[CPAP] Requesting Help with OSCAR Analysis

[omariumprime]

Let's take all pressure change out

7.4 to  7.4 EpR off

Flow Limits are driving your pressure up.  I would like to see if the pressure change itself is what's bothering you.

Attaching last night's charts with the recommended changes. Didn't sleep as long as I would've liked so restlessness in that regard, but still woke up a few times. Symptoms about the same as before so I'll stick with this for a bit and see what happens unless you have other recommendations. Thanks again for your help very much appreciated!

May 26...
   

[omariumprime]

If you go to Amazon, try searching on "arm pillows for sleeping."  I wonder whether any of the options there would help you.

Thank you I'll check that out!

[omariumprime]

Hey all! Attaching last night's graphs both of the main view but also the respiratory rate and tidal volumes. Symptoms are still just as bad as previously reported, I should be getting a soft cervical collar today or tomorrow to see if that changes anything. I'm still waking up frequently throughout the night and feeling severely unrested when i wake up, so something is still not clicking properly.

Is there anything in the respiratory rate and tidal volumes that would indicate what might be the issue? These specific graphs, even though they're not the preferred focus when analyzing OSCAR's data, seem to be completely all over the place and from what they describe I would assume they're vital for analysis. Or are they not as valuable as I'm suspecting? If the AHI is within a good range, yet I'm still getting crushed under a rock with my symptoms, then I assume what I have is much more complex than what an APAP offers.

I'm reaching out to different doctors and forums but any input would be greatly appreciated as always!

June 3 (Main)...
   

June 3 (Secondary)...
   

[omariumprime]

Hey all! Back again, squeezing every last bit of science before giving up on APAP for now. Can't decide which is worse, with or without the machine. Would really appreciate any new input in regards to my last post and any new observations for the below nights. Two of them I stayed with fixed pressure at 7.4, then had to take some time off from the machine as the usual symptoms were too severe. Tried to go back on it last night but instead of fixed I went back to one of my previous and recent auto modes with EPR set to 1. Again symptoms still all over the place (mainly consistently severe headaches, on and off nausea, and severe somnolence. Thanks as always!

*Note: waiting on two different sleep labs to get back to me for a follow-up test, so avoiding taking any sleep medications till then to avoid falling back into a cycle of doom. Could take months but gonna push through it.

June 10...
   

June 11...
   

June 18...
   

[Dormeo]

I'm sorry you are not feeling better. For a while there, it seemed as though you were on the road to improvement, and you have worked hard on solving a lot of problems. Yet here you are.

I went back and looked at your sleep study. As far as events go, you mostly had hypopneas, but what stood out to me was the number of spontaneous arousals, which repeatedly bumped you out of deeper sleep into more shallow sleep, and out of sleep into wake-ups. A little bit more here:

https://www.sleepapnea.org/treat/getting...y-details/

There was also a little bit of periodic leg movement, though it didn't seem to be associated with arousals.

Before a new polysomnographic study (i.e., with EEG so your sleep stages and arousals can be more accurately tracked), you might flag the issue of arousals, both spontaneous and respiratory-related. I don't know whether that would in any way alter how the study was conducted, but it couldn't hurt to mention it. You might also mention that your data indicate periods of flow limitation off and on during the night. (Given the periodicity, I speculate that it is REM-related.)

My (shallow) reading on the web suggests that you and your doctor may want to consider prescription medication to address the spontaneous arousals, if they show up on the new sleep study.

And something else for you and your doctor to think about: you may have several things going on. Given your reports of nausea, I wonder whether you may have reflux. Reflux and apnea are associated; more here:

https://www.sleepapnea.org/acid-reflux-gerd-sleep/

Your headaches may well be related to sleep that is not restful, but they may have some other cause. The more you can tell your doctor about their frequency, duration, and subjective feel, the better. It might be worth keeping a journal with daily notes so you can give a super-accurate account.

If you do start a journal (really, just a piece of paper you jot notes on every day), you might also note the daytime stressors you experience (work problems, feeling of anxiety, and the like), so you can spot possible correlations with headaches, tiredness, queasiness, etc.

I will be so curious what happens next. Please keep us posted.

[omariumprime]

I'm sorry you are not feeling better.  For a while there, it seemed as though you were on the road to improvement, and you have worked hard on solving a lot of problems.  Yet here you are.

I went back and looked at your sleep study.  As far as events go, you mostly had hypopneas, but what stood out to me was the number of spontaneous arousals, which repeatedly bumped you out of deeper sleep into more shallow sleep, and out of sleep into wake-ups.  A little bit more here:

https://www.sleepapnea.org/treat/getting...y-details/

There was also a little bit of periodic leg movement, though it didn't seem to be associated with arousals.

Before a new polysomnographic study (i.e., with EEG so your sleep stages and arousals can be more accurately tracked), you might flag the issue of arousals, both spontaneous and respiratory-related.  I don't know whether that would in any way alter how the study was conducted, but it couldn't hurt to mention it.  You might also mention that your data indicate periods of flow limitation off and on during the night.  (Given the periodicity, I speculate that it is REM-related.)

My (shallow) reading on the web suggests that you and your doctor may want to consider prescription medication to address the spontaneous arousals, if they show up on the new sleep study.

