WeakHeart's Sleep Journey

[WeakHeart]

Hello Everyone,

2 months ago I performed an At-Home Sleep Study indicating that I had mild OSA (7 events per hour).  The doctor prescribed me a APAP (pressure range 4-20).  I've been doing my therapy for about a month at this point.  As you can tell by my user name I've been dealing with some cardiac issues lately so please keep that in mind as you're considering my data/issues.  At the time of the sleep study, I had fluid on my lungs and I couldn't breath while lying down, so the test was completed with me sleeping in an upright position on the couch.  I'm certain that my apnea is far worse than the results of my sleep study as my pressures are pretty high and my wife has been telling for the past 20 years that i stop breathing in my sleep, all night long.  I'm fairly certain that my neglecting to get sleep tested has contributed in part to my username.  I've been fighting large leaks since the beginning, mostly due to the fact that I like to sleep on my stomach and toss and turn all night long.  I've been working on cleaning up my night time sleep habits and making small adjustments to my mask settings and it's starting to pay off.  Last night was my best large leak score, which still isn't great, but at least I think I'm receiving my therapy at this leak level.  I've also been adjusting my apap settings and feel like I'm starting to dial in to the best setup for me.  My current settings are 8-14, ERP 3, no ramp.  I'm interested in getting some opinions on the Oscar data and see if any improvements can be made.  The reason I'm looking for further improvement is that I'm still not feeling as refreshed and energetic as I think my therapy results should be providing.  I know the doctors will look at my results and usage and think that everything is great, but honestly I don't feel like I'm getting much benefit at this point.  I realize that 20 years of damage might take some time for my body to recover, so I do understand that this process won't be an overnight success.

I've attached last night's Oscar data.  Please let me know what you think about the overall results.  I'm specifically interested in my Flow Limit, which seems like it could be affecting my sleep.  I do wake up 5 or more times each night, to get comfortable.  Should my Flow Limit be better with the EPR setting at 3?  

I've also attached a close-up of what sort of looks like periodic breathing to me, which would be of concern as I was recently diagnosed with heart failure due to an ejection fraction ratio of 35-40%.  This breathing pattern is apparent all through the night at different times, and although I don't see any apnea related events in combination with the breathing pattern, I'm curious if this is something I need to be concerned with (even though my machine hasn't flagged any periodic breathing events).  Thanks in advance for your feedback, it is truly appreciated.

[WeakHeart]

Bumping this up one time, didn't recieve any feedback.  Thanks.

[Sleeprider]

It's good that you have titrated your pressure upwards from the initial 4-20 to 8-14 with EPR 3. The most prominent feature of your chart is the persistent high flow limitation. This airway resistance results in the hypopnea and RERA, both of which commonly result in arousals through the night and poor sleep quality. The best way to treat flow limitation is with bilevel pressure, and your Airsense 11 CPAP actually gives you up to 3-cm of pressure support by using EPR. Your starting pressure is 8.0/5.0 (inhale/exhale) and the pressure support, or increase in pressure as expiration ends and inspiration proceeds helps to mitigate that airway resistance, but not quite enough. The best solution would be a Resmed Aircurve 10 Vauto, and you should discuss this with your doctor, focusing on your poor sleep and showing him these persistent flow limits and flattened inspiratory peaks.

I think you might do well with a slightly higher minimum pressure of 9.0. This will start you at 9.0/6.0 and allow up to 14.0/11.0. Longer term, you will do better with bilevel, and focusing on your continuing symptoms in spite of good efficacy may move the needle towards getting that prescription.

[WeakHeart]

Thanks Sleeprider. I was thinking that bilevel might be the answer. I will increase minimum pressure to 9 and see how that goes for a few days.

Is a max of 14 high enough? I see on my graphs where I might need a little more than 14 from time to time, but my 95% pressure statistic is just below 14.

Also, did you have any thoughts on possible periodic breathing in my second graph? Thanks again.

[Sleeprider]

It's more of a comfort issue. Your pressure rises because of the flow limitations, but there is no evidence in the charts that higher pressure actually corresponds to any improvement of FL. I don't see a need for higher pressure. Be sure to as much as you can to prevent chin-tucking which may contribute to airway resistance. If you are using multiple pillows or sleeping in a position that causes your airway to not be straight, this problems can be made worse. I don't think you need a soft cervical collar, but be aware that this kind for flow limit can be caused by what we call "positional apnea" so I'm not going to rule it out. http://www.apneaboard.com/wiki/index.php...onal_Apnea

[WeakHeart]

So I've been slowly increasing my top pressure, which hasn't really made a difference in the flow limitations or a reduced AHI score, at least I'll be able to tell my Doc that more pressure isn't the answer. I've also noticed that as I increase my pressure, my positional apnea seems to get worse. I've started using a cervical collar, which I think helps a little bit, but there must be a sleeping position that Isn't great, because I still have periods of positional apnea at random times even though I'm using the collar.

I've attached last night's charts, and something that scares me, are long periods of no breathing, with lower (for me) flow limitations, and the machine isn't catching them. Why doesn't the machine flag these events?

Other thoughts, I'm wondering if I might have palatal prolapse, as I've been reading about others problems with this issue, and I seem to have a lot of the same issues, i.e. my throat closes on exhale for no reason while laying on my back, just as I'm about to fall asleep. My flow patterns also look very similar to others that have posted about this issue. I'm curious if PP could factor into some of my symptoms and the results I'm getting. Do those with PP struggle with high flow limitations, or are they separate issues?

Unfortunately, it looks like I forgot to screenshot the entire night, I'll attach those when I get home. Below are a couple examples of apneas that the machine isn't catching.

[Sleeprider]

The new charts continue to show that your sleep position is affecting the cervical alignment of your airway. I think you need a soft cervical collar. http://www.apneaboard.com/wiki/index.php...cal_Collar

[WeakHeart]

I agree, that's why I mentioned that I've been using a soft cervical collar, and the charts above reflective of the collar being worn.  Perhaps it was too tight or too loose near the end of my sleep.

I'm also concerned about why the machine isn't flagging the missed apneas in the charts I posted.  There was a 5 minute period over which I only took approximately 20 breaths, with multiple periods where I stopped breathing for 15-20 seconds, and the machine didn't doing anything about it or flag those events.  Why is this?