Well, I thought I had AHI under control...

[LookingForACleverHandle]

Well, it turns out that control is an illusion.
After about 10 days of dialing in my machine and mask, I had a month of AHI under 5 (one exception) and mostly between one and two.
Three nights ago, everything went sideways. AHI of 21.5.  Had coffee before bed, somewhat stuffy nose.  I was expecting an increase...
Early, 2300-0300 showed AHI 1-5. After 0300, I had three peaks of AHI 59, 36, then 68. Astelin used before bed. Bathroom break 0500. Surprisingly, I felt fine.
   

Night before last - AHI of 5.23.  Numerically, a perfect night from 0000 through 0830. Between 0830 and 0930, AHI climbed to 30.
At least it was better than the night before.  Also stuffy nose, used Flonaise. Awake 0215 - 0245.  Also felt normal.
   

Last night, back up to AHI of 13.  Woke 0130 return to bed 0400.  AHI increased, again from <5 at 0630 ramping up to 40 at 0730.
   

My observations:
I noticed the pressure maxed out the last couple nights.  Pressure rarely got to 12 when the numbers looked OK.
Also, most of these runaway AHI "events" occur in the morning, just before wake.  This was also true when originally dialing in my machine and mask.
Conversely, the SPO2 ring shows that period as one of minimal motion.
Oxygenation looks OK.

Not much changed in my activity level.  
Position always is supine on low pillow; the same as when the AHI was <5. 
Things that did change 
- windows were left open, 
- top blanket slightly heavier as other was in wash.
- Mildly stuffy nose not present before three days ago.  (open window?)

The OTHER Sleep site showed an increase in central apneas.  On both, I thought that I recognized waveforms that looked a lot like Cheyenne-Stokes.

Any help would be appreciated.

[staceyburke]

You are having a lot of positional apnea.  Positional apnea can NOT be controlled by pressure changes.  You have to find out what position you are getting into and cutting off your own airway.  Have you changed your sleep position?  Sleeping on your back?  Using more (or new) pillows?  These things can cause positional apnea by chin dropping to your sternum and cutting your airway.  Think of it of a kinked hose – nothing can get through – you have to unkink the hose…

IF you can’t make a simple change like changing to a flatter pillow helps then you will need a collar.  I have a link to collars in my signature at the bottom of the page.  It shows people who are not wearing a collar and the SAME person wearing a collar.  There is a huge difference between the two.

[LookingForACleverHandle]

Thanks for your reply, Stacy.

That makes sense. I always sleep supine on a 2-level memory foam pillow - on the low side - more or less head on the edge, no neck support.  I nearly always find myself in the same position - sometimes with my head to one side or the other.  Chin tucking? I haven't noticed upon waking, but that in itself is meaningless.  Could be there and I did not notice.

That would also go a ways to explain the large leak associated with that time period.

I'm not thrilled at the aspect of a cervical pillow - I'm always SO HOT, I'm concerned that it would exacerbate that particular discomfort.

Well, a pillow shopping I will go.

[Gideon]

I would also enable your EPR as I think you will benefit from that BUT you will not notice it until you get that positional apnea under control

[LookingForACleverHandle]

I took a 30 min nap today, registered a 0.0 (zero.zero).  Very careful to roll my head back.  Supports the theory of positional apneas.

I'm a bit leery about using the EPR as I've read it could encourage additional central apneas.


FWIW, I've been on CPAP for nearly 30 years, many of them on a machine that was nothing more than a blower and hose - no APAP, no EPR, no digital display, no buttons, no nothing.  Just a hidden pot to vary the output.  I have been prescribed and used for quite a while up to 18cm, again without EPR. No rookie here, I'm battle tough.

Seriously, if setting EPR for comfort, I'm not sure it is necessary given my history with CPAP over the years.
If it is for useful therapy, I could (easily) be convinced to turn that feature on.

Again, first things first.

[LookingForACleverHandle]

Hi Folks,
I’m recovering from fluid around the lung (pleural effusion), cause undiagnosed.