And something else for you and your doctor to think about: you may have several things going on.  Given your reports of nausea, I wonder whether you may have reflux.  Reflux and apnea are associated; more here:

https://www.sleepapnea.org/acid-reflux-gerd-sleep/

Your headaches may well be related to sleep that is not restful, but they may have some other cause.  The more you can tell your doctor about their frequency, duration, and subjective feel, the better.  It might be worth keeping a journal with daily notes so you can give a super-accurate account.

If you do start a journal (really, just a piece of paper you jot notes on every day), you might also note the daytime stressors you experience (work problems, feeling of anxiety, and the like), so you can spot possible correlations with headaches, tiredness, queasiness, etc.

I will be so curious what happens next.  Please keep us posted.

Thank you for the encouragement and advice! I did a follow-up in-lab study finally and just today got a call from the doctor saying my AHI was 51 (side) and 57 (back), how that jumped from the original sleep study of 5 & 7 over a year ago is beyond me, but I did add about 10lbs weight since so I’m sure the weight gain + overall unhealthy diet contributed.

I’m taking my machine to the dr’s office next week for them to connect and hopefully figure out a good setting then help me monitor from there. I was shocked with that AHI # but it certainly explains the severity of my symptoms. FYI the dr mentioned nothing else was of concern on the test results (such as centrals/UARS) and clarified that it was some apnea’s but mostly hypopnea’s. 


I’ve initiated a strict weight loss regimen (3 weeks in) as it’s my final troubleshooting step in terms of hopefully reducing but potentially treating this beast. I’ve been off the machine during this time but will try to go back under for the next few nights to try and gather some updated data for the dr when I see him next week.

Thanks again for everyone’s input and wisdom, and for anyone else out there still struggling, keep trying every possible troubleshooting avenue and don’t quit!

[Dormeo]

Congrats on getting the sleep study. If you have a copy, would you like to share it?

I'm not so sure the high AHI without PAP explains the symptoms you've had with PAP. Hypopneas have not been prevalent in your OSCAR reports, so your tendency toward hypopneas (also there in your first study) was being well treated. Even on the nights with your worst numbers, you were way, way below 51-57. -- Still, what a striking difference between the two studies!

Did the doctor give you any information about spontaneous arousals?

It sounds like you're going to have a night-time titration with your machine -- do I have the right picture? I'll be curious what settings they come up with.

[omariumprime]

Congrats on getting the sleep study.  If you have a copy, would you like to share it?

I'm not so sure the high AHI without PAP explains the symptoms you've had with PAP.  Hypopneas have not been prevalent in your OSCAR reports, so your tendency toward hypopneas (also there in your first study) was being well treated.  Even on the nights with your worst numbers, you were way, way below 51-57.  -- Still, what a striking difference between the two studies!

Did the doctor give you any information about spontaneous arousals?

It sounds like you're going to have a night-time titration with your machine -- do I have the right picture?  I'll be curious what settings they come up with.

Thank you! I’m actually waiting on a copy of the full report which I’m hoping they send my way tomorrow then I’ll gladly post here as I would love a second opinion.

I was hoping the dr’s analysis was a bit more in-depth, but he basically gave me the same summary as the dr from a year and a half ago. Also to clarify for my 2019 sleep study, I was on 50mg Seroquel at the time which I have been off for over a year now, that medication was “knocking me out” but kept me brain-fogged 24/7 and I still didn’t feel rested with it which is why I started this whole sleep troubleshooting journey. It’s just beyond me that back then I was given 5 AHI on my side and 7 AHI on my back with that medication and my weight as maybe within 5-10lbs of what it was for the recent study, versus this current study which reached 51 & 57. I have read a few articles about how weight loss for some can reduce the events by 2-3 points but took that with a grain of salt.

This most recent test I did, the only thing the dr mentioned was that “mostly it was hypopneas” and I asked about centrals,  UARS, and anything else on the report that might indicate something other than basic obstructions. I also mentioned the other conditions such as GERD (which by the way has significantly improved only about 4 days into my zero-caffeine weight loss regimen).

I feel like there are only a handful of sleep doctors out there that actually go beyond “you have obstructive apnea and you need a machine”. That’s sad considering the complexity of this beast for each individual. I am indeed taking the machine in for them to titrate it and hopefully figure out the optimal settings, which I will share here as well.

Speaking of, I had set my machine to a fixed pressure of 9.0 two nights ago and woke up with 12.4 AHI, then last night I changed it to 7.6 with EPR set to 2 and woke up to 27.2 AHI, lol so I think I’m gonna have to stick to fixed pressure and maybe try an 8 tonight. The last setting I had that resulted in consistently lower than 5 AHI was fixed pressure of 7.4 with no other special conditions, but my apnea might have gotten worse since I stopped the machine approx. 3 weeks ago.

Thanks again for everyone’s input, hopefully some day soon I figure this out before my heart grows too old.

[SarcasticDave94]

The thing is with fixed 9 vs 7.6 and EPR 2 is that these are very different settings altogether. The 7.6 and EPR 2, you would have been varying between 5.6 and 7.6. With the AHI increase like that, it's highly likely this was too low. The fixed 9 gave results that were better by comparison but wasn't good either. As is, it doesn't seem like most any setting has done very well for you.