[Symptoms] Oscar Help! Brain fog, fatigue, anxiety, etc.

[Dormeo]

By the numbers, your settings now seem to be optimized. You might want to sample a few calm-looking segments of sleep to see whether the inspiration curve in the flow rate graph is flattened. If you do that, could you let us know what you see?

Given the sudden onset of many of your problems, I do again suggest some more testing and diagnostic work with your doctor.

[Jackpine]

Dormeo pid='542175' dateline='1735862920']By the numbers, your settings now seem to be optimized.  You might want to sample a few calm-looking segments of sleep to see whether the inspiration curve in the flow rate graph is flattened.  If you do that, could you let us know what you see?

Given the sudden onset of many of your problems, I do again suggest some more testing and diagnostic work with your doctor.

You, me, and my ENT all agree my numbers look great lol. I have a follow-up appointment scheduled to discuss getting more bloodwork done. Also have an appointment with a myofunctional therapist to assess my tongue tie. My gut feeling is that I have an airway restriction that is causing micro arousals throughout the night. Not enough to wake me up, cause apnea events, or drop my 02 (have 02 ring to confirm this), but causing me to get extremely unrested sleep.

Here are screenshots from smooth areas of flow rate from 1-1-25 where you can see flat tops present:

   

   

Here is a screenshot during flow limitation also from 1-1-25. You can see flat tops along with other classes of flow limitation

   

[DaveSkvn]

Hi Jack,

Looking at the first and second screenshots, there are flat tops but I don't think that magnitude of levelling will be viewed as notable. The third screenshot is a bit more of an issue.

Do you have an explanation for your breathing rate variation (Your screenshot from 31 Dec below)? I wouldn't be surprised if each "block" is associated with a sleeping position. You won't believe how active you are at night until you video yourself.

   

You can see what a typical night was like for me further up the thread (I have video linking the blocks to positions. Though often the breathing rate crescendoed in a position before dropping back to 12 in a new position - and then rising again). This was me last night.

   

There is far less blocky behaviour (A soft foam collar made a big difference so I got a semi-rigid "Philadelphia collar" and that was the first night in use - I felt surprisingly awake this morning - but still some way to go). Also do you normally have a fairly fast breathing rate of 18 bpm? I take it you are taking long slow breaths when you switch the machine on so its hard to tell the normal state.

For me, the nuttiest graphs occurred at the highest breathing rate. Do you have 60 seconds of flow rate at, say, 06:10 and 07:00 on 31 Dec (or morning of 1 Jan!)? If you can, set the y-axis scale to a fixed value (right click to the left of the graph, select y-axis and set mode "override", min -40, max +40 or similar).

[Dormeo]

Like DaveS, I think the tops in the first two screenshots are fine. I'm intrigued by the possibility that your respiration rate varies in relation to your sleep position; another possibility is your sleep stage. An elevated respiration rate during REM isn't uncommon.

While it's possible your problems arise from subtle airway restrictions, that doesn't quite explain the fairly sudden onset of symptoms that you've described. I'm glad you'll be following up with your doctor on other possible causes.

[DaveSkvn]

On the breathing / position issue, this is my respiration rate graph from Tuesday night. I have video of moving onto my left side at 22:33 (no correlation) and onto my right at 23:51 and onto my left at 01:04 and onto my right at 01:29. Much the same story for the previous two weeks - not exact correlation but well over 50% of significant changes in respiration rates linked to a change of position.

   

[Jackpine]

Hi Jack,

Looking at the first and second screenshots, there are flat tops but I don't think that magnitude of levelling will be viewed as notable. The third screenshot is a bit more of an issue.

Do you have an explanation for your breathing rate variation (Your screenshot from 31 Dec below)? I wouldn't be surprised if each "block" is associated with a sleeping position. You won't believe how active you are at night until you video yourself.



You can see what a typical night was like for me further up the thread (I have video linking the blocks to positions. Though often the breathing rate crescendoed  in a position before dropping back to 12 in a new position - and then rising again). This was me last night.



There is far less blocky behaviour (A soft foam collar made a big difference so I got a semi-rigid "Philadelphia collar" and that was the first night in use - I felt surprisingly awake this morning - but still some way to go). Also do you normally have a fairly fast breathing rate of 18 bpm? I take it you are taking long slow breaths when you switch the machine on so its hard to tell the normal state.

For me, the nuttiest graphs occurred at the highest breathing rate.  Do you have 60 seconds of flow rate at, say, 06:10 and 07:00 on 31 Dec (or morning of 1 Jan!)? If you can, set the y-axis scale to a fixed value (right click to the left of the graph, select y-axis and set mode "override", min -40, max +40 or similar).

I normally have pretty relaxed breathing around 10bpm while awake. You can see this in the beginning of the graphs my breathing is usually deep and quicker when I put the mask on and get situated in bed. Then it will slow down to ~10bpm. I am guessing I am falling asleep when my resp. rate starts to climb to around 18bpm. However, if my anxiety is bad during the day I noticed my breathing gets very shallow and more rapid. This past week I have been focusing on nasal breathing and slowing my breathing down when this happens. It works tremendously. I've never had an issue with anxiety until this past year and it feels like it is occurring during sleep and carrying over into the daytime as I am usually riddled with anxiety from the moment I wake up. Meditation and breathing practice first thing help to calm it down.

