Low O2 and Snoring

[Bigdonpaul]

Bigdonpaul,

It's not impossible to get 0.0 AHI.  Many of us have repeatedly.  But your screenshot does show a lot of RERA (RE) which is not part of the AHI (Apnea Hypopnea Index).

You can change the reporting index to RDI (Respiratory Disturbance Index) which will include RERA + Apnea + Hypopnea.  
In Preferences > CPAP look on the right side under "General CPAP and related settings" in the drop down box "Preferred major event index" and change it to RDI.

For more info on RDI have a look at the wiki page:  http://www.apneaboard.com/wiki/index.php...ndex_(RDI)

Here is the same chart with the RDI filter:

       

[Sleeprider]

Bigdonpaul, have you discussed hypoventilation syndrome with your doctor? You are clearly a candidate for a bilevel positive pressure therapy device, and perhaps ST which is designed for obesity hypoventilation syndrome. No large man can subsist on a tidal volume of 200 mL and minute vent of only 2.75 L/min. You need pressure support to push air into your lungs and help with those flow limits. You are trying HARD to breath as indicated by the long inspiration times relative to expiration. You need pressure support. Call your doctor about a BiPAP trial.

[Bigdonpaul]

Thank you. I have an appointment with a new sleep doctor on Monday. In the meantime, is there anything I can do to improve it?

[Sleeprider]

You are in practically survival mode with your current CPAP. You don't have apnea because your body is fighting for every single breath. You have long inhale, short exhale, and if you zoom into your flow rate, you will see the flow comes up to about 8 to 10 mL/second and flattens out for the duration of inspiration. This is classic airway restriction caused by your condition. Once you have a bilevel machine, we will be able to use a lower exhale pressure to allow you to easily and comfortably expel air, but when inhale begins, you will get a boost of pressure support of 6 to 10 cm which will mechanically assist your muscles to get a complete breath much quicker. A CPAP simply cannot do that. If I could jump on Facebook Marketplace and find a fairly priced Resmed Aircurve 10 S, ST or Vauto, I would do it for you. In fact, go on Marketplace and search "Resmed Aircurve". Let me know what models you see that look affordable to you, and we can discuss the merits of them. The sooner you are on a bilevel machine, the sooner you will breathe more properly. Your doctor can order titrations and even consider if supplemental oxygen needs to be a part of your therapy, but if you can get a turbocharger for your breathing effort, you're going to feel the difference pretty darn fast, and it won't hurt to have a backup once your doctor and insurance come through. It will help you to have the energy you need to do other good things for your health, and at the very least, get you out of the survival mode that I see in your charts.

[Bigdonpaul]

You are in practically survival mode with your current CPAP. You don't have apnea because your body is fighting for every single breath.  You have long inhale, short exhale, and if you zoom into your flow rate, you will see the flow comes up to about 8 to 10 mL/second and flattens out for the duration of inspiration.  This is classic airway restriction caused by your condition.   Once you have a bilevel machine, we will be able to use a lower exhale pressure to allow you to easily and comfortably expel air, but when inhale begins, you will get a boost of pressure support of 6 to 10 cm which will mechanically assist your muscles to get a complete breath much quicker.  A CPAP simply cannot do that.  If I could jump on Facebook Marketplace and find a fairly priced Resmed Aircurve 10 S, ST or Vauto, I would do it for you.  In fact, go on Marketplace and search "Resmed Aircurve".   Let me know what models you see that look affordable to you, and we can discuss the merits of them.  The sooner you are on a bilevel machine, the sooner you will breathe more properly.  Your doctor can order titrations and even consider if supplemental oxygen needs to be a part of your therapy, but if you can get a turbocharger for your breathing effort, you're going to feel the difference pretty darn fast, and it won't hurt to have a backup once your doctor and insurance come through.  It will help you to have the energy you need to do other good things for your health, and at the very least, get you out of the survival mode that I see in your charts.

Thank you. I'm currently on Mounjaro which is helping me lose weight but obviously I need to put in more work. Will sleeping more on my back, increasing the pressure or sleeping more upright be helpful until I get a machine?

