Are any of these events real?

[BigWing]

I have been using APAP for 4 months and, with help from kind people on these forums, I have managed to get my AHI consistently below 1 - often well below. I am at the point where I am starting to question some of the event flags, as I gradually realise that the machines are not perfect at this.

I would like to offer for comment the only 3 events flagged last night, to see if I am right to be skeptical. I have synchronised the data from my Resmed 10 APAP and my Wellue SleepU pulse oximeter.

Event #1

   

This doesn't look at all like a typical hypopnea to me. The movement right from the start of the event and the pulse spike 30s later are what I see a lot of, and believe to be arousals? This particular one woke me up - 90% of them don't. The lack of any oxygen drop makes it even less likely to be a hypopnea, I believe - according to the official definition anyway (though I realise the ResMed has no way to take that into consideration).

Event #2

   

This CA was flagged while I was surely awake. At 4:18:30am I awoke (it's not clear why) and then immediately realised I needed to do one of my patented sniff-flags (5, to say I was on my right side). I do this to help me study how many times each night I am actually awake (typically 7 times) and also help work out if one side is better for me than the other (as in the hospital's PSG, it doesn't appear so). This was accompanied by a synchronising movement spike as I deliberately sharply twisted the wrist containing the oximeter. Did I really fall asleep and have a CA less than 60s later?

Event #3

   

This OA shows similar activities to Event #1, and I believe we are looking at an arousal without wakening?

Thanks for any guidance. Understanding which events are real and which aren't will help me improve my titration, which is going very well actually. I felt like I slept really well last night, with slightly fewer awakenings than normal (only 6, I think). If I am right about all 3 events being spurious, then I had another event-free night - and yet my oximeter yet again says I had a poor night!

[jcp519]

Those might just be position changes during sleep which result in some sort of breath hold. Most people get at least a few of those per night.

On another note, your spO2 is a little on the low side. 93% is enough that it might be causing an arousal. Can we get a picture of all of your stats to get a little more info?

[BigWing]

On another note, your spO2 is a little on the low side. 93% is enough that it might be causing an arousal. Can we get a picture of all of your stats to get a little more info?

Sure - here you go. Thanks for your help.

   

   

   

[BigWing]

Those might just be position changes during sleep which result in some sort of breath hold. Most people get at least a few of those per night.

On another note, your spO2 is a little on the low side. 93% is enough that it might be causing an arousal. Can we get a picture of all of your stats to get a little more info?

I did post all my stats. Does my oxygen still look low to you?

[jcp519]

There are a few areas that seem to be quite low. There's a couple drops that look to go below 90% as well. There's quite a few O2 desaturations at night too. The one super large drop at around 1:50 seems to eventually have woken you up too.

The one thing I would suggest changing is the response mode from soft to standard. I'm pretty sure the soft mode ends up missing a lot of events and doesn't increase pressure when it should. I'm not sure if this is related to the O2 drops, but it might help.

If you have a sleep doctor it would definitely be a good idea to mention this to them.

[BigWing]

There are a few areas that seem to be quite low. 

There sure are, and that is fairly typical of what I see.

I bought the pulse oximeter as an extra aid in trying to understand what was going on when I slept - after all, I thought that's the ultimate problem we are trying to solve....stopping our oxygen level dropping because of the OA, H & CA events. I expected the oxygen data from the oximeter would correlate well with the events data from the CPAP machine, but that's not what I am finding. I find very little correlation between any of the oxygen data and: (a) the CPAP data, and (b) how well I slept! [I do though find that pulse spikes and movement DO correlate well with some of the CPAP data]

I get very few LARGE drops in oxygen (i.e. below 90%), but I do see frequent random drops from my base level of 95-96% to 92-93% - and it stays there often for an hour or more. 

I am starting to realise that these low-oxygen periods DON'T correlate with CPAP events but they DO seem to correlate with arousals - frequently starting and stopping at the time of an arousal (where the graphs show a sudden weird flow shape PLUS a brief movement followed by a pulse spike). 

My working theory is that something triggers an arousal (and again, it's generally not clear what) and the resulting slight movement alters my airway - maybe due to a chin tuck - so as to permanently affect SpO2 until another arousal comes along and changes it again.

There's a couple drops that look to go below 90% as well. 

It only went below 90% once actually - for 16s at 1:56am.

There's quite a few O2 desaturations at night too. The one super large drop at around 1:50 seems to eventually have woken you up too.

Yes - 18 minutes later an arousal (wrongly marked, I believe, as a hypopnea) did wake me. I'd love to know what causes all the arousals I see (maybe 20per night).

The one thing I would suggest changing is the response mode from soft to standard. I'm pretty sure the soft mode ends up missing a lot of events and doesn't increase pressure when it should. I'm not sure if this is related to the O2 drops, but it might help.

OK - I didn't know that. I will try it.

If you have a sleep doctor it would definitely be a good idea to mention this to them.

Sadly, I don't. The National Health Service will be providing me access to one....when it gets round to it. I've been waiting 6 months so far.    

Thanks for your help.

[jcp519]

I wish I could be of more help! Seems like the problem might be outside of the scope of your therapy.

Arousals are completely normal, but the O2 drops probably are not. Maybe someone else on the forum could better answer your questions.