Variable dwell time between breaths

[gurug]

Has anyone noticed a cyclical change in the dwell time between inspiration and expiration? Last night during what seemed like a stretch of pretty good consistent breathing I was getting a cyclical pattern in the time between breaths. Sometimes the inspiration goes pretty seamlessly into expiration but then the next breath you see one cardiac pulse on the 0 line and later might get to 2 or 3 cardiac pulses. Then zooming out I noticed at about 12 minute intervals where I was getting a small snore with pause in breathing of 7-8 seconds. Attached is a picture that shows the cycle in the breaths and then culminating in the longer pause.
Here is a link to a snip of the breathing https://www.dropbox.com/scl/fi/re2ymkc2 ... bfs25&dl=0

My sleep study a month ago also noted 0 stage N2 or N3 sleep. Only had REM and N1 sleep that night.

[chunkyfrog]

It is not the machine, nor is it your body.
Difficult to accept, but it is in your mind.
Accept the fibs from your head as the bs it is.
You are not "losing it", but it will get better with time.
It's all new, and it takes time to wrap your head around it.
Been there.

[ChicagoGranny]

What Froggie said.

[gurug]

Not sure why you would say it's in my head. The apparent pattern is obvious in the measurements taken by the machine.

[chunkyfrog]

Then it's your interpretation.
The machine follows your breathing--not the other way around.
(So I suppose it is actually in your chest.)
In any case, you need to try not to think about it too much;
because to do so offers no benefit at all.
You will stress about nothing.
Do something else.

[ChicagoGranny]

a small snore with pause in breathing of 7-8 seconds

If you are snoring, there is something wrong with your CPAP process. Typically, the pressure needs to be a bit higher. It would be nice if a bedmate could confirm you are snoring.

My sleep study a month ago also noted 0 stage N2 or N3 sleep. Only had REM and N1 sleep that night.

Well yeah, this is expected with untreated sleep apnea. You are now treating the problem.

What is your AHI? What does your leak line look like? How do you feel during the day? Energetic? Any excess sleepiness?

It would be best if you quit worrying about the dwell time.

[gurug]

The breathing variability is more of the curiosity of the engineering mind. The whole breathing process and intricate systems that are involved are fascinating.

Home sleep study was done about a year ago CMS AHI 12.0/AASM AHI 24.0 with 02 levels above 90% most of the time even at altitude close to 5,000'. I've always needed at least 8 hours of sleep and snored loud for as long as I can remember even when I was 20 at 180 lbs (60 lbs lighter than now) and 6'-3". Which makes me wonder if UARS may be part of the problem.
Home sleep study - https://www.dropbox.com/scl/fi/z05juepw ... ke5k9&dl=0

The 0 deep sleep during the sleep study was on a re-titration study and used CPAP all night. The doctors report said they controlled events on 7 cm and recommended pressure of 8 cm CPAP. I changed my machine to run 7-8 cm (EPR 0) and there were a ton of flow limitations and my wife said I was snoring. So, not sure how they got 7-8 cm to work that night. Maybe it was the first night effect at the sleep lab (I did use my own FP Brevida mask with that I had been wearing for some time but with a fresh cushion). That night I could swear they were doing Bi-pap because I felt like there was a difference between IPAP and EPAP pressure. I also felt like they were running timed breaths because one of the times when I woke up during the night it felt like the pressure was coming back up before I started breathing. So, I held my breath for a moment and the pressure did return without any breathing effort. I also asked the sleep tech if they were running regular CPAP and she said no. I didn't press any further because I figured she wouldn't be able to give details and I'd see it on the sleep study.
I'm working on getting the detailed report, but below is a link to the miniature graph in the summary report.

Sleep study - https://www.dropbox.com/scl/fi/2knfylvf ... r9q21&dl=0
Night I set machine to 7-8 CM AHI1.87, but flow limits throughout the night- https://www.dropbox.com/scl/fi/8lap5ma6 ... mheyh&dl=0

My AHI reported by ResMed averages 1.06 over the last 10 months (floats between 0 and 2) and mask on time of 8.75 Hours on average (majority of that actually sleeping) but I have been super fatigued with low grade headache just behind my eyes and trouble concentrating/brain fog, but not really feeling like I could fall asleep even if I got in bed. At times I have had to lay down for a bit even if I didn't sleep around lunch time because I just couldn't focus anymore. Sleep doc even prescribed modafinil which has been a life safer to be able to feel awake enough to get through a day of work (only 8 or 9 hours not some crazy 18 hour day). So much for the ResMed your doing great 100 in MyAir.

