Not the Best Night, a Bit Odd

[MaxDarkside]

Good to see you didn't have those clusters of OAs last night. Must have been sharks!

(like) Yes, must have been sharks the other night !
AHI of 0.85 on 7 hrs. I'll take every night of < 1.0 I can get! (does a happy-dance).

[MaxDarkside]

Yes, I know that I'm WAY better off than many of you and accordingly, I may be using up a bit of bandwidth here unnecessarily, but again I had this odd cluster of apneas / hypopneas again, now 3 out of 4 nights. Here's the picture... I don't think these are Cheyne-Stokes respiration because it looks like I'm slowly decreasing my breathing, then stop, then pop up breathing heavy, repeatedly. Since this is happening always at the same point in my sleep cycle, in the 2nd REM period, it must not be positionally related unless I just so happen to go on my back right at the start of the 2nd REM period. It must be related to that sleep period.

I do have some diagnosis of Left Ventricular Hypertrophy / enlarged heart, which clearly shows in multiple confirmations in my EKGs, but an echo showed none, but I have some experience with echos and their "reliability" (they really aren't very reliable, in case you were wondering, but that's a long story, including me and other family members with Hypertrophic Cardiomyopathy, some living and some now dead).



The day after these happen I have noticeable grogginess.
I don't consider this happening a major problem, more of a curiosity as to what it is and why it is happening.

[Pugsy]

I am documented much worse in regards to my OSA in REM vs Non REM stage sleep.
Positional element didn't seem to make any difference.
In NonREM sleep I am barely diagnostic with AHI of 12.. In REM sleep I rock and roll with AHI of 53 (numbers per my initial sleep study)

When I first started therapy I saw clusters like your latest report with great frequency and multiple times a night and always pretty much corresponded to the timing of what REM stage sleep would be occurring.
Like you I also noticed a difference in how I felt general after a night with those clusters. The more of them I had the worse I felt.

As I tweaked my pressures with mainly increasing the APAP minimum I pretty much broke up the majority of the clusters. Sometimes now I might have a random small cluster sneak past the defenses. I usually just shrug my shoulders and say those REM events must be on steroids and need a bit more minimum pressure so the machine can kill them before they grow up. Since they don't happen now except very rarely, I don't feel the need to worry about them so I don't want to change pressures.

If I continually saw these clusters and continually noticed that I felt crappy when they came to visit, then I would probably increase my minimum pressure again just a tiny bit and let the machine try to prevent them a little more effectively.

It all comes down to compromises sometimes.. AHI with the cluster is acceptable on paper so how much do they really bug me? Enough to use a little more pressure all night when less works for the bulk of the night? It is an individual call. On paper there is no real need but the need might be there in regards to how we feel the next day.

And finally...yep things do change even with time. When I started on the BiPap last October on paper the reports were pretty ugly yet I felt pretty darn great. That is why I bought the BiPap after I stumbled on one for someone else and just had to try it out and woke up with the "miracle" for the first ever. So I purposely left the pressures alone after a minor tweak and let the ugly nights (on paper) just happen and over time the ugly nights (on paper) have been reduced significantly without any changes to anything.

[MaxDarkside]

Thanks. That helps. Good info. Coincidentally, I had just recently increased my min. pressure. Was at 5, I moved it to 6. I'll move it up a bit more and also raise the max just a bit. I notice the machine is not achieving the max that is set when these events are happening, it is mostly just testing and not moving up more. I'll run with it a few nights with the changes to see what happens. I do know from experience that changing the min and/or max can have somewhat unexpected effects on the behavior of various algorithms' response characteristics, particularly if they are conditional and non-linear, but I don't know about ResMed's without doing some tests.

[Pugsy]

had just recently increased my min. pressure. Was at 5, I moved it to 6. I'll move it up a bit more and also raise the max just a bit.

It may simply be that the 5 cm minimum was just a little too far away from the pressure needed for that cluster on steroids. Maximum doesn't really come into play unless the machine thinks it needs to go there for some reason.

I will try to give you my history..the short version.
Sleep titration pressure RX was 8 cm.. I bought my first machine out of pocket because I wanted APAP but I decided to try titration pressure first (well sort of)...so I used 8 cm minimum and 10 cm max.
Felt horrible. Got the software after a week of horrible.. AHI in the teens. Max pressure pegged at 10.. Obviously I needed more pressure.
I increased maximum to 12..left minimum at 8. AHI still around 10 but better...pressure sometimes hit 12 but not pegged out all night. Opened max wide open to 20..left minimum at 8....AHI still around 9 or 10 with no real difference in how I felt and all along I have these clusters..some of them pretty bad.

