[Diagnosis] WatchPAT sleep apena diagnosis low AHI higher RDI. Need advice

[Crimson Nape]

If you haven't set your "Trigger" to High or Very High, do so. This will aid in reducing the CAs. Please post a 2 to 3 minute zoom of your Flow Rate chart. Any random time slice should provide an insight of your breathing pattern.

- Red

[godiego]

If you haven't set your "Trigger" to High or Very High, do so.  This will aid in reducing the CAs.   Please post a 2 to 3 minute zoom of your Flow Rate chart.  Any random time slice should provide an insight of your breathing pattern.

- Red

I'll change the trigger, and here's a 3min flow rate chart from a stable sleep period; Thanks! 

   

[godiego]

Unfortunately I don't have anything to report because I have only slept once with the CPAP mask on. I keep trying but rip the mask off out of frustration after ~1.5 hours of not falling asleep.

I also recently had some genetic testing done (not 100% accurate, so take with a grain of salt) which showed an abnormality "significantly associated with delayed phase sleep syndrome (DSPS)" that I'm going to ask the sleep center about later this month. I've always been a night owl with a late bedtime, having extreme difficulty getting going when waking up earlier than 10 or 11 am, so who knows.

[godiego]

I went and got an in-lab sleep study to get more information. Here is a myChart writeup; I'll put in a request to get all of their data. In a second post I'll give a summary. 

"During all night polysomnography, the patient slept for 388 minutes out of 472 minutes in bed. Lights Out occurred at 22:19 and Lights On occurred at 06:11. Sleep latency was 19 minutes and REM latency was 223 minutes. Patient experienced a sleep efficiency of 82.3 %.
 
Respiratory monitoring using nasal/oral thermistor, pressure transducer, and respiratory inductance plethysmography belts revealed a 3% apnea/hypopnea index (3% AHI) of  3.9 events per hour of sleep, a 4% apnea-hypopnea index (4% AHI) of  2.8 events per hour of sleep, a central apnea index (CAI) of 0.5 and a 3% central apnea-hypopnea index (CAHI) of  0.5. The patient experienced 0.0 obstructive apneas, 0.0 mixed apneas, 0.5 central apneas, 3.4 obstructive 3% hypopneas, 0 central 3% hypopneas per hour of sleep. There was a 3% AHI of 1.6 events per hour of NREM sleep, and a 3% AHI of 10.5 events per hour of REM sleep. The patient had a 3% AHI of 10.9  events per hour of sleep in the supine position (no supine REM sleep observed), 0.0  events per hour of sleep in the prone position, and 3.6 events per hour of sleep in the lateral position (lateral REM sleep observed). The patient had a baseline saturation of 94-98% while awake. During NREM sleep, the baseline SpO2 average range was 95-98%. During REM sleep, the baseline SpO2 average range was 95-97%. Desaturations associated with abnormal breathing events were in the 85-94% range during NREM sleep and 88-94% range during REM sleep. The lowest SpO2 during the study was 85%. Patient spent 0.4 minutes with SpO2 less than 89%.
 
The snoring microphone and technician observation revealed absent snores. EMG monitoring of the tibialis anterior muscle revealed 2.9 periodic leg movements per hour of sleep and these resulted in 0.3 arousals per hour. There were 5.3 arousals per hour of sleep for no apparent reason. EKG monitoring revealed sinus rhythm.
 
If applicable, determination of sufficient AHI to initiate treatment in accordance with split night start protocol was based on 3% AHI.
 
Interpretation:
This all night polysomnogram does not provide evidence of significant obstructive sleep apnea based on a 3% AHI of 3.9 and a 4% AHI of  2.8 events per hour of sleep. Patient appears to have increased AHI during REM sleep with 3% REM AHI of 10.9 events/hour."

[godiego]

Over the phone, the sleep doctor said my AHI of 4 could be a 5 on another day and meet the requirement for "mild" sleep apnea. I did ask about UARS but they didn't seem capable of diagnosing it (?) They agreed with the pressures my CPAP is set at and said to continue using it for 30 days and to report my charts. I've been able to fall asleep with the CPAP mask on with a prescription sleep aid and my AHI is around 1 or lower. However, I haven't been able to sleep longer than 3-4 hours with the mask on and might be taking it off in my sleep. I'm going to order a chinstrap because it might be air leaking from my mouth that's causing this, or my sinuses clogging or drying up. Not entirely sure. 

I did learn that the majority of the sleep disturbances happen sleeping on my back during REM sleep, so I've been using a backpack full of towels to keep me off my back, which has reduced my CPAP AHI a little. Going to look into other solutions to keep me off my back when I sleep. 

Moving forward, I need to find out how to keep the mask on for a full night's sleep. Thanks everyone for your help so far!

[godiego]

I think I've narrowed my CPAP problem down. I had been using nasal pillows + a chin strap, but I couldn't sleep through the night without my nose clogging up & waking up. 

I visited an ENT and found I have nasal valve collapse, enlarged turbinates & a deviated septum, ~%75 blockage in both nasal airways. I think my hypopneas/apneas are from the restricted nasal airway causing airway resistance and mouth breathing, causing my tongue to fall back. 

I have two OSCAR graphs: 

• Friday, I used a decongestant (Sudafed) and Flonase before bed to keep my nasal airway open, and my AHI was zero. 
  
• Saturday I only used Flonase, and I woke up after two hours because my nose clogged up. 
  

I've also purchased a Wellue o2 ring to wear at night. I'm living with major fatigue, exhaustion and waking up unrested, so I really need to figure this out. 

I'm curious if anyone has any advice on how to keep my nasal passages clear while I sleep (such as buying a humidifier, neti pot, rinses, etc) or if I should buy a full-face mask because my clogged nose is waking me up. Thanks!

[Crimson Nape]

I have to say, your data is looking better.    

You might try sleeping elevated. This redirects gravity from adding to your problem.

As far as masks; If you like the air splinting of your nasal passages that the nasal pillow provides, you may wish to consider a hybrid mask.  These masks have the nasal cushion along with a mouth covering.  The 4 that I'm aware of are, (my favorite) the F&P Evora Full, Resmed F30 & "i" model, and the Philips Dreamwear.  The difference between the 2 Resmed F30s is the location of the supply hose.  The F30 is in front of the mask, and the F30i is on top of the head.   As for me, I find the air rushing sound by my ears quite annoying, but a lot of others don't.

- Red

[godiego]

I recently inclined my bed due to thinking stomach issues could be making my sleep problem worse, and I think it is helping.
I'll start shopping for masks where I can open my mouth if my nasal airway is obstructed. I definitely need some splinting; nasal dilators could be another option for me while using a mask.
I'll update this thread when I have some more findings. Thanks!

[godiego]

While I shop for masks, I'm trying to improve the setup I have now. I figured out I was getting many large leaks from my mouth because my mouth tape was failing, and now use 2in Cover-roll and a Knightsbridge chinstrap to keep my mouth from opening. I also have a wellue o2 ring but sometimes forget to put it on. 

Are there any settings tweaks that would improve the obstructive apnea events in my chart? 

I really appreciate your help!

[gainerfull]

Found this looking for WatchPAT posts but saw no one replied to your latest post so wanted to let you know the obstructive events are because your EPAP minimum is set too low so you may consider raising it to 8 and then adding 1cmH20 per night until they entirely disappear optimally.