[Treatment] What Do My Graphs Mean? | OSCAR

[Expat31]

Hi, just seen your post. It's l late here and will try to look at tomorrow. 
Just one easy thing that may help hopefully straight away - set EPR at 3.

11pm CET.

[TiredTim]

Hopefully this is helpful, but this is my result from last night... Relatively typical, super choppy flow rate/limitations basically all night. My AHI will sometimes get up to 1.5, but typically is below 1, all the way down to zero.

[Expat31]

Hi, 

Thanks for your latest graphs and your sleep test. 

I don't think my last idea was very helpful. The direct result of this was more aggressive spiking of flow limitations and the resulting increases in pressure.

Net effect more aggressive arousals for you.

Machine change
Maybe it does come down to another machine. I only have an Airsense 10, so have no real knowledge of the machines' attributes.
There are many users in the forum who are very knowledgeable in this area. All I know that the main alternatives are as follows (copied from wiki) :-

Aircurve 10 VAuto. (BiPAP) Bi-Level machines.
AirCurve 10 S - Fixed bilevel therapy device (10 S is static only).
AirCurve 10 V - Auto-adjusting bilevel therapy device
AirCurve 10 CS PaceWave -Adaptive servo-ventilator ASV device used to treat CAs.

Sleep report

This is the first time we have seen this. It shows an AHI of 6.2., classified as mild. 
I was curious of the breakdown of AHI by position, with all shown as supine. Is that because there was no chest strap sensor, or you really were sleeping on your back? 
Very often the supine position can cause problems, see my favourite video here. 

I know you mentioned being curious if UARS is possible in your case. If you go this route best be prepared to have as much knowledge first, ready for a doctors appointment. A couple of videos that may help. 

https://youtu.be/sa9zNYpTWlM?si=r3LWqhh-lgnVXfFe
https://youtu.be/HCiPtQhN9uk?si=ns9Z8OUDjJXXJf9G

So that's all I can think of at the moment.. 


Regards.

[TiredTim]

I generally sleep on my back but have been trying to switch to my side lately... Despite my best efforts I keep waking up on my back anyways, so its been difficult. May need to invest in some kind of pillow to help?

I did have a strap during my test so I think that info is accurate. My low AHI another reason I suspect UARS - because my symptoms are severe, even during weeks when my AHI is constantly below 0.5.

My flow limitations were the lowest when I briefly switched to nasal pillows, but had to switch back to my full face because I started to spend 3+ hours a night with my mouth wide open. Hopefully have a chin strap coming today, that plus my new Releaf SSC will hopefully let me test the nasal pillows again...

Thanks for the vids and advice!

[TiredTim]

Ok, throwing out the new theory I have after doing some more reading, let me know if it makes sense: the pressure increase/decrease is causing my flow limitations to spike up throughout the night. I think this because any night where I am stuck at 9.2 for a long period of sleep I will have zero flow limitations or apnea/hypopnea/etc. Then a snore or isolated apnea/hypopnea will send the pressure up and slowly down, and be followed by a long period of flow limitations.

So if I set 9.2 for min/max pressure, and EPR 3, hopefully it will decrease flow limitations? Maybe I will have to increase the base pressure later on if that causes for apneas.

Does this make sense, or am I reading the data wrong here?

[Expat31]

Well usually the flow limitations drive the pressure increases, but it is true that if you effectively go on a fixed pressure, the sleep disturbance of the swings in pressure are normally no more.

This could be a valid argument and well worth testing. 

I am not sure about EPR at 3, maybe at 2, but you will never know without trying.

I am suspicious about back sleeping, as in the deep sleep phase, when there is a semi paralysis of the muscles (loss of muscle tone), the tongue and soft patate, under the force of gravity, can fall back against the phalanx wall, blocking the airways. 
This can be evidenced by clusters of events in the graphs. You obviously (luckily) do not have this issue. 

But say you are moving around a lot, and only allowing the airways to partially close for less than 10 seconds, this could cause an arousal and be enough to  degrade your sleep. It would not be detected by the machine, hence not shown on graphs. 
 
Probably a bit of a stretch,  but can't discount anything. Diagram attached.

[TiredTim]

Fixed pressure was a failure.

I've switched back to 9.2-15 at EPR 2 because that has been the only setting I've found that gives a little relief. Switched back to nasal pillows which makes a bigger positive difference (even at the same pressure with the FFM). I can't keep the nasal pillows on though! Every night I take it off for some reason, but have no memory of it. But getting 3 hours with the nasal pillows makes me feel better than 8 hours with the FFM. Does that suggest anything?

Its weird, because the AHI data is better with FFM, but I feel worse. Nasal pillows my AHI will be slightly higher, but I feel better. I got a cheap chin strap I'll try out tonight alongside my Releaf collar.

[Expat31]

A shot in the dark-- try min pressure 11, max pressure 14, EPR 3.

[TiredTim]

I actually tried something similar last week, its what made me frustrated enough to come back lol. Three days at these settings (but forgot to plug my SD Card in so only have one day of data). Objectively: AHI was about the same as usual, flow limitations higher. Subjectively I felt much worse after those nights, so went back to 9.2-15 EPR 2, and now I'm back on nasal pillows.
   

My doctor doesn't want to give me an in-lab sleep study because my "treatment has been successful" as far as she's concerned. Very frustrating. I went to my doctor in 2020 and told her I thought I could possibly have something like sleep apnea, but she said I didn't have the body type of the typical apnea patient. So spent the years between having every other organ in my body tested for things that could cause my symptoms. Finally got the at home sleep study, now this idiot neurologist doesn't want to give me a real test.

[Expat31]

I don't have sufficient knowledge to go further here, except from what I have read on this forum, perhaps moving up to a bi-level machine might be a solution, something thing like an Aircurve 10 VAuto  (Bi-Level) 

From what I have seen in this forum, when push comes to shove, members have sourced their own bi-level machines to circumvent these administrative hurdles. 

As I am out of my comfort zone here, suggest you research in the forum on all things bi-pap, and maybe get the info. you need. 

Regards