Bipap Titration advice needed.

[amafra]

https://www.google.com/search?q=sleep+hy...nt=gws-wiz

Thank you, good suggestion as well.

[Sleeprider]

Sleep hygiene will help. I think you know the clusters of issues were positional, and your collar is not working very well. As to whether you use VPAP or ASV, I'm neutral on the matter. Use what is most comfortable and lets you sleep. I experienced sleeplessness last night. Woke up in the middle of the night mentally designing the plumbing repairs I need to make at the summer cottage. Sometimes life gets in the way of good sleep. Do your best.

[amafra]

https://www.google.com/search?q=sleep+hy...nt=gws-wiz

Thank you, good suggestion as well.

[amafra]

Sleep hygiene will help. I think you know the clusters of issues were positional, and your collar is not working very well.  As to whether you use VPAP or ASV, I'm neutral on the matter. Use what is most comfortable and lets you sleep.  I experienced sleeplessness last night. Woke up in the middle of the night mentally designing the plumbing repairs I need to make at the summer cottage.  Sometimes life gets in the way of good sleep.  Do your best.

Yes it does sometimes, Matthew Walker sleep specialist said many great minds figure out sleep is where you can get amazing ideas. Some sleep with a metal ball in their hand to drop it and wake up in the sleep stage. Does it help you with plumbing design?

I couldn't get a collar yet. I put two towels on this triangle that I found in the house to fix the head at the correct position. Waiting for my pillow and collar purchased over the web. 
Matthew Walker
Collar and pillow will work better. If it is not detrimental I find ASVauto is doing a better job on the latest tests.

[Sleeprider]

That contraption elevates the head and looks like it will push the chin towards the chest. May help side to side, but fore-aft is not looking good.

[Rubicon]

I'm not seeing where your apnea is positional, although since you slept at a 30 degree angle in lab, and might be sleeping flat now (are you?  And why was the bed at 30 degrees?  The kyphosis thing?) maybe there's some positional something or other hidden in there.  Maybe the positional thing is that when you simply sleep on your side there is no AHI.  With no side sleep on the titration who knows.

What is suggested on the NPSG graphs is that you have largely REM-dependent apnea.  Obstruction is usually more severe in REM, but you look like you were doing well in the final REM period.

Do you have the hipnograma from the first test?  The REM numbers in AHI graphs don't seem to jibe with what should have happened.

Stop the coffee.  The half life is ~6 hours.  At 12 hours you still have 25% of the caffeine on board.

[Rubicon]

Speaking of which, you're an Italian living in Portugal? You're drinking espresso?

And what's Microf?

[amafra]

Hi Rubicon,

I'm Brazilian, Portuguese and Italian descendant and I do live in Brazil. 
I could not figure out what Microf means as well. Yes, I take some expresso's during the day, usually the latest 2pm. I do have a hypnogram for the first lab, I will include the image here.  I had my bed 30% to prevent me from sleeping on the side. When I do, the mask pushes against the pillow and starts leaking. You're correct so we can't see how it comes out, but I'm sure I slept on the side during the test. I moved a lot on the cpap titration exam.I believe most apnea ( if not all ) happens at that time, the exam does not show.
At least in home tests, looking at OSCAR, I start sleeping on my back and move to the side. OSCAR shows start nice but after a period of time, usually when I change position, apneas start to happen.
Another thing to note, is I feel ASV auto mode is working the best for me. Many times it sustains pretty low Epap values, seems like I don't even need a CPAP machine and then at certain times apneas clusters start to happen. On fixed pressure, it seams too much air when airways are not obstructed by choking position, causing worsen OSCAR graph with apneas including many centrals.According to what I am learning here it suggests positional apneas and I'm very confident that it is a big part of the problem, thanks to members of the forum helping me to notice it. The doctor could not understand why I have these apneas. She did put a camera on my nostrils going to my throat. She said the passage is a little narrower than would be, it is not what is causing my apneas.