Most recently I'm running a pressure of 12-15 cm with EPR of 3. Last night it stayed mostly 12-13 with a brief jump to 14.2. The breathing is pretty even most of the night, but I'm getting disturbances every so often with a spike in the flow rate and a short snore according to the machine. The AHI last night was 0.64 (0 OA/0.64 CA). Leaks have been nearly 0 because I've been using the Bleep Eclipse for about a week. Last night had one big leak, but that's probably just a mouth leak since it only lasted about 10 minutes.
Full night overview - https://www.dropbox.com/scl/fi/oa0xt5hg ... hbg1p&dl=0
Spikes in flow rate - https://www.dropbox.com/scl/fi/0gcuy0cd ... egerr&dl=0
Zoom in on a single spike - https://www.dropbox.com/scl/fi/8qbf3zai ... 4t399&dl=0

I have run a few nights at 13-15 and the flow limits are nearly completely eliminated but that pressure starts getting to feel like a bit too much resistance and causes some aerophagia symptoms. Running down to 11-15 and the machine goes through some considerable pressure swings with some snoring and flow limitations throughout the night.

[Pugsy]

Zoom in on a single spike - https://www.dropbox.com/scl/fi/8qbf3zai ... 4t399&dl=0

That little spike is a quick arousal breath. Followed by a little pause in your breathing. Not a big deal. You weren't quite sound asleep. You probably don't remember it either. These are normal to see and happen for unknown reasons....called spontaneous arousal (no known cause but not airway related).
Possibly a turn over in bed pause in your breathing.
When asleep we don't take those big gulps of air.

If you aren't asleep then they really don't count except if we see a lot of such things it means the sleep quality is in the toilet for some reason or other.

[chunkyfrog]

It's totally fine to geek out over your therapy.
The more you know, etc.
It is possible to learn more about YOUR case than anyone else.
I am optimistic for your success.

[Miss Emerita]

Your persistent fatigue raises in my mind the question whether your doctor has explored other possible causes for it. Sometimes there are two problems at work, and fixing one still leaves the other.

If you haven't already been tested for other conditions that could cause chronic fatigue, here are some tests to consider: thyroid, iron, testosterone (if you are a man), autoimmune disease, especially in the connective-tissue-disease family, Lyme disease, vitamins D, B6, and B12. Any chance you have long Covid or chronic fatigue syndrome (aka myalgic encephalomyelitis)?

[gurug]

Those spontaneous arousals seem to happen every night throughout the night, but especially in the first few hours. In some portions of the data it's like clockwork occurring at around 10-12 minute intervals for at least some portion of the night.

I don't believe I have ever had COVID at this point unless it was very mild.
Last year had a bout of wAIHA (warm autoimmune hemolitic anemia) but as of last fall it had resolved. Having your hemoglobin around 8 will make you really tired. This happened a few months after starting CPAP and kept me from pursuing dialing in the CPAP.
I've had about every blood test under the sun including for rheumatoid factor searching for any cause for wAIHA
Going to be getting testosterone test in a couple months for physical bloodwork and a bunch of other bloodwork for hopefully a final follow-up with hematologist
D has been on the low side and have been supplementing @ 50,000 iu a week.

The few nights I've had a drink in the evening I almost thing I've slept better :-O. Might have to have a drink closer to bed one of these nights and note more closely how I feel in the morning.

[ChicagoGranny]

note more closely how I feel in the morning

Not a good subjective way to judge. Do the judging just before bedtime the next night. Were you energetic during the day? Any excess sleepiness during the day? Fatigued but not stressed at bedtime?

[gurug]

Trying to get my pressure dialed in, but by the time I hit a pressure that is pretty reliably eliminating flow limitations and snores I'm getting pretty bad aerophagia. I've even had to do pretty big burbs in the night.

Getting down to 12-15 cm with EPR 3 seems pretty good.
Tried 11.4-13 cm with EPR 3 and was good, but a flow limits and snores starting to show
Tried 10.8-12 cm with EPR 3 and got 10 minutes of quite a bit of flow limitation and snores that were up to 5.0.

On the other hand I have seen flow limits creeping in even at 14-17 cm with EPR 3 when the machine was up at 16 cm

Do I bother trying to get up to the higher pressures to eliminate the snores and flow limitations, shoot for comfort and keep it just below the aerophagia threshold or push for a BiPAP to get more pressure support?

[Pugsy]

Do I bother trying to get up to the higher pressures to eliminate the snores and flow limitations, shoot for comfort and keep it just below the aerophagia threshold or push for a BiPAP to get more pressure support?

Sometimes we have to make some compromises.
Which is worse in terms of what it does to your overall sleep quality and how you feel in general??
1...those FLs and snores
2...the aerophagia issues

I always vote for comfort first because I have always felt that without comfort to start with I don't sleep so great and when I don't sleep so great I usually feel like dog poo.

[gurug]

I'm thinking I'll probably shoot for maxing the pressure short of getting aerophagia and see how I fee.

Any experience with going to BiPAP to clear flow limitations/snoring without aerophagia?