flow rate irregularities during REM

If you don't feel great breathing through your nose during the day, then nasal congestion could be a cause. nasal congestion will get worse in REM sleep period - blood vessel expanding. High pressure cannot treat congestion in the nose.

a few things to check:

do you still see similar pattern with side sleep or prone sleep?

does your sleep quality get worse with lower CPAP pressures like 10cm?

Pugsy wrote: ↑

Fri Jun 25, 2021 10:45 am

Morbius wrote: ↑

Fri Jun 25, 2021 10:25 am

I got another one-- "Train Wreck Sleep Architecture".

Based on what has been stated so far, IMO you don't have an "SDB" problem, you got a "S" problem.

That's a good one. Gotta remember that. TWSA

Sort of like this guy below who didn't even have OSA (per in lab sleep study AHI 1 ish) but had really, really crappy sleep.
He got rather annoyed at me because I couldn't pull some magical machine settings out of my bag of tricks to fix his problem and wanted him to at least consider the Wellbutrin/or similar med (I forget exactly what he was on) as a contributing factor to the crappy sleep.


FWIW to the OP here....I see variances in flow rate similar to yours pretty much every night. It might be the phasic REM like Morbius talks about or it might just be from some tossing and turning a lot since I do have some pain issues causing some sleep problems.
Heck, might even be dream related changes in breathing.

I do see the repeated struggle to need higher flow rate (with sleep interruption) after a long period of low flow rate breathing (airway is still open but the flow rate is too low to be enough). So this could possibly a case of high nasal resistance during deep sleep.

Miss Emerita wrote: ↑

Fri Jun 25, 2021 1:19 pm

Just to pick up on the question about FLs and flex. When pressure increases at the beginning of inhalation, that little boost can prevent FL in some cases, reducing the effort and potential disruption that FLs can (in some cases) cause.

You might try A-flex, which might reduce the feeling that you're being hustled too fast into your next breath.

If I go this route, since I was titrated at 13, what would you suggest as a minimum pressure and EPR setting?

musculus wrote: ↑

Tue Jun 29, 2021 1:35 pm

If you don't feel great breathing through your nose during the day, then nasal congestion could be a cause. nasal congestion will get worse in REM sleep period - blood vessel expanding. High pressure cannot treat congestion in the nose.

a few things to check:

do you still see similar pattern with side sleep or prone sleep?

does your sleep quality get worse with lower CPAP pressures like 10cm?

I don't breathe great through my nose during day but hasn't been enough of an issue up until maybe now to look into it. I went to an ENT recently and he says that my nose has a slightly deviated septum. Upon me taking more notice I have realized my right nostril doesn't flow nearly as good as my left.

You know I'm not honestly sure if my sleep position has an effect or not because I'm not aware of what position I'm in during the night at what time. But if I was a betting man I would say that it's not significant because I haven't noticed better sleep in that position upon waking from it. But I have noticed I have trouble sleeping on my side with pressures above 13 cm because I get aerophagia.

It could be totally just my imagination but I think I do feel slightly better I think at a higher pressure. I can get an equivalent AHI at 9cm compared to 13+cm.

JC,
If it was me, I would drop the minimum to about 7 and then start working on UAR's(Upper airway restrictions). For $13 you can get a product called nasopure on Amazon that you use to clear out your sinuses before you go to bed. There are videos on the Amazon page to explain usage.UAR's would not be affected by your high pressures. I have airway issues and if I clear out my sinuses before sleep, I sleep better, I feel better, and I get lower AHI's and less flow restrictions. 15 minimum pressure sounds terrible to me, I'd never get any sleep. Try clearing out your airway.
Thumper

Because you aren't showing much in the way of obstructive events, you have some leeway to experiment with lower pressures and see how that works for you. Because you are using min = max, I'd suggest you drop the pressure by 1, to 12, and see how that goes. If you don't see an uptick in OAs or Hs, then try 11, and so on.

All of this is assuming that the one chart you posted is typical. It'd be useful if you could post another chart fairly soon.

I went back to look at your first post, where you wrote this:

"I often throughout the day feel fatigued, have hand tremors and feel wired but tired. have a horrible time falling asleep. I feel like I drank a pot of coffee even though I didn't drink any caffeine. My ahi usually falls between 1-3. One of my doctors says it could be my adrenals are burnt out from going awhile without cpap?"

If your doctor was referring to so-called adrenal fatigue, please read this from the Mayo Clinic:

https://www.mayoclinic.org/diseases-con ... q-20057906

Bottom line: "adrenal fatigue" is not an accepted medical diagnosis.

In your place, I'd pursue your daytime symptoms with a doctor who will listen attentively and do some relevant testing if needed. "Wired but tired" sounds to me like significant anxiety, but I'm not a doctor, much less YOUR doctor. So I hope you'll follow up.