singingkeys

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.

I've had apneas before that last up to 85 seconds and I never drop below about 93.

I had an MRI of the brain last year. It was fine. I had a CT scan of my sinuses last year and also my ENT doc did turbinate reduction surgery and fixed my deviated septum. For most of my life, my breaths took longer to inhale (about 2-3 seconds longer than most people) and afterwards I breathe quickly, but it hasn't fixed the sleep issues. I just breathe better through my nose in general. I have a couple of fixed bridges and some previous Invisalign work (2 years) that was done before those fixed bridges could be placed. I also have a couple of front bottom center teeth that are, oddly enough, still baby teeth. They're a little wiggly because they're much smaller than the others and the adult teeth never existed. My upper lateral incisors never existed, either...hence the bridges and Invisalign work to make the gaps to do fixed bridges for a pontic in their place. So I'm a little iffy on the mouth appliance because I'm scared it will mess up my bite like so many horror stories. I avoid the boil-and-bite ones for the same reason, so I have to mouth tape with paper tape, instead. Otherwise I puff air out of the corner of my lips like I'm blowing a kazoo or something. Sometimes the pressure also activates my voice box and makes my throat make a little hum here and there or something.

Not overweight, no known health issues, fit body, not a large neck size, not a typical candidate for sleep apnea.

In-lab study in March 2018 showed 4.7 AHI and 18.1 RDI. Sleep doc was an idiot and said I didn't sleep apnea because I was 0.3 AHI away from the required 5.0 to diagnose it. Regarding the 18 RDI, he joked, "Good thing you have an active job or you'd be asleep in your chair if you had a desk job!" It wasn't funny. Yes, when I get off from work and take the bus home, I pop awake with hynogogic jerks like every minute because I'm dead tired. I also fall asleep in my computer chair at home and even in the car as a passenger. Yet my oxygen levels never drop below the lower 90's around 93 or so.

I requested my own mail-order home sleep study. 5.2AHI. Mild to moderate sleep apnea with a warning that it could be even worse than that because their study isn't as accurate as in-lab. Longest apnea was 85 seconds. Hypopneas and apneas averaged about 20-30 seconds. Pulse rate shoots up to 90+ and drops down to lower 40's.

I came across my in-lab study details today. Buried in the back of the paperwork are my arousal indexes that nobody talked to me about. I slept for 2.75 hours that night.

REM: 2 total spontaneous. Arousal index of 18.5.

NREM: 44 respiratory, 10 snore and 77 spontaneous for a total of 131. Arousal index of 49.4.

Arousals: 45 Respiratory, 11 snore, 80 spontaneous for a total of 136. Arousal index: 49.3.

Awakenings: 2 snore, 2 spontaneous for a total of 30. Arousal index: 10.9.

Ar + Aw: 45 Respiratory, 13 snore and 108 spontaneous for a total of 166 arousals and awakenings combined over 2.75 hours. Arousal index: 60.2. No leg movements. No PLMS. No PLMS arousals.

Could I have something wrong with my brain causing all of this? I can't tell if I have UARS or what's going on. I'm popping awake a lot throughout the night even with my APAP (Air Sense 10) machine with near-perfect numbers (some nights 0 AHI and usually 1 or less) and leak rates ranging from 0 to 4L/min using a nasal mask. I am a mouth breather, but I tape and it works. Full face mask wasn't comfortable at all. I use a home security camera with night vision to hook to the main security system and keep it trained on my bed. I jolt awake throughout the night as if wondering where I'm at and then I look relieved that I'm in my bed and go back to sleep. No idea what is causing it. I have been a very "jumpy" person since I was a kid and 37. Didn't get sleep study until the age of 36. High school was a big struggle. To this day, I still can't focus enough to drive a vehicle (scared I'll have a wreck - I feel that tired and unfocused even after a full night of sleep with the machine). Should I go and talk to another sleep doc or what? In-lab study and home study both said I don't have central sleep apnea. No odd limb movements noted on the in-lab study. Central apneas do show up on my sleep numbers in Oscar sometimes if I have a bad/unrestful night while using the machine. Even then, they're like 0.5 and happen only when I'm extremely tired from days before when I didn't rest well. When fully rested, I don't get them. They also seem to kick in when my machine kicks up the pressure, so I'm not convinced that I have central sleep apnea. There are no centrals when I'm rested decently from days before.

