Post-radiation changes... help requested

[REMember]

No worries, Crimson Nape. Let's get this figured out. The changes to my airway have changed everything I thought I knew, and I'm looking for a path forward. Please also keep in mind that I'm looking for recommendations for a new machine.

[Sleeprider]

Many thanks for your help, gentlemen.

Strange good or strange bad... for the last quarter of a century at high pressure, I really didn't have to make much of an effort to inhale. When I stopped exhaling, the machine kind of fed me a breath. Last night, that wasn't the case. I was conscious, at least at first, of the need to draw a breath. At such a low pressure, the machine almost felt like it was turned off. 

Subjectively, I'd say that last night was the worst night I've had in quite a while. That was my first impression when I awoke. I tried to do some physical work in the yard but was quickly fatigued, and I'm just not all here. I'm making silly mistakes. But I'm here to learn and you folks are quite sharp. So what's your recommendation for tonight? Other than the tweaks to the trigger setting and TI Max, the same settings?

This makes me inclined to take EPAP min to 8.0 and PS 4.0.

[REMember]

Morning, all

These CAs defy everything I know about setting up my machine. My AHI is moving in the wrong direction. What do you see? We made these tweaks yesterday:

EPAP min from 7 to 8
PS from 3.0 to 4.0
Trigger from Med to High
TI Max from 2.0 to 3.2  I felt this one and it seemed like a positive change. Can it be extended even a bit further for slow-breathers?

For comparison, I found data for two nights when I had the S9 in CPAP mode at 16.6

[Gideon]

you need to ignore the CA clusters when you restarted and at the end of the night. Anything that close to a clear full wake period is very suspect of not occurring in your sleep, that halves your CA count and your CAI dropping your AHI to 2.06

[REMember]

Ah! Thanks, Gideon! But if it makes a difference, I fall asleep at the drop of a hat. I am usually asleep in less than one minute.

[Crimson Nape]

You can extend the Ti max if you wish. I don't see any downside for you. Your chart shows your 99.5%tile to be 2.72 seconds. This is well within your current setting. I wouldn't be too concerned about the CAs. They are to be expected anytime you jack around with the pressure parameters. Allow your body to become normalized to its new environment.

BIG question; How do you feel? Better? Worse? The same?
- Red

[REMember]

Morning, Red. I sat on the edge of the bed assessing how I felt before I glanced at the machine. My first word today was, [epletive deleted]... heh heh. I feel foggy, compromised, not all here, and not the sharpest tool in the shed.  My senses tell me that it was a bad night.

It's the CAs that I've been chasing for awhile. My numbers went south when they showed up. I can get them to go quiet in the 16 range, but it's inconsistent. The OAs have gone largely quiet at all settings. That in itself is amazing, but the post-radiation atrophy is significant.

[Crimson Nape]

It sounds like you may be exhibiting a sensitivity to pressure changes.  However, looking at last night's graph doesn't seem to support my theory.  Looking at the Events tab - CA events, what are the times (roughly) in apnea?  

In order to aid in reducing the CAs, the alternatives are:
1. Going back to a PS of 3.
2. Increasing the Trigger setting to Very High.
3. Both #1 and #2.
- Red

[REMember]

Here are the CA events for last night.

[Crimson Nape]

Except for CA event #2, and maybe #8, they don't appear all that long.  Have you noticed that they start out occurring about every 2-hours and decrease to 1-hour intervals, with a crescendo after 5AM?  H-m-m-m-m-m.

Have you mentioned any medications that you are taking, maybe just before bedtime?