Help me interpret my second Sleep Study results

[YouTakeMyBreathAway]

   

[YouTakeMyBreathAway]

Tonight: Same same but different.

   

Questions I have:
1. No flow limitations: My flow limitation p99.5 was 0.01 today and 0.00 yesterday. Does that mean any remaining breathing issues are unlikely to be obstructive/restrictive? Does that mean they would be central?
2. Root cause: What other causes could be waking me up throughout the night if it is not obstructive/restrictive? 
3. Arousals: How many arousals per night are normal? Clearly I woke up/moved almost every 15 minutes last night judging by movement and heart rate. I count roughly ~30 distinct movement clusters and heart rate spikes above the p95 for each. These also come w/ segments of breathing junk on the flow rate (+ increased Minute Vent), so clearly I am waking up.

   

   

[KeepSmiling]

YouTakeMyBreathAway,

My knowledge only goes as far as the first 6 graphs in the OSCAR standard view.

I couldn't see the sleep study page properly. What was the SpO2, baseline, during the night. Has your SPO2 been monitored while on a machine to see if your oxygen level stays up when there no events? Has your oximeter been calibrated or tested against another oximeter?

On post #31, SD at 06:42:45, if you expand that section you may see some flatish tops,

Nov 20, - look at scans, Flow Limit shows some flow limitations. Expand the flow rate are the peaks flatish?

in OSCAR there is an Events tab, if it shows SD or PC, expand each event and look at flow rate, were the tops flatish, what came first, movement, mask leak, flattish top, were you awake ect. This may help you understand your body.

There maybe more than one issue going on.

For me to get deeper sleep/less arousals:
Lately I have been battling a leaky mask. I found wetting the cushion, that goes around my mouth, with water just before putting it helps. Did you notice if you got deeper sleep with the full face mask vs the pillows?

Covering my eyes got me to a deeper sleep. I am about to try a weighted blanket.

[YouTakeMyBreathAway]

KeepSmiling; 
1. Yes the peaks are flat when the flow limitations are flagged
2. SpO2 was 96% (the same value each) for Awake, REM and NREM during the sleep study. They did not report a "baseline" specifically.

I feel more tired today and also struggling a bit to read (brain fog / forgetfulness). Here's my chart for the night:


(https://i.imgur.com/hWZHV7w.png)

[Sleeprider]

Desaturations seem to track respiration rate rather than tidal volume. When resp rate drops so does minute vent. There isn't much we can do to regulate the respiration rate because the Vauto does not have a backup rate to trigger a breath, so we are reliant on spontaneous effort. My best guess is that with the high pressure support you are using, you become somewhat hypocapnic (lower CO2) and the respiration rate and even volume drops. The reduction of SpO2 inversely tracks your CO2. I'm seeing some variable breathing as this apneic threshold cycle occurs, but you seem to rapidly recover without any respiratory events. I think the root cause is PS a bit too high.

[YouTakeMyBreathAway]

Let me reduce PS by 1 and see how it goes.

It seems like whenever my respiration rate reduced, my tidal volume increases and minute vent stays more steady.

Here is my nights on SleepHQ, this should allow you to zoom in I believe, but unfortunately it seems like no way to share SpO2 there…

Nov 19: https://sleephq.com/public/ac3fbfbf-65e3...612444e74e

Nov 18: https://sleephq.com/public/81a0f060-2807...ba9ea9f46d

Nov 17: https://sleephq.com/public/93d06f95-78fa...5093dc64cc

Nov 16: https://sleephq.com/public/083b7ab7-8f57...e40b0cd8ae

Nov 15: https://sleephq.com/public/21b71afb-1927...31ec45c444 (best night!)

[Sleeprider]

It is normal for minute vent to remain the same, while respiration rate and tidal volume have an inverse relationship. Mv is the best metric of your respiratory needs and the average should not change a great deal from night to night.

[YouTakeMyBreathAway]

Is there any way to increase my Minute Ventilation more consistently? The nights w/ my highest Minute Ventilation were the ones where I woke up the most refreshed (and also had the fewest oxygen drops).

--

Reduced PS by 1 this night, no obvious change in outcome (tidal volume reduced a bit, but made up by respiration rate increasing):

[Sleeprider]

The body's respiratory regulator is a marvelous thing, and as long as we are relying on spontaneous respiration, it's tough to increase Mainlv due to the complex interaction of respiratory gasses and chemistry, your experience of decreasing respiration rate with increased tidal volume, and vice-versa is pretty common. In hospital respiration, a higher PEEP (positive end expiratory pressure) is used to recruit more lung volume and improve gas exchange to increase oxygenation.

[pholynyk]

Is it true, then, that we can achieve a higher PEEP by increasing our EPAP? Not beyond comfort, of course... Or am I missing something?