Help - daytime sleepiness, frequent deep sighs

[2SleepBetta]

CD, 

I see you handled my shorthand times correctly but also saw that I  blundered by not making clear that the two time interval spans were in the later APAP graph when I confused things by indicating I didn't see much to comment about, otherwise,  in that later APAP graph. Further, my tunnel-vision focused on other FL -related matters, I still should  have immediately noticed that the summary for the APAP graph conflicted with the two pressure curves, plain as day (and I  do recall seeing two curves, but that didn't register at the time). My bads.

My two time interval call outs were attempts to see zoomed views at transitions from higher FR to attenuated FR at pressure, or vice versa, and/or FL and leak-change times (which you can see in the APAP graphs).

That said, I did look at your two zoomed views given, my error, to see what might be salvaged there from the CPAP graphs.  There larger I-E time differences overall, from a "best visual SWAG" with an on-screen ruler, showed  I/ E = 1.7/2.1 for the 03:45 curve starting, and 1.5/1.6 for the  curve with 05:25 starting.  Those ratios seem high (compared to the commonly seen acceptance of 1/1.8 as a "normal" or example ratio)  but the latter ratio of yours conforms fairly closely to your 95% RRs near 20 .

By fortunate accident, you captured the time matchup of a high I and a low E (worst case zoomed). It was I/E =2.25/1.2 (a very high ratio, bad if  continuous) at about 03:45:45 (see graph and the FR burst between the 3rd and 4th RERA). That is a strong clue, along with the local (all) RERAs, and it, IMO, calls for  larger zooms inside that 03:05-04:35 area with pronounced  FR attenuation, high FL and leak: zooms that would capture FR, L, FL, I and E times all in one view. Pulse and O2 info, if any, should also be looked at. This looks like it may be your hard work in sleep.

Cherry picking only the highest I and the lowest E in the frames, with mismatching times, those tended to be close to 1.5/1.5m--again, close to your 95% RR. 

Further interpretation of the I/E times along with all matters of titration are better left to more qualified hands and minds than mine. I still think there are strong showings of positionally caused/aggravated flow limitations--probably at low levels even where there are no FL flags, but that remains to be seen, quashed or dealt with. Your report of daytime sleepiness and unrested sleep, assuming there are no other explanatory health issues, "declares", IMO, UARS  in your poor sleep quality with low AHI. 

Please do examine zooms in the CPAP graph  at about 3:40 - 3:50 and look at the times and extent of largest divergences between the I and the E curves in those same views. Those divergences with persistent  I/E ratios of 1.0 and larger,  need some attention IMO.

2SB

[attachment=34240]

[CrazyDreamer]

I appreciate the help thus far and am hoping more information can help provide some information to help someone help me figure out what is going on and what I should do next.

I wore an oximeter to bed last night and it fed data to my phone.  I had my phone volume turned off as I didn't want any audible alerts to wake me since this is to try to figure out what a "normal" night might be like.  My oximeter did get me two vibration alerts with saturation dropped below 88 but I don't recall feeling them.

My saturation dropped to 87 twice within three minutes of one another for just two seconds but was below 90 for 18-30 seconds during those two episodes.  I am including the PDF report as well as an Excel spreadsheet with all readings with links below to the files in my Google Drive.

I discovered that I should have adjusted the time on my Resmed machine, it was about 16 minutes behind actual time.  Below I am linking to PNG screenshots of the entire night's sleep and then zoomed in to the what I believe the first period of time was for my first episode where saturation reached 87.  I am including to zoomed screenshots, the "top" screenshot are the typical files in the recommended Oscar layout and the "Lower" includes some of the charts that 2SB had previously requested.  These are also included as links to files in my Google Drive so that I can include everything in one post and to save data on the forum hosting.

Some of the comments (such as by 2SB) above leave me largely confused, I just don't understand the comments about the inhale/exhale ratios, etc.  Obviously, many of you spend a great deal of time understanding much more of this than I can expect to ever understand, I have just such a busy schedule and can't get everything done as it is.  If I can get some simple clear explanations, it would be greatly appreciated.  I still felt tired today and took a nap and also feel out of breath at times, with big sighs.  I was hiking last week and do fine with that other than the struggles from being obese, but still keep up a pretty good pace.  I feel more out of breath just sitting around, it seems.

Yesterday I was formally diagnosed as having ADHD as I suspected to be the case.  I started a prescription for 40mg Atomoxetine (Strattera) this morning.  The psychiatrist's office coincidentally is next door to the office where I had my sleep study in 2017.  This is in Lodi, California.  If someone has a exceptionally good doctor within an hour or two of there I would appreciate the recommendations.

Thanks in advance.

