That's a very reasonable plan.Billymadison420 wrote: ↑Thu Oct 13, 2022 3:31 amI agree with your assessment! I am going to do one more meeting with a separate sleep specialist to be the tiebreaker in reading all the data. That way I can put the particular narcolepsy issued to bed. And start focusing on other causes.
There are a few things that jump out to my eyes in the data you posted.Btw here is a known good night of sleep (in that I felt well the next day):
https://sleephq.com/public/da98d7d9-882 ... c513ab8abf
Vs a known bad night of a sleep (felt bad the next day):
https://sleephq.com/public/765931a6-f86 ... c55e2af034
First, is there any chance that leaks are causing you to wake up more than you think? Overall, you do NOT have a serious leak problem in terms of the size of the leaks or the duration of the largest leaks, but on both nights, there does seem to be some evidence of restlessness after some of the leaks. And if leaks are possibly waking you up, then it may be time to consider whether you need to try to fix them even though they are neither large enough nor long enough to affect the efficacy of your therapy.
Second, you seem to get both flow limitations and snoring detected when the pressure is near the min, which then drives rather steep pressure increases and sometimes there is evidence that you get restless right around the time of a steep pressure increase. Your bad night (Aug 4) has a minimum pressure of 7cm, and your good night has a min pressure of 9cm. Have the number of better (not bad) days increased since you bumped your min pressure up to 9cm? Also your titration study (https://www.dropbox.com/s/mnzns34ikliyzws/PSG.jpeg?dl=0) seems to indicate that they needed to increase the pressure to somewhere between 12 and 14 to eliminate the snoring as well as the apneas and hypopneas. It's just possible that pressure increases might also be triggering some arousals/micro-wakes. Or it could be that the snoring and flow limitations that happen when your pressure is near the minimum are just enough to cause you to arouse or awake and that starts the restlessness. In either case, you might sleep better with an APAP range where the min is higher than 9cm, particularly if you are not dealing with any kind of aerophagia problems.
Third, on the bad night (Aug. 4), it appears that you tried to take a couple of naps earlier in the day. And there appears to be more restlessness throughout the night---as in the breathing pattern does indicate you could be having some problems with sleep maintenance. Though it is counterintuitive, sometimes naps can mess up your night time sleep. And one thing that people with sleep maintenance insomnia are often told to do is to eliminate all naps in an effort to help consolidate the sleep cycles at night and minimize the number and length of the spontaneous wakes during the night.
Fourth, do you need the ramp? On the good night (Sept 9), you ramp up from 7cm to 9cm over what looks like a 5 minute period, but you don't fall soundly asleep until about 5 minutes after the pressure reaches 9cm. (And all five of the CAs scored right after the ramp goes off are SWJ---i.e. they're not "real" CAs that would be scored on an in-lab sleep test.) Starting the night out at your full minimum pressure may make it easier to fit the mask so pesky leaks don't wake you up when the machine ramps the pressure up towards your max pressure setting.
Fifth, once the SWJ CAs are discounted, you really are not having that many events on either the good or bad nights. And that's evidence that your PAP therapy is treating the sleep disordered breathing just fine. Which means one of the following:things:
- some other sleep problem is causing your on-going daytime fatigue symptoms, with the most likely culprit being some kind of sleep maintenance problem
- something else is causing your on-going daytime fatigue problems---i.e. the depression and/or anxiety and/or the medications and/or some other health problem is causing the daytime fatigue
- or both