I had a lot of leaks, notice it happens when I move my chin towards my chest on supine or sleep on the side.

I had better sleep tonight and I believe the main issue is positional apnea and preventing myself from choking will be the first step to having better sleep as very well noticed by Sleeprider. Second step will be fixing leaking, preventing too much movement or changing the mask to pillow or other non full face mask that leaks when pressed on the side. Later if I don't have any apneas or little due positional fix,  lower body fat to 15%. that can be done on a ketogenic diet, may improve airways even more. According to Roger Seheult (medcram), 10% gain weight increase apnea changes in 6 folds over a 4 years time period.
Apnea video: https://www.youtube.com/watch?v=NZszF7OaDVE
He offer free respirator course that might worth checking out: https://www.medcram.com/courses/COVID19-...entilation

Thank you all for help. 


First sleep study test hypinogram (no cpap titration)

Results:
During the total sleep period, he remained awake for 19.0 minutes and there were 210 micro-awakenings (rate of 33.9/hour). During the recording, the mean heart rate was 75 bpm, the highest was 94 bpm and the lowest was 94 bpm. 61 bpm. 0.0 periodic movements of lower limbs/hour were identified. There were 259 respiratory events, 0 being central, 259 obstructive and 0 mixed. The total apnea/hypopnea index was 41.8/hour, with 20.4 apnea/hour and 21.5 hypopnea/hour. The apnea/hypopnea index in REM sleep was 24.3/hour, with 3.5 apnea/hour and 20.9 hypopnea/hour. Baseline oxyhemoglobin saturation was 93%, with a mean saturation of 89%, the highest of 96% and the lowest of 77%, with 194.7 minutes (49.9%) of recording remaining with saturation below 90% and 0.4 minutes (0.1%) with saturation below 80%. There were 266 desaturations. 

Summary of results 
1. Normal sleep efficiency; 
2. Severe degree of apnea and hypopnea, characterized by obstructive events; 
3. Oxyhemoglobin desaturation; 
4. Increased awakening rate; 
5. Reduction of REM sleep; 
6. Presence of snoring

Micro Desp = Micro Awakening
Apn. Cen = Central Apnea
Apn. Obs = Obstructive Apnea
Apn. Mis = Mixed Apnea
Hipopnea = Hypopnea
Supino = Supine
Direita = Right
Freq. Card = Heart Rate




Second sleep study test hypinogram (cpap titration)

Results:
The exam started at 10:24:01 pm and ended at 4:17:45 am, with a sleep latency of 7 minutes and REM sleep latency of 135 minutes. The total sleep time was 282.5 minutes, with a sleep efficiency of 79.8%. The distribution of sleep stages showed 7.1% stage 1, 52.7% stage 2, 23.7% stage 3 and 16.5% REM sleep. In the total sleep period, 71.5 minutes awake and there were 120 awakenings. During the recording, the mean heart rate was 64 bpm, the highest was 83 bpm and the lowest was 56 bpm. There were 97 respiratory events, 0 being central, 97 obstructive and 0 mixed. The total apnea/hypopnea index was 20.6/hour, with 10.6 apnea/hour and 10.0 hypopnea/hour. The apnea/hypopnea index in REM sleep was 50.3/hour, with 40.0 apnea/hour and 10.3 hypopnea/hour. Baseline oxyhemoglobin saturation was 94%, with a mean saturation of 92%, the highest of 97% and the lowest of 84%, with 11.6 minutes (3.3%) of recording remaining with saturation below 90% and 0.0 minutes (0.0%) with saturation below 80%. There were 92 desaturations.




Last night OSCAR data (ASVauto Epap min 5, Epap max 10, min PS 2, Max PS 7).
No centrals here, fixed  EPAP/ IPAP induced centrals I think or may be wrongly interpreted by OSCAR. I don't know.

[Rubicon]

So in Portuguese Microf is probably microfone (microphone) or snore channel.

[amafra]

You are correct. That is possible, I didn't know I had a microphone on me. 
Learning Portuguese from you.