My charts & data

[fozsleep]

I'm not sure if this is a success story, but it is a story.  My wife hounded me for many years because I am a notorious snorer, and she said I sometimes stopped breathing several times in the middle of the night.  She didn't like that and it affected her sleep.  So I finally gave in and went for a sleep study.  Tressed up like a science fiction horror character in an unfamiliar setting, I was sure I didn't sleep once the entire night.  I did hear the character in the next room snoring like crazy.  I was somewhat surprised when the meeting with the doctor indicated mild/moderate sleep apnea with an AHI of 33, and occasional mild O2 desaturation (87%).  So, it was on to a CPAP trial.  The DME was nice and certainly wanted to sell me a machine.  I was still doubtful so started to look for info and found this forum.  

I then went independent and bought an Resmed Autoset for Her.  I got a couple of nasal pillow masks and found they were better than the mask the DME had started me with.  Looking at Sleepyhead my AHI was always below 2 and the events were mostly CA, with the occasional OA or H event.  I lasted about two months then stopped using the machine.  That was over three years ago.

My wife also snores and she started hounding me again about using the machine.  In response I said she should get evaluated!  She was having headaches on a regular basis.  Well, she did a home sleep study and was diagnosed as well!  She went to the same DME but I convinced her to go the on-line route and save some dough.  After looking at her Sleepyhead charts she does need the machine more than I do!!

 I was getting a dull head feeling even when I hadn't had a glass or two of wine the night before, so now that she is using her machine,  I have also returned to using my machine on a regular basis.  I like looking at the charts so we will see how it goes.  I have obtained a copy of my sleep study and it looks like the apnea events were clustered in two short phases during the night when I was snoring. Tome it looks like the total events were 33 and not an index of 33. I still wonder if my sleep apnea is all that bad.  If I set the machine at a constant low pressure over night (say 4)  would it record a bunch of apnea events? Being a scientist by trade I might just try a little experimentation!

[Melman]

Most feel starved for air at 4. I suggest you post some Sleepyhead data and we will be better able to advise you. See the links below for how to rganize and post data.

[fozsleep]

Most feel starved for air at 4. I suggest you post some Sleepyhead data and we will be better able to advise you. See the links below for how to rganize and post data.

Right, I'll do that.

[fozsleep]

Couldn't make it within 30 minute edit time, so here is another post.

Right, I'll do that.  Just configured and took some screenshots.  The first ones are from 2015 when I travelled to Australia, so the times are off.  The last two were from Saturday when I restarted.  I have had a few nights when I had OA's, but not many, perhaps 3 or 4 in one night.  My AHI has never been  over 3, so I haven't been too concerned. Does this indicate that the CPAP is useful and preventing OA's or that it's not needed.  Also attached is the original sleep study chart.  The diagnosis was a 60 yr old male with an AHI of 33 and an oxygen drop to 86%.  IF it was actually 33 perhaps I should be wearing the darn thing!

[Melman]

It's good to see that your CA events have decreased since 2015. Your event numbers look good but it appears your pressure is increasing due to flow limitations and suspect that a low constant pressure of say 5 would result in some obstructive apneas. Since your pressure increases immediately to about 6 and your median pressure is a little over 7 I suggest trying a minimum pressure of 5.5 or 6.

[fozsleep]

It's good to see that your CA events have decreased since 2015. Your event numbers look good but it appears your pressure is increasing due to flow limitations and suspect that a low constant pressure of say 5 would result in some obstructive apneas. Since your pressure increases immediately to about 6 and your median pressure is a little over 7 I suggest trying a minimum pressure of 5.5 or 6.

Great Thanks.  When I got the machine I really didn't look at changing any settings.  Your recommendation makes sense.

[Gideon]

I'm going to suggest an experiment. Set your machine to CPAP at 4 cm water (min and max to 4 is OK.  And turn off EPR).
Why?  First Melmans suggestion of pressures is right on.  If you wish to stay on CPAP he nailed it.   But your pronounced lack of big numbers provides a CHANCE that you may not need CPAP.  without question, the therapy will help with the flow limitations and will not hurt you.

In your sleep study ALL your events were in tight clusters, and when that happened you had a lot, yes I think the 33 would be about right, BUT they were in tight clusters with otherwise normal sleep, desats were all at this same time.  These clusters imply a positional component, a strong positional component

That suggests that you may be able to get away without CPAP, but I would like to see more data to back that up.  

Steps:

1. Replicate that positional apnea with CPAP (if possible).  This is why the very low pressure of 4 and no EPR.  We will use the machines capability to identify apneas if the 4 doesn't catch them then I will suggest a sleep lab study, with and without a loose cervical collar to treat the positional apnea I see in your sleep study.
   
2. Add a soft cervical collar and see if the captured events (step 1) go away.
   
3. Take a full Sleep Lab study without CPAP, a diagnostic study, split with and without the cervical collar The purpose is to see if you really need a CPAP machine or is the cervical collar alone is sufficient.
   

If I am right you MAY be the rare individual that may not need a CPAP for the rest of your life.  The positional apnea I refer to occurs when your chin drops at night thus blocking the airway. The collar keeps it from dropping.  The Sleep Lab study is needed to measure and identify apneas without the benefit of a CPAP machine.

Fred

[Melman]

Great suggestion for an experiment. Bonjour's been at this longer than I have. I think you should try his experiment.

[mesenteria]

...
My wife also snores and she started hounding me again about using the machine.  In response I said she should get evaluated!  She was having headaches on a regular basis.  Well, she did a home sleep study and was diagnosed as well!  She went to the same DME but I convinced her to go the on-line route and save some dough.  After looking at her Sleepyhead charts she does need the machine more than I do!!

...

Please don't take this the wrong way; my intent is not to heap blame on you.  But, if we are to take what you say here as accurate, do you see that your own behavior over the past three years may have contributed to your wife's condition, or perhaps only hastened its onset by a year or more?  If her sleep was truly affected, and not for the better, tons of valid and peer-reviewed research points to the problems one can expect when one loses sleep chronically.  Weight gain, heart problems, cognitive problems, memory problems....  She is the other principal component in your 'system' as a couple.  Sleep-wise, a couple sharing the same space, with one not doing well due to being hyper vigilant, or just suffering in silence, it won't be long before both are greatly troubled. Happened to me...or rather, MY wife.

I say this for the sake of onlookers who are lurking here, toying with the idea of finally getting a definitive diagnosis, or finally giving in and trying once again to live with PAP devices.  It isn't all about you.  Your partner is suffering in her own way.  In fact, you may lose her before your own system gives out.

[Sleeprider]

I'm going to be the voice of dissent here. Your test results indeed point to clusters of apnea/hypopnea accompanied by snores which suggest positional apnea and might offer an opportunity for the low or no CPAP therapy. However you had persistent RERA throughout the night associated with low SpO2, and these arousals are very disruptive to sleep quality. I presume that without CPAP, you will have fairly persistent upper airway restriction which is apparently easily treated at fairly low pressures.

My observation of your CPAP results is that you are at pressures of 4-9 with EPR at 3. All of your centrals occur at the higher pressures when EPR is at full extent. In my opinion the EPR is providing pressure support that minimizes flow limitation, but pressure is mostly increasing on flow limits (the flow limit graph is mostly cutoff). If I was optimizing your CPAP, I would select a pressure range of 6-9 at EPR 2.

Bottom line is I think you benefit significantly from CPAP, even at low therapy pressures, but your pressure range and EPR need optimized.