Please help me talk to my doctor

[cps22]

I'm encouraged by my better SpO2 data, and the fact that I didn't see a big increase in CAs during sleep which I've had before with EPR. I think only one of them looks like it might be a real central apnea - the rest look like me moving around and holding my breath.

[HalfAsleep]

You’ve just been through winter months. Perhaps with overcast? Have you thought of checking Vitamin D levels?

[cps22]

Yes, my doctor ran a set of labs on me this week - blood count, comprehensive metabolic panel, thyroid, Vitamin D, iron, folate, B12, etc. All look normal.

[cps22]

Last night's session went well, other than having to get up to pee around 4:15 and not getting back to sleep until 5:00. That big cluster of CAs just before 5am was me struggling to adjust all of my pillows and get into some sort of position that was reasonably comfortable. 

Most of the other CAs throughout the night appear to be either while I wa awake, or just as I was dropping off to sleep, so they're probably not important. 

The first few look like they might be "real" central apneas, but I don't think they were too bad and didn't seem to cause much disruption. So I think so far that's not an issue with the new settings.

I had a lot more SpO2 desaturations than the night before, but they seem to pretty much be from those CAs when I was awake. The first stretch of the night when I was sleeping look much better than usual. 

My sleep overall was better and more restful, with fewer awakenings and more deep sleep than usual, and I feel slightly less tired than before. 

I've attached my overall night, a snip from one of the sleeping CA's, and my sleep cycles.

[cps22]

Today I am actually feeling pretty functional, despite not having a great sleep! I had very little deep sleep and spent a lot of time tossing and turning, but it still felt pretty restful. It was a glorious spring day here, and after spending most of the afternoon working in the yard, I rewarded myself with a couple of cocktails on the deck, so that might have affected my sleep. 

I turned off the User flags since they were distracting in the chart. I think that, as usual, most of the CAs are either when I'm awake or just as I drop back off to sleep. My O2 stats look pretty decent.

[cps22]

I've had 9 nights on the recommended settings now. 

From my Oscar Statistics report on May 17 when I had 7 nights of the new settings on AutoSet (last week | last 6 months):

Average AHI is higher due to more CAs, but still under 5. (3.40 | 1.38)
RERAs down (0.05 | 0.07)
Hypopnea index slightly down (0.32 | 0.39)
95% flow limit, about halved (0.04 | 0.09)
Average SpO2 slightly higher (94.13 | 93.13)
Min SpO2 higher (82 | 74)
SpO2 drop lower (10.76 | 14.05)
Average pulse rate slightly lower (67.84 | 68.15)
Pulse change index slightly lower (13.56 | 14.76)

Just eyeballing my I/E ratio, it looks slightly better, but I still have much longer inspiration time than expiration. Last night was 3.26:2.40

As for how I feel with the changes: My sleep feels more comfortable and restful with fewer long awake periods, but I'm having more micro-awakenings (a minute or less), and I'm getting less Deep and REM sleep. (Deep sleep has averaged about 35 minutes in the last 9 days, compared to somewhere around an hour previously.) I definitely feel less fatigued and have a bit less brain fog than I did with the fixed pressure, but it's still not great. But most days I can make it to at least mid-afternoon before the fatigue gets pretty bad. I'm pretty tired and foggy this morning, but I'm getting a cold so that could be contributing.

The night before last (May 17) was the worst night since changing - I had an AHI of 5.29, and my SpO2 drop was 16.81. Yet average SpO2 was still decent at 93.74, and I felt pretty good in the morning.

So where do I go from here? Are there other changes I should try? Or just discuss this with the sleep doctor PA, and if so, should I be asking about a diagnostic drug-induced sleep endoscopy or switching to a bipap? I haven't made an appointment yet, so I don't know how long it will be before my PCP bugs me about it.

I'm attaching the last 2 full nights (the bad night of 5/17 and last night's, which is about average for the past week), plus a zoom from part of last night. 

Also: I did not anticipate from my original post in this thread that it would turn into a therapy thread, so perhaps it should be whooshed into my previous thread here?

[Sleeprider]

Your flow rate would be easier to read if you change the y-axis range. Right-Click on the graph vertical axis, and select Over-ride, then change the range to -80 to +80. The increase in EPR to setting 2 has reduced your flow limits from around 0.08 to 0.04, but your CA event rate seems considerably higher. If you want to go back to EPR 1, then minimum and maximum should be 8.0-10.0. You will hit maximum pressure fairly often, but event rate may drop. If you want to try EPR 3 just to confirm EPR increases events, that would also be helpful to better understand your response to therapy options.

[cps22]

Thanks, I'll try those changes - though since I'm getting a cold, my results right now might be kind of wonky. 

I'll change the Y-Axis too. My desktop PC's power supply died a couple of days ago so until it gets fixed I have to work from my laptop, and the screen resolution is not as good so everything looks a bit squished on the charts anyway. New power supply is supposed to be delivered tomorrow, so fingers crossed that it fixes the PC.

[cps22]

Even at a Y-axis of 80, it still wasn't all that easy to read so at least for last night's, I changed it to +/- 50. Me and my shallow breathing...

   

[Crimson Nape]

May I suggest that you reduce the Events graph.
- Red