Great AHI etc. but also fragmented sleep?

[DayDreamBeliever]

I'm quite new to this CPAP game. I believe I've gotten used to it, my settings seem basically well-titrated and my stats look good. But I'm not feeling less tired during the day.

My machine is Resmed AS10 Autoset, and my mask is Swift FX (exhaust vent partly covered with gauze).

I'm vaguely conscious of adjusting my mask at different times in the night, I think because of noises from leaks or the exhaust vent. But this is only vague recollections. My flow rate chart looks pretty "spiky" later on in the night. Are these spikes evidence of this? Are they arousals? Or are they just REM? Here's my chart on SleepHQ.

I can't tell whether these spikes in flow rate are caused by prior leak events, or whether they are movements which subsequently cause transient leaks?

I followed the usual advice on adjusting the mask: just tight enough to keep it on properly, etc.

Any advice would be great, thanks!

[ChicagoGranny]

my mask is Swift FX (exhaust vent partly covered with gauze).

This is a bit of concern. CPAP masks are designed to vent at levels necessary to prevent CO2 buildup. Covering part of the vent could allow CO2 to rise to unhealthy levels.

[Miss Emerita]

I think you'll benefit from learning to identify arousal breathing. Some of the spikes are just deep breaths, but others are part of a bit of arousal breathing.

What you need to do is to zoom in on the flow-rate graph and take a closer look. A spike may just be a sigh while you're asleep, but it may be part of a bit of arousal breathing. Arousal breathing is much less regular than asleep breathing. It often includes flow traces that show deeper inhalation and exhalation for multiple breaths, and you'll see that the shapes of the traces are distorted by comparison with asleep breathing.

Short arousals during the night are normal. We don't generally remember them, and they don't necessarily interfere with sleep architecture (the succession of sleep stages throughout the night). But if arousals are very frequent, or if the awakenings are prolonged, they can contribute to daytime sleepiness.

I notice that your total time with the machine is 7 hours. Any chance you can rearrange your schedule to get more like 8 hours?

I also notice that your pressures change fairly frequently, mostly in response to flow limitations. Do you think they might contribute to your sense that you aren't sleeping as soundly as you might? It appears you have EPR set at 2. As an experiment, you might try going to 3, to see whether that tames the FLs a bit more. You'd want to raise your minimum to 7 to get the benefits of the EPR of 3, since the machine can't go lower than 4.

[DayDreamBeliever]

my mask is Swift FX (exhaust vent partly covered with gauze).

This is a bit of concern. CPAP masks are designed to vent at levels necessary to prevent CO2 buildup. Covering part of the vent could allow CO2 to rise to unhealthy levels.

Yes, absolutely. I got some guidance from @robysue1 about this. I'm using gauze, which is less dense than her solution, and it's also only partly covering the vent.

I can feel the warmth of my exhaled air with my hand next to the vent, and it changes to cool air almost as soon as the exhale finishes. I take this to mean that the CO2 is dispersing properly.

[DayDreamBeliever]

I think you'll benefit from learning to identify arousal breathing. Some of the spikes are just deep breaths, but others are part of a bit of arousal breathing.

What you need to do is to zoom in on the flow-rate graph and take a closer look. A spike may just be a sigh while you're asleep, but it may be part of a bit of arousal breathing. Arousal breathing is much less regular than asleep breathing. It often includes flow traces that show deeper inhalation and exhalation for multiple breaths, and you'll see that the shapes of the traces are distorted by comparison with asleep breathing.

Do you have any pointers where to learn more about how to distinguish arousal breathing from sighing, movement, etc.?
Thanks so much

[lynninnj]

I'm quite new to this CPAP game. I believe I've gotten used to it, my settings seem basically well-titrated and my stats look good. But I'm not feeling less tired during the day.

My machine is Resmed AS10 Autoset, and my mask is Swift FX (exhaust vent partly covered with gauze).

I'm vaguely conscious of adjusting my mask at different times in the night, I think because of noises from leaks or the exhaust vent. But this is only vague recollections. My flow rate chart looks pretty "spiky" later on in the night. Are these spikes evidence of this? Are they arousals? Or are they just REM? Here's my chart on SleepHQ.

I can't tell whether these spikes in flow rate are caused by prior leak events, or whether they are movements which subsequently cause transient leaks?

I followed the usual advice on adjusting the mask: just tight enough to keep it on properly, etc.

Any advice would be great, thanks!

