Help Needed to Understand Arousals

[ravman]

   
Hi Everyone, I am a new bipap user and need help from wiser minds to determine the cause of my heart rate spikes / arousals / awakenings most nights. Quick background I got a sleep study done last year that showed mild SA (AHI 8.7), I used a mouth appliance in the last year with mixed results, AHI dropped to 1 but rdi was 5.2 and rem rdi was 8.9. Few months back I stopped using the mouth appliance because of jaw issues and it was not helping with upper airway problems. My sleep doctor got me an Aircurve 10 vauto that I have got nicely acclimatized to and am able to keep it on all night. My current settings are epap - 4, ipap - 8, ps -4 and trigger set to medium.
I continue to struggle with nightly HR spikes and awakenings and am trying to figure out my data on Oscar (last nights chart attached). My doctor is very slow to respond and I am not sure how much help I will get there. I am very new to Oscar as well, have seen a few introductory videos and understand the basics. This is a wonderful community with lots of data but overwhelming for a newbie. Any help will be much appreciated

[Jay51]

You are hitting both of your max epap of 4 and max ipap of 8 in your median (50th percentile).  It would probably be wise to raise both your epap and ipap.  PS of 4 may be ok.  

But first try lowering you pillow height, possibly side sleeping instead of back sleeping, or as a last resort if the OA clusters continue:  a soft cervical collar.  

These 3 things my enable you to keep the very low pressures you have right now 4 epap and 8 ipap.  Post some more OSCARs after you try these thing.  


You have clusters of OA's.  That is most likely positional apnea.  Here is some reading and tips to help stop it:   

• 5.3Positional Apnea
  

[staceyburke]

You are 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.

[ravman]

Thanks staceyburke and jay51. I will try a soft cervical collar and a lower pillow and then change my Epap to 5, Ipap to 9 and keep PS same to 4. I will post additional OSCARs. Learning every day!