[CPAP] PSG1 - Therapy Thread

[PSG1]

Hello,

I am new to CPAP and sleep apnea. What led me here is 2.5 years of severe symptoms, looking back I can see my recovery dwindle despite great habits. They can at least be partially be attributed to PTSD, however, even with tons of work and discipline something was still just gnawing at me (While I have no doubt my work continues there, as I am trying to look at this as holistically as possible). Could not get docs to listen. Got the usual "all in your head". After pushing for a study, I got the below PSG results. I am on no medication. I practice many of the Huberman sleep hygiene/circadian recommendations.

I am just starting out, some nights I feel some sense of progress and honestly feel like the mask (N20) doesn't bother me. Some nights I have even had the pleasure of not being woken from nightmares with headache/fog and crushing feeling in my chest, but still many nights with that and feeling like I'm riding a wave of tired adrenaline all day. While my overall AHI looks much better, it still seems to spike quite a bit around REM, which also happens to be when I start to notice the above symptoms coming on.

Would the experts be willing to take a look and point me in the right direction? My gut instinct knowing as little as I do is to reduce the EPR from 3 and up my pressure a little. Or am I just chasing my tail and need to keep my focus on PTSD? 

My sleep doc is okay, but pretty nonchalant about the whole thing saying I can just sleep without CPAP whenever I travel or camp since it's so mild. Therefore, I am not sure he is really the digging-in type

Thank you for your measured input!

PSG:

AHI: 12.5 all obstructive hypopneas (AVG length 15.9s; 44 in total)
AHI 4%: 4.3/hr
AHI REM: 22.1
Arousals/Index: 83/23.6/hr
Low SpO2: 90%

Notes: Typical events were O. hypopneas w/ cortical arousals, snoring noted (didn't know I snored)

 Split w/ CPAP:
AHI: 2.6/hr (AVG length 15.9s; 5 in total)
AHI REM: 8.3/hr
RDI: 3/hr
Arousals/Index: 49/25.9/hr
Low SpO2: 91%
Significant REM rebound, no limb movement, no snoring, titrated to 6cm.

The attached was not my worst night or my best. About AVG.

[gainerfull]

Welcome to the board!

Moving forward it will be helpful if you can screenshot the "daily view" after minimizing the calendar so we can eval all of the data plus settings.

1. You're experiencing positional apnea, considering the close proximity of obstructive events.

2. It seems likely that you'll want to consider raising your pressure from 7cmH20 to 8cmH20 and look for the obstructive events to disappear.

Note: No amount of pressure is going to fix your sleeping position so please consider and different sleeping position, a flatter pillow, or wearing a soft cervical collar.

[PSG1]

This is a few nights up to 8cm with EPR 2. Some of the leaks I believe are me itching my nose. Another thing I noticed was a couple instances of my jaw dropping open causing a leak with the N20. Tried mouth taping one night, but not much better overall. Sleep seems to be getting worse. Waking with pretty nasty anxiety. Where to go from here?

Also, is this screenshot better?

[PSG1]

Hello,

I am still unsure what is going on. It seems the lower my AHI, the worse I sleep/feel (more nightmares/awakenings). I am going back and forth about possible UARS, or I am falsely attributing all of this to some sort of sleep disorder that is really just PTS. My sleep doc just says that my numbers look good and to keep getting used to it, but he has a fairly hands off approach. 

When I awake, I sometimes notice pretty significant nasal congestion or 'felt' flow limitation (breathing through a straw). I blow my nose and use a spray on occasion. Sometimes that helps, sometimes not. ENT says I could try turbinate reduction and septoplasty. However, I feel like that may be a hammer/nail situation.

I always seem to wake between 1-3 AM. I an experiencing lots of nightmares, waking in a panic (feeling pressure in my carotid, like maybe a lack of oxygen), feeling head pressure, dizziness. Again, this could all still be PTSD (which I am working on), but I was hoping to have some of the site experts look at my data and chime in rather than going purely on my biased feelings. I posted a couple nights (one "good" 1.17 AHI, and one "bad" 0.39 AHI w/ a zoom).

Thank you,
P

[BoxcarPete]

I'm going in for septoplasty and turbinate reduction later this week, but I'm also having my adenoids removed for the second time along with them, so it's possible my experience will be different from what yours would be. I still plan to check in here to report how it all went.

