(08-15-2023, 09:20 AM)Sleeprider Wrote: Your AHI is consistently zero, as are flow limits and any apparent respiratory based issues.  Arousal is a common feature of normal sleep and it is a kind of hard-wired mechanism that may have contributed to our survival in our early evolution. https://www.verywellhealth.com/arousal-during-sleep-3014849  https://en.wikipedia.org/wiki/Arousal  If you research sleep arousal you will quickly learn that some level of arousal is very normal, and it varies between individuals.  It is generally not related to respiratory distress or effort, but often is when sleep apnea is inadequately treated. You are not inadequately treated.

You don't have hypopnea or other respiratory issues.  I admire your persistence, but when you have solved the CPAP puzzle to this excellent outcome, it's time to start looking elsewhere for the cause of your arousals, or accept them as normal and not get stressed about it, or treat them with natural or pharmaceutical options.

(08-15-2023, 10:26 AM)Sleeprider Wrote: I don't see evidence of hypocapnea in the form of central events or depressed respiration rates or volume.  If you are concerned with hypocapnea, why are you using high PS which would make that worse?

(08-15-2023, 10:39 AM)Gideon Wrote: Sleeprider and I are in lockstep on this.
With that high of a PS I expect your CO2 levels to be on the low side of "normal" to possibly just below that.  Look yon your metabolic lab tests, that's where mine is at a PS of 6.  I don't use a higher trigger level.  And IMHO that doesn't mask CA events it actually treats them.
I do understand the need for higher PS and higher EPAP to feel comfortable, my min is 11 and under 10 just doesn't feel right.  You may want to try to slowly back off your high pressures and PS and see if that helps you some.  That is simply a trial to find a sweet spot for comfort.
I don't feel your Arrousal level is abnormal.

(08-15-2023, 01:06 PM)Gideon Wrote: A high leak rate might mask a CA but show me a CA in the Flow rate, and I see nothing there that would mask such an event.  To a point CA events are prevented by initiating an inhale easier, they never happened.  

By your definition an ASV is ineffective, (it is very effective) because it "masks" or hides CA events, it doesn't prevent them( it does prevent them)

(08-15-2023, 01:30 PM)Sleeprider Wrote: PLM at 20 events per hour is roughly every 3-minutes. Do I think that might be disruptive?  Of course. Pathological significance is greater than 5 per hour. PLMS at the rate of 15 or more/hour of sleep is considered abnormal and is supportive for diagnosis of PLMD if associated with hypersomnia/insomnia, which could not be explained by other current sleep disorders or other disorders.  I’m not sure if your results remain valid with your current therapy efficacy.