New to Board. Need help interpreting OSCAR

[gainerfull]

T2BF - I'm not sure the switch to APAP benefited you as much as hoped and your results speak for themselves.

In order to get you back on track and get another good night under your belt I'd recommend switching back to constant pressure mode at 9cmH20 and turning EPR off until we can get a gander at your sleep study results.

Get a couple of good nights in with above settings then I'd be curious to see a night of constant pressure @ 10cmH20.

Right now, EPR may be contributing to your prevalent central apneas and constant pressure. I think someone mentioned as well but in that last REM segment the events are very close together which suggests positional apnea that is typically solved w/ a soft cervical collar. I use one from Walgreens for $13 that works well.

If ramp helps you get to sleep it's not the worst thing ever to turn it back on but try to limit it to just enough for you to fall asleep.

Even with the wrecked sleep - do you know why you're waking up so frequently? What's your sleep hygiene like?

[Travel2BFree]

Attached is a copy of a sleep study done in June of 2013. I had another done a couple years ago but don't have a copy in my file but have requested a copy and will have within a week

[Travel2BFree]

The frequent waking is fairly normal for me. I assumed it was related to the urge to urinate which is probably due to enlarged prostrate. Lately, I have had more difficulty than usual getting to sleep and staying asleep. I am not exactly sure what it is all about. It could also be related to a medication that I am tapering off of. I only take one medication, methadone, and it is not unusual to have difficulty sleeping when tapering.

[Travel2BFree]

Last night I used the cervical collar, set ramp to 5 minutes, went back to CPAP 9 but forgot to turn off EPR which was left at 3. My AHI dropped down from around 12 to 2.6. Do you suggest that I still turn off EPR? Last night's chart is attached. Thanks for your help!

[gainerfull]

Looks like last night worked out well for you aside from the persistent central apneas towards the end of the night. Your sleep study doesn't mention any centrals as part of your sleep study and you've been using CPAP for years so it's unlikely to be treatment emergent central apnea. Can you post a screenshot of the clustered central period towards the end of the night? (zoomed in)

EPR can cause c02 wash-out which can cause your body not to take a breath (because there's no c02 to expel). If you felt good this morning after last night I don't see an issue with keeping these settings for a couple of nights to see if the centrals disappear.

Edit: Is there a reason you go to bed so late? Your sleep quality will be much improved if you can build a habit around going to bed around 10p.

[UnicornRider]

The frequent waking is fairly normal for me. I assumed it was related to the urge to urinate which is probably due to enlarged prostrate. Lately, I have had more difficulty than usual getting to sleep and staying asleep. I am not exactly sure what it is all about. It could also be related to a medication that I am tapering off of. I only take one medication, methadone, and it is not unusual to have difficulty sleeping when tapering.

If you goggle "Central Sleep Apnea with Methadone" you will find several studies that recognize the relationship between the two. So if you are tapering off the methadone there may be relief from all of your CA events after you've cleared your system and your body has time to recover. That may be something to discuss with your Sleep Doctor or PCP.

Otherwise I suggest you may have to accept some of the CA's, unless someone here has prior experience they can enlighten us with. But I encourage you to go for the comfort settings that maybe out there.

    Meanwhile as for your waking several times a night, that guy that sleeps here, had a Urologist address the very same issue. First the Urologist took pictures of the inside of his bladder to ensure that there were no complications there, As the camera passed the prostrate the urologist commented "That should ream the prostrate out". Now I have to tell you, the only anesthesia they offered,,, was a little lube that contained "4% Lidocaine", smeared on that long snake like camera tube.

      Oh and I got to hold his hand to distract him while this procedure was going on. The urologist did write a prescription for "Tamsulosin" commonly called "FlowMax" by the pharmacy techs. Since then the nighty pee awakenings has reduced to only once every third night, instead of 5 to 6 times per night.

So if you decide to go that route, when it was My turn to have bladder pics, I told them only if I was in the hospital, under general anesthesia with an anesthesiologist watching over me. After the pics were taken I walked out of the hospital, no wheelchair ride for me. And I could walk, didn't need three days in bed. Of course I don't have a prostrate either.

[Travel2BFree]

Attached is a screenshot of this morning's central apneas. This is a long overdue education. CPAP has been a mystery to me and I didn't know that a forum like this existed. I have been too complacent about my own treatment. 

The reason that I am going to bed so late has been in response to recent difficulties falling asleep. When I am unable to fall asleep, I get anxious and get up and try to find a way to relax more before going back to bed. After many failed attempts to fall asleep, I started to develop an aversion to attempting to go to sleep and to stave off that negative experience starting staying up later and later until I was tired enough that I knew that I would fall asleep. At this point, my sleep hygiene can use a little work. I would like to get back to a more normal sleep cycle and 10pm sleep is my goal. 

I did feel a little more rested today so will keep the settings for another day.

[Travel2BFree]

While I was reading your post about the urologist procedure, I was grimacing and experiencing sympathy pains for your boyfriend. I hope it was worth it. If I go that route, I am definitely taking the general anesthesia.

Thanks for the info on central sleep apnea and methadone. I had no idea that there was a relationship between the two but it doesn't exactly surprise either. I will have to look further into it.

[40plus]

As someone who used to have a severe and long opiate addiction (high functioning addict with work) i can safley say that all opiates affect sleep quality. Usually its much harder to fall asleep on opiates atleast on doses that are psychoactive meaning doses you can feel, like giving you a small "high".

Now the longer you take them and if its a steady dose you will adjust and be able to sleep, but most people can never sleep as well on opiates as without them no matter how used to them you are. But then again for some the effect of opiates are necessary due to pain management.

[UnicornRider]

As someone who used to have a severe and long opiate addiction (high functioning addict with work) i can safley say that all opiates affect sleep quality. Usually its much harder to fall asleep on opiates atleast on doses that are psychoactive meaning doses you can feel, like giving you a small "high".

Now the longer you take them and if its a steady dose you will adjust and be able to sleep, but most people can never sleep as well on opiates as without them no matter how used to them you are. But then again for some the effect of opiates are necessary due to pain management.

I was wondering about that, I know i have had to adjust my PAP pressure with respiratory infections, chemotherapy and some medications. Will the PAP pressures required for effective therapy decrease as you reduce the use of and/or cease the use of opioids?