[CPAP] OSCAR confusing me with leaks/apneas

[SarcasticDave94]

Agreed, it's very possible in some. Say for example that the mask straps tighten when your head tilted up or back. If discomfort increases, the natural tendency is to tilt your head downward towards your chest. Bam, a kinked airway and positional Apnea are right there.

[godletmesleep]

Hey guys!

Here are the results from the first night of the N20 and some issues I've discovered with positionals.

• 4/29/2021 | Apnea Events: 21
  
• 4/29/2021 | Hypopnea Events: 30
  
• 4/30/2021 | Apnea Events: 12
  
• 4/30/2021 | Hypopnea Events: 14
  

The N20 seems to of worked a bit well, I have fewer apneas after the first night. I can't tell if that's due to how sensitive the mask is at detecting it or otherwise as I see a few spikes that aren't flagged but they're not apneas, just random large inhales and exhales?, so that's probably why.

I still feel kinda meh, but that's probably because I still have around two to three apneas/respiratory disturbances an hour. It is better than before though.

Anywho, I ran a webcam with an exact timestamp to see what I was doing in my sleep, and sure enough, I am rolling onto my stomach for a few moments and shoving my face into my pillow. I don't think any collar is gonna stop that. Looks like this is causing an obstruction as I can clearly hear myself struggle to breathe immediately after doing it, and it is at the same timestamp as a cluster.

Hopefully, I can provide more details on that later for possible addition to any encyclopedia we have here at ApneaBoard.

[godletmesleep]

Reviewing the video further now with the help of some motion scanning, I seem to be flailing my limbs around ALOT in my sleep. Legs randomly moving, arms reaching across to throw blankets, tossing myself pretty aggressively towards another position. Some causing respiratory issues, some not. 

What would the threshold for a disruption be? 

I had a lot of sudden arousals that weren't linked to anything respiratory in my study. 

In fact, I had more "spontaneous arousals" than I did respiratory ones, but it didn't score them as movement-related. Worth noting that there was movement recorded in the study, but nothing that would meet a "Periodic Limb Movement Threshold" as it was written.

I guess there's a PLMD factor to this as well

[sheepless]

maybe instead of movement (plmd) causing disordered breathing, your disordered breathing is triggering your movements, which in turn probably result in more events. IF that's the case, continuing to optimize your settings and ensuring you're on the right machine (I haven't re-read this thread to remember your history) may relieve the movements.

before I gave in and had my 7th sleep study and finally started papping, I thrashed wildly against apnea in the struggle to breathe. I know this because I became aware of it as it woke me so frequently, my wife complained for years and I had a phone sleep app with a noise activated audio recorder. the recordings are gut wrenching to listen to. it took me a long time and multiple machines to get my ahi down to a consistently respectable level but the result is I no longer thrash as wildly and as much.

a footnote: ironically it turns out I also had/have restless legs and periodic limb movement. I still move and it's disturbing to sleep, but the movements are subtle. I'm completely unaware of them and most of the time my wife is too. I've seen video of some pretty wild plm, but mine isn't and it's nothing like the nearly violent thrashing apnea used to trigger.

[godletmesleep]

maybe instead of movement (plmd) causing disordered breathing, your disordered breathing is triggering your movements, which in turn probably result in more events. IF that's the case, continuing to optimize your settings and ensuring you're on the right machine (I haven't re-read this thread to remember your history) may relieve the movements.

before I gave in and had my 7th sleep study and finally started papping, I thrashed wildly against apnea in the struggle to breathe. I know this because I became aware of it as it woke me so frequently, my wife complained for years and I had a phone sleep app with a noise activated audio recorder. the recordings are gut wrenching to listen to. it took me a long time and multiple machines to get my ahi down to a consistently respectable level but the result is I no longer thrash as wildly and as much.

a footnote: ironically it turns out I also had/have restless legs and periodic limb movement. I still move and it's disturbing to sleep, but the movements are subtle. I'm completely unaware of them and most of the time my wife is too. I've seen video of some pretty wild plm, but mine isn't and it's nothing like the nearly violent thrashing apnea used to trigger.

