Desperate for help adjusting my settings before I see my doctor tomorrow

[goodbenefit]

Hi, first time posting here, a bit desperate at the moment. My sleep apnea has generally been under control, but recently it's gotten worse and when I told my doctor that my AHI was raised, they raised the pressure. However, it seems that I have a decent amount of CA events, which makes me think maybe the pressure is too high now?

Here's a screenshot of my OSCAR chart from last night

   

and another from the night before, before they raised the pressure from min 8 - max 12 to min 9 - max 13.

   

Ramp is on auto, EPR is set to 3. Machine is Resmed Airsense 10

Those represent typical bad nights of sleep, but last week there was also a night with barely any CAs in comparison, but hypopneas. Here is a screenshot of that.

   

When my AHI is over 2, I feel like a zombie the next day and can barely do anything. This is seriously interfering with my work and I am falling behind deadlines, which is why I just want to try something new tonight so I can hopefully get work done tomorrow.

Even looking at my OSCAR data, I can't really see what exactly is the common denominator that might be causing these problems.

I'm going to see my doc first thing tomorrow morning, but what can I change tonight to help reduce the amount of CAs and hypopneas where I can?

[Deborah K.]

To help you we need to see the following items on your chart, in the order listed:  Event Flags, Flow Rate, Pressure, Leak Rate, and Flow Limits.  We need to see to the very bottom of the flow limits.  

Later, also remove the calendar so that we can see more information below it.  Thanks!

[goodbenefit]

To help you we need to see the following items on your chart, in the order listed:  Event Flags, Flow Rate, Pressure, Leak Rate, and Flow Limits.  We need to see to the very bottom of the flow limits.  

Later, also remove the calendar so that we can see more information below it.  Thanks!  

Ah, sorry for missing the format! I might just chalk it up to sleep deprivation, which is why I'm here haha

Here's the chart for last night

   
   

It only lets me attach 3 screenshots per post, so I will make further replies with the rest!

---

It only lets me attach 3 screenshots per post, so I will make further replies with the rest!

Here's the night before!

   
   

---

And here is the last one!


   
   

[BoxcarPete]

Flow limits are high per the info list to the left, but without seeing the graph we can't tell if it's clustered or constant. Please squish some of your graphs down so the flow limit line is visible in your screenshot.

Edit: I see them now, posted as separate pictures. They are slightly clustered, but not completely. I see that EPR is set to 1, increasing that can sometimes reduce FL that occur throughout the night. Increase to at least 2, or perhaps 3, and try that. Pressure range should be sufficient as-is if the FLs are cleaned up by pressure support, but if OA events start showing up we can address from there.

[goodbenefit]

Flow limits are high per the info list to the left, but without seeing the graph we can't tell if it's clustered or constant. Please squish some of your graphs down so the flow limit line is visible in your screenshot.

Edit: I see them now, posted as separate pictures. They are slightly clustered, but not completely. I see that EPR is set to 1, increasing that can sometimes reduce FL that occur throughout the night. Increase to at least 2, or perhaps 3, and try that. Pressure range should be sufficient as-is if the FLs are cleaned up by pressure support, but if OA events start showing up we can address from there.

Thank you so much for the input! I’m going to increase it to 3, should I adjust something else as well or leave things like that tonight?

[Dormeo]

Could we see a 5-second zoomed-in view of a typical CA and also a 5-second zoomed-in view of a period when your nominal respiration rate is high?

I'm struck by how high your nominal RR is, though my suspicion is that this is an anomaly of your flow-rate form rather than an actual elevated RR. But it'd be good to see.

You can get the key graphs into one screenshot by grabbing the gray bars that separate them and pushing them up. Please include:

Events
Flow rate
Pressure
Leaks
Flow limitations
Snores.

[Dormeo]

Be aware that increasing your EPR may increase your CAs. In my opinion, that probably doesn't matter, and the experiment of using EPR of 3 is a good one. You may sleep better with lower FLs -- or not, but it'd be good to find out.

I would suggest changing nothing else. You have so few OAs that the lower exhale pressure may well not matter.

By the way, if your doctor raised your pressure in response to an increase in CAs, you should consider finding a new doctor.

I do still hope to see those zoomed-in views.

[goodbenefit]

Could we see a 5-second zoomed-in view of a typical CA and also a 5-second zoomed-in view of a period when your nominal respiration rate is high?

I'm struck by how high your nominal RR is, though my suspicion is that this is an anomaly of your flow-rate form rather than an actual elevated RR.  But it'd be good to see.

You can get the key graphs into one screenshot by grabbing the gray bars that separate them and pushing them up.  Please include:

Events
Flow rate
Pressure
Leaks
Flow limitations
Snores.

Thank you for the input! Here is the relevant graphs with a CA. Will make another response with when the RR is high!
   
   

---

Be aware that increasing your EPR may increase your CAs.  In my opinion, that probably doesn't matter, and the experiment of using EPR of 3 is a good one.  You may sleep better with lower FLs  -- or not, but it'd be good to find out.

I would suggest changing nothing else.  You have so few OAs that the lower exhale pressure may well not matter.

By the way, if your doctor raised your pressure in response to an increase in CAs, you should consider finding a new doctor.

I do still hope to see those zoomed-in views.

Here are screenshots from a part where my RR was high!

   
   
   

[goodbenefit]

Be aware that increasing your EPR may increase your CAs.  In my opinion, that probably doesn't matter, and the experiment of using EPR of 3 is a good one.  You may sleep better with lower FLs  -- or not, but it'd be good to find out.

I would suggest changing nothing else.  You have so few OAs that the lower exhale pressure may well not matter.

By the way, if your doctor raised your pressure in response to an increase in CAs, you should consider finding a new doctor.

I do still hope to see those zoomed-in views.

For what it's worth, every once in a while I have a really, really bad night and there are quite a few OAs. Attaching a screenshot here. When it's this bad, I feel like my brain is completely non functional the next day. I'm so desperate to try something new tonight and hopefully have a day of being able to work tomorrow. Keeping all that in mind, would your recommendation still be to put EPR to 3 and see what happens, or do you think it would be safer to put it to 2 and see how that goes first?

[attachment=65613]
[attachment=65614]

[staceyburke]

On this night you were having positional apnea.  You can see positional apnea where either H or Oa events are clustered together.  Getting rid of as many as you can will lower your AHI.  Positional apnea can NOT be controlled by pressure changes.  You have to find out what position you are getting into and cutting off your own airway.  Have you changed your sleep position?  Sleeping on your back?  Using more (or new) pillows?  These things can cause positional apnea by chin dropping to your sternum and cutting your airway.  Think of it of a kinked hose – nothing can get through – you have to unkink the hose…

IF you can’t make a simple change like changing to a flatter pillow helps then you will need a collar.  I have a link to collars in my signature at the bottom of the page.  It shows people who are not wearing a collar and the SAME person wearing a collar.  There is a huge difference between the two.