Big swings in AHI

[sttebr]

Thanks for your comment. Like you, I too have seen conflicting comments and videos ( Lanky' Lefty's You tube) regarding the use of both EPR and APAP. I'm going to try working my way back up on EPR and see what effect it has on how I feel. I know PLMD / RLS is sometimes resolved after using PAP therapy for a while, so I am going to stay optimistic and keep working on the apnea side of things.

[sttebr]

Still looking for help understanding all the variability in my nightly Oscar charts. 

I am nearing 90 days since starting PAP therapy and strictly by the numbers seem to be doing OK with AHI usually between 2-4, 100% compliant with average usage between 7-8 hrs a night, low leak rate since changing to a full face mask, trying to stay off my back and using a soft collar. The swings in O2 levels and pulse rate spikes are now much better with O2 averaging 96-97% most nights and very rarely falling below 90. I do still have PLMD that seems to last an hour or so most nights, usually early in the sleep cycle. Most days though, I still don't feel very rested and just don't have much energy.

When reviewing the past month's charts, there doesn't seem to by any consistency to the events that make up the AHI score. One night will be mostly CA's, another OA's or Hypopneas, some nights flow limits are high, others very low, etc. I think I have solved most of the positional  causes by using a soft collar, although I do still sleep on my back quite a lot. I'm sure that some of my fatigue is due to PLMD arousals, but my understanding is the machine doesn't recognize them. 

I've tried all levels of EPR, while keeping pressure at 8-10, but event makeup still varies night to night. Is this typical / normal? It's hard to know what to focus on. Last night, I had the most OA's I have scored since starting PAP, but no flow limit spikes. Later in the night, I have what I think looks like a good flow rate pattern, but flow limits are high.

Any thoughts or advice is appreciated.

[Sleeprider]

Significant OA in these result practically mandate a higher pressure, and the flow limits might be improved with EPR 3 rather than 2. I can't rule out positional issues, but I think you might be ready for a fairly significant change in settings assuming that other than the apnea, you are comfortable with the pressure. Let's move from minimum pressure 8.0, maximum pressure 10.0 and EPR 2, to minimum pressure 10.0, Maximum pressure 13.0 and EPR 3. Give it a try and provide feedback on comfort. The efficacy will speak for itself.

[sttebr]

Thanks for your reply and advice. I will make the suggested changes tonight and try it for a few days and report back.

Attached is a screen grab from my Oscar stats page showing the past 30days results. It appears to me that most events were showing improvement from the 30 day averages, but then suddenly something like last night happens. Last night it was OA's, but other nights it might be something else with OA's being low or 0. I did have a rare cold about 2 weeks ago that hindered my sleep for about a week, but it is gone now.

[sttebr]

Follow up after increasing pressure / EPR. 

I made the suggested changes, 10-13 / EPR3, but didn't have much success. I only made it thru about 4 hrs before turning off the machine due to frequent waking and mask leaks. In my barely awake state, I changed the machine back to fixed 8, but forgot to change EPR, so I was dropping to 5 for the rest of the night which is too low for me. Overall it was a bad night with AHI of 9.75.

Since then I am back to fixed 8.4 with EPR 1 and back to average AHI of 2-3 with a mix of CA's and OA's.

I have been monitoring my sleep with a small Wyze camera for a while and have found that almost all events that are not movement related happen when I am on my back. On my side, I still have some issue with PLMD, but very few recorded events. I use a soft collar to prevent chin tucking and a FFM, but apparently when on my back my airway is compromised pretty quickly.

I prefer not to use a dental appliance or crank up the pressure to let me stay on my back and would rather learn to stay on my side, but the simple tools... tennis ball, back pack, etc. haven't worked for me. I know they are pricey, but has anyone had success using positional monitors like Night Shift or Nigh Balance?

[Kingsway]

I see there is an Android app called - Torena sleep position trainer, which might be worth a look?

There are also several low-cost gadgets available on eBay

[sttebr]

I see there is an Android app called - Torena sleep position trainer, which might be worth a look?

There are also several low-cost gadgets available on eBay

Thanks for the info on Torena. I have a pretty simple Android phone which may not have all the required features, but if it will work I'm going to give Torena a try. If not, I'll look around eBay some. Night Shift and Night Balance devices get good reviews, but $400 -$500+ is pretty crazy for what it does I think.

Thanks again.

[Sleepy Quixote]

Following Sleepriders advice to others got me on track as far as AHI goes but I was still pretty tired in the morning. Like you I was diagnosed with pretty severe PLMD, also have peripheral neuropathy and RLS. None of the sleep professionals seemed to care about the PLM, I even asked the sleep nurse if it was at least half the problem, she frowned and shook her head and said once we get the therapy dialed in the PLM would likely calm down and that it was a minor part of it anyway. After bringing it back up with the Doc, nurse, and therapist during subsequent sessions and me still complaining of being tired, they just shamed me for changing machine settings and sent me on my way. I got frustrated and scheduled an appointment with a neurologist and brought in my sleep study diagnosis and some extra data and he just shrugged his shoulders and said your sleep Doc should know how to handle this. Let's try a medication, not sure if I can say what it is, but it's the most common med used to treat RLS. It took about 2 weeks of escalating dosage and adjusting administration schedules and lo and behold with the reduction of all the PLM, neuropathy and daytime RLS I've had the best few nights sleep I can remember. Good luck in your quest, keep at it, you are making progress on the long road to a good night's sleep. (The only reason RLS is mentioned is it's relation to PLM and neuropathy)

[Sleeprider]

Sleepy Quixote, thanks for your post. Nothing is better than the experience of others that have worked through the problem.

[sttebr]

Following Sleepriders advice to others got me on track as far as AHI goes but I was still pretty tired in the morning. Like you I was diagnosed with pretty severe PLMD, also have peripheral neuropathy and RLS. None of the sleep professionals seemed to care about the PLM, I even asked the sleep nurse if it was at least half the problem, she frowned and shook her head and said once we get the therapy dialed in the PLM would likely calm down and that it was a minor part of it anyway. After bringing it back up with the Doc, nurse, and therapist during subsequent sessions and me still complaining of being tired, they just shamed me for changing machine settings and sent me on my way. I got frustrated and scheduled an appointment with a neurologist and brought in my sleep study diagnosis and some extra data and he just shrugged his shoulders and said your sleep Doc should know how to handle this. Let's try a medication, not sure if I can say what it is, but it's the most common med used to treat RLS. It took about 2 weeks of escalating dosage and adjusting administration schedules and lo and behold with the reduction of all the PLM, neuropathy and daytime RLS I've had the best few nights sleep I can remember. Good luck in your quest, keep at it, you are making progress on the long road to a good night's sleep. (The only reason RLS is mentioned is it's relation to PLM and neuropathy)

Thank you for sharing your story and encouragement.

I agree, Sleeprider's knowledge and advice as well as reading thru other posts and the wiki have been by far the main reason for the progress I've made so far. I don't feel qualified to offer advice to others, but I hope that these posts about my journey will be helpful for those with similar issues. I live in a small town in Texas and rely on my primary care doctor for most of my medical needs. He listens and I like him, but he isn't much help when it comes to OA or CPAP, so this forum is where I go for help.

I'm glad that the RLS medicine has helped your PLMD. I'm starting to think that most of my fatigue is related more to PLMD arousals than to apnea now that the apnea seems to be fairly controlled and O2 levels are staying well in the 90's. I'm going to give CPAP a little more time and keep working on getting off my back, but beyond that I don't know what else to try except prescription medicines. My primary doctor offered to prescribe Mirapex if I want to try it... is that what you are taking and if so what dosage?