After knee surgery, recommended to sleep on back AHI high

[ozij]

I agree with going to APAP for a while.

However, you also write:

As well as the discomfort of knee surgery I keep waking up constantly. Need sleep desperately. My pressure is 11, machine was new September 2022, headgear replaced about a week ago.

Our AHI can shoot up because the machine can't properly analyze our wake breathing.
You are:

1. Not sleeping in your usual sleep position
2. Suffering from the discomfort of surgery
3. Waking up frequently

We have no idea if your frequent waking is caused by 1 and / or 2, or if lying on your back is causing breathing disruptions that wake you up.
OSCAR charts will make that easier to tease out.

[kteague]

Waking a lot with pain can really make the data look bad. Some people are good enough with looking at the data to say if the events were around wakings, but I'm not one. The pain from the surgery should soon diminish enough that you find yourself sleeping in longer chunks of time and getting better numbers. I'm now almost 6 months out and the miserable nights are a vague memory. That's a big deal for me because sleep had been horrible for years before surgery because of knee pain. My doc was quick to tell me to sleep however I felt most comfortable. While I appreciated that, I'm thinking it contributed to my delay in getting my knee entended and flat to their expectations. Good luck with everything.

[LindaGinCanada]

Without seeing details, and if it were my therapy, my stab in the dark would be maybe to put it in APAP mode and to set the minimum pressure to 9 or so, depending on comfort, and the maximum to 20. Then I would see how that went to tweak from there.

But if you are able to post some nights of OSCAR following the instructions on what the experienced eyes like to see, I am sure you will get better observations and suggestions than that.

You'd probably want to stick to this thread to do that, and once properly-formatted OSCAR info is linked to, then adjust the thread title to mention OSCAR to make sure it doesn't get overlooked by the talented ones.

I think you are gonna be fine, Linda. Glad you are putting the work in to get there with your sleep. I hope you feel the joy in that!

-Jeff

Thanks Jeff, I have downloaded Oscar, and in the process of checking which files need to be uploaded. I did switch back to APAP, pressure was roughly the same, was able to sleep in chunks of almost 2 hours, AHI still high but certainly not as high as a week ago. I really think that is because I'm sleeping on my back and it just leaks more that way. Next is so master sleeping on my side to bring the leaks and AHI down even more. I really appreciate the help I've been getting, glad to have found this group.

[LindaGinCanada]

Still figuring out what screenshots to post from Oscar. Will keep working at it.

I think the high AHI numbers are because I'm not sleeping in my usual position. Pain from surgery has diminished, what I get most now is discomfort from being in the same position on my back and the need to move my leg a bit.

[lazarus]

Setting the minimum to 9 or above may (or may not, but it's worth a try to) help that AHI.

Personally, I don't use ramp, since I am more comfortable without it and since the consistency in pressure allows me to keep irritating leak lower, myself. Others need ramp for comfort reasons.

Most of us choose to use an image hosting service like imgur and then post the links to images hosted elsewhere, because of the limitations of this board and in order for the images to be if higher quality.

Hopefully more experienced ones than me, such as ozij and others, will chime in with their more educated thoughts and observations.

Glad you found cpaptalk. May you continue to make progress!

[LindaGinCanada]

Setting the minimum to 9 or above may (or may not, but it's worth a try to) help that AHI.

Personally, I don't use ramp, since I am more comfortable without it and since the consistency in pressure allows me to keep irritating leak lower, myself. Others need ramp for comfort reasons.

Most of us choose to use an image hosting service like imgur and then post the links to images hosted elsewhere, because of the limitations of this board and in order for the images to be if higher quality.

Hopefully more experienced ones than me, such as ozij and others, will chime in with their more educated thoughts and observations.

Glad you found cpaptalk. May you continue to make progress!

I don't use ramp either, had it turned off for ages. I use my personal website hosting to link to my images as I saw that image hosting is full at this site. Thanks for your input.

[lazarus]

I may be misreading your chart, but it seems to say at the lower left that you are using ramp for 10 minutes. No biggie, tho.

With an EPR of 3, which basically lowers EPAP (breathe-out pressure, which is key to apnea-prevention) by 3 cm, you may need to set overall minimum pressure higher than 9.

You may also (or as an alternative) want to consider setting AutoSet Response to "Standard" instead of "Soft," if comfort isn't a big issue for you, just to see if that keeps pressure-change response in the algorithm closer to what you need, although we generally only change one parameter at a time, so we scientifically know what made the difference, and then see if that helps over time.

