Correlation to Keto- AHI has skyrocketed

[robtheironguy]

Ketosis was part of my cunning plan- Once I'm fat adapted, I can get on the bike, which I'm already doing, but go for a 4-6 hour ride without any nutrition- Boom, 1lb of calories gone. Can't do that if I'm just watching calories because I need to supplement with Carb gels which can negate some of the calorie loss

[robtheironguy]

Made adjustments to my settings and got things down- would like to see lower numbers on the CA and AHI, not sure if I can tweak anything from here or if its residual Keto/fasting effect. Would greatly appreciate any insight.

   

[Geer1]

That did reduce things a fair bit. The residual centrals, hypopnea and periodic breathing are often occurring post arousal which is often also related to CO2. The arousal breathing is large amplitude and washes out CO2 and then apnea follows as you transition back to sleep. From a PAP point of view you could still try lower PS or stick with it and see if body adapts as it often does to treatment emergent centrals.

At this point I am curious to know how/why you are on a bilevel with high PS? Also it would be nice to see a few typical pre keto nights of data (2 or 3 nights that you would say are representative of normal nights). That will help us understand how much has changed and how much might have been pre existing but just not causing apnea.

[robtheironguy]

The reason I have high PS is I have no idea what I'm doing. Once the BiPap was initially set, I screwed around with the settings to feel more comfortable, whilst keeping an eye solely on the AHI reading in the morning on the machine. So any nudges in the right direction would be welcome. I do have a Dr appt to review this as well but that will be a few weeks out to get to the specialist. I've added 3 samples across last year that might give some indications.

           

[Crimson Nape]

When taking your screenshots, please use the F12 key while in OSCAR.   This will reduce the calendar and allow the important data, lower down on the left, to be seen.

[robtheironguy]

Updated Pics

           

[Gideon]

Why are you running with a PS of 6.5?

Your docs will be very pleased with your results with AHI typically under 1.

How do you feel?

[robtheironguy]

I was put on CPAP due to Atrial Flutter. Started the treatment and I have not had another episode over 5 years until last summer. Since then i have had a few episodes which it turns out were correlated to the Keto/Fasting, but appears to be incremental to poor settings as well.

I'm uneducated on what proper settings should be. I screwed around with my settings including the PS to get more comfortable when I first started treatment and have left it with the high PS as the only metric I was watching was the AHI on the machine, which looked great. Stopped watching a few years ago to be honest. 

Some guidance further up the thread recommended reducing the PS number, which I did last night.

Feeling wise, always fine, although in hindsight my heart rhythm was a little "irritable" which I blamed on recent Atrial Flutter attack, but a few nights with low AHI will fix that.

[robtheironguy]

Not sure what to do with my settings- tonight I'm going back to my historical settings:
Min EPAP 7.5
Max IPAP 16.0
PS 6.5-6.5

I gather I should tweak these but I look forward to waking with no CAs and an AHI below 1.0

[kappa]

Interesting that diet is having such a dramatic effect. It would be good to zoom in at the start of one of the CA trains, e.g. around Jan 6 23:25 for 5 minutes or so starting 60s or so before the first CA.

There seems to be a fair amount of periodic breathing flagged even without significant CAs present so perhaps there is excessive PS here?

I wonder if Keto is triggering PLMs or some other arousal trigger after which your breathing fails to stabilize.