My suspicion would be it's secondary to my Restless Legs Syndrome.

My apneas still have not dipped below 2 AHI ever on therapy, this is getting pretty frustrating I will admit. I bumped my pressure up, I guess I will start titrating it to see if that helps. I'm still foggy and tired, my sleep is still showing up constantly interrupted and it's just very confusing to see so many people immediately feel better and I still feel like nothings really changed.   

I'm honestly running out of ideas here. I still have all those underlined questions throughout the thread if anyone wants to take a crack at them.

Looks like a majority of my apneas last night though, were after my head "scooched" off my pillow or scooched onto the edge of it.

[sheepless]

the flow rate pattern in the upper screenshot in post #21 could be your respiratory response to rls/plm. I've attached a shot of what mine looks like.

feeling 'meh' may be as much a consequence of rls/plm as apnea, if you have it. optimizing pap is difficult in the presence of rls/plm. pap won't do anything for plm. not sure about pr machines but resmed's ineffective response to plm induced flow limitations can be even more disturbing.  if you have it, the only thing for it is to find a treatment that reduces it.  guessing at a number, drugs have reduced mine by about 80%, which is a great improvement, and it still causes many arousals and fully wakes me several times a night, usually in the first few hours of trying to sleep.

[godletmesleep]

the flow rate pattern in the upper screenshot in post #21 could be your respiratory response to rls/plm. I've attached a shot of what mine looks like.

feeling 'meh' may be as much a consequence of rls/plm as apnea, if you have it. optimizing pap is difficult in the presence of rls/plm. pap won't do anything for plm. not sure about pr machines but resmed's ineffective response to plm induced flow limitations can be even more disturbing.  if you have it, the only thing for it is to find a treatment that reduces it.  guessing at a number, drugs have reduced mine by about 80%, which is a great improvement, and it still causes many arousals and fully wakes me several times a night, usually in the first few hours of trying to sleep.

Looking over those clusters, and reviewing the video, they seem to happen as movement starts. I start moving around and I suppose that would cause issues with my airway. Though some of those movements could be in response to an obstruction.

I do find several instances like these cropping up, although unflagged.


There are quite a few drugs that can curb PLM, I know there are some studies regarding it. In one study melatonin was found to reduce PLM symptoms in 60% of those studied.

I wonder if Deviated Septum is also causing issues for me though, could be expanding present problems.

Quick Edit: I did have around 6 spontaneous arousals an hour in my sleep study. Is that indicative of PLMD or?

[sheepless]

sorry, which clusters are you referring to? I see a fair number of events in your 4/30 & 5/1 screenshots, but not too bad and nothing that really stands out as a cluster, at least not the kind that calls for a soft cervical collar to mitigate.

the pattern in post #37 looks like a couple pauses in breathing, probably obstructive, not long enough to be flagged, that might have caused some arousal but not enough to wake you, and by the looks of it, weren't accompanied by a rollover magnitude position change.

honestly I have no idea what spontaneous arousals are. I assume it's like 'idiopathic', a euphemism for 'no explanation'. if leg movements were monitored in your sleep study they would have assessed plm frequency, arousals and awakenings. I've even seen leg movements identified and counted that weren't categorized as plm so they must have a specific definition of what constitutes plm.

spontaneous arousals must be caused by something but figuring out what isn't easy and something sleep medicine doesn't seem much interested in. afaik, it's the kind of thing that's ascribed to sleep hygiene issues for lack of a better explanation (maybe properly so; idk).

I might have missed it but your first mention of plmd that I saw was post #33. aside from the video showing movement, what else makes you think you have plm? e.g., rls before bed, psg report, audio/video, witness reports...? since you have video, keep monitoring that to try to learn more about the character and timing of your movements and any associated observations (feelings, whatever you're conscious of at the time or after, lifestyle patterns that might be triggers, what oscar charts look like at the time of the movements, etc. you can also compare to some online plm videos.

