Help me interpret my second Sleep Study results

[YouTakeMyBreathAway]

OK yesterday seems to have been just a one off perfect night.

Got a new Tempur mattress topper for my bed and slept on it for the first time. It did seem to fix my hip pain, which is nice. I was hoping this would lead to fewer arousals, but my sleep overall was similar to before.



I was thinking a lot about what I may have done differently yesterday and the only thing that comes to mind is that I ate a low carb meal w/ just lettuce + chicken. Will give that another try.

[YouTakeMyBreathAway]

As promised, tried the Arugula + Chicken dinner combo again to see if I could replicate the perfect night's sleep - no luck in terms of replicating 0 oxygen drops below 93%.

That being said, I had significantly fewer mask off events, either because of my new Tempur mattress topper (second night on it) or potentially there's a connection to the food.

[YouTakeMyBreathAway]

Mask off events remained low, even though I ate regular food again. I assume the new Tempur mattress topper is what is helping me stay asleep.



My SpO2 has become less stable again. It does seem like the SpO2 dips are caused by unflagged breathing dips. Here is an example:

[YouTakeMyBreathAway]

Overall my Minute Ventilation seems to be on the lower end when comparing to others. During my first few days of CPAP my Minute Ventilation was at 4.88 and I have been able to gradually increase it w/ pressure adjustments. I got it to 5.5 on CPAP and now I got it to 6 on BiPAP

There still seems to be a lot of variance and dips in my Minute Ventilation chart:



Minute Ventilation closely tracks my heart rate variance:



Overlayed:

[Lucid]

From several days ago:  "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."

Here's are some suggestion to try:  don't wash your face with soap unless you are wearing heavy sunscreens or have exceptionally oily skin.  Even then, I would only at most use Cetaphil Gentle Skin Cleanser for Dry to Normal, Sensitive Skin.  Don't scrub with a wash cloth, etc.  (Soap disrupts the skin's normal moisture barrier and PH.)  Don't scrub with a wash cloth, etc.  

You could also try moisturizing your face, especially around your nose, with Neutrogena Hydro Boost.  There are several formulations; I can vouch for the body gel cream, fragrance free, for sensitive & dry skin.

I've tried scores of moisturizers and lotions at all price points and thought I had found excellent ones, but Hydro Boost blows them all out of the water.  It's the most moisturizing and yet the lightest feeling.

Also, if you're sleeping on your sides, be careful what detergent you are using to wash your sheets and pillow cases, and avoid fabric softeners, dryer sheets, etc.  Something like 7th Generation Fragrance Free or a generic version would be good.  And don't use more than the recommended amount of detergent -- you might be able to use less than that.  Select extra rinse or equivalent, too.  

Same with the mask -- I cringed when I watched The Lanky Lefty video where he's washing his dad's CPAP equipment and dumping a ton of dish soap in there.  The more soap you use, the harder it is to rinse it off.

I have no affiliation with these products or any of their points of sales.  They're on lists recommended by my dermatologist for eczema patients.

Good luck, it looks like you've lessened the sleep disruptions recently, which is great!

[YouTakeMyBreathAway]

Lucid, I think you're on to something w/ the soap. I switched my mask for a new one and I didn't have to take of my mask to scratch myself once all night. My daughter woke me up 4x, unrelated to my mask.

I'll follow your advice on using minimal soap - maybe I'll just try warm water for now. Have you found any particular soap that you felt works well to wash your mask?

I somehow still ended up feeling more tired tonight. Nothing obvious from the charts. There were two obstructive apneas while sleeping on my right side and my oxygen dipped to 89% once when I was awake.

One question I had was whether my minimum pulse rate of 40bpm is considered normal? I know really athletic people have a lower resting heart rate, but I'm not athletic at all. 

[Lucid]

I use 7th Generation [fragrance] Free and Clear dish soap (or store brand equivalent) for washing my mask once a week and don't use any kind of wipes on it.  If I see moisture in the pillow or detect any funkiness in between washings, I just wash it again.

I try to remember to moisturize my face during the day rather than right before I go to bed, so that I'm not getting lotion on the nasal pillow, but I'm not sure it matters with Hydro Boost.

Give these changes a week so that your skin has a chance to recover.

I feel for you with the itching -- hope this helps!

[YouTakeMyBreathAway]

I got some 7th Generation dish soap and used this to wash my mask this morning, fingers crossed.

I also thought to myself, why am I not playing around w/ my settings to see if they are fully optimized, so I did this:

1. Previous night: Increased PS from 6.0 to 7.0 
Since this led to leaks around my nose, I tightened my straps. The tighter straps made me feel like there was somehow less air/pressure coming (huh?!) and it felt like my breaths were cut off short.
4. This night: I changed my "Cycle Sensitivity" setting to "Very low" in hopes of fixing this. The flow still felt lower, but my breaths were not cut off anymore.

This morning, I felt potato, presumably because I once again kept waking up to scratch my nose, very frustrating.

To my surprise though, my oxygen levels looked great!



Looking at my stats in OSCAR, this seems to be because the lower cycle sensitivity increased my I:E ratio:



Interestingly, this chart also shows that my I:E ratio actually dropped when I tightened the straps, so something really happened there? It has been consistently 47-50%, then dropped to 43% yesterday and increased to 56% today. What can I do about the strap-tightness causing changes in flow? Is there an optimal I:E ratio?

[YouTakeMyBreathAway]

Will continue using unscented dish soap instead of unscented hand soap for a bit, but haven't yet noticed a difference (still woke up itching a few times).

That being said, the Cycle Sensitivity at Very Low may actually have been a good change. My oxygen again was more stable than average!



I:E Ratio remained higher than before at 60%:



I want to evaluate this for a little longer before making any other changes, but I noticed this matches Resmed's titration recommendation for "Restrictive Lung Disease (Neuromuscular Disease, chest wall abnormality)", which suggests setting a high trigger sensitivity (I did this) and a low cycle sensitivity (I did this) and a higher TiMin (what I'd like to try next). After observing for a few days that this wasn't a fluke, I also want to reduce the PS down because I don't think I saw any benefit from going from 5->6 and from 6->7.

What I found interesting is that Resmed's titration guide also recommends setting TiMax to 1.5s (vs 2.0s for "Normal Lungs") - this feels counter-intuitive to me if the issue is that in these cases inhalation doesn't happen long enough, but I guess doesn't hurt trying...

[YouTakeMyBreathAway]

OK, for some reason this morning I've woken up super tired, so I had to take a nap for the first time in a while. My SpO2 drops also are back up, but I didn't change any machine settings. 

When I took the nap, I actually jolted awake while falling asleep, felling like I wasn't getting enough air and looked at my SpO2 sensor and noticed my oxygen had dipped to 93%. So I guess even though these dips are not massive, they do seem to arouse me.

Besides all that bad news, my itchiness has remained low ever since I switched from hand soap to dish soap to clean my mask.