So then I started up with the minimum pressure of 8cm. Increased in 0.5 cm increments till I arrived at 10 cm minimum and the clusters were gone. With 9.5 cm minimum the clusters were significantly reduced but I would still see one or 2 a night. When I used lower than 10 cm minimum the machine took too long to get to where it needed to be at to prevent the super duper events on steroids.

So the minimum pressure is the most critical. The maximum doesn't even come into the equation unless the machine is pegged out because the events drive it up. It won't go where it doesn't think it needs to go. No need to limit maximum UNLESS your mask leaks drive up the pressure or the variations in pressure disturb your sleep in some way. I routinely saw 18 cm on my reports and yet I had no clue that things went that high until I saw a report. So pressure changes never have bugged me. Other people find a 2 cm range disturbing...APAP mode is not good for those people.

I used APAP 10 minimum and 20 maximum for well over 2 years until my recent adventure with BiPap starting this past October. My overall AHI during that time was/is around 1. On a very rare occasion a small cluster might have occurred but they were so rare I didn't think they warranted any more minimum pressure. BTW my overall average pressure was between 11.5 and 12 and overall average 90 % pressure was just a wee bit above 12. So the excursions to 18 or so were brief and random.
My BiPap story...I have in another thread which I need to update and will soon.

[MaxDarkside]

Yes... I understand what you are saying about raising the min. Thanks. I think I will do some experiments, sometime later when I finally get dialed in, on my S9 to see how raising, lowering, compressing and expanding the range affects its algorithm and how it affects me and my events (of all sorts, not just these). Thanks muchly.

[Pugsy]

think I will do some experiments, sometime later when I finally get dialed in

I still experiment now from time to time. Things get awful boring after a while. Sometimes I make a big mess of things and have to laugh at myself. I did that last August when I decided to turn off AFlex. Huge disaster. I had no idea how much I had come to rely on AFlex.

I think you have an excellent understanding of how things work and realistic expectations and quite able to handle some experimenting. I also think later is better once you have a good solid baseline dialed in.
Sometimes people get in such a hurry to change things just because they can that they go all over the place and can't really document which change caused what result.

[MaxDarkside]

I am trying to dial in by making small changes as my initial settings were workable and I'm just tuning a bit and set a baseline. Professionally I characterize processes (of all and any sorts, from toilet paper manufacturing to oil and gas production) in part by making modest as possible changes to (or merely observe) factors that we can change ("Controllable Factors") and other influencers that we cannot change to see the effect on "performance", then that data can be analyzed for cause and effect, correlation and sensitivity (to what extent a change in Setting X makes a positive or negative change in Performance Measure Y). I'm still grappling a bit on what "performance" is in this case, as it's rather subjective, like, on a scale of 1-5 how do I "feel" today. There are some quantified measures (Zeo's ZQ) but ZQ's utility depends on how ZQ correlates to how I "feel". I'll probably need a month's ZQ to figure that out. I may build a software application to measure my response times at, say, waking and again at Noon. I'd like a "groggy" measurement, though I don't really know other than, again, on a scale of 1-5 how "Groggy" do I "feel" today, maybe at waking and also at Noon.

I've identified about a dozen controllable factors and 2 dozen measurable factors that are mostly results, which may be mappable into "How Good I Feel Today".

When SA came into my life, and I discovered it, I turned to it and said, "Oh boy, you picked on the WRONG guy!" LOL !

[Pugsy]

I've identified about a dozen controllable factors and 2 dozen measurable factors that are mostly results, which may be mappable into "How Good I Feel Today".

Knowing what you do for a living I am not surprised. That and being a male....well it is pretty much ordained.

My markers are much more simple and I still struggle with them sometimes.
The CPAP gods conspired against me from the first day and made it difficult for me to measure success.

[MaxDarkside]

All those factors are just a start, there are more. I'm talking here using "at the end of sleep" data, which could be used to have our software tell me "set these settings this way..." for the next night, auto dialing in performance. This is important because we humans are "non-stationary", which means we change over time (get old, exercise more, or less, etc.), and thus our settings probably should be adjusted over time too, or based on what we just did to ourselves ("Hey, software, I just drank a whole bottle of Jägermeister doing Jägerbombs, what should I do?") LOL

Then, there is the real-time data. If I can properly estimate my "feel good" from the data, conceivably (already done by me presently in commercial systems) I could have our software quantify *now*, during sleep, how good I *will* feel in the morning...get this... in real-time during the night. What to do with that? I don't know, I haven't thought it through, but I suppose if my "Feel Good" predicted metric goes into the crapper (signals bad, low) for a period of time I could have the software alarm and wake me up and tell me I should do something about the situation, maybe offer recommendations.

Sorta dreaming ahead of myself, but these things are possible. It's how I make my living.