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Help me interpret my second Sleep Study results
RE: Help me interpret my second Sleep Study results
I suspect you are chasing zero, please don't.
At PS of 6 that about all you should do.

How do you feel,. The only thing you should be chasing is comfort. And I don't mean perfect comfort.
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RE: Help me interpret my second Sleep Study results
Objectively: Treatment definitely helped. I rarely need a daytime nap now and I needed that frequently before. My SpO2 drops reduced from >20/h to <5/h. When I went to high elevation the last few days my stats reverted to the levels before treatment (except AHI) and I was tired and needed daily naps, which made the difference evident.

Subjectively: It is a mix how I feel, some days I feel pretty good (rarely ever amazing), others I still feel tired.

The remaining tiredness could be related to something else. For example I do feel more tired after meals. 

My doctor had also ordered a Vitamin D test, which came back towards the lower end at 30ng/ml. I have been taking a supplement daily for over a month now, but haven’t noticed a difference.

There seems to be a correlation between my night time PC (pulse change) index and how refreshed I feel during the day, which makes me believe there is some remaining arousals that keep me from being well rested. I assume some are from mask tickles waking me up.
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RE: Help me interpret my second Sleep Study results
Noticed two interesting things:

1. When I woke up during the night, I felt a bit out of breath and my SpO2 was 91%. No nose itching that time, making me think the oxygen drops to ~90% may be arousing me.
2. I noticed a pattern only on some of my nights where right as I fall asleep my minute ventilation drops down to ~2.0 and my SpO2 also drops. This doesn't happen on all nights. On the nights it does happen, I tend to also have a less stable SpO2 chart throughout the entire night.

Is the drop when falling asleep normal? What could be causing me to only have it on some nights?

Totally understand the sentiment that oxygen drops from 97% down to 90% generally don't need to be treated (b/c >88%), but out of curiousity - if you absolutely had to treat - how could it be achieved?

Oxygen trend tonight was overall rougher again w/ more drops:
[Image: lonetIg.png]

Example of breathing pattern when falling asleep:
[Image: aCsJvoU.png]
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RE: Help me interpret my second Sleep Study results
Hi. Elevation definitely lowers overall O2 and I notice bigger sporadic drops while sleeping. We left 8k for the holidays and went to sea level. About a 5% O2 increase for me both day and night (92 average to 97 daytime and 90 to 93 average night). I had to lower both Ipap and Epap by 2 to feel comfortable. Zero AHI for 4 of 6 nights.

I forgot how nice oxygen filled air is… and 75 degree days were pretty nice as well. Your thread is an interesting read so please keep up the good work and posts.
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RE: Help me interpret my second Sleep Study results
Thanks Mugsy, that is helpful information, particularly how much you needed to change your IPAP/EPAP!

Last night was kind of interesting again, same thing happened right as I fell asleep, this time the machine actually recognized it as a central apnea:

[Image: YfxiUD0.png]

So I guess tl;dr question: Why could I be having central apneas right as I transition from wake to sleep?

On a positive note, it seems like my nose/face tickles have reduced and I have fewer mask off events! My SpO2 was much more stable than yesterday but I can't tell why, I didn't change anything.

[Image: z3g5E7c.png]

I see two potential reasons why fewer tickles:
1. My mask is wearing out and my beard is growing, leading to a poorer seal (leak was previously ~0, now constant) --> maybe the extra airflow helped.
2. I switched the soap with which I wash the mask and I also switched the body wash and shampoo I use --> maybe allergies reduced.

What is odd is that tonight I had few oxygen drops (2.0 SD/h) and few mask off arousals (0.53/h), but I ended up w/ higher heart rate variability (20.66 PC/h). So either:
1. I'm still having micro-arousals
2. PC is actually not as useful of a metric as I had hoped 

For #2 it could go something like: 
1. Low amplitude PC events -> bad (I read low HRV is a sign of an unhealthy heart)
2. Medium amplitude PC events -> perfect (opposite of above)
3. High amplitude PC -> bad (real arousal beyond a certain pulse rate)
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RE: Help me interpret my second Sleep Study results
Went to bed more tired (and later) this time around. 

Two things happened:

1. While I usually keep taking my mask off to scratch my face, this time I slept through. Almost guaranteed to be at least partially related to being tired, but I also changed the soap I use to wash my mask.
2. I had more oxygen drops (10.71/h) and a higher AHI w/ 4CA and 3OA events (0.99/h).

[Image: UZO4GrC.png]
I shaded the areas where I slept on my back for context.

Just during time on my back (141 minutes) I had:
- 36 SpO2 drops [15.3/h]
- 4 OAs/CAs [1.7/h]

Maybe I need to increase my EPAP a bit, it seems like it may not be enough for when on my back and tired.
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RE: Help me interpret my second Sleep Study results
OK, complete 180 flip: 
1. Good: Oxygen drops are back to almost ~none again, but 
2. Bad: Mask-off events from itchiness are at ~2/h again. 

I didn't really change anything. Same soap and actually just trimmed my nose hair before bed, so that shouldn't have been the problem.

Has anyone done laser nose hair removal? I'm seriously considering it, but not sure about whether it would be successful or a waste of money.

Any other hints also appreciated. I'm going to get a new mask soon, will see if a fresh mask fixes the issue, which could point towards allergies to soap used for washing.

[Image: PKWHcsE.png]
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RE: Help me interpret my second Sleep Study results
If it is an allergy, you may consider taking a 25mg Benadryl at bedtime to see if it relieves or reduces the itching.

- Red
Crimson Nape
Apnea Board Moderator
Useful Links -or- When All Else Fails:
The Guide to Understanding OSCAR
OSCAR Chart Organization
Attaching Images and Files on Apnea Board
Apnea Helpful Tips

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RE: Help me interpret my second Sleep Study results
Unfortunately Benadryl completely knocks me out the next day, same w/ Zyrtec, Allegra, so that ends up defeating its main purpose...  Sad

Tonight I noticed that ~all my wake-ups were because of itching between my mustache and nose, not within my nose, so that re-enforces that this whole itchiness may actually not be related to nose hair or at least not solely.

[Image: HMlURrW.png]

I was also able to re-confirm that PAP is helping me, as I took my mask off and slept on my back without for a bit and my SpO2 and HR clearly show it.

There was a weird segment of elevated heart rate and SpO2 drops from 3:00 to 3:45am. It begins as I turn onto my right side and it ends ad I tuck my chin a bit, staying on the right side. I wonder what could be causing these patches that I have on most of my nights. While the SpO2 drops are probably alright since very minor, the heart rate went all the way up to 104 bpm during that segment.
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RE: Help me interpret my second Sleep Study results
Woke up pretty tired this morning, so I was surprised to see that I actually had my best night ever in terms of oxygen drop, w/ my oxygen not dropping below 93% once. 

This has never happened before. I didn't change anything. My assumption is my body is getting used to what appropriate ventilation feels like and this is reverting a low-grade chronic hypercapnia that accustomed me to a small amount of hypoventilation - is that a thing? I looked at my blood work and found that my CO2 (Bicarbonate) value was consistently at 30mmol/L until my most recent measurement (on BiPAP) where it dropped to 25 mmol/L.

I think this re-enforces the hypothesis that my remaining tiredness is not related to oxygen drops, with the most obvious culprit being the high amount mask-off events (from itchiness) (1/h last night) and last night in particular I also had some leaks towards my eyes that bothered me towards the end of the night.

[Image: 6L6brmE.png]
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