[godletmesleep]

sorry, which clusters are you referring to? I see a fair number of events in your 4/30 & 5/1 screenshots, but not too bad and nothing that really stands out as a cluster, at least not the kind that calls for a soft cervical collar to mitigate.

the pattern in post #37 looks like a couple pauses in breathing, probably obstructive, not long enough to be flagged, that might have caused some arousal but not enough to wake you, and by the looks of it, weren't accompanied by a rollover magnitude position change.  

honestly I have no idea what spontaneous arousals are. I assume it's like 'idiopathic', a euphemism for 'no explanation'. if leg movements were monitored in your sleep study they would have assessed plm frequency, arousals and awakenings. I've even seen leg movements identified and counted that weren't categorized as plm so they must have a specific definition of what constitutes plm.

spontaneous arousals must be caused by something but figuring out what isn't easy and something sleep medicine doesn't seem much interested in. afaik, it's the kind of thing that's ascribed to sleep hygiene issues for lack of a better explanation (maybe properly so; idk).

I still see a handful of bunched-up events occurring throughout the night in both 4/30 & 5/1, an obstructive next to hypopnea or several hypopnea's together. I figured those were clusters?
   

When cross-checking the pattern in #37 with video, there is movement as I roll over into a different position. Most movement can be spotted on otherwise different parts the respiratory charts being put out, least from what I can tell. Random limb movements and aggressive position changing are pretty prevalent.

As for your rls/plmd flow chart that you posted, a lot of those disordered or excessive breathing events crop up every night for me it seems. Sometimes they are flagged as periodic breathing and sometimes they are just spiking out on the flow chart.

Am I missing something here? I'm not 100% sure what PLM would look like on a respiratory chart, I just notice several events like this every night on the flow chart without any additional flagging.
   

Getting these images in was difficult but that's because my screenshot service decided to die.

sheepless
I might have missed it but your first mention of plmd that I saw was post #33. aside from the video showing movement, what else makes you think you have plm? e.g., rls before bed, psg report, audio/video, witness reports...? since you have video, keep monitoring that to try to learn more about the character and timing of your movements and any associated observations (feelings, whatever you're conscious of at the time or after, lifestyle patterns that might be triggers, what oscar charts look like at the time of the movements, etc. you can also compare to some online plm videos.

I mean, you kind of answered your question here but... the biggest suspicions would probably be the fact that I have RLS (irresistible urge to shake leg while laying down and trying to fall asleep) and 80 to 90% of people with RLS have PLM. The other being that video is showing otherwise unnatural limb movement, such as lifting a foot into the air with no prompting and fighting with a blanket, or the strangest one I have seen is just flailing my arm around. All of this in times that I do not recall being awake for

[sheepless]

re clusters, I see what you're saying. I have a different concept of clusters as illustrated by this screenshot but I get your point.

watching your video, what's your guess as to whether movement is causing events vs events causing movement? it would be nice to know but probably not necessary since we have to continue work to reduce ahi under any circumstances and since (afaik) rls and plm are treated the same, you can seek relief for rls without having to prove plm to see if treatment helps.

I don't know if the plm flow rate pattern looks different in different people. I'm only certain what it looks like in my flow rate and I've seen that same pattern in the charts of maybe a dozen other members. I do suspect a 'softer' version in my charts that looks more sinusoidal, more like what you show in the highlighted area around 3:31 in post #39, but I haven't confirmed it. if that was my screenshot, I'd say it's plm. I'd expect it to last longer but I do occasionally see evidence of just a few kicks in my charts now and again.

I don't recall mine ever being flagged as csr or periodic breathing. sometimes my plm pattern is punctuated by events, mostly not.

as you say, if you have rls, there's a good chance you also have plm. all I can say is to repeat that plm makes dialing in pap therapy all the more difficult, pap therapy won't help plm, the machines' reaction to our respiratory response to plm tend to be disturbing to sleep, and your best bet is to seek relief with the assistance of your doctor by trying supplements if deficient and/or various prescription meds.

I don't think those of us with plm will ever achieve restful restorative sleep through cpap alone. even treated, that goal is elusive. with meds, my plm is maybe 80% reduced but the remaining 20% continues to disturb and awaken.

I hope you keep us posted on how you deal with this.