Flat lines in flow rate, waking up in a panic

[cupcakechinchilla]

Happy Thanksgiving eve, everyone!

I have been trying to figure out what is keeping me from hitting a deep sleep over the past couple of months. It seems to be related to flat lines in flow rate and dip in Exp time. I have widened the range of my pressure (typically 10-13) to see if it makes any difference with higher or lower pressure, but it appears to happen as low as 7 and as high as 11.

I had a new sleep study a couple weeks ago and still have severe apnea, I'm waiting for a new machine. I spoke to my doctor about this and he wants to do a wide range pressure test on the new machine, but due to the shortages, that might not be until early next year.

Does anyone know what might be causing this?

Thank you in advance!

   

[Gideon]

The circled items in the flow rate are all arousals. You have flow limitations leading up to them and while your 95% value of 0.07 is under 0.10 it is above the preferred 0.03.
I have seen some PLM show as similar spikes in the flow rate so that is also a possibility.

Let's see what happens when we attack your flow limitations first .

Set EPR=3, Fulltime (not ramp only)

Please let us see and read your events chart.

[Sleeprider]

I agree with Gideon. Setting EPR to 3 full time will help to resolve the flow limits we see and should help reduce the arousals.

[cupcakechinchilla]

The circled items in the flow rate are all arousals.  You have flow limitations leading up to them and while your 95% value of 0.07 is under 0.10 it is above the preferred 0.03.  
I have seen some PLM show as similar spikes in the flow rate so that is also a possibility.

Let's see what happens when we attack your flow limitations first .

Set EPR=3, Fulltime (not ramp only)

Please let us see and read your events chart.

---

I agree with Gideon. Setting EPR to 3 full time will help to resolve the flow limits we see and should help reduce the arousals.

Thank you both, I will set EPR to 3 before bed. Any preference for moving back to my normal pressure range, or should I keep the wider range? 
Here's the event list and chart expanded.

   

[Gideon]

If EPR works like we expect it to there will be no need.

[cupcakechinchilla]

If EPR works like we expect it to there will be no need.

Thanks for the suggestion, here's where I'm at.

On Wednesday night, I set the pressure to 10,14 and enabled EPR3, but I still kept waking up so I set it back to 7,14 but left EPR3 on, to see if a lower pressure helped. The Flow Limits were worse at 7,14 EPR3 then they were at 10,14 EPR3. My overall flow limit was 0.04 which is much better, but I woke up 5-6 times. I did not include screenshots for this, as Thursday night (more info below) was very similar. 

On Thursday night, I started at 9,13 EPR3. During the night, I woke up around 11:20, 1:50, 2:40, 4:00 and 4:25. I have posted three of these time frames below. 

Due to the lack of sleep and constant wakeups at the higher pressure (9,13 EPR3), I decided to set it back to 4,13 EPR3 at 5:00am, even though now I see the Med was 9.56 for the night so I probably should have left it at 9,13. My Flow Limit was 0.04, which was the same as the night before (as opposed to 0.07-.010 before enabling EPR3). 

So the EPR3 setting definitely helped with the Flow Limits, but the arousals are still happening. I keep thinking, is my pressure too high or low, but changing the range for a couple days seems to make no difference.

I have changed up my routine to see if an outside factor could be causing this. I've cut out caffeine for 10 days, I've been eating dinner earlier and I've taken my medicine 4 hours earlier, but none of this made a difference. I changed from my nasal pillow to a full face mask for a month, but the full face mask leaked more than 60% no matter which size and fitting I tried.

According to my sleep tracker, when I experience these arousals, I am not getting in to a deep sleep until about 4am. At the time of these arousals, my heart rate jumps from low-60s to mid-80s. The lack of sleep is taking it's toll during the day.

Are there any other suggestions you might have?

11:20pm
   

2:40am
   

4:35am
   

[staceyburke]

Your min is to low at 4. You have your EPR (exhale pressure relief) at 3. 

The absolute lowest pressure your machine is 4. So your EPR is doing NOTHING.  Min 4 - epr 3 is still 4. 

You have to raise the min to 7 for EPR to work. Min7 - epr 3 = 4.  4 is your exhale pressure and 7 is your inhale pressure.

[cupcakechinchilla]

Your min is to low at 4. You have your EPR (exhale pressure relief) at 3. 

The absolute lowest pressure your machine is 4. So your EPR is doing NOTHING.  Min 4 - epr 3 is still 4. 

You have to raise the min to 7 for EPR to work. Min7 - epr 3 = 4.  4 is your exhale pressure and 7 is your inhale pressure.

Oh, that is good to know! Thank you. When I did 7 EPR3 I was still getting .06 Flow Limits so I think moving it back to 10-14 EPR3 or 11 EPR3 seems closer to where it needs to be.

[cupcakechinchilla]

If EPR works like we expect it to there will be no need.

I noticed my CPAP clock was off by one hour. I have now pinpointed the exact moments that my heart rate raised last night, and it correlates with a very distinct Flow Rate pattern. 

From my limited research, this looks like it could be caused by a mouth leak. Can anyone with more experience confirm or deny this?


   
   
   

[Sleeprider]

At 00:58:30 there is a legitimate OA event where inspiration is obstructed. The inhale following apnea shows tissue occlusion / snore and an arousal with recovery breathing.

At 02:15:20 you have increasing flow limitation leading to arousal which is classic RERA. This is followed by an inspiratory breath-hold at 02:16:30 and an apparent shift in position. Both events would cause heart-rate increase.

At 04:31:50 you again shift position inhaling and holding breath while moving. After shifting position, you exhale, take a larger than normal inhale and exhale before resuming normal sleep rhythm.

All marked events are normal arousal or movement during sleep causing heart rate increase. The OA and RERA might be treated or avoided with higher pressure, but with this low event rate, no changes are indicated.