Events worse in the morning and events in general getting worse

[Elizabeth79]

            I have been on APAP since summer of 2022.  My sleep study showed an AHI of 2 and an RDI of 15, and said I had mild positional obstructive sleep apnea.  I am a woman, age 44,  BMI is a little over 21, with my jaw structure being the cause of my apnea.

I wake up several times a night, and I am not sure if that is due to insomnia or because of something going on with the apnea. 

I have previously had events ranging from generally .5 to somewhere around 3 per hour, per my OSCAR data. I feel like things are getting worse recently and I am trying to figure out why.  I noticed that often I will have more events in the hour before I get up.  I did not have any centrals in my sleep study, or if I did they were much lower than I am getting now. I can post the sleep study once I located it, if that would help. 

I have a Resmed Airsense 11. I use a nasal mask and tape my mouth shut.  I tend to keep EPR at 3, and my pressure settings are currently 6-10.

Any advice would be great.

Thank you

[Old Steve]

From what I can see on your charts you are having some positional apnea during the night.  The stuff right before you wake up appears to be some sleep/wake junk and some positional apneas.  Do you sleep on your back or side, do you use a soft cervical collar?

Are you using screen shots to post your charts as the quality is quite bad and and almost impossible to see any settings info.

[Sleeprider]

Elizabeth, your events are mainly CA and H events with some periodic breathing, and they occur in clusters at various times and more at the end of the night. This is fairly common in CPAP therapy. In technical terms, it is "loop gain" and occurs as CO2 is or added your respiratory drive responds to that fluctuation, also known as apneic breathing. If you zoom in on those events, they probably start with a fluctuation in respiratory volume and or rate, resulting in a repeating oscillation of respiration with CA or H events where you hypoventilation and carbon dioxide starts to rebuild, and changing to hyperventilation where your CO2 is vented. This cycle repeats until stabilize. The important thing is, your respiration is mostly stable, other than these episodes.

The solution is pretty simple. We reduce the effects of ventilation by turning down EPR or pressure. This reduces the loss of CO2 and avoids the apneic breathing. Your settings are currently 6.0 to 10.0 with EPR at 3. Let's turn EPR down to 2, and your pressure to 9.0. Give that a try and we can revisit your charts to see if you need any further adjustment.

Please read the tutorial linked in my signature on Organizing Your Oscar Charts to learn how to take a screenshot rather than taking a picture of your screen.

[Nightynite]

I agree with Steve on those clusters in the morning, SWJ , I get those also, I have always thought it’s just my body’s way of saying it’s time to get up. I feel rested and therefore I don’t worry about them.

[Elizabeth79]

Thank you for your insight. I’ll decrease EPR and max pressure both by 1 tonight

[Elizabeth79]

            ]My doctor has at my request switched me from CPAP to BiPap because I felt my sleep was disrupted while on CPAP.  A fellow CPAP user on reddit had looked at my charts and told me that my flow limitations were very high, which was causing me to wake up.  My AHI on CPAP bounces around from .5 per hour to around 4 per hour.  

I used the Bipap for a few days  this month.  It drastically reduced my flow limitations, but it substantially increased my centrals, so much so that I had almost 12 events per hour on the last night I used it. After that night, I switched back to CPAP.  Attached are screenshots from the first night I used the Bipap, and from the final 2 nights (all were last week/week before). 

I am trying to figure out if I should try to stick with the Bipap, which I do find slightly more comfortable than the CPAP, or limp along with the CPAP, which I have been doing since March of 2022.   

I can take CPAP screenshots as well, if that would be helpful.

I am grateful for any assistance you can provide, as this is affecting my day to day well being significantly, and my doctor is of little help.

Thank you

[Sleeprider]

This is great. A small setting change should help even more. Change trigger sensitivity to high, and if that does not cancel out the CA events, go to very-high. This makes Vauto switch to IPAP with less spontaneous inspiratory effort or flow and can help to stimulate a breath where the CA events otherwise occur.

[Elizabeth79]

Thank you Sleeprider. Any reason not to go right to “very high?” I’m just trying to find relief fast

[Sleeprider]

Many people that try high, find very-high is better. I'm an incrementalist in changing settings, but that decision is yours. It won't hurt you and if it feels like you're pushed too hard, just back off.

[Elizabeth79]

Ok, thank you and will do