PSG Results: Could this be UARS?

[deebob]

https://imgur.com/a/yq5HplJ

So the past couple nights have still not been great.  I tried keeping my pressure at 8, and a couple nights ago I tried PS of 4, which wasnt great, so I tried just going back to 8 IPAP with 5 EPAP, like I had with the Autoset back in February, and it didn't seem to help. I feel like I'm hungover today...really fatigued and headachey. I haven't really been dealing with anxiety lately, maybe a bit of depression from poor sleep and quarantine lifestyle. I am back to waking up every hour or two during dreams, with heart racing pretty often, and sometimes sweating (it is getting to be a warmer time of year which doesn't help with that). I seem to be having more OAs with the Aircurve than the Autoset. I don't know if that's due to something with the machine, or just something going on with me....but when I was using the Autoset in February I was very rarely having OAs, and the few events that were showing up in the data were often SWJ....whereas a lot of the events I'm seeing now don't seem to line up with times when I was awake, and actually seem to be really apneas. 

I still can't help but wonder if there's something about the Aircurve that is subtly different than the Autoset that's not working for me. I know everyone says it's pretty much the same machine if it has the same settings, but it doesn't feel the same even with the same pressure settings. Could there be other settings that I'm missing? Or maybe I was just feeling better mentally/physically at the time when the Autoset seemed to be working for me, and perhaps I wrongfully attributed my better sleep at that time to the machine.

[Dormeo]

It'd be useful to see a recent daily chart, deebob. I think you are on to something when you say you may take a break from news and devices and spend a lot of time outdoors. This certainly can't hurt, and it would be very good if it helped.

[deebob]

These are from the past two nights: https://imgur.com/a/yq5HplJ

With a couple zoomed in on OA events.

[Geer1]

Your data looks the same to me. Under 1 AHI means there is no issue with apnea. Your OA's like on Autoset are also almost always following a deep breath. These aren't real OA's, they are you holding your breath likely while changing position or something along those lines.

The only potential sleep disordered breathing visible is the flow limitations that are occurring although it isn't obvious that they are a problem. Higher PS is what normally helps with flow limitations, you could try higher pressure too but I imagine it will only make things less comfortable.

These machines use the same breath waveform and if you are using the same pressures there is next to no difference between the machines. The only functional difference is the addition of a couple timing controls but those likely aren't affecting you.

You can try changing trigger and cycle sensitivity if you want to try something. These are extra features on the Vauto, the higher trigger sensitivity is the sooner it will react to your spontaneous breathing and start to increase pressure. Cycle is similar, the higher it is the sooner it will change back to lower pressure. Some people find a higher trigger sensitivity is more comfortable for them, cycle seems to be less important. You can play with the settings when awake to see the difference they make.

[deebob]

https://imgur.com/a/BHgB7iN

So I experimented a bit with slightly higher pressure, 8.6 and 8.4, with high pressure support of 3.6, and I have not been sleeping well at all....and had a couple of nights where I experienced what felt like central apneas....even while awake and trying to fall asleep, I would almost have the sensation of forgetting to breath, and kind of gasp/jolt myself awake. This may have been because of anxiety or something else, but it seemed to go away when I changed the PS back to 3.2.  

Now the problem I'm facing is that I'm still not getting good sleep, and waking up frequently, and I think there are still issues with flow limitation, so I think I should probably try to do higher pressure, I just feel like the higher pressure has disturbed me in the past. I didn't do so well with the feeling of my stomach ballooning full of air, or my cheeks puffing up. I could try increased pressure support to alleviate this but I'm not sure if that will cause those central apnea feelings, even around 4 PS. Maybe I just need to force myself to try this higher pressures/PS and just get used to it.  I seemed to do OK around 8.0-8.4cm during the last week of my CPAP trial but it's not doing anything for me now with the Aircurve.

When I look at my breathing curves in OSCAR, they always look the same, even when I seem to be sleeping 'normally', can anyone explain to me how it should look, versus how mine looks, and what's going on there?  I always see this little squiggly plateau at the beginning of every curve. Is that resistance happening during inhale or exhale? I'm not really sure what is inhale and what is exhale.

[slowriter]

Inhale is top of the curve, and should be rounded; not jagged.

From what I can tell, your's look fine. Your FL numbers are also really low, which suggest you don't have a problem there.

Not sure on the squiggly part, but some have suggested they are related to heart rhythms.

[Sleeprider]

We really can't tell what is going on at the breath level unless you zoom into about a 2 minute segment of the flow rate, but you don't have any events, no flow limitation and at the full night level there is nothing to say. Let's take a look at a zoom and see.

At one point, you changed the trigger and cycle sensitivity, and you might want to put that back to medium or try some other settings.

[Dormeo]

Sleeprider, if you scroll down in the Imgur stuff, you'll see a couple of two-minute zooms. To my eye, they look fine, as slowriter says. The tops are smoothly rounded.

The "plateau," deebob, is the pause between your exhalation and your next inhalation. That is normal and as it should be. The little squiggle is almost certainly the result of your heart beating. I have the same thing. It is called the cardioballistic effect, or cardiogenic oscillation. It is harmless.

[Sleeprider]

Ah! of course! I was only looking at the top image. All normal with a kind of long exhale, which brings me back to changing out of the low trigger sensitivity.

[deebob]

OK I actually don't think I changed the Cycle or Trigger settings.  They are currently Trigger: High, Cycle: Medium.  I also have Ti Max 2.0s, and Ti min 0.3s.   Would it be beneficial changing any of these?