Please help me talk to my doctor

[cps22]

I tried that, but it wouldn't reduce any further. 

But it should look better when I get my desktop running again.

[cps22]

Well, that was interesting. I changed the settings to pressure 8-10, EPR=1, and had 0.0 AHI... Sounds great EXCEPT that I was drugged up on Nyquil. I'm surprised the machine didn't think anything of all my coughing and sneezing. Looking back to the end of last year when I also had an awful cold and took Nyquil, my AHI was 0 then as well.

So I guess I need to suspend further testing until this cold runs its course, or just start guzzling Nyquil every night.

[cps22]

I am back in business now that my cold is gone and my PC's power supply has been replaced. 

I've attached last night's Oscar data, SpO2 report, and Apple watch sleep cycles. 

I have been keeping a spreadsheet of data since the first of this year, and it's interesting that last night's data is nearly dead-on "average". More minutes in "SpO2 < 90%", but average for number of drops and % of time in drops. Fewer RERAs, but I suspect I'm having some that are not getting flagged by the software. 

So I guess last night's experience is about as "typical" as it gets. And how do I feel today? Very tired. Which is also "typical". 

If it's of any note, I rarely move while I'm asleep, so the "movements" on my chart are when I'm awake - either changing positions or fussing with the @$%# mask because of very minor leaks caused either by my jaw relaxing (despite using a collar) or from changing positions. I just ordered an F30 mask to see if I like it any better than my current F30i. 

My averages since 1/1/24, for my own reference as well as for anyone else interested in statistics:

AHI: 1.43
AHI Median: 1.22
OA index: 0.00
H index: 0.38
UA index: 0.01
CA index: 1.03
RERA index: 0.07
95% FL: 0.09
CSR: 0.00

Avg SpO2: 93.15
SpO2 Drop Index: 13.00
% time in SpO2 drop: 45.31%
ViHealth SpO2 score: 9.4
Minutes < 90%: 9
ODI 3%: 2
ODI 4%: 0.55
Avg pulse: 68.99
Pulse change index: 14.33

For SpO2 minutes < 90%, I had a couple of enormously bad nights that skew the average (mean) upwards. A more reasonable number is around 3:
The median this year is 3
The mode values are 1, 3, and 4.

[cps22]

Last night's data, still at pressure 8-10, EPR=1. 

This morning I feel like the bottom of a garbage can. When I first woke up and was still in bed, I was thinking that it wasn't too bad a night because I felt like I hadn't been awake as much as usual. But as soon as I got up, I felt very tired and "spacey", and had a mild headache. And 5 hours later I still feel the same. Despite having an Amazon Echo for 5-6 years, I couldn't remember it's "name" (Alexa) this morning for anything. Alexis? Alexi? After 5 minutes of total mind blank, I had to go to the computer and search for it. Then I spent 15 minutes crying because it upset me so much. I feel like I don't even remember what it was like not to have so much fatigue and brain fog. 

   

[cps22]

Last night was night 9 with the current CPAP settings. It was better than the night before – it actually felt pretty restful until just before 5:30 when I woke up feeling like I couldn’t breathe through the mask very well. I thought maybe it was just squishing my right nostril closed or had shifted so the nasal holes weren’t lined up, but trying to reseat it didn’t help. I finally took it off, went to the bathroom, then tried again, and it seemed better – either because of the mask position change in pressure.
 
My flow limits were improved and my SpO2 was better (fewer drops and not as extreme, so better-than-average “average”, and only a couple of seconds under 90%).
 
Despite feeling that my sleep was more comfortable and restful, I’m still very tired, but at least I don’t have a headache.
 
I had some interesting breathing around 22:52 when I was in deep sleep – like some “double inhales”? I see this throughout the night, but at least at that point I know I was sleeping and not in REM.
 
Should I continue at this setting for longer, or make adjustments?

[Sleeprider]

We didn't to well with EPR greater than 1, so with your current results, it looks like a slight increase in minimum pressure to 8.6, might help. Your results looks pretty good at this point, and there is not much we can do with CPAP to reduce CA events. I would really like to see higher EPR/PS, but you don't tolerate it.

[cps22]

OK, I'll try upping the minimum. I appreciate your help on that. 

Is there anything you would suggest that I mention to my doctor, like maybe my I:E ratio, or anything else that seems out of whack?

[cps22]

I'm back again! It's been 9 nights on pressure 8.6-10, EPR 1. 

Where do I go from here? 

I've attached the last 2 nights of Oscar data. My stats at these settings look pretty decent, with 95% flow limit averaging about 0.06 compared to my YTD 0.09 on fixed pressure of 8, and I'm having slightly fewer and shorter awakenings. I'm having a little less brain fog, but still a lot of sleepiness - maybe because although I'm not awake as much, I'm still not getting enough deep/REM sleep. I feel a little more like I did before I started CPAP (rather than feeling much worse) but it's still not good. 

Last night I woke up around 3:30 when my O2Ring buzzed at me because my O2 dropped to 87 (I usually have the alarm set lower so that the ring doesn't wake me up all night, but I had to do a factory reset on it and forgot to change the settings). I tried to go back to sleep but my mask was too hot and sweaty and it seemed like inhaling was more difficult than usual, so I shut off the CPAP and spent the rest of the night without it. My O2 was actually better the last half of the night. (Well, that's interesting... I used the CPAP for EXACTLY 5 hours. Couldn't have done that if I'd actually tried.)

ETA: Had to re-upload the images because I'm stupid.

[cps22]

I was thinking to go back to fixed pressure of 9 with EPR=1, as that seemed to give me the best sleep (though more CAs) - maybe with more time the CAs would resolve?

But I've gone without using CPAP at all the last 4 nights and I feel better than at any time in the past 8 months. I have a very slight amount of tiredness, but mostly I feel "normal". My sleep has been far more restful, with actual sleep cycles and more periods of deep sleep. My SpO2 data is not really significantly different from when I use CPAP.

Clearly I have some sleep-disordered breathing, and I believe I have a lot of RERAs. (I had a lot on my sleep study, too.) I'm wondering if the benefit I'm getting from the CPAP in treating whatever OAs I might otherwise have is being outweighed by sleep disturbances from using the CPAP - whether it's the actual air pressure itself, incorrect pressure amount/type, discomfort from the mask/collar, sleep position, emotional angst, or whatever. Without CPAP, I often sleep on my stomach - maybe that keeps my tongue/soft tissues from blocking my airway as much?

Would it be worth asking my doctor about doing a drug-induced sleep endoscopy?

I'm not looking for a get-out-of-jail-free card, I just want to figure out what gives me the best results so that I can be a functional human being.