Shallow uneven breathing

[DTDude]

Hello everyone,

I was diagnosed with OSA about a month ago and am in my 3rd week of using a CPAP machine. My untreated AHI is 9, with most of those events being hypopneas. 

I'm starting to feel better. I'm not struggling to stay awake sitting up at my desk in the afternoons. I watched a movie this weekend with the lights off and didn't fall asleep. I do still feel a little off-kilter and somewhat fatigued, especially in the morning. I want to make sure from a therapy standpoint there's nothing I should change to make things a little better. 

Looking at my Oscar data, I notice that most nights my breathing starts out nice and even and controlled, but several hours in gets somewhat erratic. It looks like I'm taking small breaths and but exhaling hard. 

Is this normal? Does anyone see anything that stands out as unusual and is there anything I should tweak? This is last night:

   
   

Thank you!

[OpalRose]

Welcome to Apnea Board!

Good looking charts. The changes I'll suggest are mostly for comfort.

Let's move your minimum pressure to start at 8cm. Set max pressure to 15cm.

Also, the 95% flow limitation is a bit higher than we like to see. We like to see it around .05, preferably lower. High FL can cause pressure swings and sleep disturbances. In order to tame this, we suggest using EPR. EPR also helps with Hypopnea and breathing out against pressure, so should be comfortable overall. Set EPR at 3 (full time).

Repost after a couple days and we'll see how you're doing.

[DTDude]

Hi Opal Rose!

Things appear better. In fact the first night I had EPR on my AHI was 0.0! I've also been sleeping through the entire night without waking up. That was not happening before. I feel a bit better too. Flow limit is well under .50 now. This was last night. Note that I did leave the max pressure at 20. You recommended 15, however I am seeing some nights that I was at or just above 15 for a short bit. Min is at 8 though.

   
   

I do have 2 follow up questions though. I am still seeing a lot of spikes in flow rate. My understand was that this is not desirable and should be more even. Is this correct, and if so what can I do to fix it.

I'm also seeing some spots on the flow rate chart that sure look like an apnea but the machine isn't flagging it.

   

Does higher pressure seem appropriate here?

[OpalRose]

It's fine to leave the max on 20. The reason I suggested to cap it at 15, was due to the flow limitation, which is famous for causing the pressure to rise, which could cause sleep disruptions. But I see the 95% FL was .03 on 7/3, so that really good.

The reason why you have Flow Limitations is hard to answer. I was trying to line the FL graph up with the Leak graph, but was unable to see it side by side. But you leaks are low either way. The spikes could just be from movement.

The apnea you see on your graph would have to be at least 10 seconds before it would be flagged.

[DTDude]

The spikes could just be from movement.

I've always been a very restless sleeper. I had to have sensors re-attached 3 times during my sleep study and have even managed to get sheets off the bed in my sleep. This is a very good possibility.

Either way, I'm happy with how things are going. I feel a lot better so I'll call it a success.

Thanks for your input!

[OpalRose]

Your Welcome!

Feel free to post your charts when you have questions.