AutoSet Response can be set to either Standard or Soft. If set to soft, patients will receive gentler pressure rises during therapy.--https://www.resmed.com.au/healthcare-pr ... technology

Just trying to give you thoughts as options. Hope I'm not throwing too much at you at once. Some like that. Some don't.

[LindaGinCanada]

I may be misreading your chart, but it seems to say at the lower left that you are using ramp for 10 minutes. No biggie, tho.

With an EPR of 3, which basically lowers EPAP (breathe-out pressure, which is key to apnea-prevention) by 3 cm, you may need to set overall minimum pressure higher than 9.

You may also (or as an alternative) want to consider setting AutoSet Response to "Standard" instead of "Soft," if comfort isn't a big issue for you, just to see if that keeps pressure-change response in the algorithm closer to what you need, although we generally only change one parameter at a time, so we scientifically know what made the difference, and then see if that helps over time.

AutoSet Response can be set to either Standard or Soft. If set to soft, patients will receive gentler pressure rises during therapy.--https://www.resmed.com.au/healthcare-pr ... technology

Just trying to give you thoughts as options. Hope I'm not throwing too much at you at once. Some like that. Some don't.

I did go back and check, and yes Ramp was set to 10 minutes, thought for sure I had turned it off (perhaps thinking of old machine) Turned off now.
I'll try AutoSet to Standard and see if that makes a difference.

Physiotherapist was here this morning and said I should be fine to go back to sleeping on my left side now, so will also be giving that a try tonight.

Thanks for your help.

[lazarus]

Physiotherapist was here this morning and said I should be fine to go back to sleeping on my left side now, so will also be giving that a try tonight.

Thanks for your help.

Great news!

You are more than welcome. Any time.

I took a peek at your site/blog. Nice! You are truly an artist.

[ChicagoGranny]

Instructions on formatting OSCAR charts properly are in the third link in my signature.

[ozij]

Without seeing details, and if it were my therapy, my stab in the dark would be maybe to put it in APAP mode and to set the minimum pressure to 9 or so, depending on comfort, and the maximum to 20. Then I would see how that went to tweak from there.

Here's a suggested flashlight:

My pressure is 11

The machine was originally set in APAP mode while pressure was determined. Once my supplier determined 11 seemed best it was set that way.

Given what you've told us, and this image, if your pressure was set to fixed 11, and your AHI has shot up, then the minimum APAP pressure should be 11.
the image shows that you're getting many obstructive events at pressures lower than 11.

When I agreed that changing to APAP for a while might help, I meant "give the machine space to give you more pressure, should that be necessary" it didn't mean "put it back in the "searching for the correct pressure mode".

Before your surgery, you were doing fine at a pressure of 11. So that's where I'd set the minimum. No sense in creating a situation where the machine goes through a cycle of "oh, this is an obstructive event, better raise the pressure.. good now we can drop it... oh no! another obstruction" and so on.

If you're back on your side, you may want to return to a fixed pressure of 11. But whether on your side or on your back, I see no reason at all for your minimum APAP pressure to be less than what worked for you before your surgery.

[LindaGinCanada]

Given what you've told us, and this image, if your pressure was set to fixed 11, and your AHI has shot up, then the minimum APAP pressure should be 11.
the image shows that you're getting many obstructive events at pressures lower than 11.

When I agreed that changing to APAP for a while might help, I meant "give the machine space to give you more pressure, should that be necessary" it didn't mean "put it back in the "searching for the correct pressure mode".

Before your surgery, you were doing fine at a pressure of 11. So that's where I'd set the minimum. No sense in creating a situation where the machine goes through a cycle of "oh, this is an obstructive event, better raise the pressure.. good now we can drop it... oh no! another obstruction" and so on.

If you're back on your side, you may want to return to a fixed pressure of 11. But whether on your side or on your back, I see no reason at all for your minimum APAP pressure to be less than what worked for you before your surgery.

I am back to side sleeping now, things were much better for first night, so thought I would give the APAP a try for a few days and if there wasn't any drastic difference will go back to set pressure of 11. Thanks for your help.

[LindaGinCanada]

My AHI numbers have dropped way down since I am now able to side sleep after knee surgery. I did switch to APAP and noticed my maximum pressure has gone up a bit, will leave it as it right now, till I'm able to check in with my supplier.

I really appreciate the help I received. I'll leave the images for a little while then delete from my personal server to save my storage space.

[zonker]

My AHI numbers have dropped way down since I am now able to side sleep after knee surgery.

back sleeping always increases my ahi. it makes sense in that the tongue can slide down the throat and cause blockage on some folks.

[Hang Fire]

the tongue can slide down the throat

Man, that sounds sexy!