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Thank you - it's actually the deep sleep that I'm getting woken from, probably even worse than REM! I'm getting this from the Oura data, which shows sleep stages through the night. It's not too hard to match the times with OSCAR. I think that going into deep sleep must change something to cause positional apnea.
I will start moving the minimum pressure up gradually.
And I will continue moving my bedtime forward. I am getting tired very early these days.
I think that the soft cervical collar has eliminated the OAs. I'm attaching Oscar results for 3 nights. I'd been away until 8/31, and unfortunately I seem to have left my Somnoseal behind. I quickly ordered another, but it was LD weekend and it hasn't come yet. So there has been some leaking. I am double taping my mouth until the Somnoseal comes.
I'm still getting very little sleep most nights, usually 4-5 hours. The cervical collar has been bothering me a lot. I hope I get used to it, as I've gotten used to the CPAP machine/ports and the Somnoseal/mouth tape.
Sat 8/31: 6.5 hrs sleep, no OAs, some leaking/flow limits
Sun 9/1: 5.5 hrs sleep, very interrupted, lots of leaking, but no OAs
Mon 9/2: subjectively and according to Oscar, a great night - but I forgot to wear the Oura ring
Last night was terrible, insomnia and only 3 hours of very interrupted sleep.
I'm wondering if I should make any changes to my pressures? Should I still move the minimum pressure up?
I'm sorry you're not consistently getting good sleep. I really hope you can adjust to the collar, because it's worked wonders for your OAs. Would it be worth trying a different size or brand that might be more comfortable?
You could try raising you min a little more, just to see whether that would help with the flow limitations. But I caution that FLs may not be interfering with good sleep, and raising pressure (as opposed to EPR) may not do much to reduce the FLs. So you could give it a try, but if it's uncomfortable, return to your current settings.
You probably know this, but the Oura ring can only guess at deep sleep, because it lacks any EEG functionality.
When you feel subjectively rested, it doesn't much matter what Oscar says, unless it reports a disaster.
I forget whether this has come up already, but you might keep some daily notes to see whether you can correlate good/bad nights with other possibly relevant variables. Those might include Oscar data, exercise, exposure to sunlight, anxiety, diet, or night-time noise or uncomfortable temperatures.
You've done a lot of problem-solving, and I really hope you'll soon start seeing a lot more good nights than bad.
Yes, with the help of the good people here, you in particular, most of the problems have been solved! I had another night with zero OAs. I will look into whether a different size/collar might be better. I ordered a popular one from Amazon without even doing any measurements, because I was so tired and busy. It did not bother me that much last night, though, so I might just need to be used to it.
I know that the Oura isn't perfect at identifying deep sleep. In my sleep study, even with 20 AHI, my deep and REM sleep percentages were not that far off from optimal. But I did find that the Oura-indicated entry into deep sleep was followed immediately with clusters of OAs a number of times.
I do need to keep better notes on those other factors that affect sleep. CPAP therapy is working very well now. The few times that I took all the CPAP stuff off during the night, the Oura indicated breathing issues when I wasn't using it. And on the nights that I use CPAP the entire night (almost every night), the Oura indicates very high oxygenation and little heart rate variability. So the therapy is accomplishing what it need to. I will try raising the minimum pressure a bit more, as you suggest, but I think that at this point I am mostly dealing with non-CPAP sleep issues.
I actually had a good night of sleep last night - 7.5 hours actually asleep, according to Oura, 38 mins deep sleep, 1:15 REM. I think that when Oura indicates deep sleep, I am in deep sleep, but I also think it must be under-counting it. My OSCAR results look pretty good; absolutely no OAs. I'm still waiting for the SomnoSeal, which I need to completely stop leaking. Double taping + cervical collar don't completely stop it.
The collar didn't bother me last night!
I'll wait until the Somnoseal comes, then track a few nights and consult you again about pressures. Thank you for all your expert advice!
CPAP is working well, but I'm still struggling with sleep. There have been some gradual improvements; I get at least 4 hours most nights, and there have been some nights with around 6. I still have a problem with waking up at least once during the night and having trouble getting back to sleep. According to Oura, I have multiple awakenings every night, but I am not aware of most of these. I don't get enough deep and REM sleep.
One problem is that I often take the CPAP equipment off after about 4 hours and then going back to sleep. According to Oura, I'm not having breathing issues after taking it off (although I don't think Oura is particularly sensitive to this) and my heart rate and blood oxygenation are not being affected.
I'm using the Brevida nasal pillows now. The Bleep nose ports were sometimes causing itching (waking me up) and the Brevida is so much easier to put on. After reading a thread here on stopping leaking with the Brevida, I have not had any significant leaks at all. I'm using the SomnoSeal, mouth taping, and a cervical collar. No mouth leaking and absolutely no OA events.
Last night I slept solidly for 6.5 hours (took equipment off after 4 hours). Oura shows multiple awakenings, but the only one I remember is the one when I took the equipment off, and I barely work up then. I got more deep and REM sleep than usual and felt more rested than usual. My OSCAR results look great.
The only factor I'm wondering about now is flow limits. Mine are usually around 0.12 (95%), so not bad, but every one of my waveforms is flattened. So I'm thinking that maybe I should adjust pressures. My minimum is 8, and Dormeo suggested trying raising it to see if it improves the FL. If anyone has any comments on last night's OSCAR results, I'd be grateful.
Nice-looking chart -- except for the total usage time. What do you think is causing you to take your mask off after four hours or so? It would be far better to leave it on. You may be having events when you're not using it that you're not aware of, and over time these could be detrimental to your general health. In addition, the more you do this, the harder you may find it to break the habit.
So it would be good if you could analyze exactly what is going on when you take the mask off so that you can do some more of your good problem-solving.
About FLs: they disturb sleep for some people and not for others. So they may or may not be a problem for you. You're maxed out on EPR, so a little increase in your min pressure is your only option for experimentation, especially since you're a committed back sleeper.
About arousals: it's normal to experience multiple arousals during the night. Some are from sleeping to waking, some are from deeper sleep to more shallow sleep. Many are so brief we don't remember them. It's *very* common to wake up after REM sleep. (I wake up after virtually every chunk of REM sleep I get.) This study has its flaws, but you might like to take a look:
The bottom line is that arousals per hour can range from 11/hour at age 18 to 22/hour at age 70.
This may sound a little off-the-wall, but might you consider leaving the Oura ring off for a week? When I was using the Dreem headband, I learned a fair amount, but I also came to realize that the self-monitoring was contributing unrefreshing sleep.
I realize that I should not be taking the mask, etc., off. With the Bleeps, it was intense itching from the adhesive; with the Brevida, minor irritation. But it is becoming a habit, and I agree that I need to break it. Usually, I take the stuff off only after I've awakened and have not been able to get back to sleep, because I know that if I take it off I'll go to sleep right away. But last night, I was barely conscious when I took it off.
Would FL improve if I were to sleep on my side? I could try to switch, but I know that I will wake up multiple times to change position. If I'm on my back, I don't move all night.
I may leave the Oura off for a while. The data was quite helpful in the beginning. Specifically, it revealed that my OA clusters occurred immediately after I entered deep sleep. This convinced me that I did, indeed, have "positional" apnea, even though macroscopically I don't change position. The cervical collar completely eliminated OAs, and I am used to it now and it doesn't bother me.
I'll try raising the minimum pressure slowly. Thank you for your suggestions, and for the link to the paper. I feel much better about the arousals now.
