Thoughts on my Auto Data?

[robysue]

Hydrangea,

The data you've posted looks EXCELLENT. As in your CPAP therapy is about as close to optimal as you are going to get it, regardless of how much "tweaking" and "tinkering" you do from here on out.

In other words, at this point, you need to focus on what makes you most comfortable when you are in bed and what gives you the best sleep you can get in terms of factors that are NOT related to your OSA/CPAP therapy.

I double checked. A-Flex is ON. And I recently moved it down to 1 (from 2).  I guess I didn't feel 2 was doing a good job of getting rid of the Hs.

Your current settings have all but wiped out the Hs, along with everything else. It is unrealistic to expect an AHI = 0.0 every night. Your data shows that your AHI is consistently below 1.5, and often below 1.0.  What do you think reducing your already extremely low AHI is going to do in terms of how you feel during the daytime?

You also write:

I recently put my min pressure down from 7 to 6, to see if it might help decrease my daytime ear pain.  (Time will tell.)  I also decreased my exhale support...

Two comments:

1) Tweaking to reduce the daytime ear pain is worth it. Has reducing your min pressure to 6 done anything in terms of the ear pain?

2) Decreasing the exhalation relief setting may be increasing the ear pain. My advice is to set the Flex at whatever setting makes you most comfortable, both when you are trying to get to sleep and during the daytime.  If I were facing this problem, I would see if increasing the exhalation relief helps with reducing the daytime ear pain.

I also decreased my exhale support because I'm a tinkerer, and to see if it may help reduce the Hypopneas (I felt like I was getting too many).  (I don't know if I gleaned that somewhere, or made it up.)

There are people who claim that when exhalation relief is set too high that it creates problems. Some claim it causes CAs. Others blame exhalation relief for excessive numbers of residual Hs.

But your AHI is so low that it is unlikely that increasing Flex from 1 to 2 or 3 will increase your AHI significantly.

Seriously: How many Hs are you seeing in your data? And why do you feel like you are "getting too many Hs"?

Here's last night's screenshot.  I bought a buckwheat pillow from Amazon, and WOW my body didn't move all night!  I was on my back for quite a while.  Then I moved to my side - either when the events started, or maybe that caused the start of events?? 

Your events are well separated in time, you have no clusters of events, and you averaged less than 1 event per hour.

Even a person with totally NORMAL sleep has a few isolated apneas and hypopneas now and then.

In other words, you're making a very large mountain out of a very small molehill when you start trying to figure out "what caused the start of the events" on a night where your AHI is 0.83.

And then throughout the more wakeful AM hours (thanks to dogs, kids, husband, etc.) I tossed and turned, alternating back and side sleeping. 

You can't blame restless sleep caused by dogs, kids, the husband, etc on inadequately treated OSA. If the tossing and turning during those "more wakeful AM hours" is causing you to feel less than rested when you do get out of bed, then the fix is dealing with finding a way to minimize the external sensory stimuli (dogs, kids, husband).  All the tweaking in the world of your PAP won't stop the dogs, kid, and husband from disrupting your sleep in the early AM.

But when I slept, between my faux tempurpedic mattress and this awesome pillow, I did not move!

Comfort is the important thing now. Sounds like the mattress and the pillow combo is working exceptionally well.

But I will add: Not moving at all during the night can lead to its own set of problems: Lots of times an arm, shoulder, leg, hip, or back will develop mysterious "aches" if you stay in the exact same position all night long when you sleep.  Some movement while sleeping is normal.

[robysue]

The popping is related to swallowing.

I don't have any diagnosed TMJ problem(s), but I think that's because my jaw doesn't click when I move it.  

I grew up with lots of ear infections, into early adulthood... until I eliminated dairy from my diet.  So I imagine my ear drums and other ear things could be weakened from that(?).

I grew up with lots of ear infections and still get the occasional one, even though I'm in my late 50s.

It's not that dairy somehow weakened your ear drums.  My guess is that you've just got small eustachian tubes, and maybe a small ear canal, both of which make it much easier for the ear to get stopped up, and hence infected.

But dairy may have increased the swelling in your small eustachian tubes if you had allergic reactions as part of lactose intolerance. And eliminating dairy would then reduce the swelling, which would lead to fewer (or no) ear infections.

[Hydrangea]

The data you've posted looks EXCELLENT. As in your CPAP therapy is about as close to optimal as you are going to get it, regardless of how much "tweaking" and "tinkering" you do from here on out.

In other words, at this point, you need to focus on what makes you most comfortable when you are in bed and what gives you the best sleep you can get in terms of factors that are NOT related to your OSA/CPAP therapy.

Ok.  I hear ya.  