[Sleeprider]

Your charts don't show what we call positional apnea, but sleeping position can be very important. Avoid sleeping sitting up or inclined or with tall or multiple pillows. Avoid any position which causes your head to sag causing chin-tucking. This obstructs the airway and makes breathing more difficult. You want to sleep in positions that cause the minimum compression to your chest, abdomen, and throat as possible. Try to find ways to keep your chin elevated. I'm sure if you sit in a chair and allow your head to sag towards your chest you will immediately notice the difference this makes. Keep your airway clear. Most people will say back-sleeping is worse for respiration, but you have to decide what is both comfortable and effective for you.

I want you to take your charts with the respiratory statistics to your appointment with the sleep doc on Monday. They need to be aware of your respiratory hypoventilation, and the urgency to get you on an appropriate therapy that helps to resolve that. Some doctors are only concerned with AHI or events. Your AHI is low because you simply have a great respiratory drive and are already running too low on air to skip a breath. You need bilevel pressure support, but it appears you do not need a "ventilator" with a backup rate, because you have great spontaneous respiratory drive. I don't think you need anything too fancy, and just a S or Auto Bilevel will be effective. Request a script for a PaCO2 and PaO2 test to evaluate your blood CO2 and oxygen levels, or at least ask if the doc thinks this would be useful information. This will help support your need for bilevel, and may indicate a need for supplemental oxygen.

[Bigdonpaul]

Your charts don't show what we call positional apnea, but sleeping position can be very important.  Avoid sleeping sitting up or inclined or with tall or multiple pillows.  Avoid any position which causes  your head to sag causing chin-tucking.  This obstructs the airway and makes breathing more difficult.  You want to sleep in positions that cause the minimum compression to your chest, abdomen, and throat as possible. Try to find ways to keep your chin elevated. I'm sure if you sit in a chair and allow your head to sag towards your chest you will immediately notice the difference this makes.  Keep your airway clear.  Most people will say back-sleeping is worse for respiration, but you have to decide what is both comfortable and effective for you.  

I want you to take your charts with the respiratory statistics to your appointment with the sleep doc on Monday. They need to be aware of your respiratory hypoventilation, and the urgency to get you on an appropriate therapy that helps to resolve that. Some doctors are only concerned with AHI or events.  Your AHI is low because you simply have a great respiratory drive and are already running too low on air to skip a breath. You need bilevel pressure support, but it appears you do not need a "ventilator" with a backup rate, because you have great spontaneous respiratory drive. I don't think you need anything too fancy, and just a S or Auto Bilevel will be effective.  Request a script for a PaCO2 and PaO2 test to evaluate your blood CO2 and oxygen levels.  This will help support your need for bilevel, and may indicate a need for supplemental oxygen.

 I've started wearing a soft neck collar that goes on the front of my neck. Should I keep wearing that?

[Sleeprider]

Soft cervical collars when fitted well, can prevent chin-tucking and positional apnea. See the wiki linked in my signature and this http://www.apneaboard.com/wiki/index.php...onal_Apnea The pattern I associate with positional apnea ranges from bursts of flow limits with a mostly clear airway in-between to heavy clusters of OA events. I have not seen that from you, rather a consistently high airway resistance is present that has very high flow limitation and RERA. The collar helps as long as it doesn't hurt Seriously, if the collar is too small or impinges on the tissues of the throat making breathing harder, it is bad. If it corrects that condition by keeping the chin from tucking and obstructing the airway it is good. What do you feel with the collar vs not wearing it?

[Bigdonpaul]

Soft cervical collars when fitted well, can prevent chin-tucking and positional apnea. See the wiki linked in my signature and this http://www.apneaboard.com/wiki/index.php...onal_Apnea  The pattern I associate with positional apnea ranges from bursts of flow limits with a mostly clear airway in-between to heavy clusters of OA events.  I have not seen that from you, rather a consistently high airway resistance is present that has very high flow limitation and RERA.  The collar helps as long as it doesn't hurt  Seriously, if the collar is too small or impinges on the tissues of the throat making breathing harder, it is bad.  If it corrects that condition by keeping the chin from tucking and obstructing the airway it is good.  What do you feel with the collar vs not wearing it?

The collar is very comfortable. I don't have it really tight so I don't notice it too much. I can try to tighten it a bit and see if that helps. I will also lessen the amount of pillows I'm using.

[Bigdonpaul]

Last question for now: should I do anything with my pressures? I have it starting at 13-20.