I've noticed from my APAP results in the Oscar sleep software that my hypopneas/apneas happen after usually an hour or two of sleeping and start the most when I'm in deeper sleep after 2-3 hours. Since I only slept 2.75 hours, they didn't see what may have been a bulk of them for the later half of the night in deeper sleep.

Among that time for the in-lab study, I got 44 minutes of N1 sleep, 86.5 minutes of N2 sleep, 28.5 minutes of N3 and 6.5 minutes of REM sleep.

Latency results from in-lab study:

N1: 4.1 minutes. N2: 20.1 minutes. N3: 116.6 minutes. REM: 228.6 minutes.

On my Air Sense 10, my obstructive apneas and hypopneas seem to be treated beautifully. 1 AHI or below every single night, very low leak rate typically 4L/Min to 0L/Min with my Dreamwear mask. However, I feel that I am still exhausted because it isn't treating the RERA's. Should I be adjusting pressure UP to treat those? Current minimum settings are 6.2 starting and minimum (for consistency) and max pressure set at 9.0 because my auto settings always go up to 8.9, so I simply set it for 9 as the bar to reach. If I let it go over that, I start getting central apneas, which I think may be RERA-related because no central apneas were found on my in-lab study or home sleep study. I believe the machine is misidentifying them as centrals when they may in fact be RERA's. I've only seen the machine show RERA's one or two times specifically in Oscar.

Should I up my max pressure to a higher setting? I'm starting to think that the central apneas that show up do not matter and that's UARS after my obstructives are taken care of.

I've been on CPAP for about 3-4 months now. It took over 2 months for me to actually find the right mask, discover the "sweet spot" settings that I need to keep AHI down and yet also keep centrals from showing up (I don't have it, but it shows up when pressure goes too high). My leak rate was high when I first got the machine and I know that I puff air out of my mouth, so I started taping my mouth closed at night with two pieces of overlapped paper tape. Leak rate dropped a lot. However, as of this morning, my leak rate hit an impressive 0L/Min with a 0.5 AHI. Original AHI was 5.2 with an 18 RDI. Everything looks good in Oscar. I had 4 hypopneas for the whole night and even obstructive apneas didn't show up like they used to. Unless I find a mask with over-the-head hose that is a little more comfortable with gel nasal pillows in the future, my final mask choice is the Dreamwear with gel nasal pillows. I like the way it seals because the gel pillows have the center portion that sticks into the edge of the nose and yet they also have a larger rim around the outside portion and it gets a good seal.

I still wake up pretty tired in the mornings, then after 20-30 minutes, I'm awake and feel more energetic than before I was on the machine. However, I go to work and do my job (physical job in a warehouse) and I'm fine until I get off from work and take the bus home. On a 30-minute ride on a loud, noisy bus...I'll get a bunch of hypnogogic jerks when my head falls forward and I pop awake every minute or so. I do the same thing if I am leaning back. My body has "jumped" awake ever since I was a young kid single digits in age (37 now). Pretty embarrassing. I get incredibly sleepy right after work. Then the thing is...once I get home, I'm up until bedtime.

Starting to wonder if it is my thyroid or something I'm low on. Machine numbers are good, but energy levels are not good. My "sleep attacks" only come when I'm at home in my computer chair or on the bus. I don't just randomly fall down sleeping when standing up, for instance. None of the symptoms of Narcolepsy seem to fit me other than tiredness during the day. I just don't know why I don't feel better.

I have had scalloped tongue for most of my life. The visible edges all the way around from front to back and such. You probably have a larger tongue and/or a smaller jaw frame, like me. My sleep doctor told me that scalloped tongue was a classic sign of sleep apnea, but it seems like many aren't sure nowadays. Lots of causes for it, including health issues.