Suggestions from my waveforms.

Hi,

I've suffered from bad sleep (insomnia), brain fog, (according to doctors: related) memory issues for a some while (years). I also have severe bruxism, so need to wear dental night guards. After 'failing' my first sleep study (slept less than 40minutes) on my second try, I finally got diagnosed with severe sleep apnea last year and after some time of waiting got AirSense11 in the beginning of the 2024. My sleep has improved from average of 4h to 6h already, but the AHI has been in 10-14 range so far.

I do know that my jaw/throat is causing most of my troubles (although I also need to use nasal sprays and antihistamines to keep my nose unblocked). My BMI is in 'healthy' range, but still I will snore 100% of time I sleep without CPAP on my back. If I nod my head forwards or push back my jaw even slightly, airways in my throat gets severely obstructed.

I have tried 4 types of masks. ResMed AirFit F20, AirTouchF20, AirFit P10 and EvoraFull. Unfortunately, nasal masks are not for me, even with taping my mouth. The AirTouch has been best for me, but not great due to pushing back my jaw more than others. Looking forward checking out the AirFit F40 - hopefully it will fit my face better than Evora, that is very close to being good (when it sits, it's great, but if it shift out of place even slightly, it's terrible.)

Last week, I finally found out about this forum and did some amazon shopping and already the first night my score improved significantly - taping my mouth (with breathing hole), using chin strap even with full mask and side sleeping position were the major changes. It's a bit complex to explain, but I can't sleep on my side normally - the tape was the key to this! Last night my AHI was already significantly lower, and I saw more of and more vivid dreams that I remember having for years, so huge thanks already to this board, cpap YouTubers and developers of Oscar!

This is my first night of recording the data with SD card, and would like to hear if there are suggestions how to get the AHI lower, and especially how to reduce the central apnea events.

We need to see your more recent (slightly improved) OSCAR detailed report.

Just how many centrals per hour are we talking about wanting to reduce? It is normal to have an occasional central and we don't worry about a handful of centrals that occur while asleep.

Oh, I tried to attach the images, but apparently that failed (quota full).

https://imgur.com/4DMEKHp

https://imgur.com/8jtH7hB

Information that things look ok are extremely welcome as well!

Couple of questions.

Are you waking very many times during the night? If so...any idea why?

How would you rate your sleep quality as well as how you feel during the day?

Do you take any meds of any kind?

On the zoomed in section you posted....the bulk of those flagged events you weren't sound asleep when they were flagged (and this doesn't surprise me since you are so new to cpap therapy) and if you weren't asleep then they don't count except to confirm that you weren't asleep.
I think if we can improve on your sleep quality your events flagged will lessen.

Far from a horrible report and actually not unexpected results considering you are new to therapy.
The bulk of your AHI is central apneas but I suspect that you weren't sound asleep for the bulk of those centrals.

To reduce your central apneas we need to try to fix the sleep quality problem first. ....and to do that we have to try to figure out how to improve your sleep quality. I don't think they are related to pressures or even EPR so I don't know that tweaking the settings is going to help much. Reducing or eliminating EPR might help a bit but that's only if EPR is the trigger for the centrals but I just don't see it ...at least on what you shared now. You have to be asleep and you weren't..

Thanks for the reply!

I don't feel like I'm waking up several times. Just to help me to understand the data better: what in the graphs show that I'm waking up? If I would need to guess the reason it would be uncomfortability with the CPAP equipment; mask, tubing and airflow in particular.

I have FitBit monitoring my sleep and I've tracked my patters with SleepIO. According to those and myself, my sleep quality has been extremely bad. It's been getting better, and last night was much better than average. I feel exhausted, groggy, lethargic and have cognition and memory issues during the day.

In general, I am a bad sleeper (as is my mother and sister), i.e. I have severe difficulties getting enough good quality sleep. My mind does get into 'grooves' of repeating thought patterns and can't "switch off". When I wake up late in the night/early in the morning, I will not be able to get back to sleep. Brain just doesn't let go racing thoughts. I've gone through CBT and have done everything in order to improve my sleep - very regular times, no naps, regular exercise, lights/TV/phone off hour before bedtime, no reading/audiobooks in bed, cool, quiet & dark bedroom, no heavy meals in the evening, no alcohol or tobacco (at any time). I've tried meditation and other ways to instill benign thoughts, but without too much success.