Those symptoms you describe are more likely to be related to hypercapnia than hypoxia. Fancy words meaning too much CO2 could cause a feeling of panic with headache and dizziness, lack of oxygen won't really do that. Check your mask vents to ensure that you are not re-breathing too much air.

One other thing if you're considering UARS, your inspiration time is significantly greater than you expiration time, this can often be associated with resistance to inspiration and often is helped with pressure support or EPR. Since you are already using EPR the next step on the path would be a bi-level but I have no experience with that so I'll leave it to some of our other members to pick up from there if it seems like it might be a good fit.

[PSG1]

I was moved to a bi-level. The struggle continues and I feel like I am gunna break.

I wake up feeling like someone is lightly holding down around my neck and I just forget to breath. The rest of the day my body is freaking out and on edge, but am exhausted. The PTS isn't helping, but I can't be imagining all of this. It always happens when I start dreaming a lot.

It has started affecting my hormones (free T3 and testosterone), my GP says it is likely stress and sleep which need to be resolved. The sleep doc says my AHI isn't that bad. 

Please help...

[PeaceLoveAndPizza]

How did you end up with your current settings? Doctor prescribed or self-titration?

The current settings seem too low based on what I am seeing. I would like you to try the following:

Mode Vauto
EPAP min 6
IPAP max 12
PS 4
No ramp

Going to Vauto mode will help with finding a good range. Based on the chart and your comments it seems your pressure is too low. We need to find the proper pressure settings. You can get a great AHI with low pressure, but it does nothing to help sleep quality.

[PSG1]

How did you end up with your current settings? Doctor prescribed or self-titration?

The current settings seem too low based on what I am seeing. I would like you to try the following:

Mode Vauto
EPAP min 6
IPAP max 12
PS 4
No ramp

Going to Vauto mode will help with finding a good range. Based on the chart and your comments it seems your pressure is too low. We need to find the proper pressure settings. You can get a great AHI with low pressure, but it does nothing to help sleep quality.

This was titrated on the attached study. More pressure with so many centrals? Respectfully, that seems the opposite of what I have read. Can you explain the reasoning for your recommendation?

[PeaceLoveAndPizza]

My eyesight is not what it once was and I may be missing it, but I do not see anything in the attached study mentioning pressures titrated.

Having an EPAP min of 4 is too low for almost everyone, except maybe someone very petite or with breathing issues. Working you towards a more useful range is needed to understand what will work as we have no background data from previous attempts at self-titration. I was going to suggest going to a range of 8-14, but thought it would be too much given your current pressures.

You can have great AHI and poor sleep quality. AHI is strictly a number that may or may not have a correlation to sleep quality. Two completely different things with some relation to one another. Too many assume a low AHI means good sleep.

You do not have many centrals. The ones you do have are clustered towards the end of the night. The latter ones I would call sleep-wake junk and ignore them. The ones around 04:00 are likely related tossing and turning where you held you breath whilst adjusting your position. We would need to see a 2-3 minute zoom to be sure.

Bottom line, your pressure is too low. Regardless of what your sleep study said.

[PSG1]

My eyesight is not what it once was and I may be missing it, but I do not see anything in the attached study mentioning pressures titrated.

Having an EPAP min of 4 is too low for almost everyone, except maybe someone very petite or with breathing issues. Working you towards a more useful range is needed to understand what will work as we have no background data from previous attempts at self-titration. I was going to suggest going to a range of 8-14, but thought it would be too much given your current pressures.

You can have great AHI and poor sleep quality. AHI is strictly a number that may or may not have a correlation to sleep quality. Two completely different things with some relation to one another. Too many assume a low AHI means good sleep.

You do not have many centrals. The ones you do have are clustered towards the end of the night. The latter ones I would call sleep-wake junk and ignore them. The ones around 04:00 are likely related tossing and turning where you held you breath whilst adjusting your position. We would need to see a 2-3 minute zoom to be sure.

Bottom line, your pressure is too low. Regardless of what your sleep study said.

It may be on the following page of PSG report, I was titrated to 8 and 4. Higher pressures caused aerophagia and worse sleep. I am open to try, but again I thoughts centrals were from too high pressure? It seems the machine is not picking all of the moments up. I added some more snips... Maybe Palatal issues? Definitely worse around REM/dreaming.