Dreamstation Puff vs Resmed No-Puff?

[Carleton]

Hi Pugsy & Others!

Does anyone have a perspective on these screenshots?

Any insight you can offer would be much appreciated!

Last night I set my pressures to Min 5 / Max 8 / EPR 2, and while I was sleeping my max pressure peaked ~7.5cm, so I might have found my sweetspot.

Tonight I'm changing settings to Min 4 / Max 8 / EPR 3 to see if there if anything changes.


-Carleton

[Pugsy]

Pick 3 flagged centrals that you think are real asleep centrals and post those images.
Zoom in per the way it is done at the video links above. Make sure you have some flow rate prior to the flagged event showing on the left side of the flagged event.

You are changing settings willy nilly...gotta keep a setting for about a week and watch for patterns or trends.

If you can't do without EPR...you can change it to ramp only and make use of the ramp feature.

[Carleton]

Thank you Pugsy!!

I respect your opinion, but have to disagree that my changes are willy nilly. I'm trying to dial in what works for me (and what doesn't) with an absolute minimum amount of suffering. I really don't want to spend a week at settings that aren't working at all, hence my experiments with EPR.

And if last night is any indication, it might be working! I finished work really late so didn't get as much sleep as I would like, but slept soundly for almost 6 hours with just about no events while I was actually sleeping. I will attach the full night's graph.

I'll also attach some flagged CSA closeups from last night as requested.

I'm tempted to increase my min pressure to 5 again, but in the interest of not appearing willy nilly, I will leave all the settings where they are unless you suggest otherwise.

I've actually had Ramp turned OFF since I got the machine last week.


-Carleton

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[Carleton]

In case you're interested, here are some other closeups from last week that looked interesting to my untrained eye.

I've looked closeup a lot of my flagged CSA events from the past week, and they appear to vary from 10-30 seconds long, with most being 15 seconds.

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[Pugsy]

All those zoomed in CAs/centrals...all preceded by arousal/awake breathing flow rate breaths.
You weren't asleep. They aren't real and they don't count other than to point to being awake or half awake. You paused your breathing....we all do it and don't even realize it.

With EPR off...a reduction in the number of centrals.
Makes me wonder how much of an impact EPR is on your central apnes that are real asleep centrals (if you have some).
An experiment to think about doing at some point...gradually increasing EPR to see if the centrals also increase.

Making changes every night...that is willy nilly. You don't know if the change in a setting was a factor when there are different results or simply the fact we don't sleep the same each night.

There is no urgent need to increase the minimum to 5 cm unless you aren't comfortable with the 4 cm minimum.
More pressure only deals with OAs or hyponeas and you aren't having enough of those to worry about.

Your choice how long you wish to continue with an experiment in setting changes.
But you can't fix centrals with more pressure.

[Carleton]

Wow, I didn't even consider that I might be waking up, but I can see it by the graph's shape now!

So would a true central apnea go right from the rhythmic sleep breathing to completely flat?

Could this mean that many/most of my recorded events are some other disturbance in my sleep other than obstructive or central apnea?

I've looked through all the flagged Central events from the time I was actually sleeping over the past week, and they all have multiple wakeful-looking breaths that precede them. I've attached a screenshot of the only one I could find that isn't preceded by multiple wakeful breaths.

I have no memory at all of waking up last night, and usually I don't recall ever waking/stirring unless it is for an extended period of time.

With respect to EPR, some of those closeups could get confusing, as until last night, most of my sleeping with the CPAP has been problematic. The graphs have meaning, but the numeric data isn't very diagnostic aside from last night, as many of those earlier days I laid there for 2+ hours with my mask on, just trying to sleep. Anytime I spend awake with the mask on seems to trigger the Airsense 10 into recorded lots of AHI Events based on my erratic wakeful breathing patterns.

Last night I turned EPR up to 3, and had almost no Events while sleeping. And anecdotally I have felt much better whenever EPR is on. I'm going to keep my settings the same this week, and depending how it rolls I might consider reducing or turning off EPR next week and seeing what happens. My few attempts doing that so far haven't been pretty.

I really hope I can get a new sleep test done and get some proper hard data on my sleep WITHOUT CPAP, but I haven't heard back yet.

Thanks again for everything!! It's really nice to hear from folks who are both knowledgeable and passionate about this.


-Carleton

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[Pugsy]

You zoomed in a little too close with this last one and while there is a brief blip in the breaths right before it went flat it's not nearly as remarkably obvious as your other examples were. It's a bit iffy but I would probably lean more towards sleep. Sometimes they aren't so easy to figure out. We just do the best we can.

Remember it is entirely normal to have a few central apneas here and there...everyone has a few even people without the OSA diagnosis.
So I don't worry about a few centrals that are real asleep centrals.

I don't have a good example of a central apnea of my own that is a real asleep central but I have a good example of an OA that is a real asleep OA...a real asleep central will look the same.
Easy to see that the breathing flow rate breaths point to being asleep and bam...OA gets flagged. Same thing could happen with a central apnea.



Here's another example of a grouping of flagged events but I wasn't asleep. Note all the irregular breathing.



I would have to examine each and every flagged central to get an idea of how many of yours are real asleep vs awake/arousal related but I suspect a chunk of your flagged events are awake related.
Sometimes the flagged events are a symptom of poor sleep quality and not necessarily the cause of the poor sleep.

Arousals....we have them often and don't remember waking up because we are awake so briefly that we don't have time to form a memory of the awakening. So arousals/awakenings may or may not be associated with remembering the awakening.
Now sometimes the arousal breathing comes after the real asleep breathing and that means the flagged event caused the awakening/arousal.
But not all arousals are from some sort of apnea event....sometimes it is from something totally unrelated to the airway.
I see a lot of arousals myself...especially on a night where I know I didn't sleep so great and in my case it is usually pain related but sometimes it has been the damn dog or cat or both. Thunderstorms...being too hot or too cold...lots of things can mess with sleep.

[Carleton]

Thank you Pugsy!! This is very very helpful.

I am keeping my settings the same, and will post some more data in the next week when I have more to go by.

I might be becoming a bit too affectionate with my Airsense, and the wife is starting to look a bit jealous of all the time we spend together in bed. Although it hasn't caused me any arousals that I know of...quite the opposite.

[Carleton]

Hi Pugsy!

Here is my data for the past week.

If you happen to have a chance to have a look at it and let me know what you think, I'd appreciate it!

And please let me know if you want any zoomed shots of anything.

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[Carleton]

And three more nights.

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[Pugsy]

You only gave me numbers and graphs and no report on how the sleep quality was....sleep soundly or have very many wake ups? Numbers and graphs don't tell the whole story. I like to know the whole story.

The bulk of your AHI is still central/CA and a lot of the central clusters are shown at what were probable awake times...like right at the beginning and ending of the night. I suspect that the higher AHI nights with higher central count are nights where you didn't sleep so great for some reason or other.

You have some quite decent nights and some rather ugly nights but we know you can have decent nights....I am wondering what changed to cause the rather ugly nights because something had to have changed.