Crazy Breathing Patterns, Difficult with CPAP Post Covid

[asuter060514]

Hello All!

My breathing patterns seem to be completely erratic in my sleep post covid despite my AHI being incredible low of under 1. However, I've woken up the last two days very short of breathing and dizzy as if I was breathing incredible rapidly for a long period of time. I'm not seeing any heart rate spikes, but my Apple Watch SPO2 has shown to be lower than normal the last two days with CPAP. I've slept without CPAP and am not waking up with dizziness or experiencing the same kind shortness of breath when waking up. My wife said I'm actually barely snoring if at all without the mask.

I've attached screenshots of examples. I breathe like this almost all night. I tried EPR at a higher level the night before and had a similar issue. Not sure what to do, but its concerning me especially since I've been having issues breathing with my mask on since recovering from covid which I did not have before.

[Gideon]

The first chart is IMHO mostly awake breathing as indicated by the very irregular nature of the breathing.

The second chart the first CA is a legitimate central surrounded by typical CO2-induced breathing. The 2nd CA id following a brief bit of awake breathing then you most likely holding your breath.

The 3rd chart 3:27:45 the spike is an arousal followed by awake breathing going off the page.

More significantly you have flow limitations pretty much throughout all of these samples so I also assume throughout your entire night.

Now let's see what we can get out of this machine, though I suspect that you will require a VAuto.

Set EPR = 3 fulltime then repost. EPR treats Flow Limits! The question becomes is EPR=3 enough?
Include the full night not zoomed and also several zoomed images as you have here.

[asuter060514]

The first chart is IMHO mostly awake breathing as indicated by the very irregular nature of the breathing.

The second chart the first CA is a legitimate central surrounded by typical CO2-induced breathing.  The 2nd CA id following a brief bit of awake breathing then you most likely holding your breath.

The 3rd chart 3:27:45 the spike is an arousal followed by awake breathing going off the page.

More significantly you have flow limitations pretty much throughout all of these samples so I also assume throughout your entire night.

Now let's see what we can get out of this machine, though I suspect  that you will require a VAuto.

Set EPR = 3 fulltime then repost.  EPR treats Flow Limits!  The question becomes is EPR=3 enough?
Include the full night not zoomed and also several zoomed images as you have here.

What do you mean by “not zoomed” this is the only way I’ve seen. I can post the full night, but you’re right that I have flow limits all night long. My breathing is completely erratic unless I’m sleeping on my side. 

I will try EPR 3 again. I tried it at 2 a couple nights ago but felt like the pressure was too low as I felt like I couldn’t breathe. Should I move my pressure up, too? It often feels like I can’t breathe right, so I’m all thrown off. 

Would the flow limits explain why I feel short of breath in the mornings when I wake up?

[Gideon]

Increasing your pressure would be my next step.
Think about this though.
Your "pressure is your high pressure when you breathe. This is the pressure most people complain about saying they can't breathe in or some other things. EPR as a "comfort feature" reduces the exhale pressure only. Therapeutically it is the difference between exhale and inhale pressures that treats Flo Limits, hypopneas, RERAs and UARS. Your low AHI says you are optimized but the Flow Limits displayed say maybe not.

By not zoomed I mean without any of the gray bar that is encroaching from both sides. Right click on any graph title such as "Events" then click "100% Zoom Level"

[asuter060514]

Ohhhh that makes sense. I’ll grab a screenshot tomorrow and post as I’m already in bed for the evening.

I moved EPR From 1 to 3 and will see if that helps. I also moved pressure up to 10 since the pressure will be reduced due to EPR

[Gideon]

Actually no. The "Pressure", which on a CPAP remains the same, the exhale pressure, in this case, is set at 3 below the Pressure/IPAP/Inhale pressure.
That said I have no problem with the increase.
The increase in EPR WILL help the Flow Limits, the question is will you be able to tell.

[asuter060514]

Actually no.  The "Pressure", which on a CPAP remains the same, the exhale pressure, in this case, is set at 3 below the Pressure/IPAP/Inhale pressure.
That said I have no problem with the increase.  
The increase in EPR WILL help the Flow Limits, the question is will you be able to tell.

Okay, so I did and my central apneas went up a lot, but its still technically in treated category and I feel fine. I also felt like I could breathe this morning and I wasn't dizzy when I woke up which is obviously a welcome sensation. I've attached a screenshot of the whole night.

I'm still getting flow limits, though. I THINK I might be chin tucking as my pillow kind of forces me to do that. I'm using a cpap pillow that's slightly elevated and only elevates my head, not my neck. So, I might switch pillows. My O2 levels on my watch were normalized last night as well.

[Gideon]

Your flow limit chart is and was ok at both EPR settings.
I am not seeing indications of chin tucking here.
Please post some zoomed views as you did before, Let's see what the flow tells us.
CA events are Consistently Inconsistent meaning that they jump all over the place. They are within that scope and the excess CA will likely dissipate over a few months.

If you are not experiencing any bad symptoms there is no need for the deep dive into your flow rate.