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Your current PS is 4, down from 4.6, and your min EPAP is 8, up from 4. I think this is consistent with what Dave and I were suggesting. I'd recommend that you stick with these settings for a while longer.
I suspect that as you sleep better, the CAs will come down because you will have fewer arousals. (Arousal breathing is deeper and can blow off enough CO2 to briefly reduce your drive to breathe. It's the arousal that's the real problem, not the CA.)
You had a small cluster of OAs, possibly cause by tucking your chin down toward your chest. If you had a lot of similar clusters, I'd recommend a soft cervical collar, but so far I don't see a reason to take that step.
Did you change the mask setting on your machine when you started trying the FFM? If not, no biggie, but do take care of that.
It's encouraging that you might be feeling better today. I hope the trend will continue. Keep us posted!
Apologies for the late reply, been busy with work and trying to find out if my fatigue is due to other issues, but no luck so far.
I've made a few changes, namely increasing my EPAP to about 12 to reduce my OAs and increasing the trigger to very high, which has reduced my centrals.
My pressure support has more or less been the same as last time (4-4.2)
I still feel only marginally better (probably due to the lower apneas), but i still have really bad brain fog.
Do you all have any idea what i should do? would increasing my PS further help, in case i have underlying UARS? I also noticed my tidal volume and minute vent is abit lower than average. Should i also be fiddling with the trigger/cycle further?
Thank you all again for your help! I have attached my latest OSCAR reading here.
Your chart looks excellent, and I don't see a reason to change your settings. You can try inching down the PS if you want to, though.
Your TV is within a normal range for adults. If you are a tall person, it might be a bit on the low side. If Sleeprider swings by, he might be able to speak to this better than I can.
You can zoom in on your flow rate to around 3 minutes or so and scroll through looking for arousals. (They will be periods of irregular breathing that is deeper than normal asleep breathing.) Microarousals are not uncommon, and I don't know quite how to quantify how many is a lot. But if you count them, let us know.
I suspect that sleep-disturbed breathing is not really at the root of your brain fog. You mentioned that your thyroid and T tests were normal. Has your doctor also explored the range of autoimmune diseases that can cause fatigue? Blood sugar fluctuations? Infectious diseases? Neurological problems? It's hard for diagnosticians to arrive at a helpful diagnosis based on a general symptom like brain fog. I hope you have a doctor who listens carefully and asks good questions.
Thank you for your reply. I have gone through a few tests already, and might be going through a few more to rule out other conditions such as autoimmune issues.
I think i might try reducing PS. Would an excessively high IPAP disrupt sleep?
I have attached a screenshot of a period of weird breathing. There are a few of these in my sleep charts.
I haven't heard of PS disrupting sleep, but that doesn't mean it couldn't happen. Try reducing it and see how you like it -- and what the effects on your AHI and FLs are.
The zoomed in view shows normal sleep breathing on the left, and then, just before where your cursor is, arousal breathing. Bracketing 8:22:00 is breathing with a reduced flow rate amplitude, then an increase, another decrease, another increase, and then back to normal. This pattern of waxing and waning is common after an arousal. The arousal breathing washes out enough CO2 to reduce the drive to breathe. Then the CO2 builds back up during the reduced period, leading to an increase, etc., until you've restabilized. I can't tell whether you were back asleep during the waxing and waning.
There's nothing to worry about in this, except that you had a mini-arousal.
I see. I noticed that I had quite a few of this when I zoomed in randomly into the chart, which is why i thought that they might be the cause of my sleepiness.
One more thing i didnt mention earlier - at least once/twice a night, i experience aerophagia when im sleeping on my side, causing me to wake up from deep sleep. Am thinking of reducing min EPAP (together with PS, since I dont appear to have much FL), so that the machine can reduce the pressure when its not needed. Abit worried about the impact on my AHI though, as when my min EPAP was lower at 6-8 my AHI was higher (around 5, if i recall correctly).
About aerophagia: you can experiment. Start with a pressure low enough to avoid the aerophagia, then go up from there by increments of .2, staying at each new pressure for at least a few nights. When aerophagia kicks in, go back down by .2. For some people, the difference between having and not having aerophagia can be a difference as small as .2.
Also be aware that if you have lots of flow limits they will drive the pressure up, and you can end up spending more time at the higher pressures that are pushing air into your stomach, and so push more air into your stomach over the whole night.
If you have high pressure time slices which are relatively short, then the total amount of air that ends up in your digestive tract ends up lower than if you have more extended time periods of medium pressure.
It's all a balancing act, and sometimes a short sharp goose in pressure will be the difference between being in pain from the bloating vs being annoyed by some belching and farting.
