New user - UARS(?) and CA events

[PeaceLoveAndPizza]

Always follow SleepRider’s and other moderators advice over the rest of us punters. We are all learning from them as they have way more experience helping than the rest of us.

There are few black and white decisions in dealing with apneas. Listen to all and make your own decision.

[Sleeprider]

Your flow charts all look normal except slow breathing, which may not be a sleep pattern.  All of the flow rates are reaching peak flow with an efficient inspiration.  If I wanted to nit-pick, there are just a few breaths with a hint of flow limit like 02:43:55 and 02:44:20. We're certainly not going to act on those individual outliers. Note the Y-axis on the 10/25 chart is from -66 to +55 mL vs the other charts that use -80 to +80 mL.  The first two charts are using EPR 1 and the last is EPR 2.

I'll say that as much as I like to think I provide the best advise or suggestions my skill and experience allows, the other members are NOT punters. If I see some hair-brained thing you should not do, I will call it out. While, as a group, we have some variations how we approach optimization, most members offering help are drawing from their valuable personal experience, research and observations.  We learn from each other. There are many threads I do not participate in when I see good advise being offered by others that I could only repeat, or sometimes a novel idea that seems interesting enough to observe how it works out.

[PeaceLoveAndPizza]

Mea culpa if “punter” is a derogatory term in US slang. No insult was intended. I simply meant those of us who frequent this establishment but have no official responsibilities,

[egret]

Follow-up:

With more time and some minor settings adjustments, I'm getting fewer and shorter CA events and generally feeling pretty good. AHI has been between 1 and 6 recently.

I have noticed one pattern in my CA events in OSCAR. It looks like they almost always start with a set of big, irregular breaths, then no breathing, followed normal breathing. This seems like the opposite of the pattern where people have apneas followed by recovery breathing.

Does this big-breaths-followed-by-no-breaths pattern that I'm seeing mean anything? And if so, is there anything I can adjust to make it better?

Attached a screenshot with an example sequence.

   

[PeaceLoveAndPizza]

Those are arousals are typically from position shifting or turning over. 

It does look like you have some positional apnoeas showing up as CA’s. Consider trying a flatter pillow or soft cervical collar to help with those. 

Also consider trying a bit more pressure and EPR to help with the pressure changes and remaining flow limits that cause it. Maybe 7-11 EPR 3.

[egret]

Are you saying that you think the pattern shown here is arousal based on shifting position followed by positional apnea?

I am skeptical these are positional because there’s no recovery breathing and because they are decreasing over time on their own without any positional intervention.

[PeaceLoveAndPizza]

When we see multiple events close to others, it typically is caused by positional changes and/or chin-tucking. In the example you highlighted it shows movement, cessation of breathing while settling in, then a big breath and exhale. Zoom in on the multiple close events and you should see similar flow rates.

[egret]

I’m not seeing the big breath after the cessation of breathing. Can you point out where you see it?

Yes, the pattern looks similar in basically all events, but it’s harder to see when clustered. Deep irregular breaths followed by no breathing followed by normal breathing usually or occasionally a repeat of the same pattern. The whole pattern is happening less over time and the duration of no breathing is getting shorter (initially it was as long as 50-60 seconds and now it’s almost always <15 seconds). There are also lots of other times this pattern happens but it isn’t flagged because the breathing doesn’t stop for very long. The screenshot has one flagged event and one non flagged event

[PeaceLoveAndPizza]

No big breaths to see on the highlighted chart as it begins with some normal sleep breathing (notice the cardioballistic artifacts when at the zero line), then some movement (ends with sigh), a breath hold (as you settle in for ~15 secs), followed by a breath, then back to sleep breathing. This occurs again about 4 seconds later, just not at the same level.

It is probably happening a good portion of the night. From looking at all the earlier charts you posted there are a number of arousals (which look like spikes) showing recovery breathing, though not every recovery breath is a BIG deep breath. One good thing is your respiration rate is really good at about 11 bpm.

If you have not done so take a look at some of the LankyLefty27 YouTube videos on UARS and RERAs.

If it was me I would try slowly inching up the pressure a bit with more EPR to help settle the flow limits. You may be one of the lucky ones that get their sleep disrupted by even small pressure swings. The work will go into finding the minimum range with enough EPR to get consistently good quality sleep.