Oximeter files:
Graph report as PDF: https://drive.google.com/file/d/16yKo9Ac...sp=sharing
Excel spreadsheet of all data: https://drive.google.com/file/d/1Sq0Ca6t...sp=sharing

Oscar files:
Standard charts for full night: https://drive.google.com/file/d/1jSGXCrV...sp=sharing
Upper charts for zoomed period: https://drive.google.com/file/d/1uUDsHLZ...sp=sharing
Lower charts for zoomed period: https://drive.google.com/file/d/1MpiFLt8...sp=sharing

[S. Manz]

Judging by the description of your current condition and barring any other medical condition, I would appear that there is a strong case for you getting tested for CSA.
Look up published work by Mayo clinic researchers .Their research associates have done extensive work on Central apnea and in fact they first discovered a link between CSA and prolonged use of CPAP.
I used to have almost identical symptoms of day time sleepiness before I was properly diagnosed and started therapy with a ASV machine.

[2SleepBetta]

CD,

Re your Drive holdings, I don't use and am not familiar with Drive, but have had, for a long dormant group, a gmail account, which had been idle. After opening it again, after months, I thought  signing in there might enable me to open your Drive deposits. Not so. So I think you may have gotten my message asking you to "let me in".

For me to help against your low-AHI  but unrestful sleep, IMO, I have to look at greatly expanded views of FR wave peaks (ca 2-minutes), as you have done according to my faulty call outs, look at CA levels at EPR and EPAP pressures and look at Inhalation and Exhalation times, the latter both in absolute levels and as ratios. Also, it's good to view clear transitions from one FR level and pattern to another, all the more so if changes are as stark and as associated with other stark sleep metric changes as yours were in your first two OSCAR graphs. Leak curves with big changes, IMO, show probable motion. (In my case, and borne out by an accelerometer, even small leak changes caused or corresponded to even small movements during lateral sleep).

If you haven't already put such on Drive (assuming I "get in"), I'd like to see next a 2-minute straddle of all the following items in one full-screen view--FR, FL, TV,  L, I and E--the latter two with I next to and above E--all centered at the start time of the graphic I sent back to you (where the grey vertical bar identifies the 2.25 second I and the 1.2 second E point and amount of divergence . Am not sure, and can't look back easily, but think that the time was near 03:45 where there a burst in FR began near the middle of very attenuated FR.

I have often seen the most common ratio, I:E or I/E, expressed as 1:1.8. The higher your exceptional ratios are above your healthy range of normals indicates you are laboring harder and harder to breathe and it usually to points-to/correlates-with (a) increases in deformations of the shapes and flatness of your corresponding FR curve and  its +wave peaks and (b) probable increases in arousals that ruin sleep. The graphic I posted showed/suggested very briefly, at its start, that your breathing had just become freeer after a bout of very labored breathing: 3.37:1 vs the more typical 1:1.8.  Your RERAs in, and bracketing, the attenuated FR curve further witness transitions into and continuation of highly labored breathing.

Whatever you post, I'll see what opinion I might offer.

[CrazyDreamer]

Strange, because I chose the option to share it with anyone who had the links.

I'll post my Oscar screenshots first and then covert the PDF to a JPG file and post it but skip the Excel file.

Full night, standard chart:
   

Zoomed into period with low saturation, top portion of charts:
   

Zoomed into period with low saturation, lower portion of charts:
   

[CrazyDreamer]

SPO2 Report:
(by the way, I was very surprised that my heart rate dropped to 42, it was only there for 2 seconds, but was below 50 for some fairly long periods)

   

[SarcasticDave94]

Just sticking with the SpO2 chart, less than 90% under 2 minutes, not a serious condition. Heart rate can slow like this while asleep. I don't think either represent a serious issue on this chart.

[CrazyDreamer]

Okay, thanks, any thoughts on my Oscar charts and frequent daytime sighs?

[2SleepBetta]

CD,

After all your work and my being unable to access it (your later sleep session images that is), I ask you to stick with helping both of us understand what we see in a big transition of FR and FLs in your first graph, that one with high flow limitations and a deeply attenuated flow rate for a long period toward the middle of the session. 

The image below is the best I can do to improve on, I hope, my earlier request for changes of that presentation. It asks for a 2 minute 15 second view, beginning at 03:43:45, which will roughly straddle a time, 03:45:45, you included at the beginning of one of your zooms. It looks like there was a big change at that 03:45:45 mark where your I/E, as your graph and my reply  graph showed, was very high and your labored breathing became easier (according to the numbers and graphs, although there was a large increase in the FR signal there too). The breathing irregularities there need closer examination, IMO.

I realize you may be pressed for time and wish to drop this. How frequently do you have FR attenuations as shown in your first two graphs? Maybe they are rare exceptions and will not shed helpful light on why your sleep is so unrestful, but I believe at least that change, but probably more, needs a good inspection.

I will again try opening your later sessions you linked, but think trouble in them is of a related but less serious (?) SDB type or extent than the labored breathing to be depicted as requested below. To-the-second accuracy is for the purpose of being specific, but it would be good to span at least the time span requested, but not much more as FR deformities become more difficult to see.

 [attachment=34330]

[sheepless]

re daytime sighs. I think it was after quitting years of high doses of adderall, I had so many big shaky involuntary inhales followed by a big exhale/sigh, that I mentioned it to my doc. he said they were like yawns, for whatever that's worth.