Inexplicable fragmented sleep

[musculus]

What happened August 2018? Any big weight increase around that time?

It looks like pressure should be higher, but you could not tolerate it. I would say increase it 0.5 at a time to higher pressures.

my thorat developed LPR (Laryngopharyngeal Reflux) , which narrowed the airflow.
How do you know i need more pressure from the graphs can you explain ? i keep hearing i need less pressure

looking at the 2 flow limitations in the 2nd graph, the airway collapsed and then quickly normalized within 2-3 breaths. The airway won't go back to normal unless there is signal from the nervous system, which won't send signal unless arousals happen.[emphasis added]

It means your brain was fairly sensitive to flow limitations, aka more arousals, that's why the sleep quality is poorer than what the AHI says since you have more arousals due to flow limitations, and they are not always showing up as event (e.g., the first one) for AHI calculation.

This is more UARS like symptoms. If you expand the flow graph around 1:45am (~the first REM episode) I suspect we will see similar patterns.

Musculus, could you clarify, please? In the 2nd graph, I see two CA but no Flow Limitations. In the third graph, I see two instances of Flow Limitations, but no indication of arousal.

In fact, Flow Limitations look rather minimal throughout the entire night (graph 1), at least to me.

Actually I meant the 3rd graph, now corrected.

My reasoning is as follows:

As the sleep goes deeper, the brain and muscle relax to the point of narrowing airway, the airflow was limited. This process will not reverse unless the brain get alerted and send signal to tighten the muscle tone. Thus, I think there must be a micro-arousal for the flow rate to go back to normal smooth sigmoidal from the rugged shapes of FLs.

I see lots of the same pattern in my CPAP data as well.

[Jay Aitchsee]

Thanks for the clarification. Interesting theory.

However, I count about 17 significant FL instances in the OP's approximate 8.5 hour sleep graphic number 1. If, indeed, each of those resulted in a micro arousal, that would yield a micro arousal index of approximately 2.0. Do you feel that is significant? Using those criteria, my micro arousal index would be much higher and I don't consider my sleep to be fragmented.

If you do feel it to be significant, what is the fix? Higher EPAP?

[musculus]

Thanks for the clarification. Interesting theory.

However, I count about 17 significant FL instances in the OP's approximate 8.5 hour sleep graphic number 1. If, indeed, each of those resulted in a micro arousal, that would yield a micro arousal index of approximately 2.0. Do you feel that is significant? Using those criteria, my micro arousal index would be much higher and I don't consider my sleep to be fragmented.

If you do feel it to be significant, what is the fix? Higher EPAP?

I guess everyone is wired differently, probably why some people has more arousals, which decreases desaturations, while others have more prolonged OA/HA, and O2 desaturations.

I would think if you are seeing prolonged periods of FLs, that means your brain is not that easily alarmed, so the REM sleep can remain in a deep state for a longer while. WHile in OP's case (3rd graph), a bit of muscle relaxation and you have an arousal soon after, and muscle tone go back to normal: I think his brain was constantly being alarmed by the tiniest airway obstruction, and cannot go to a deeper stage of sleep.

I don't have good solutions: higher pressure would be good if tolerable...should adjust based on subjective experience of sleep quality, since AHI or even FL index might not be so helpful in such typical UARS case.

Physical exercise could be useful to reduce stress level, making brain more restful. Medications (inhibitor of neural activities such as benzodiazepines or some antidepressants) are not long term solutions in my opinion

[nicholasjh1]

What happened August 2018? Any big weight increase around that time?

It looks like pressure should be higher, but you could not tolerate it. I would say increase it 0.5 at a time to higher pressures.

my thorat developed LPR (Laryngopharyngeal Reflux) , which narrowed the airflow.
How do you know i need more pressure from the graphs can you explain ? i keep hearing i need less pressure

looking at the 2 flow limitations in the 3rd graph, the airway collapsed and then quickly normalized within 2-3 breaths. The airway won't go back to normal unless there is signal from the nervous system, which won't send signal unless arousals happen.

It means your brain was fairly sensitive to flow limitations, aka more arousals, that's why the sleep quality is poorer than what the AHI says since you have more arousals due to flow limitations, and they are not always showing up as event (e.g., the first one) for AHI calculation.

This is more UARS like symptoms. If you expand the flow graph around 1:45am (~the first REM episode) I suspect we will see similar patterns.

This is exactly what happens to me, Even though my AHI was "low" it was because of constant arousals and hypervigilance. For me I had to find a way to do higher. I do get aerophagia and fart like an insane person in the morning. I have to take plenty of walks during the day to work that S*** out.

[calusa]

The main issue is i can't have a good night sleep because i keep waking up 4-5 times a night
(always in rem cycle, i wake up remembering the dream)

This sleep quality makes me feel like a zombie all day.

You're assuming that your zombie-like feelings are caused by waking up 4-5 times a night.

They might be; but by jumping to that conclusion, you're closing off exploring all the other possible causes.

Others have suggested quite a few. I'll add one more, since last year I also started waking up 4-5 times each night, always after vivid dreams, and assumed a connection to my declining ability to focus on anything the next day. Turns out, my situation cleared up just by essentially forcing myself to try sleeping another hour per night. Often I can't; but just averaging an extra half-hour per night has made a world of difference -- the same improvement I experienced when starting on CPAP therapy in the first place! I still wake up 4-5 times each night, always after vivid dreams, and I still don't like it -- but now I take it in stride.

This approach may not help you at all; it's just to illustrate that the obvious problem may not be the real problem.