As far as the sleep report, when I first go to sleep, I have nearly a perfect set of traces as far as AHI and inspiration time. Then, everything goes off the wall. OA, CA, Hypopnea numbers go up to nearly constant events. Periodic breathing becomes the norm. Inspiration time goes over 10 on the scale (seconds?). Funny thing is I feel as I have slept well.

Counterintuitively, SpO2 is mostly in the mid 90s, with occasional dips to around 87, when my ring vibrates. It is improving. Bradycardia has been diagnosed.

The trend graphs before show basically single digit AHI, with occasional jumps to mid 20s or so, also unexplained.

Since I began Lasix, the AHI and inspiration time are slowly going down.

It looks like this (Awake gap in the middle)
https://sleephq.com/public/61462684-23b7...0c929931f4

[Sleeprider]

Please post an Oscar screenshot. I will not interpret that Sleep HQ mess. Also, please use this merged theread as your therapy thread and don't start a new one every time you get a chart. We need the background to see your progress and better interpret problems. So far, your therapy sucks because you have positional apnea, and you need EPR as discussed earlier.

[LookingForACleverHandle]

Sleeprider,
My apologies for starting a new thread.  Different forums, different protocols.  

I attached "Sleep HQ mess" as you call it, rather than the static Oscar Capture because:
1. The standard capture does not include certain traces I would like to address, namely inspiration time.  I have read the forum rules enough to know there is an inferred limit to the number of screen captures.
2. I must be missing something - I cannot understand how a given trace can be expanded sufficiently from a static .png capture to separate the extreme number of events I have, and the underlying flow-rate anomalies i.e., periodic breathing.  I can attach attach additional graph captures, but then again, there is that graph attachment inferred limit.
3. I can understand the animosity between the Apneaboard and the SleepHQ, as they lifted the code for OSCAR to drive "their" analytics.  That said, "the mess" link operates nearly the same as OSCAR, in that all the graphs are there, and they are dynamic; able to drill down to individual hours, minutes, seconds.  Apneaboard and their OSCAR development, as wonderful tools as they are, simply do not have the capability to share one's data as well as the "SleepHQ mess".
4. As "the mess" is a single link without any storage overhead (other than the characters seen, not a large .png file).

It was with good intent that I included the Sleep-HQ link.  I actually thought their tool would have been superior both in terms diagnostic value and a lower server load.

Posting a new thread was a misunderstanding of the previously not stated desire of the folks that can help to have history.

Mea Maxima Culpa.

[UnicornRider]

CPAPFriend, one of our forum members, has several YT videos that are very interesting and may yield some information you could utilize to better maneuver around OSCAR and ZOOM in on features that are of interest to share.


https://www.youtube.com/watch?v=32JwMc6dphQ

https://www.youtube.com/watch?v=ujaoKvBnP00

His other videos are worthy of viewing. There are other searchable YT videos available with demonstrations on the features of OSCAR, 

I can easily import my Wellue Pulse/Oximeter reports into OSCAR
 
   

The Zoom feature has enabled me to show a  link between Flagged Events , SpO2 Drops & Pulse Changes  and Flow Rate distortions on my OSCAR Reports.

   

By opening the "Events Tab" I can open an events category such as Pulse Change (PC) then click on individual events to quickly move around to view zoomed views of those graphs.

   

Therefore I can share a detailed view of events that are the subject of interest.

I hope this helps enable you to work with OSCAR to communicate the information needed.

[Sleeprider]

The standard image of the Detailed View in Oscar can easily be changed, and you can use the Menu option "View" to Reset Charts to an Advanced View which features the respiratory charts. The main problem with the SleepHQ chart is that the events are so compressed they are illegible, and in spite of the abundant event rate, your SpO2, Pulse, Movement and Sleep Stage traces offer no enlightenment to help you, and the Daily View statistics remain a more important feature of the Oscar charts to help understand things like tidal vent, minute vent, resp rate, insp time, exp time, flow limits, settings and event distribution. The only thing your Sleep HQ chart showed that was useful was an erratic and high leak rate, and huge clusters of events confirming your problem remains positional apnea.