I do have high stress and demanding job, so there is that, but when I've had less stressful periods I just worry about lesser things, the amount remains constant. My sleep doctor shrugs these problems and just asks to focus on the CPAP at this point. He basically asked "have you tried not staying awake in bed?"

SleepySleeper wrote: ↑

Sun Mar 24, 2024 3:09 pm

what in the graphs show that I'm waking up?

Asleep breathing is very regular and rhythmic and without gulps of air because we don't take gulps of air when we are asleep.
So if you see irregular breathing right before a flagged event...you weren't asleep.

I circled the asleep breathing on this example below....the stuff not circled in red is awake/arousal breathing.

and here's the same time frame but zoomed out a little more so you can see more of the "not asleep breathing".


Here's arousal breathing is circled...right before a flagged event. That flagged CA/central isn't a real asleep central.


And here...a lot of yours are like this one. That gulp of air circled right before the flag means you weren't quite asleep.
We don't take big gulps of air like that while asleep. This one might have been someone just turning over in bed and holding their breath briefly.


Here's another one...I circled the arousal breathing.


Now this one below...I was asleep when these 2 OAs got flagged. Note the nice regular pattern and no gulps.
I don't have an example with a central apnea that is a real asleep central but just pretend those are CAs instead of OAs because they would look the same.

Thanks!

Uuh, zoomed in, the flow rate doesn't seem regular for long periods of time - there are irregular sections even with CA flags - with this it indeed seems I don't get much of good quality sleep. FitBit reports 20-30min on REM/Deep Sleep per night for most of the nights, so that might be accurate. Not ideal. I'm run out of things to consider, suggestions are very welcome.

It also seems that the events can last 20+ seconds - sounds a bit more than holding breath briefly. Is there any cause for concern? On the positive side, what you say seems to indicate that there are really no central apnea events! Overall it seems that the apnea is more or less in control, my sleeping isn't.

I didn't notice the question about meds. Just some Terbinafine for toenail fungus and antihistamines for nasal congestion. I avoid sleeping pills and use them only as last resort (e.g. second night in a row that seems to go without sleep).

SleepySleeper wrote: ↑

Sun Mar 24, 2024 8:07 pm

Overall it seems that the apnea is more or less in control, my sleeping isn't.

Exactly.

Common problem though. Lots of people have crappy sleep and were expecting the cpap to fix all their crappy sleep problems but the machine can only fix one problem and that is the OSA problem. If OSA was the sole cause of your crappy sleep you would be home free but you have other sleep problems and the machine can't fix the other problem because it isn't from airway issues.
It happens a lot and people get disappointed because they expected the cpap machine to fix all their problems but it simply can't do it.

I wish it were that easy....dealing with OSA alone is actually fairly easy. Fixing long standing sleep problems unrelated to airway issues is a much more difficult job.

There are 2 types of insomnia...sleep onset insomnia where we have trouble falling asleep and the second is sleep maintenance insomnia and that's where we have trouble staying asleep or wake up frequently and have trouble going back to sleep.

I feel your pain....I have bad sleep maintenance insomnia due to some pain issues and even though I know the problem the fix for it is elusive for sure. When I do the scroll through zoomed in thing on my flow rate I see LOTS of evidence of arousal/awake breathing myself. Some I remember and some I don't but the arousals are there anyway. I have a RX on hand for a sleeping pill and like you I drag it out when I have had a couple of "bad" nights because I feel so horrible from lack of sleep. It's not a great solution but it's better than nothing.
I take a newer kind of sleep aid...Belsomra...which helps a person stay asleep a little longer. It doesn't take 4 hours and turn it into 8 hours but it gives me maybe an extra hour and the sleep I do get before I wake up is a little bit better quality sleep. If I can get about 7 hours of fairly decent solid sleep I feel decent the next day.