Just don't feel any better

[Rubicon]

The NPSG shows the baseline TWA.

Your O2 saturation is WAY too low for an "athlete", retired or otherwise. Additionally, those prolonged drops look suspect.

Got a PFT?

With a low O2 saturation baseline you could, in theory, have elevated pCO2

IIWM I would get the raw data and rescore it myself.

How'd you end up on 14 cmH2O? You got recent oximetry data?

[Rubicon]

Your O2 saturation is WAY too low for an "athlete", retired or otherwise.

And your heart rate is too high.

Definitely consider some overtraining syndrome in there.

[Rubicon]

CPET: I did get a workup from a cardiologist around a year ago..

What tests did you get? An echo?

[Rubicon]

3% desaturation scoring rule is a little aggressive. Wonder what AHI would be with the 4% rule.

Final Takeaway:

You, sir, have a sleep problem. SDB happens to be coincidental.

[lynninnj]

I thought everything was abbreviated in the military?

[The Tired Vet]

I thought everything was abbreviated in the military?

Everything is, but we're not making it up on the spot as we go

[The Tired Vet]

Padding: are you talking about those pads that come with the headgear and go around the parts that are on my cheek?

Yes...those side fleece wraps. In my case I ended up having to wrap everything with some fleece and also use a size small DreamWear frame and it still moved around a bit too much and I just couldn't get it to not leak with the moving.

I understand the hesitancy about taping the lips....I had the same thing when I first started cpap therapy.
To be honest when I first heard about it my first thought was "no way in hell"....but then a bit later I had to re-evaluate that thought.
First thing I did though was apply the tape while awake and test it to see just how much effort it took to break the seal just by opening my mouth. I used the blue painters tape because I had it handy and I am the queen of cheap. It's really easy to break the seal...a nice yawn will do it. Then I decided to try it all night and you know what happened....thunderstorm came up my first night of taping and we lost power. I did wake up when we lost power but I was breathing just fine through the vent holes in the mask. No distress whatever and it was the silence that caused the wake up.
You can move enough air just through the vent holes to not suffocate. It might take a little bit of extra work but it can be done.

And yes...a one night experiment just to see for sure where the leaks are coming from and then decide how to address the problem once you know for sure what the problem is.
I don't know that the leaks (from whatever cause) are a factor in your crappy sleep but they might be and for that reason I would suggest at least trying to reduce them.

I am just tossing out various ideas that could be a factor in your crappy sleep...some may pan out and some won't but if you don't investigate you won't know for sure.

Sleep quality can be very fragile and easily disturbed and not so easy to fix. Been there and done that myself.

Play with taping your mouth while awake and under no stress to go to sleep. Play with breathing through the mask without power by just using the vent holes. See if you can reassure your brain that you won't go killing yourself.
It's just one night or even just a part of the night so you can see that leak line.

Working through trying some of your suggestions one at a time, I have been using all the same set up but turned on the EPR to a setting of 3 (that's what it was at from way back when I last used it). I haven't had time to dive into my supplies to find the felt sleeve wraps to see if those help the mask fit better but here is my data from the last two nights. The leak numbers, at least, seem to have improved, although not sure if that's true of everything else.

August 24th: https://sleephq.com/public/c61d0750-936 ... 4b9243e904

August 25th: https://sleephq.com/public/4b990d16-68d ... e94b375a8e

[nightnight]

Seems like you do better when you DO have mask leaks!

I would try to cut the pressure DOWN, and see how that works for you. Find out how low............you can go...........

[The Tired Vet]

Seems like you do better when you DO have mask leaks!

I would try to cut the pressure DOWN, and see how that works for you. Find out how low............you can go...........

That's an intriguing idea. One of the thoughts I have been having lately is that the high pressure, while it might open up my airway is causing my breathing to get messed up. i can't rule out that I have disordered breathing while I sleep as additional unrelated problem, of course.

[The Tired Vet]

I thought some of the lurkers might find this interesting.

An article on partial pressure of carbon dioxide: https://www.ncbi.nlm.nih.gov/books/NBK551648/

An article on oxygen saturation: https://www.ncbi.nlm.nih.gov/books/NBK525974/

A couple of random things about CO2 and O2:

-PO2 is the concentration of O2 in the blood (as PCO2 is a measure of CO2 in the blood) and it can be measured in a few ways. One is by taking an arterial blood sample and running blood gas measurements on it right there (PaO2, a for arterial). This is done a lot in critical care settings (e.g., an ICU) or in an emergency room.

