Pressure increases without any significant OA's

[MyronH]

I've been doing somewhat better, but still feeling tired in mornings like I still don't get quality rest.  I had one OA at 3:00am, and 5:00am. And in between those two hours, my pressure fluctuated. 

What I'd like to know is why the pressure would sometimes increase without any significant OA's occurring?

[Walla Walla]

Flow limitations and snores both will cause an increase in pressure. If you look at your flow limitation chart you'll see it matches with your pressure rising.

[MyronH]

Flow limitations and snores both will cause an increase in pressure. If you look at your flow limitation chart you'll see it matches with your pressure rising.

thanks Walla Walla. I think I'm finally starting to understand a few things. I still just don't feel well rested and another sleep doctor wants to use a PES device to check negative pressure in my throat for UARS. 

Does "flow limitation" mean my airway was still restricted in some way? Would that mean that I have a type of UARS?

[Walla Walla]

Think of a obstructive and Hypopnea events as large flow limitations. Flow limitations are like events but aren't severe enough to be classified as events. A Resmed will count a Hypopnea when the limitation reaches 50% of the air flow and lasts 10 seconds or longer. An obstruction would be 80% and 10 seconds or longer. Anything less than those two are considered flow limitations.

[Sleeprider]

Myron, you recently dropped pressure significantly, and had very good results. Your pressure is increasing disproportionately on minor flow limitations. I would suggest a small increase in minimum EPAP pressure and slight increase in PS may resolve this. I categorically reject the idea you should do PES testing, invariably leading to surgery. You do not have a severe problem that merits that response. My approach would be go go to EPAP min of 5.0 and increase PS to 4.4.

[MyronH]

Think of a obstructive and Hypopnea events as large flow limitations. Flow limitations are like events but aren't severe enough to be classified as events.  A Resmed will count a Hypopnea when the limitation reaches 50% of the air flow and lasts 10 seconds or longer. An obstruction would be 80% and 10 seconds or longer. Anything less than those two are considered flow limitations.

Okay I get it now. Last few nights I've felt unrested in the mornings again. I check my graphs and see where the pressure shoots up because of "flow limitations".

Myron, you recently dropped pressure significantly, and had very good results.  Your pressure is increasing disproportionately on minor flow limitations.  I would suggest a  small increase in minimum EPAP pressure and slight increase in PS may resolve this.  I categorically reject the idea you should do PES testing, invariably leading to surgery.  You do not have a severe problem that merits that response.  My approach would be go go to EPAP min of 5.0 and increase PS to 4.4.

Okay looks like I will need to try your suggestions here soon on increasing EPAP and PS. I hope increasing PS doesnt cause more CA's. In the past on APAP, I had to decrease PS to 2 to get rid of most of my CA's.
 
I know my tongue base is main culprit of OA's and even with ResMed dental appliance and cervical collar something is still blocking airway at night. Right now I have machine set to MAX IPAP 18, and my doctor only wanted it set to 14. But sometimes my flow limitations occur and the machine wants to go even higher!

1. Regarding PES testing, would this not show more detail where the flow limitation is located in my throat?
2. I still don't feel well rested in morning. I have some weird issue with my HR shooting up to 100+, whenever I sleep for a long time, and then wake up in middle of night. I move one leg or arm, and BAM, it shoots up to 100+ and I get major palpitations. Not sure what that is, but got tested for dysautonomia and it was negative.
3. Another issue is that when I get up from bed initially, my oxygen level seems to be all over the place. The Contec SpO2 will  dip down into the low 80's, even when I stand at my kitchen bar area without moving. My oxygen levels seem to take almost 30min-1hr to level out. At first I thought it was the inaccurate Contec meter, but now I'm not sure. Because I feel lightheaded when standing as well for quite some time in the morning.

My DAMN doctors can't figure out what is causing the dizzyness and lightheadness nor my rapid HR that occurs when I just move a little in bed.

Issue with the dysautonomia testing is that i didn't lay for a long time. These issues with my blood pressure, HR increasing, and dizzyness upon sitting up and standing, occur if I've been immobile for awhile. Like asleep for an hour or more.

[MyronH]

Think of a obstructive and Hypopnea events as large flow limitations. Flow limitations are like events but aren't severe enough to be classified as events.  A Resmed will count a Hypopnea when the limitation reaches 50% of the air flow and lasts 10 seconds or longer. An obstruction would be 80% and 10 seconds or longer. Anything less than those two are considered flow limitations.

Myron, you recently dropped pressure significantly, and had very good results.  Your pressure is increasing disproportionately on minor flow limitations.  I would suggest a  small increase in minimum EPAP pressure and slight increase in PS may resolve this.  I categorically reject the idea you should do PES testing, invariably leading to surgery.  You do not have a severe problem that merits that response.  My approach would be go go to EPAP min of 5.0 and increase PS to 4.4.

So I haven't increased anything yet. I was doing good for awhile. Then had palpitations again last night. I'll sometimes wake up between 2:00-4:00am most nights. Last night around 2:15am woke up with the palpitations.  One of the 25sec OA's caused my SpO2 to go to 83%. I guess this is something I have to live with for now on? O2 dropping? Because the sleep doctors I've gone to, haven't been of help.

Would the flow limitations cause that much strain on making me breathe harder, that it causes palpitations?

[mesenteria]

I think it would be highly instructive for you to find a way to have your heart rhythm monitored for the next while.  The goal would be to see if what you sense and think of as 'palpitations' are coincident with increases in pressure to get you to the right flow rate.  The pressure changes are obvious to you...we can all see when they take place and for how long, but we don't know when your heart is acting up and if the two events take place essentially concurrently.  For example, does your heart flutter, and then you have the other things happening as a result because you are being aroused and turn over, changing the flow limitations?  Or is it the other way around?

[MyronH]

I think it would be highly instructive for you to find a way to have your heart rhythm monitored for the next while.  The goal would be to see if what you sense and think of as 'palpitations' are coincident with increases in pressure to get you to the right flow rate.  The pressure changes are obvious to you...we can all see when they take place and for how long, but we don't know when your heart is acting up and if the two events take place essentially concurrently.  For example, does your heart flutter, and then you have the other things happening as a result because you are being aroused and turn over, changing the flow limitations?  Or is it the other way around?

I would love to have another EKG monitor at night, but my doctors already done multiple earlier in the year. They wont approve another. On my Sleephead charts, where I cut off the machine at 2:15a and 5:30a is where I sensed palpitations both times. Major palpitations.

I reviewed my Webcam video recording, but couldn't tell anything that I had trouble breathing. Although it looked like I was taking deep breaths.

I dont think it's heart flutter, but who knows at this point. It possibly could be. My Contec sensor only records beats. I tried using my Kardia ECG device when I woke up both times, and my heart was in a normal rhythm. Although that thing wont sense heart flutter.

I never turn over in middle of night. I was laying entirely on my back through this period when I had the palpitations. It shows in my videos I never move from that position. Unless I purposely wake up and move to my side.

[zzzlessinMS]

Do you remember dreaming around these times?  I wake up with heart racing and fast breathing after a dream (good or bad).

BTW.  I found my Contec oximeter was low by as much as 10% when done at same time as doctor's pro equipment.  So 83 could really be 93.  Don't put too much confidence in OTC oximeters.