AHI went up, seeking for help

[pjurson]

Hello guys, I've been lurking through forum and even posted for quite some time. I've received much help from you so thanks for that. My settings were well adjusted for a long period of time:
   

However, I still didn't feel great - always tired, frequent waking ups during the night, groggy in the morning, need for naps etc. In pursue of better quality of life I have been going to psycho-dietetian and it has been discovered that my intestines are in a very bad shape (I'm 33y/o, male, 178cm, 80kg) thus I went to recovery period since July. I am on a low fodmap diet, quit smoking marijuana, cut white sugar, coffeine and taking supplements / vitamines. 

My sleep is in the worst shape as I can remember. When I'm on CPAP im waking up about 1.5h-2h after falling asleep. I am not tired anymore, I am exausted to the point it's really difficult to get myself from the bed. Charts looks like this
   


Or even like this from last night (after tweaking settings like a madman):
   

I have no idea what happened. I even upgraded my sleep hygiene to the highest personal levels:
- Bedroom's temperature 18 ℃ (65 ℉) with AC
- Got myself cozy weighted blanket
- No blue screen before bedtime
- No eating or exercise before bedtime
- 5HTP Melatonin and Gaba supplements (suggested by my doctor after having bad sleep experience)

Please help this poor soul before going mental.
Cheers!

[staceyburke]

You are having some positional apnea.  Positional apnea can NOT be controlled by pressure changes.  You have to find out what position you are getting into and cutting off your own airway.  Have you changed your sleep position?  Sleeping on your back?  Using more (or new) pillows?  These things can cause positional apnea by chin dropping to your sternum and cutting your airway.  Think of it of a kinked hose – nothing can get through – you have to unkink the hose…

IF you can’t make a simple change like changing to a flatter pillow helps then you will need a collar.  I have a link to collars in my signature at the bottom of the page.  It shows people who are not wearing a collar and the SAME person wearing a collar.  There is a huge difference between the two.

[pjurson]

Thank you kind sir! Yeah, you were right I did change my pillow to more fluffy one. I switched back to my old flat pillow and results are better but not great:
   
I'm always trying to sleep on my side.

Do you think I have to add collar to improve my ratings? With these settings and old pillow I was 1-2AHI every night, dunno what happened... I get alot of CA which is kinda new for me

[staceyburke]

I would not worry about your ratings but more importantly how you feel.  If you don't feel like the nights sleep was good you always try a collar.  to get the correct fit you need to measure the distance between your chin and sternum plus of course the fit for around the neck.   It does not look bad enough to get one, I would try first just  to be sure you are not on your back and maybe put a little bit of the pillow under the chin.

[pjurson]

Thanks again for the reply. I am doing everything I can - seal my mouth with tape, flat pillow, sleep on the side, collar and these are results from last night:

   

First time seeing Cheyne strokes respiration, its going downhill for me and of course I feel like a wreck of a man. Do anyone have some tips how improve my sleep? It's horryfing..

[aquamike]

Hey feel your pain

Can you provide a zoomed in shot of one of your clusters so we can see the wave forms?

[pjurson]

Yeah, sure. I hope it's nothing serious.. 
   

[mesenteria]

I don't see CS, I see only CA.  And at the rate it seems to be happening, I think you're going to need an ASV...adaptive servo-ventilator.  But that's just me...please wait for a couple of the more savvy members here to offer their considered opinions.  They'll be important to you.

[pjurson]

Guys, do u think I need new machine to treat my CA events?

[Gideon]

Most of the events in the zoom are associated with arousal, some are very minor, and others definitely disturb your sleep. Most of the "events" are you tossing and likely holding your breath.

ResMed calls (incorrectly IMHO) all Periodic Breathing CSR. It very rarely is actual CSR. Yours definitely is not CSR.

I'm not sure what is actually causing the arousals, the scale needs to be tighter to see if flow limits are the cause.