-SpO2 can be low for a few reasons (not an exhaustive list)
You are not getting enough oxygen
There is something wrong with the SpO2 probe or the placement of the probe--the latter happens A LOT
You are dead

-SpO2 is a surrogate measure of the concentration of O2 in your blood and is used a lot because it is noninvasive--how many people want to try to sleep all night with an arterial line in? Also, ouch.

-CO2 can be measured by arterial blood sample as well. If you do that it's called PaCO2.

-ETCO2 is a measure of CO2 in expired air (the air you breath out). It's a really neat tool because it changes quickly (more quickly than SpO2, imo) during anesthesia and critical care so it lets you know how your patient is doing right now.

-ETCO2 can be low for a few reasons
You are breathing too much (hyperventilation)
There is something wrong with your ETCO2 probe--I don't think this is that common; certainly doesn't happen that often in the OR
You are dead--if you are not alive you do not produce CO2--this is bad.

ETCO2 can be high for a few reasons
You are not breathing enough (hypoventilation)--this is what could happen with central apneas
There isn't enough O2 in the air you are breathing
There is a restriction or blockage in your airway (still called hypoventilation, but we're calling it obstructive apneas and obstructive hypopneas)
You cannot have a high ETCO2 and be dead--you might be about to die but you don't produce CO2 when your body has ceased to perform aerobic respiration

We tend to be more interested in O2 because it keeps our organs, including the squishy one between our ears, functioning, but too much or too little CO2 is a problem as well. For one thing too much CO2 can contribute to metabolic acidosis (here's an article that'll explain it better than I will: https://www.ncbi.nlm.nih.gov/books/NBK482146/)

Slightly obscure example: surgeons who operate on the brain will often hyperventilate their patients, say, targeting an ETCO2 of 15 mmHg or maybe lower (I usually use 36-44 as a normal for anesthesia but lots of others use 35-45). When you overoxygenate the blood flow to brain slows down and actually shrinks the brain a little (less blood in the brain = smaller brain). I think they do this to control the bleeding a little. It relates to the the chemoreceptors in the body and how they regulate blood flow and respiration (example here on the carotid body: https://medicine.uiowa.edu/iowaprotocol ... tic%20tone).

There is obviously an interplay between CO2 and O2. By definition if your O2 is low your CO2 is going to be high...unless you're dead. If your O2 and CO2 are both low and you are alive I would check the probes and/or retake measurements.- If your O2 is high (and a working SpO2 probe would not, I would guess, falsely read high) then your CO2 is probably low normal. You need both CO2 and O2 in your bloodstream to breath normally, but you are also constantly producing CO2 from O2 in aerobic respiration in your cells (there is some debate about this latter point if you want to get picky, but only read this if you want to understand the finer points...or confuse yourself--https://pubs.asahq.org/anesthesiology/a ... Dioxide-or).

Please let me know if I made any errors

[The Tired Vet]

Seems like you do better when you DO have mask leaks!

I would try to cut the pressure DOWN, and see how that works for you. Find out how low............you can go...........

Oh, one question: when I first started CPAP I was on a 6-12 setting and I was waking up every hour all night long. I narrowed the range a lot and that helped a lot--I don't have any data from that era but I head read that some people get woken up when the pressures go up suddenly while they're sleeping.

To move down...gradually add to the lower end and see how I tolerate it?

[clownbell]

In the earlier discussion regarding leaks and taping, there doesn't seem to have been any mention of looking at the leak chart. AFAIK, when you zoom in as much as possible, flat tops signify mouth leaks and spiky tops signify mask leaks. Can the experts confirm this?

In my case, leak control makes all the difference. Could help the OP?

[ozij]

AFAIK, when you zoom in as much as possible, flat tops signify mouth leaks and spiky tops signify mask leaks.

As far as I knw, it's the opposite - saw tooth is mouth leak. Constant, flat, is mask leak.

[Rubicon]

Please let me know if I made any errors

An error of omission.

What's ECO2?

[Rubicon]

AFAIK, when you zoom in as much as possible, flat tops signify mouth leaks and spiky tops signify mask leaks.

As far as I knw, it's the opposite - saw tooth is mouth leak. Constant, flat, is mask leak.

IDK if either rule can be made, but if we're discussing the above waveform, there were no leaks.