I saw significant uptick in flow limit spikes with the “soft” response. Standard seemed to have helped.

Might be worth a tweak.

Not sure how it works on everyone but everyone is different so there’s that.

hth

[palerider]

my mask is Swift FX (exhaust vent partly covered with gauze).

This is a bit of concern. CPAP masks are designed to vent at levels necessary to prevent CO2 buildup. Covering part of the vent could allow CO2 to rise to unhealthy levels.

Yes, absolutely. I got some guidance from @robysue1 about this. I'm using gauze, which is less dense than her solution, and it's also only partly covering the vent.

I can feel the warmth of my exhaled air with my hand next to the vent, and it changes to cool air almost as soon as the exhale finishes. I take this to mean that the CO2 is dispersing properly.

As long as the gauze isn't actually blocking the vent, it's fine.

[lynninnj]

Soft response: https://sleephq.com/public/043fb92e-978 ... 0c64a90756

The next day with standard response:

https://sleephq.com/public/748cc0c4-cd8 ... e9470f78bf

could be random but I don’t think so.

Notice flow limit on this trend.
https://sleephq.com/public/b744eed9-22d ... 66f3ba53ac

The days with the greatest yellow section in flow limit was all soft response. Go figure.

[Miss Emerita]

About arousal breathing: Lanky Lefty has a video that is very helpful, but I can't seem to find it. Maybe someone else can provide a link?

I hope the attached illustrations from my night last night will help. The irregular breathing marks a brief arousal. In both of these cases, I fell back asleep quickly. If you wake up and lie there awake, the arousal breathing may be followed by regular breathing. For me, that interval will usually show a diminished flow rate and a lower respiration rate than asleep breathing. Then when I fall back asleep, the flow rate amplitude and respiration rate will increase.

Brief arousal zoomed out.png

[Jlfinkels]

About arousal breathing: Lanky Lefty has a video that is very helpful, but I can't seem to find it. Maybe someone else can provide a link?

Miss E, is this the one you were thinking covered it?

https://youtu.be/iX_ivhUyEnk

[Miss Emerita]

Interesting! This actually isn't the video I was thinking of; there's a longer one where I think he reviews a polysomnogram and tosses out a lot of CAs because they follow arousals. Does that ring a bell?

This video puts forward the theory that we can identify REM sleep via patterns in the flow rate, respiration rate, minute ventilation, and tidal volume. I think for many people's charts it just isn't possible to do that, and I'm least convinced that the contrast between even flow rates and spiky flow rates correlates with the difference between non-REM vs REM sleep. Others may have a different view of this.

(For what it's worth, I used a Dreem headband for a while several years ago. It has some EEG capacity, unlike other wearables. The Dreem data showed that sustained increases in my respiration rate almost always occurred during REM sleep, though the REM periods often extended beyond the higher RR periods. The Dreem also shows arousals of 2 minutes or more, and mine correlated very well with the kind of arousal breathing I illustrated above.)

[DayDreamBeliever]

I hope the attached illustrations from my night last night will help...

Maybe you can help me get a better feel for this. At the beginning of the night my flow chart is very regular:


Later on there are quite frequent spikes:
e.g.


and


How can I figure out if these are arousals? Or if they are disturbing my rest?
Thanks!

[DayDreamBeliever]

This video puts forward the theory that we can identify REM sleep via patterns in the flow rate, respiration rate, minute ventilation, and tidal volume. I think for many people's charts it just isn't possible to do that, and I'm least convinced that the contrast between even flow rates and spiky flow rates correlates with the difference between non-REM vs REM sleep. Others may have a different view of this.

I think this has been thrashed to death on another thread. Maybe it deserves its own topic.

[Jlfinkels]

Interesting! This actually isn't the video I was thinking of; there's a longer one where I think he reviews a polysomnogram and tosses out a lot of CAs because they follow arousals. Does that ring a bell?

Could this be it? https://youtu.be/6u7-TpSkb2A

[Miss Emerita]

Another interesting one, though focused on the EEG data we mostly don't have access to outside a sleep lab.

To the OP: brief arousals, unless there are a whole lot of them, are probably not messing up your sleep. But if you are awake for a while after an arousal, your sleep architecture may be affected.

Just looking at a stretch of regular breathing doesn't tell us whether you're awake or asleep. Instead, you want to look at the context. Did the stretch of regular breathing follow an arousal? And is your respiration rate a bit lower compared to your median for the night? If yes to both, then that's probably awake breathing.