singingkeys

History: in-lab sleep study showed 4.7 AHI and 18 RDI over 2.75 hours of sleep. Total REM sleep during that time was about 6 minutes. Had deviated septum surgery and turbinate reduction surgery. It was a success. Breathing capacity improved, but didn't help my sleep. Home sleep study a long time after surgery recovery showed 5.2 AHI with average apneas of 20-30 seconds and one up to 85 seconds. No drop in blood oxygen levels (nothing below 93%) in in-lab study or home sleep study. I have also done my own SPO2 monitoring lots of times and I see a spiking heart rate, but oxygen levels are within reasonable levels of 93+%. Heart rate went down to the lowest point of 42bpm, which was alarming since O2 levels did not drop with it.

I'm on APAP (Air Sense 10) in CPAP mode right now. Starting pressure at 7, EPR set at 3 to Ramp Only, bumping up to 8cm max pressure after 5 minutes. Numbers are great. Typically around 0.5AHI and RDI using a nasal pillow mask with mouth taping. I average about 2 hypopneas and 1 apnea per NIGHT. I don't think it is OSA. It must be something on top of it.

Still feeling terrible. I'm about to begin my second journey to see what else could be wrong, starting with a full panel of blood work. I get heart flutters or palpitations on a daily basis. My resting heart rate is higher than normal and sometimes I feel like my heart is beating harder than usual when I do something that shouldn't really raise my pulse rate or make me that tired (e.g. carrying a moderately heavy object at work that doesn't weigh that much). Resting heart rate seems up sometimes for no reason and other times it is about 80bpm, but still feels like it is beating heavy as if I'm totally exhausted; and I am totally exhausted. Not overweight, very muscular and fit. 37 year old male. Had this issue since pre-teen years and seem to be no closer to figuring out what it is.

Scared to drive due to not feeling alert. I take a bus home that takes about 30+ minutes to get back to the station. I fall asleep after like 10 minutes of setting down in the afternoon around 3pm to 4pm. My job is active and keeps me standing and moving around all day, but if I sit down anywhere, I instantly get so sleepy that I could just go to sleep within minutes. I fall asleep sometimes within minutes of sitting down in my computer chair at home. As a passenger in a car, I could drop off to sleep within minutes of getting in. The little bumps on the road and feeling of the motion of the car moving are so relaxing to me. Hyper-sensitive reflexes. If anything brushes against my head, it makes my lower back muscles arch to abnormally jerk me away. Been to a neurologist and they have no idea why. Blood work in the past has revealed nothing with thyroid checked twice. A scary blood draw situation one time where I fainted for 15 minutes and blood pressure shot down to 60/60 and 52bpm pulse. They never figured out why. Obviously, they do an EKG when you're having the in-lab study and nothing was noted on that, so I don't think I have heart issues. There have been times lately where I have been scared that I do, though...simply because I feel so weird sometimes with the way it beats.

Anyone else have anything on top of sleep apnea? Suspected Narolepsy, but I'm not sure that I would actually fall asleep in a Multiple Sleep Latency Test setting and I may not even have it.

Mine looks blocky until I restart the program after changing it, then it seems to work right. The RDI is the exact same as the AHI. Is that generally right?

Under File---> Preferences ----> CPAP tab, there is an option to select "preferred major event index" and one of them is AHI and the other is RDI. I purged all previous data (started a new week with new settings yesterday and didn't need the old ones) and I switched that option to RDI before importing last night's study.

I don't see anything RDI-related in there, just the plain AHI as usual. Where can I find it?

Yes, both at 8cm.

Alright, so I did start pressure of 8 (didn't want to try the 7 yet) and EPR of 3cm on Ramp only.

2 hypopnea events and one obstructive for the whole night. I also had the craziest dream(s) this morning, which I think may be because of getting more REM-related sleep than normal. Some of them seemed like they lasted forever. Zero centrals showed up, so it probably is that EPR messing it up.

I saw a bit of odd looking, choppy-like breathing that I'll take a quick screenshot of later and post just because it looks so strange. Otherwise, I feel pretty good. I also went from medium to small on my Dreamwear nasal gel pillows. The Medium was more like a larger and the small is much more comfortable and doesn't cause painful sores on the bottom sides of my nose, so that is also helping. Just got that yesterday, as well.

So last night I tried 8CM pressure. Just to see, I didn't reduce the EPR and left it at 3. I would have expected my centrals to lessen. I had 4 obstructive, 3 hypopneas and 3 CA's. Less than the 3 CA events and 6 obstructives the night before. Should I try for 7cm pressure and probably take the EPR down to 2 or 1 or maybe even off completely? That makes me even more curious because I've lessened the pressure and had less obstructives last night. Normally, of of course...lessening the pressure would cause obstructions to increase because it isn't sufficient enough to keep the airway open. The only thing I can think of is that on exhale it might be messing with the soft palate in the back of my throat causing it to umbrella out on exhale.

Curiously, last night I tested the CPAP with the ramp still off, pressure at 9cm fixed and I lowered the EPR from 3 to 1. Breathing seemed more labored (I expected that and that probably would take a little while for the lungs to get used to pushing out air against more pressure) since it wasn't lowering as much upon exhale. However, I also wanted to see what it would do for how I felt the next day. I did feel more energetic today, but I also got a full 8 hours last night with the mask on, which is rare in itself and I'm still working on that. That's probably why. However, lots of events last night. 3 CA events and 6 obstructives. It felt like the EPR being set down was actually pushing the soft palate in my throat somehow and causing me to have more blockages, so that's kind of odd. Since I was a kid, I have always had this thing where I can blow air out of my nose and if I do it hard enough, it is like my soft palate blows up and causes a blockage of the air trying to escape from the throat to the sinuses. So that may just be something odd with my soft palate being a little larger or extended somehow. It puzzles me now why setting my EPR down lower actually causes more CA, obstructives and hypopneas.

