[Treatment] Why do I wake up every couple of hours??

[TommySnores]

Hi - I have been learning from you folks for the last 10 months. Thank you for providing such an incredible wealth of knowledge. You have given me the tools to understand and optimize my OSA treatment.

I was diagnosed with moderate OSA in September 2019. I had no symptoms other than severe snoring, and nocturia. My urologist put the pieces together and recommended a sleep study. I have dialed my Airsense10 Autoset in using knowledge gained from this site and routinely have an AHI less than 1.0 with close to zero leak rates. 

       --Is there anything in my data to suggest why I wake up 4-5 times per night....and then always visit the bathroom? 
       --Are there setting changes you would recommend to further optimize my sleep?

I have enclosed a redacted sleep study, and two typical nights of Oscar reports. I do not feel any different on CPAP compared to not being on it with the sole exception of not being hoarse in the morning from snoring. My wife however sleeps much better and is very thankful!

Tom

ps - kudos to the Oscar software development team. Oscar installed in minutes on my mid2012 MacBook Pro. Absolutely no problems. Oscar has been flawless with incredible capability. I am super impressed.

[staceyburke]

I see a lot of flow limitations. That is just smaller hypopnea and if you have many together that could bother sleep. I would try moving the bottom number up .5 and see if that makes less of the limitations if so move it up another .5. Not much of a change but maybe enough...

[Sleeprider]

Stacyburke is getting pretty good at this, and focused on the flow limitations. I agree, but doubt increased pressure will effectively change things. Your sleep study documented hypopnea dominate obstructive sleep apnea. This is a pattern common in upper airway resistance syndrome (UARS) which is a fancy way of saying airway restriction that results in flow limitation. Even with EPR 3, you still have a fairly high flow limitation and snores, both of which are a problem for satisfying sleep, and will result in respiratory effort related arousals.

We have a wiki that discusses UARS http://www.apneaboard.com/wiki/index.php...ome_(UARS) and much of that article is from Dr. Krakow. We have used his recommendation for bilevel therapy in treating the flow limitation of UARS very successfully on the forum. Your sleep study actually mentions "BiPAP", so it might not be out of the question for you to discuss your arousal problems with your doctor, and with a better understanding of why flow limitation affects your sleep, request a prescription for bilevel. We like the Resmed Aircurve 10 Vauto over the Philips BiPAP Auto. The solution to your problem is likely an increase in pressure support (PS) which is the difference between IPAP and EPAP. Your Airsense 10 Autoset has a limited pressure support of 3-cm, but a Vauto would allow us to increase that to where the flow limitations, snores and RERA are fully treated. Your AHI is good, but your flow limitation is affecting your sleep.

[Gideon]

A bit of a different approach.
Increase your max to 20. You are bumping into your max and staying near your max for extended times. This is to give more room for your AutoSet to operate.
Instead of bumping your min by . 5 try bumping by 1. With snores and flow limits I'd prefer to increase pressure support but you are already maxed at 3 (EPR). Increasing pressure is the remaining option.

[TommySnores]

Good Morning staceyburke, Sleeprider, bonjour - thank you for your prompt suggestions!

I bumped minimum pressure to 11.0 and raised the max to 20.0 as bonjour suggested. Last nights chart is attached. Pressure did not show any top stop limits other than the chin tuck at 12:45am. (The chin tuck happens once or twice a week for me. Still working on a cervical collar that I can sleep on my side with and yet still provide enough vertical support for my chin.) I woke up five times which is about normal. Seems like I should see what happens over the next few weeks. Still hoping for less wake-ups. Any other suggestions?

Tom