Camera shows highly disturbed sleep but numbers are "good"

[geauxdbl]

Ahh, the 6.8 comes from my previous thread:

http://www.apneaboard.com/forums/Thread-...#pid322124

I find it comfortable but am open to suggestions.

[Geer1]

Sounds like he was matching one of your previous APAP setting and his comments were the same (probably lower EPAP). Having you EPAP set at 6.8 is just supplying an extra 2.8 cm of pressure which is probably not necessary. I would lower it to 4 and start adjusting PS from there. Increase EPAP if you start having obstructive apneas but I doubt that will happen since you weren't really having them even without cpap (just hypoponeas in sleep test data you posted).

[geauxdbl]

Update: I tried lowering EPAP a little, raising pressure support to compensate, and slept subjectively worse.  I then had an epiphany: my obstructive events during the night are all false positives, since they happen at sleep transition or after an arousal.  The VAuto algorithm is targeting them like it was instructed to and dutifully raising the pressure, which in this case isn't helping.  I switched to S mode and took its decision making privileges away.

Started at fixed EPAP 6.8 and IPAP 13.  Bumped IPAP up to 14 last night and changed trigger to high, cycle to low.  Woke up feeling good this morning - positive and alert.  This despite a weird feeling from the aggressive trigger settings, which made me feel like my breath was being forced upon me a bit.  I switched back to medium, keeping cycle low, after waking up early this morning and it felt much better.  Will see how that works tonight.

Flow limit is absolutely gone.  Not even a phantom blip.

Median resp. rate fell from 14 to 12. Insp. and exp. time increased, tidal volume at near record level.

If we were going by numbers, the results would look worse since my AHI has risen to 1.6 from an average of around 0.4.  But I'm not going by numbers.  I can completely discount the 1 obstructive and 2 CA events reported at night, since I recognize the waveform and know they're false positives.  But I'm still getting hammered by sleep transition apneas.  10 events stretching over 5 minutes, alternating OA and CA, with minute vent falling to as low as 2.  This has been a consistent problem for the last month, even when I was at my previous VAuto settings.  I've been ignoring it, just starting to become concerned now.

My overall feeling is that I'm getting longer blocks of better quality sleep.  I took the camera down the other day but will consider putting it back up to verify.  

Once again, thanks to everyone for the wealth of information that is this board.

[Geer1]

Yes if your obstructive events aren't real then they definitely aren't going to be helping by increasing your pressure. Just as I don't believe you need an EPAP of 6.8 and that the extra 2.8 is probably negatively affecting you as well. You want to minimize pressure so I would lower EPAP to 4.

I was talking with a sleep therapist a couple days ago and she was saying you don't want a large PS, you want as little as possible. PS acts as a type of ventilation which is why it increases tidal volume. This is what helps deal with the flow limitations but it can also be too effective in reducing the work your body does and at washing out the CO2. This lack of CO2 is what is causing your central apneas, your brain regulates breathing on CO2 levels and if they are low it says I don't need to breath. This is indicating your PS is too high and I would probably jump back down to 5. If it is only during your original transition to sleep then that is less of a worry then if it is happening throughout the night (after each arousal etc) and may be because your body has to adapt to the higher PS as it keeps over responding to the current CO2 level.

These new settings would give you EPAP of 4 and IPAP of 9. I would try that in S mode and then slowly increase EPAP if you have real obstructive apneas or PS if you are having excessive flow limitations. You don't need to get rid of every flow limitation, flow limitations are only an issue if they are happening repeatedly causing your CO2 levels to increase. Unless you can definitively say that you are having less arousals at a higher PS then you should probably lower it.

Remember some of this will take time, weeks/months not days.

[3rdMarDiv]

If you have UARS, it seems well-treated by the current PS 4.2, and your pressure range varies by less than 1-cm through the night. Your flow limitation does not even show up on the 95% stat and is only 0.02 in the maximum, snore is zero.  I don't see any evidence that this is affecting your therapy from the charts posted.  Whatever is going on, appears to be external to PAP therapy.  You may want to try changing trigger sensitivity to high. I found that helped in my own therapy, but in your case it will be mainly a comfort change.

Also, most security cameras allow for length or duration of video time after trigger. Mine allows a max of 30 minutes, which, I use.

If you get into apnea events more may come and re-extend the duration, thereby, giving you much more data or time on target..LOL


Videoing yourself is very enlightening and sometimes a bit startling.

I learned so much that I was able to greatly reduce my apnea events.

[geauxdbl]

I've really been very pleased with mine - it's a Reolink model that records over wifi to a Synology server that I already had set up in my basement. I start and stop it manually to record the whole night, and it flags motion - all I have to do in the morning is pull up the Synology security camera app on my iPhone and scroll through it, jumping from motion event to motion event. Highly recommended.

Progress has been good. I'm currently still on S mode with EPAP of 6.0 and IPAP of 11.0. I tried dropping EPAP to 3 (surprisingly, the VAuto goes to 3) and it triggered an honest to god OA. Woke up with my heart racing. I had forgotten what those were like.

Will post further updates in a couple of days if the current positive trend continues - just need to give it some more time to see what's what.

[geauxdbl]

Some positive news to report today: 4 straight days of 0.0 AHI.  Even better news: I feel more positive about life and my anxiety level is dropping.  This feels like some of the best treatment yet.

Pressure is very comfortable now at fixed EPAP 6 and IPAP of 11.  The last change I made was Ti Max to 3.0, Trigger to high, cycle to medium on Saturday.  I also replaced my climateline air hose, as it had stopped heating.  I don't ever see an insp. time above 2 when I'm asleep, but it seems to help the feel of the machine when I'm awake and trying to go to sleep.  I find the feeling of the pressure supported inhale very, very comforting, and having it cut off prematurely was just weird.  The CAs on sleep transition have disappeared.

The unflagged sleep disturbances are still happening.  Reviewing my data again, they've been there all along -- ever since my first days of treatment in 2015.  Along the way, I frequently confused them with OA and CA events (because that's what they looked like).  Solving them will be my next challenge.  Based on the moaning/creaking/groaning noises that my wife used to complain of, I suspect Catathrenia but can't prove it. 

The only successful mask so far has been the F&P Vitera.

My experiment with dropping EPAP to minimum resulted in a real OA, so I know that they occasionally happen, but at 6, so far so good.  With bilevel I now get sufficient air in through my deviated septum at IPAP 11 to breathe comfortably, but not so much that I struggle to exhale.  Xlear packets have been doing a stellar job of keeping my nose clear.

[Geer1]

Can you post some examples of these unflagged sleep disturbamces?

Some amount of disturbance in sleep is normal including spontaneous arousals, odd little yawns, changing positions, the odd obstructive and central apnea etc.

Now that you have found a comfortable setup it might just take some time for body to adjust and for some of these other issues to sort themselves out (or they might be non issues). Many users find continuous improvement over weeks/months once they get on the right settings.

[geauxdbl]

But of course:

Last night with my Aircurve VAuto
   

In October 2019 with my Airsense 10 Autoset
   

In 2015 (flagged as an OA)
   

[jaswilliams]

As the disturbances have an inhale before them they could be nothing more than roll overs, we move arround after REM sleep before dropping back into REM sleep, I would not worry about these they are unflagged as the Apnoea is less than 10 seconds. Our sleep varies from night to nighT and thes type of events don’t always indicate issues that need dealing with. Sometimes we need to just sleep and get on with our lives not everything is disordered breathing due to sleep apnoea