I think the higher pressure must be causing CA events simply because more air is blowing to the point where the exhaled air with CO2 doesn't have as much of a chance to escape before being bumped out of the way with new air to inhale; so more CO2 is breathe in again than normal, potentially causing central apneas. At least, I speculate. Could be wrong.

I don't know why, but I actually have gotten so used to the pressure now that I feel good simply starting at full pressure and staying at it without using autoramp at all. My last "best" results so far on no ramp CPAP mode were at 9cm with EPR of 3. I had 1 obstructive, 2 centrals and one hypopnea for the whole night.

Every central event that I looked at, the breathing got slower and the chart measurement got lower until it virtually flatlined and then I started back breathing normally again and it went back up. In spite of the in-lab study (2.75 hours) and home sleep study (6 hours) saying that I didn't have central apnea, sometimes I think I might have just a touch of it on top of OSA. What I'm seeing on my nightly charts looks like legitimate CAs even down to the seconds where it just drops off and I stop breathing and start again. Yet there's only about 3 or 4 of them even on a bad night. I could lower the pressure from 9cm, but that's what is required to get my AHI down as long as it was between 0.5 and 1 on a typically decent night. Adjusting the pressure down to 8 would likely cause more OA events and maybe even centrals, so it is all a bit confusing and almost seems backwards in my case.

I'm attaching a quick grab of one of the CA events from last night. Definitely looks like a real central event to me. Also, before the one that was marked by the machine...I see one that wasn't marked by the machine and wasn't quite as pronounced, so it didn't label it CA.

Climate Control shows as Auto on the machine. I've always kept it in Auto. Not sure why Oscar is making it show as Manual. I do have the ClimateLine hose and I keep it at 80F and preheat about 15 minutes before bed so that it is ready.

I used to like having the ramp feature on to start at say 6 or 7 and then ramp up to whatever was needed, but I felt like each ramp was waking me up and decided to try CPAP. I had camera footage of myself jolting awake in the middle of the night looking around to see where I was at. I feel like a constant pressure throughout the night helps me to sleep better and get less events than ramping up and down, for some reason. So now that I have the auto ramp off and it starts at and stays at the same pressure all night in CPAP mode, I have gotten quite used to this rather quickly. So instead, I start at 9cm and stay at it all night.

Should I simply play with the EPR and adjust it down to try to get used to it in CPAP mode? In the past even with Auto Ramp on, I switched EPR from 3 to 2 and I felt like I was suffocating.

I know that for normal nights when I'm well-rested, my required pressure with the ramp is 9. If I'm super tired, I'll have a bad night and it will ramp to 10 or 11 and cause centrals and a lot of events. 9 seemed to be the max number that I knew would clear my obstructives, but there was doubt on my behalf as to whether or not it was enough to prevent RERAs. Those central apneas look like I'm stopping breathing for 15-20 seconds on average. They were also rapid-fire in a row at only a certain time of sleep halfway through the morning. I wonder if I have a touch of central apnea that shows up during a certain stage of sleep? Neither sleep study detected it, however. I have also had a lot of nights where AHI was 0.5 or so and there were absolutely no centrals or hypopneas anywhere. Just like one apnea for the whole night.

My biggest concern was that my breathing seems to look quite shallow sometimes.

I think I'm going to have my thyroid re-checked again and get some blood work. My understanding is that it can cause breathing-related problems if it is not functioning properly. From last night, I see 4 central apneas within a 15-minute span. That started a few hours after I was asleep and just that cluster of 4 of them and then no more showed up. AHI of 0.66 on CPAP mode with 9 constant pressure and 6 EPAP. That seems to be my sweet spot for the numbers, I just still feel really horrible and I'm thinking there's something else going on. Could be just the pressure, though 9 isn't really that high of a pressure. I mouth tape and leak rate was 4L/Min. Obstructives are certainly under control. Unsure if there are non-visible RERAs still going on at this time. I do feel more energetic than usual, but still get hit with sleepy spells around 3pm to 5pm. Those look like genuine centrals where the breathing gets low very quickly and just stops for about 15 seconds before starting again.

Previously, I've been trying a typical combination of 7 minimum with a max of 9. While the ramp sometimes would go up to 10 if I set it to 10 or 11, I would also get more centrals when it did that. Keeping it lower seems to keep those centrals in check. 8.9 is known to be my sweet spot that the auto ramp always stops at when I'm decently rested.

I have been getting low AHI, typically below 1 and very low to near-zero leak rates. I mouth tape. I'm not sure if it is just because I'm averaging 6 or so hours a night that I feel so terrible in the morning or if it is my RERAs (UARS) causing it after the sleep apnea is under control.

What do you think of my chart for last night? It was almost 6.5 hours. I need to get that to 8. Working a lot lately and my body doesn't want to turn off early enough to go to bed at the time that I need to.

I switched it over to CPAP mode. I'm not too familiar with that mode. I still see "ramp" options available, but I have set it at 9 all night. I felt pretty decent tonight, so going to give that maybe 2-3 weeks to see how I do. Particularly on the weekend when I sleep more.

Does my breathing look okay or too shallow or anything? I switched to CPAP because I feel like the ramping up and down throughout the night might actually be waking me up from the pressure changes and I also feel like the CPAP being constant would hold my airway open all night long to help avoid the RERA's to begin with, since I understand them to be between a snore and an actual apnea. Is this a good idea?

I was originally 5.2 AHI and 18 RDI. UARS suspected.