Your current settings have all but wiped out the Hs, along with everything else. It is unrealistic to expect an AHI = 0.0 every night. Your data shows that your AHI is consistently below 1.5, and often below 1.0.  What do you think reducing your already extremely low AHI is going to do in terms of how you feel during the daytime?

My goals, over the last couple months, have been to 1) get rid of the ear pain, and 2) get rid of my awareness of choking in my sleep (either when I'm falling asleep and it jerks me awake, or while I'm sleeping and it causes me to awaken).

1) Tweaking to reduce the daytime ear pain is worth it. Has reducing your min pressure to 6 done anything in terms of the ear pain?

Reducing the pressure didn't help my daytime ear pain at all.  So I raised it back up to closer to my 95%.

2) Decreasing the exhalation relief setting may be increasing the ear pain. My advice is to set the Flex at whatever setting makes you most comfortable, both when you are trying to get to sleep and during the daytime.  If I were facing this problem, I would see if increasing the exhalation relief helps with reducing the daytime ear pain.

Decreasing my exhalation relief to 1 has now completely eliminated my daytime ear pain and popping.  I'm THRILLED about this!  HUGE game-changer for me!  My DH was trying to convince me to give up CPAP due to it causing the ear pain; and honestly I was tempted, because the ear pain was constant and very painful.  So I'm absolutely relieved that decreasing the exhalation relief did the job!

Seriously: How many Hs are you seeing in your data? And why do you feel like you are "getting too many Hs"?

My post where I said that was several months ago, when I was still trying to understand the data.  But I've given up on that.  I'd love to understand what Sleepyhead is showing me, but honestly I'm not looking at my data anymore since I don't understand it.  I only shared my info here again because I had hoped it might give insight into what I was experiencing with this choking awake.  I don't sleep near an alarm clock (I'm too blind to see it at night anyway), so I have no clue at what times I choked awake, so I don't know where to even look in the data to try to see what it looks like as a data point.


I really am not worried about AHI.  My dr doesn't care at all about my AHI (never did even before I got the CPAP); and you guys don't care at all since it's so low.  So I'm not worried about my AHI.  It's my quality of sleep that I'm caring about.  I don't like to choke awake.  And I feel like "Isn't that the CPAP's job??  To make it so I don't choke awake anymore?"  That was the entire reason I went for a sleep study in the first place.  So yeah, I'm not choking awake as much as I used to; but if twice in one night, I specifically am choking awake and it's bothering me and interrupting my sleep, then I feel like SURELY there's GOT to be something I can do it help make that go away.  Isn't that the whole point of the machine?

So... I'm just going to slowly up my pressure until it goes away, since I don't know what else to do... and I really want to not choke awake anymore.

[quiescence at last]

ok, do you have an oximeter that you can use to record your oxygen and pulse rate during the night? if you do, then you should see evidence of the choking awakening by reviewing the pulse rate - it should increase noticibly when you are fighting to recover from choking. that will let you home in on the areas of your detailed breathing to see what is happening immediately prior to the event. your machine should be registering a RERA at that point unless it is so subtle it is not detected. you may find that the choking does not have to do with collapse of airway, but related to secretions like phlegm and/or throat allowing you to breath in fluids or food (food would be a surprise unless you eat lying down just before nodding off, or you are sleep walking).

I hope you get the answers soon!

QAL

[Hydrangea]

I've been experimenting over the last couple of months, to try to eliminate the ear popping during the day.  Decreasing the exhale pressure relief (ie: keeping the exhale pressure closer to the inhale pressure) helped tremendously... but not all the way. 

I've had the opportunity to try the ResMed Airsense 10 Autoset.  In experimenting with the exhale relief settings on the ResMed, I experience MUCH more significant relief of the daytime ear popping.  BUT I'm yawning during the day, and I'm needing 10 hours of sleep (2-4 more hours than with my DreamStation).  

I switched back to DreamStation for a while, to see if I could experiment with the exhale relief settings to get the same comfort as I can achieve with the ResMed... but no luck.  So I'd like to stick with the ResMed.  But I'm hoping you can help me optimize the treatment on the ResMed so I can get rid of the daytime sleepiness and need for extra sleep.  I'm hoping you can look past the good AHI and help me make the finer tweaks to make it so I'm not as sleepy during the daytime.

Here is a screenshot of a night with the DreamStation:


And here is a screenshot of a night with the ResMed:

[Sleeprider]

Hydrangea, you need slightly higher minimum pressure on the Resmed to account for the greater exhale relief. I'll suggest 8.4 cm which will keep minimum EPAP at the same level as with the Philips. This should avoid a few OA. You have more continuous therapy time with the Resmed with fewer breaks,and I really can't explain the need for more sleep, unless you are just more comfortable.

[Gary1of2]

May i make a suggestion for ear pain ? Dab a cotton ball in vicks vapor rub and put it in you era it wilk helo with oain.