Something changed and numbers suck - ideas?

[Beej]

There have been some changes in meds over the past year and my numbers basically suck. I did see the advanced practice nurse and they want to get 2 nights with an oximeter to see if that explains anything.

I sleep on my back as anything else is uncomfortable. 
Plus, I'm recovering from surgery for a broken, dislocated shoulder with massive rotator cuff repair.

Here is the most recent day I uploaded. I'd appreciate your thoughts.

[attachment=8833]

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[jaswilliams]

You need to provide the settings screen down the left as this gives us valuable information. Is your machine st to a max pressure of 9 ? It looks like you machine wanted to go higher but could not. You may be need to increase your max pressure

[Walla Walla]

I would guess the cluster of OA's was positional.

[yankees123]

Besides positional changes is there anything else that can cause clusters of events showing up on sleepyhead graphs?

[Beej]

Updated 1st post in thread.

I sleep on my back and don't move.
There was a very slight increase in overall AHI when my thyroid dose was reduced.
Armodafanil (Nuvigil) was added ths summer.
Lamotrigine was increased a year ago.
Parathyroid hormone levels have been fluctuating and these affect weight inversely. That has gone up and down a little over the year.

[Melman]

Your machine is almost immediately going to max pressure of 8.8 and staying there. It appears you need a higher max pressure. I would also consider raising the min pressure to at least 7.

[Gideon]

Besides positional changes is there anything else that can cause clusters of events showing up on sleepyhead graphs?

I find a swift jab with the elbow by the wife does it ;-)
Seriously It may be related to your positional discomfort when not on your back. it may not be but I believe that a partial roll could cause it.  Based on your statement the discomfort you describe from your surgeries could cause stress and the rise in your Flow Limits.

Your Flow Limits are quite high and should be reduced if possible.  If you raised pressure settings I suspect your pressure would rise to the max pressure.  That said I would raise your pressure by 1 cmw and also increase EPR from 2 to 3.  This is to help with the flow limits.  

And do work on the positional apnea.  

A 2-minute close up could help show some light on your breathing pattern and flow limits.

[Sleeprider]

I agree with suggestions to increase maximum pressure to 12 and minimum to 8.0, and consider soft cervical collar for positional issues. Your current pressure is low for most, and clearly too low for you. With the pressure increase I recommend EPR 3 for the flow limits and comfort. I think oximetry is a good idea, but will not resolve the obvious OA and flow limits.

[Beej]

Here is a shorter section of the night.

[attachment=8841]

[Sleeprider]

Pure OA. Higher pressure and or positional therapy with a soft cervical collar.