring which notes multiple periods at night when my heart rate goes from the 50's to the 90's and higher which really concerned me.

Over the past few months I've been trying to optimize my settings but to not much avail. It seems like the changing of pressures on APAP seems to disturb me, but I still wake up on CPAP mode. I'm currently trying a constant pressure of 7 with EPR of 1, which seems to have the best balance of aerophagia and apnea events, but I would like some more advice. I've also found that increasing my pressure too far above 7 causes pretty severe aerophagia that wakes me up, and higher EPR doesn't seem to do much for me either.

I've been using a full face mask as my mouth opens when i sleep, sometimes giving me dry mouth. I also try to sleep on my sides but often feel that I move around a lot in my sleep. I've attached my sleep data with for last night and would be open to any suggestions you all may have (with regards to either CPAP settings or equipment), thank you!

[manacles]

So I tried using a soft cervical collar to deal with what I thought was some positional apnea after waking up with my chin tucked for a few nights and got some odd results, can anyone help explain these flow limits? I've also been recording my sleep with sleepcycle and it reported snoring at about 3:30 and 5:30 am.

[Sleeprider]

In your first set of charts, flow limits were being under-counted, and we would need to see some zoomed images to show this. In that 03/23 chart we see signs of severe flow limitation at 00:15, 02:15 and many other times during the night, mostly corresponding to RERA and hypopnea. The 03:29 chart shows extended period of high flow limits along with periods of no flow limitation, so something about the collar fit or height is not working as this is typical for positional apnea, however it did reduce the severity of obstructive events. I think you should continue to work with the collar fit and be sure it is supportive of your jaw and chin, but not impinging on the soft tissues at the back of the chin or front of the throat. I'd also suggest EPR setting 2 to try to help with the flow limits. If you want to try some autoset pressure, you can limit the pressure range to minimum 7.0, maximum 8.0 and that will avoid making aerophagia worse.

[manacles]

Thanks for the advice, I'm not sure exactly how tight I should be wearing the collar. From reading online it says to not be constrictive but tight enough to be snugly around the neck, but I'm not sure if that's correct. I've gotten 2 more nights of data with that fit and was wondering if you could have additional advice. Should I start with increasing EPR or max pressure first, or do them both at the same time? Thanks!

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I'm also still looking for advice on how to stop waking up too early and disrupting my sleep, as well as understanding my O2Ring data.

[Sleeprider]

The only charts we need are the ones showing events, flow, pressure, leak, flow limits. The respiratory stats, SpO2 and pulse are not of great interest in your very good therapy. The biggest takeaway for me is the intermittent high flow limitation that likely results from positional obstruction. These episodes are consistently associated with any arousals and respiratory events. Your therapy is excellent, and settings are not a problem, but I think whatever collar you are using may not be perfect. All of us have a different tolerance for the amount of respiratory disturbance we tolerate before sleep is frustrated, so while your results seem very good, your March 31 results look much more disruptive than March 30, even though the 95% flow limit was lower.

I really think you need to move to Autoset pressure to increase EPAP as needed and increase EPR to 3. If you choose to do this, change to Autoset pressure, minimum 7.0 maximum 10.0 and EPR 3.

[cmpman1974]

Now those are some SPO2 figures I could live with! Wow. Those pulse rates are pretty high though if all reflective of sleep time.

[mesenteria]

Pulse rates can climb steeply during REM, but it might be an indication of nocturnal atrial fibrillation.  Usually, though, people are aware of AF, and frequently complain that theirs is most active when they are in bed.  Others, like me, have their most active during the day.

[manacles]

I've been trying to increase my pressures but it seems to really disturb my sleep. Even going to EPR 2 pressure 7-8 causes me to wake up almost immediately after falling asleep so I'm not sure if I should just keep trying to get used to it. As for the heart rate thing, I've still never figured it out. If my O2 and AHI scores are good could it just be unrelated to my apnea? But I don't know what it could actually be, I'm 25 and considered fit so a heart problem seems (hopefully) unlikely....

[manacles]

I've managed to get to EPR 3 with APAP 7-10 with soft response to minimize disturbances, and I'm still having problems with high heart rates and hypersomnolence. At this point though I'm not sure if it's my OSA or something else entirely. Is there any other potential changes I could make to my CPAP settings based on last nights data?