Regarding sleeping position, it is very interesting you mentioned this. My whole life, before I got cpap 4 years ago, I had been primarily a prone and side sleeper. I am guessing because gravity would pull everything down and open my airway. When I started cpap therapy I had a full face mask which made it impossible to sleep prone and very difficult to sleep on my side without causing massive leaks. Because of this I switched to sleeping on my back primarily and would end op on my side a lot with my mask leaking like a sieve. I also had to tighten the neck straps very tight to try and stop leaks. Over time the muscles in my neck, traps, shoulders, and upper back started getting very tight. Tight to the point I would have episodes where my neck would get completely locked in pain and could not move it. switching to the nasal pillow mask and mouth taping 6 months ago solved the majority of this. However, I have still been sleeping on my back and side primarily... I tried sleeping prone and on my side the past two nights with minimal pillows and my TMJ pain has gone down by like 80%!!! My tinnitus also seems to be improved by maybe 25%? I also remember dreams that I had, which never happens. I also feel more refreshed than I typically do by maybe 20%... All this to say I forgot to put my memory card back in so I didn't log any of the data   . I also seem to be coming down with a cold that my had this past week so that will probably affect my sleep over the next week.

Here are those screenshots from 6:10 and 7 on the morning of 1-1. Do you have any recommendations on a camera to record sleeping positions during the night? I'll have to try a soft collar as well.

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[Jackpine]

Like DaveS, I think the tops in the first two screenshots are fine.  I'm intrigued by the possibility that your respiration rate varies in relation to your sleep position; another possibility is your sleep stage.  An elevated respiration rate during REM isn't uncommon.

While it's possible your problems arise from subtle airway restrictions, that doesn't quite explain the fairly sudden onset of symptoms that you've described.  I'm glad you'll be following up with your doctor on other possible causes.

I am intrigued by sleeping position as well. I am guessing this has an impact. Going to try and record myself sleeping to get confirmation.

I should have done a better job explaining the timeline of my symptoms. They weren’t completely out of nowhere. There was certainly a build up, but they got extremely bad very quickly. If you reference my previous reply I outline the muscle issues in my neck and shoulders that slowly started to get worse ever since starting my cpap therapy 4 years ago. I also started noticing brain fog and some slight dizziness along the way. My symptoms got very bad about a year ago after having an anxiety/panic attack for the first time in my life that seemed to come out of nowhere. I Have never been an anxious person and have always been really good at handling stress. It was almost like one day my parasympathetic nervous system broke and wouldn’t turn on. I have seen countless specialists, gotten imaging and bloodwork done, and am continuing to do so to get to the bottom of this. After discovering I have a mild tongue tie my search for answers got pointed back in the direction of my sleep apnea/breathing. My ENT hasn't been any help though and just says my numbers look great. I wake up feeling so terrible though that it seems my sleep is at least a component.

[DaveSkvn]

Oh dear. A Cold and CPAP. They do not go together well.

I have to say your graphs at 06:10 and 07:00 look nothing like mine when a high resp rate was recorded. Here is one of the less ridiculous examples.

   

You breathing remains orderly and just gets faster. Mine becomes a mess - nothing like normal breathing. I think its fair to say that whatever I have and whatever you have are not the same thing.

The following is just a hypothesis. I have no medical background but it might give you something to think about... You mention tinnitus and dizziness. I've never experienced either. I don't think they are common symptoms of OSA or UARS. From what you've indicated your breathing rate is fine during the day but becomes elevated during sleep. You have TMJ (caused by bruxism? - in turn known to be caused by stress/anxiety). You wake more anxious/stressed than when you go to bed. You don't get good rest and the whole sleep thing seems to create immense anxiety.

Just a check: do you use energy drinks (or other substances) to deal with the daytime fatigue? You can be vague if you wish...

Also your breathing rate seems to vary in blocks. Its almost as if something is giving you pain that varies with position - e.g. a pinched nerve. It might be worth giving a soft foam collar a go and if that helps step up to the "Philadelphia collar".

I think it would be worthwhile recording yourself sleeping. It would allow you to see if your position is related to any breathing rate changes (or completely unlinked). It would also show up any flinches in pain / jerks or acting-out-dreams that may be going on.

I would do a search on your favourite online market place for "night vision webcam USB" or "infrared webcam USB". There are wifi options. It doesn't need to be high quality - just be able to tell which way up you are. I have a technical background so I've been using "vlc media player" to record from my webcam. There is also free software (dvr-scan) which scans a video file for motion - so you don't have to sit through the entire video of you lying motionless (hopefully).

I would get the camera, let the cold pass and see what the video has to tell...

Good luck!

[Jackpine]

As you pointed out my flow doesn’t look terrible but my resp. Rate is elevated consistently throughout different parts of the night. This is why I am thinking UARs could be the culprit. Enough space to breathe, but restricted enough to require more resp. Effort.


I’ve gotten MRI’s, CT scans, and a digital motion xray when the muscles surrounding my neck, traps, and shoulders was extremely bad It revealed I had forward neck posture and mild ligament laxity in my C1-C2, but still at the upper bound of normal. Every specialist I encountered said it shouldn’t be causing issues… that pain is mostly gone now after switching to nasal pillows from full face masks and the pain went from a 10 down to a 2… Now I currently get muscle tightness in the front of my neck, left trap, and left jaw/ear. After sleeping prone for two nights and getting a ton of relief from neck and TMJ pain, I think sleeping position is playing a big part. I am also learning how breathing restrictions can cause forward head posture to help open the airway. Not sure if I had this my whole life or not. It isn’t crazy bad, by my neck is straight instead of a gentle curve as it should be.

I used to drink coffee regularly throughout the day. Cut that out completely a year ago as the caffeine spikes my anxiety almost immediately.

Thanks for the camera tips. I will check them out

Thanks!

[Dormeo]

If you like prone sleeping, you might take a look at this:

https://www. a DME-owned forum .com/wiki/index.php/Sleep_Positions