Help me interpret my second Sleep Study results

[YouTakeMyBreathAway]

Still more tired than average today. Trending back to what I had before: more itchiness/mask-offs and fewer oxygen drops.

Two theories: 
1. Sleep deprived: I had little sleep over the past few days, so I probably had some level of sleep-deprivation which may have caused both me not noticing the itching and the decrease in my ability to keep my SpO2 stable throughout the night.
2. Stuffy nose: I had not done nasal rinses the past two days while I usually do them daily. I tend to have a slightly stuffy nose, which causes a slightly unpleasant feeling on exhaling and I think it causes me to not exhale as forcefully as people usually do (when awake) and maybe also causes micro-arousals from that feeling when asleep.

I backed down the pressure support to 6, will try this for a few days and if good will try going down further.



Besides "very low" cycle sensitivity, what is the best way for me to make me I:E ratio higher? I want to see if that may help.

[YouTakeMyBreathAway]

Feeling great again today morning! Woke up and got out of bed easily and even remember a dream! 

I'm still trying to understand what is causing these deltas between nights. Let me know if you have any hypotheses!

Here's my really bad day (2 days ago) compared to a ~perfect day (today):

Really bad day:
(note that stats include the nap I had to take later that day)



~Perfect day:


The strongest correlation I see in the data is with SpO2, which dropped more often on the bad night and was very stable for a couple of hours before waking up on the good night. There is also some correlation with Pulse Change (PC), in particular when not looking at the avg number and instead looking at the length of segments that had no pulse change flags, which were longer on the good night.

[YouTakeMyBreathAway]

I had a few decent days again and then bam, feeling super tired again today. This is last night:



My tidal volume today was a bit lower at 380 and my Minute Ventilation was lower as well at 5.88. What's the best way to increase Minute Ventilation?

I'm gonna try increasing TiMax from 2.0 to 3.0 in an effort to try to increase my tidal volume. I was also considering potentially moving to S-mode and disabling Easybreathe, I assume that'd also increase tidal volume, but it isn't very comfortable...

[YouTakeMyBreathAway]

I ended up leaving TiMax at 2.0 but upped TiMin from 0.3 to 1.0. It looks like this did result in an increased Minute Ventilation (6.63) but I ended up having a lot of oxygen drops for the first half of the night. It also didn't seem to actually increase my median inspiration time, so I'm gonna go back to 0.3s.



I wonder if potentially my issue is that I actually need to have shorter inhales. The problem w/ setting shorter TiMax is that in VAuto the device ends up not getting to the max pressure in that time, so I'd have to turn off Easybreathe and decrease the rise time manually I assume. I tried this just for a few minutes to see and it felt pretty uncomfortable...

I also believe one of my issues is nasal congestion - I struggle to exhale all the way / forcefully because my nose seems to be swollen inside. I can also tell that sometimes when I inhale there's a snoring noise coming from all the way in the back of my nose.

[YouTakeMyBreathAway]

Definitely something up with my nose being stuffy.

I wake up at night feeling hot again like I did before PAP, feeling out of breath like I can't get enough air through my nose and my mouth is dry (with full face mask).

What could cause by nose to suddenly be blocked? I don't think I changed anything that I eat.

I'm wary of taking Azelastine b/c antihistamines can make you drowsy themselves and Flonase has the potential sife effect of a runny or stuffy nose in itself.

I have already been doing nasal rinses daily. I use a sterile pre-made container, so unlikely that it would have caused issues.

I put on an AB filter on my machine and replaced he hypoallergenic filter with no luck.If it was an allergen that I breathe in, I'd assume that should theoretically have helped?

[YouTakeMyBreathAway]

Would love any recommendations on the stuffy nose, I'm pretty convinced this is my problem and also why on some nights my sleep is ~perfect while on others it is terrible.

[YouTakeMyBreathAway]

I felt like my F30i doesn't pump as much air into my nose (maybe given the small size of the holes?), so I tried the N30i w/ chin strap.

It went pretty well for the first ~2 hours, then my wife woke me up saying the mask was noisy. I could feel the very back of my throat being dry, so I swapped it out thinking I probably had a mouth leak again (reason I switched to full face). 

However, looking at the leak data, I am not sure if this actually was a mouth leak and my mouth itself was actually not dry, just the back of my throat? At the same time, I did experience SpO2 drops there, so something did change.



Anyway, after that I continued on with the F30i, but I adjusted the straps to not be as tight, trying to see if that would bump more air into my nose. This actually seemed to work and it did feel like there was more air coming into my nose (and my tidal volume was the highest in a while at 440), but it did cause leaks around my nose unfortunately... maybe time to try another full face mask?

[YouTakeMyBreathAway]

Felt pretty terrible yesterday and today doesn't feel any better from what I can tell so far. My oxygen plot also shows it.

[url="https://i.imgur.com/7zjFrMq.png][/url]



It looks like I need to make my mask super tight again to reduce leaks. I had re-adjusted my mask (F30i) after realizing it is so tight that it seems to hinder airflow into my nose a bit, but obviously this isn't working either.

I also still have the sense that my nose is clogged up more, but I can't identify any new source of allergies.

[YouTakeMyBreathAway]

I took Flonase yesterday for the first time in forever, in hopes that this may reverse my trend.

I feel absolutely miserable today. While the last few days were pretty bad in general, today I feel the same as I felt before treatment, so even worse.

Nothing obvious in my OSCAR data, but things I noticed:
1. SpO2 drops while falling asleep: While I was falling asleep, I jolted awake 3 times feeling out of breath and each time I checked my SpO2 sensor and it showed levels around ~91%, so something was up. The chart shows that my Minute Ventilation dropped to 2.5-3.5 three times, so that checks out, too. The drop is driven primarily by a below median respiratory rate (not tidal volume, which remained close to median). Flonase does list as side effect "troubled breathing", but I have had similar nights before, so not convinced my tiredness is from Flonase yet.
2. Mask didn't turn on after scratching: At 5:10 I took the mask off to scratch my nose and when I put it back on, I forgot to turn it on and it didn't trigger on. I turned it back on 20 minutes later when my wife woke me up b/c I was snoring. Interestingly my SpO2 remained fairly stable w/o the machine, potentially because I still had the mask on and was rebreathing more CO2?
3. Tighter mask fixed leaks: I re-tightened the mask to very tight again and the leaks are completely gone again. I ordered an F20 to compare.
4. Slept on back more: I checked my camera footage and I did sleep on my back for a bit this night (which I didn't for the last few), but it didn't correlate w/ the segments in OSCAR where my oxygen dropped slightly, so not sure if this actually is the issue, but potentially breathing was still more effort?





Looking at my long-term trends, my Minute Ventilation remained much higher than before treatment. Nothing obvious to see. I did remember I changed cycle sensitivity to "Very Low" on 1/16:

[YouTakeMyBreathAway]

Got myself Nasonex and used it for the first time today after starting on Flonase yesterday. (stopped Flonase)

It was a very noticeable difference - my nose felt significantly more clear throughout the night. Not 100%, but almost.

One thing I noticed is that it was harder for me to fall back asleep when I woke up at night - I had a similar experience when I have taken Afrin and Sudafed in the past.

Leaks remained at zero w/ the tighter mask.