Is this Positional Apnea?

[zzz1]

I switched from a Dreamstation to a Resmed Autoset 10 about two weeks ago.  My AHI went from 7 - 10 at best on the Dreamstation to under 2 and sometimes under 1 for a week with the Resmed.

All of the sudden the AHI started climbing back to 5 and I started seeing clusters.  I've been on APAP for about 2.5 months now and I'm wondering if as I get more comfortable with wearing the mask if I'm starting to sleep on my back again?  

I also seem to be waking up every hour to hour and a half.  I don't know why.  Even if my AHI is decent, this waking all night is making me tired.  I started looking into threads on sleep hygiene.  I took 1mg of melatonin before I went to bed last night.  I went right to sleep, but woke up within two hours and started the every 1 - 1.5 hour thing.  I also noticed I'm switching from my left side to my right side all night.

Could this positional?

[Sleeprider]

Read these two wiki sections:
http://www.apneaboard.com/wiki/index.php...onal_Apnea
http://www.apneaboard.com/wiki/index.php...Limitation

Compare the flow rate prior to the clusters of apnea on your own chart for flow limitation. I think we need to increase your minimum pressure and add EPR.

[zzz1]

I'm not real sure what I'm looking at so I posted a close up of another day in which there was a larger cluster.  I think I may have been awake for at least a part of that cluster and eventually threw in the towel and took the mask off.

I had also just turned off EPR because there were a couple of times I found myself taking several very deep breaths for no apparent reason and I thought maybe it was because of EPR.  It was kind of arbitrarily set to 2 when I picked up the machine so I put it back to 2.

When I look at the flow rate it seems uniform until maybe three minutes before the cluster.  FWIW I don't see anything recorded in the flow limitation graph.  I'm supposed to meet with my sleep doctor in a couple weeks.

Do you think EPR back to 2 is reasonable?  Thanks for your help with this.

[Sleeprider]

I would guess this is mostly central and not positional due to the lack of any apparent flow limitation. The previous chart from 3/22 looked to have more positional aspects to it. EPR does not cause you to take occasional deeper breaths, it mainly makes each breath a little easier. Hard to say whether it would increase CA in your case, and you don't have much flow limitation in your graphs, so if you try it, it's more of a comfort experiment.

[zzz1]

So my AHI has gotten pretty stable with a median of 1.94 over the past 30 days.

I recently  met with my sleep doc who is a pulmonologist and he looked at my data with the Resmed provider portal while I was in the room with him.  From what I could tell it only showed him three data points per day (AHI, usage and something else).  He said everything was green and looked good.  I didn't see anything in-depth like what we see in Sleepyhead.  He also had little knowledge of the algorithms.

Sleeprider- you mentioned increasing my minimum pressure.  What number were you thinking about?  Right now I have it set at 5 - 18 with an EPR of 2.

[Sleeprider]

zzz1, I would go with a minimum pressure of 18. Considering you are using EPR at 2, this would result in a starting pressure of 6/4, and your pressure would be more consistently delivered. Your AHI is very good at this point. With that said, there is nothing to suggest you are actually getting any EPR in this chart. You should check the machine clinical settings to confirm EPR is on, full time and set to 2. You may want to post something more current as this image is from March 20.

[Dormeo]

Sleeprider, is 18 a typo?

[Sleeprider]

Yes...I thought that should read 6.0.  I don't know how that happened

[zzz1]

No worries. I knew it wasn’t 18, but you did get me for a second!

[zzz1]

This data is from last night.  I changed the min pressure to 6 and confirmed EPR is at 2.  I have auto ramp on starting at 5.

[attachment=11384]