String of open airway events

[vinegarben]

I  am in my early 70s and have been using a Resmed 10 machine for the past 3 months for obstructive sleep apnea with an AHI in the 20s.
I have had  short strings of clustered open airway events since I have been using the device.
My sleep doctor has me use a fixed pressure of 7.
I tape my lips regularly  at his suggestion and tried a soft collar for the first time last night. On the night I used the collar I had long strings of OA events.
I do not know if all the OA events occurred while I was asleep as I take deep regular inhaltions and exhalations (sometimes termed Farinelli breathing in the world of choir singers) to help transtion into sleep.
Anyway, any thoughts about this pattern before I call my sleep doctor? Anything I should do to give him more information?
Thank you for your help!

[OpalRose]

Hi vinegarben,

Welcome to ApneaBoard!

A couple questions....  Did you have a sleep study done?  If yes, did it show just Obstructive?  Were there any Central Apnea?  If you have a copy, can you post it here?

Also, the CSR sometimes represents heart problems.  Do you have a history of any heart issues?   If this is something that you see regularly on your graphs, you should discuss this with a cardiologist.  

With that said, it's probably nothing to worry about, as ResMed labels Periodic Breathing as CSR, so what we see on that graph could just be some periodic breathing, as it is a short period of time.

Your 95% flow limitation reading is a little higher than we like to see.  We usually use EPR to help offset that, but with the large number of CA's, I would hesitate to change that.  

Let us know if the CSR/CA's are just an occasional thing on your graphs or is this the norm, and you see this regularly.

[vinegarben]

Thank you for your reply.
I have attached my sleep study report.
The open airway events have occurred regularly in clusters, but for never as long as in the section I posted.
Interesting, when I did not tape my lips, I had frequent unclassified apneas.
I was recently evaluated by a cardiologist, and do not have any recognizable cardiac disease.
I have also attached the Oscar report from last night, when I slept on my side and wore the neck brace. Quite a difference.

[OpalRose]

Interesting, when I did not tape my lips, I had frequent unclassified apneas.

The reason is that with no tape on your lips, you were probably mouth breathing and causing a high leak rate.  When that happens, your machine can't compensate for the leaks and flags apneas as unclassified.  

This chart is much better than the prior.  I'm also glad that you have no heart disease, which means that the CSR flags are just periodic breathing.  This can happen for different reasons.  

One thing I see is that your 95% flow limitation is at .10.  Ideally, it should be below that, preferably around .03.

Using EPR may bring the FL and Hypopneas down, but can also increase Obstructives and CA's, which we don't want. But if you'd like to try, set the EPR to 2.  We can always change it back if an issue.

[Gideon]

Please always show us a full night, your first showed periodic preaching for the full time, 50+ some minutes. seeing a full night would provide better context at the least. By all means zoom in on areas you wish to highlight in addition to that.

Your current chart shows EPR=3 in the Ramp only, why? That hides the results in that events are not shown during the ramp and turns off EPR for most of your night. IMHO if EPR is bad for you after the ramp, it must also be bad for you during the ramp.

Here we mostly view EPR as a therapeutical aid, treating hypopneas, RERAS, and flow limits with a comfort factor thrown in. We prefer to at least try EPR then if it produces bad results to react to them. Based on your sleep study we will very carefully watch for that

[vinegarben]

I have attached the Oscar report from last night. (I only used  CPAP sporadically during the night of my original post).
I will turn on the EPR and set it to a level of 2 tonight, as suggested by OpalRose, and report back tomorrow, if all goes well!
Thank you for your help.

[OpalRose]

Can you tell us what position you sleep, on your back or side?  Do you use more than one pillow?  I'm not sure, but you may have some positional apnea, (chin tucking).

Try to sleep on your side, using one thinner supportive pillow.  

The CA's are all over the place, but go ahead and try the EPR and we'll see what happens.  

Include these graphs: Events, Flow Rate, Pressure, Flow Limitations and Leak Rate.

Taking a screenshot:

Set your display to the Standard view.  
(View > Reset Graphs > Standard)
Take a screenshot of your Daily screen.
* For Windows or Linux: Use the F12 key
* For a Mac: Use Fn+F12

[vinegarben]

I was mostly sleeping on my back. For the past few days, I have been trying to sleep on my side.
I have attached Oscar reports from last night, when I turned the EPR on and used a level of 2, as well a summary of previous sleep parameters for the past few months. I also included a "blow-up" of a time when there was a short cluster of events.
Thank you for your help.

[vinegarben]

I have attached my report from last night, July 2, and there are many more clustered open airway events on this night than on the previous night with the same settings. Some are grouped at the beginning of a sleep cycle.
Are these signs of some pathology that needs correction? Any other suggested measurements or settings changes?
Thanks!

[OpalRose]

That's a lot of CA's.

I see a couple breaks in your sleep. It's always helpful if you tell us how well you felt you slept.

Maybe Gideon will be back around to advise, but until then, maybe back off EPR to 1.