Is there anything other than ASV I could try?

My AHI was below 5 but I still felt like crap so recently, I had a PAP therapy analysis with CPAPfriend and made significant progress. Upon inspecting my flow rate, he noticed irregular breathing patterns, shallow inhalations compared to exhalations, and long periods of waxing and waning breathing. Additionally, my SpO2 and pulse rate were highly variable. We theorized that I am likely experiencing numerous arousals throughout the night.

He reviewed various setting changes I've tried over the past five months and ultimately recommended discussing ASV therapy with my doctor. In the meantime, he suggested adjusting my trigger sensitivity and TiMax settings. First, I tried the high trigger sensitivity, which improved the situation, and then the very high setting, resulting in about a 50-75% improvement, depending on the day. My breathing has become more regular, except for the waxing and waning periods. However, my I:E ratio is still quite low, less than 0.5. Increasing TiMax did not seem to help significantly.

I have an appointment with a new doctor in July who seems promising, but I wanted to get your thoughts based on my charts. I've included a full-night screenshot, a zoomed-in view showing the waxing and waning pattern lasting over an hour, and a detailed view of this pattern. I've also summarized all the changes I've tried and their effects.

Here's what I tried in the past:

I tried tightening the range to 4-13 to see if higher pressures were the issue. No effect.

I tried raising just the EPAP to eliminate obstructive apneas. No effect

I tried ResMed 's BiPAP titration protocol. No effect

I tried switching to CPAP mode at 6.2 and for two days I felt that fantastic well rested sharp minded feeling in the morning. My hypopnoeas and flow limitations were rough compared to BiPAP though.

When 6.2 stopped feeling good I started ResMed's CPAP titration protocol to see if I could get rid of the hypopnoeas and flow limitations and improve my sleep. I couldn't get them eliminated and at a pressure of 11 I started feeling worse so I stopped

Next I tried a wedge pillow to keep me off my back and it did it's job well but no improvement.

I also tried lowering the PS on BiPAP just to see what would happen but it had no effect.

Lastly I tried a soft cervical collar for a week using the settings from my best nights to see if any combination of pressure and the collar would help. No improvement. If anything it made things worse so I stopped using it

Screenshots:
https://imgur.com/a/12vG8Zi

Is 6.2hours a typical night for you? When I get that much I just refill the humidifier and put on a blindfold and go back for more. 2am is late, eh? Any caffeine dependencies we should know about?

Without SleepHQ graphs we can't zoom in. My O2's looked like that until I got big pressures. With PS3 at those low pressures you might be on the edge of CO2 stripping... but you said you tried straight CPAP no diff. ASV is for folks with CA's or Cheyne-Stokes IIRC.

LordofthStrings,

There's nothing in the data you posted that screams, "FIX ME". The data says your machine is doing a good job at addressing sleep apnea issues.

Even your "waxing and waning" breathing period is not pronounced enough to scream, "FIX ME"

So that raises the question: What else could be messing with your sleep?

And that raises all kinds of other non-CPAP related questions:

What's your usual bedtime? On the data you posted, OSCAR says you first turned the machine on around 2:30 AM and, given a run time of 6:12, that means you turned the machine off around 8:40AM. For lots of folks, 6 hours of sleep is just not enough sleep to feel rested and refreshed every morning.

Are there any night time wakes that you remember in the morning?

How much caffeine do you consume during an average day? What time is the last caffeine consumed?

How much alcohol do you consume during an average day? What time is the last alcohol consumed?

When do you eat supper?

Is your bedroom too warm, too cold, too humid, or too dry for you to sleep comfortably?

Any chronic pain issues? If so, do you take anything for the pain? If so, when's the last dose?

Any pets share your bed? If you have a significant other, do they toss and turn at night?

As you can see there's a whole host of other things that can explain bad sleep once the OSA is addressed by xPAP.

That's not a typical bedtime for me, no. I usually get a solid 8 hours. Probably not a good night to use as an example in terms of my overall sleep. Just wanted to address that waxing and waning pattern, which looked like periodic breathing to me.

I don't drink caffeine or alcohol. No pets or significant other that sleep with me. I'd say my sleeping environment is very comfortable and quiet. Last full meal is around 6 with a snack around 10. Tried intermittent fasting once a few years ago and that didn't affect it so I don't think it's related to food.

I've thought about increasing the pressure because I noticed while looking over my data last night that the waxing and waning pattern got waaaay worse every time the pressure was lower. Like it was all night long with the exception of the handful of days I felt really good for no discernible reason. I know it may not scream bad but that's the only difference I've been able to find between a good night and a bad night thus far.

LordofthStrings wrote: ↑

Tue May 21, 2024 9:08 pm

I've thought about increasing the pressure because I noticed while looking over my data last night that the waxing and waning pattern got waaaay worse every time the pressure was lower.

IMO raise ePap 1 and lower PS 1... try it a night. You might need more CO2 in your mix.

I would recommend that you eliminate the late-evening snacks. Beyond that, I recommend that you start keeping a record of how you feel during the day each day, along with potentially relevant additional information. This might help you spot correlations.

The potentially relevant additional information might include stuff from your graphs, but it could also include how much exercise you got during the day, how much exposure to sunlight, how much stress, how much exposure to screens during the hour before bedtime -- you get the idea.

The way you feel during the day should really be the central focus of your attention, given that your numbers are generally good. In fact, you might try not looking at your charts for a few days in a row to avoid getting over-invested in their details.

@vandownbytheriver

Thanks, I'll try that. Just to clarify you mean 9-11 with a PS of 2 then?

LordofthStrings wrote: ↑

Wed May 22, 2024 2:45 pm

@vandownbytheriver

Thanks, I'll try that. Just to clarify you mean 9-11 with a PS of 2 then?

Yes... worth a try.