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Help me interpret my second Sleep Study results
RE: Help me interpret my second Sleep Study results
A few weird thing happened today. 

1. I had a bunch of oxygen drops while wearing CPAP (!) starting at 00:24. Not sure why?! All I can think of is that my nose felt a little stuffy, flow limitations at the time were pretty small, but I think this may still have been it... i.e. lying w/o the mask for a while clogged up my nose. Does that make sesne? I pasted the image of that segment below. The segment w/o CPAP before and after are both segment w/ me in the bed but forgetting to turn the machine back on (w/ mask on face). The second segment w/o machine w/ the many drops is on my back
2. I took some CBD before bed and it made me super tired throughout the night. I woke up at ~3:45 to use the restroom (still 90% asleep doing so) and when I came back I simply forgot to put on the mask, I was so tired. But here's the thing - I didn't have almost any big oxygen drops at all while sleeping on my left side w/o a mask like I usually had...?!  Huhsign
3. Maybe it was the CBD that helped - I had a longer than usual segment w/o nose tickles / mask off events at the end (3h7m). But it's a mixed bag either way if it makes me forget to put the mask back on and I also feel similar to having a caffeine withdrawal crash now.

[Image: V6IWZ72.png]

[Image: HVPiix7.png]
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RE: Help me interpret my second Sleep Study results
OK, same weird thing happened again today (but more severe)! Please help...  Huh

1. No CPAP + No Oxygen Drops: 3:12 - 3:48 (36min) - Position: Left side
2. CPAP + Oxygen Drops: 4:49 - 5:14 (25min) - Position: Right side

Positional? I don't think it's related to the side I sleep on, because my segment from 1:29-3:14 was also all on the right side. It could possibly be from tucking my chin more, but wouldn't that show on my charts as reduction in tidal volume or something?

CBD? I still feel significantly more tired since trying CBD the evening before yesterday, including barely being able to open my eyes during the night when I wake up and in the morning. It looks like CBD half-life is ~2 days, so plausibly that is still making me over-tired. Still weird that it doesn't show up in my flow rate despite pretty sizable oxygen drops?

Minute Ventilation OK? The most confusing bit is that Minute Ventilation actually looks OK during the period of more drops (same was true yesterday). 

[Image: BSnmlCq.png]

[Image: BW50pR5.png]
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RE: Help me interpret my second Sleep Study results
CBD probably starting to get fully out my system now - night looked normal again, still with a lot of mask offs for scratching...

[Image: 6L1PkJd.png]

There were some minor drops while wearing the machine again - would it be worth bumping my IPAP?
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RE: Help me interpret my second Sleep Study results
Great data tonight again.

I washed my face w/ Dr. Bronner Unscented before bed and I had fewer mask off events, so maybe this actually is helping, will keep trying.

There was only one section w/ oxygen drops (1:15) and it seems like I had a few unmarked hypopneas during that time. I had some unmarked hypopneas around 3:25 as well (but oxygen didn't drop quite as much).

If I understand titration right I need to increase IPAP to fix hypopneas, but am hesitant b/c the data overall looks pretty good.

Full Night:
[Image: kellLYS.png]

Hypopneas w/ Oxygen Drops at 1:15:
[Image: nGm5jzB.png]

Hypopneas w/o Oxygen Drops at 3:25:
[Image: liBoWUD.png]
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RE: Help me interpret my second Sleep Study results
I have a bunch of very interesting new data points, would love your thoughts!

I went to high elevation (6250ft) for a few days and my oxygen was low throughout the day and night, my BiPAP didn't seem to help. It looks like my Minute Ventilation dropped significantly (6.0 --> 5.0) driven fully by a lower tidal volume.

Day 2 at high altitude:
(Used F20 - usually I use an F30i. Leaks were really good (~zero))
Time below 90% SpO2: 1h32m (17% of sleep)

[Image: LgM0yzb.png]

Afternoon Nap at high altitude:
Time below 90% SpO2: 3m (6% of sleep)
[Image: BIqPatP.png]

Day 3 at high altitude: 
(Increased PS from 5.0 to 6.0 at midnight - no effect on respiration metrics)
Time below 90%: 2h52m (32% of sleep)

[Image: ANY0qLM.png]


Now that I am back at low altitude (~sea-level), my latest night also has very interesting data points:

[Image: u3H9oR9.png]

1. [0:24 - 0:55] I was lying on my back. High heart rate variability started and stopped exactly as I turned onto/off my back. Is my pressure still too low to support back-sleeping?
2. [0:43 - 1:00] (zoomed below) SpO2 drops w/ mask on. I thought this was b/c of back-sleeping, but my SpO2 kept dropping for ~7 minutes after turning on my side. (??)
3. [4:14 - 5:00] (zoomed below) SpO2 drops w/ mask on lying on my side the entire time. 

Zoom of #2:
[Image: EvpQvCP.png]

Zoom of #3:
[Image: FSsuyrQ.png]
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RE: Help me interpret my second Sleep Study results
Similar story today with a few sections of oxygen drops while wearing my mask. What do I need to adjust?

[Image: 44ZoN8V.png]
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RE: Help me interpret my second Sleep Study results
With these numbers your concern should be predominately comfort.  IMHO you could be over titrated.  You are using a PS of 6.  I see no reason to require this in the data.  
On Oximetry I didn't deep dive.  When I look I consider duration at or under 88% to be the critical factor.
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RE: Help me interpret my second Sleep Study results
Thanks Gideon

I just increased the PS to 6.0 three days ago when I went to high elevations and my oxygen was under 88% for more than an hour at night, hoping it may help - but honestly it did not seem to change anything at all.

I’m down to try to reduce it back even lower than 5.0 if you think this would potentially be helpful.

One thing to note is that my sleep study without and with CPAP almost exclusively flagged hypopneas, which IIUC should be treated by increasing PS according to the Resmed titration guide.
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RE: Help me interpret my second Sleep Study results
With 1 hr LTE 88% I'd try that too.  But increase EPAP as well at altitude.  
When this is of concern add this as an initial note.

Plan on two different settings, one for altitude and one for normal.
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RE: Help me interpret my second Sleep Study results
That makes sense, will use higher EPAP as well next time I travel to high elevation.

Would love any advice on how to treat my remaining hypopneas. Here's an example from last night with mask on, side-sleeping. 

These areas are sprinkled throughout the night and always look similar with some breaths having reduce tidal volume and some having reduced respiration rate.

[Image: BaDGGXj.png]
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