(07-30-2023, 10:23 AM)mper6794 Wrote: _ Hi, Sleepy
_ your pictures called my attention; it looks something similar to my case, eventually; after some 4 years on the Resmed aircurve, also stucked on residual wakeups associated/interrupting majority of of my REM stages (say, after 5, 10, 15 minutes of REM, quite often; and also punctuated by arousals/awakenings). 2,3, and even 4 times within some 7 hours sleeping. See attached pictures;
_ used to taking clonazepam 0.5 mg since very long ago, and since beggining of therapy with the Bilevel. Currently at no medication at all. Managing quite well my RLS and REM-associated apnea/UARS (no flagged FL, no apnea or hypopnea, after reaching tailored pressures as here, on my profile), even though REM-associated wakeups bother me a lot (go to toilet, and back to sleep), and sometime lead to poor nights. I think I have learned how to sleep on phases with those interruptions in between (take advantage of some to meditate, etc)
_ REM interruptions always follow  bad dreams/nightmares, and NPT when I wake up;
_ Ongoing conclusions and decisions:
..... I would have a very sensitive nervous system, which dramactically reacts to every minor residual flow restriction (far beyond what would be detected by machine algorithm, as hypopnea or RERA). Like you, maybe, Clonazepam 0.5 adds some improvements, by facilitate back to sleep, muscle relaxation (add for RLS), even though I gave up forever I think. Decision: live with these drawbacks;
..... Not sure on the role of hormones (very high tostesterone, or something else) on NPT (present on every REM-associated wake ups), and on NPT on REM interruptions. Decision: back to MD's to investigate on NPT and hormones; this week, maybe.

_ your charts and sleep study, in my modest opinion, indeed, suggest you are right; strong suggestions of REM-associated Flow Limitation/RERA, worked out with your current Bilevel (which one?) parameters... and Limb Movements (contributing to your sleep instabilities and arousals/awakenings, and wake ups?;
_ it looks we are on same boat currently! It looks you also have got at a point, from which the bilevel (best machine ever, in my opinion) could not go any further;

all the best and good luck

Very good analysis indeed my numbers are slightly different,  10/4.8 I found higher epap doesn't help lower PS makes it worse. 
Lower epap and I start feeling the throat spasms. (Very fast throat closing my nervous system arouse me for it less then 1 sec duration)

I did check my hormones and were all in normal range, my Testosterone on lower side even, no NPT.

I'm in 1mg clonazepam which stopped helping before bed, but extend sleep after arousal for around 1 hr only (0.5mg)

How did you cope with arousals? How long do you stay in bed total time to function in the morning? I'm not able to function, or have Nirmal schedule. Benzos /ambien/melatonin which helped me sleep on time now have reverse effect with insomnia withdrawal. I have to stop them as I became dependent. 

(07-31-2023, 08:25 AM)mper6794 Wrote: _ hi, sleepy
....(Very fast throat closing my nervous system arouse me for it less then 1 sec duration). I know little on throat SPASMS.. is it same thing as laryngospasm? have you investigated the causes (SDB itself, GERD, etc)?
....CLONAZEPAM: it might worth giving you my experience. I took it for years and years (actually, some 3 decades maybe; with some interruptions; never more than 0.6 mg); saved my life and carreer, long before finding out troubles with SDB (only in 2017). After PAP, daily careful observations, led me to conclude on: benefits for RLS and for REM-associated AHI and FL (muscle relaxation, shorter back to sleep; increased a little total time of REM, diminished arousals, and so on). However, this year I found out that over 0.4mg, Clonazepam started bringing some flow obstructions, reflected mainly as much more mouth breathing. Then, I decided to stop it since some 3 months ago; clear good effects on pretty much no mouth breathing, clearer thinking, better memory?. stronger legs, etc. Also, overall, surprisingly, the withdraw does not bring significant losses on HOW I FEEL (rather good indexes theses days, in general; knocking on wood!)
... my AROUSALS: only happen in REM sleep, however, not in all REM's during a night; quite often I sleep some of them without arousals, until the REM sate is truncated; in general 10 to 15 events/hr in the jeopardized periods (they occur every night), it general I am able to sleep through them, until the ones at truncations. As per Doctor Barry Krakow's experience, it looks sleep blocks (N1, N2, N3, REM....) would be more important than total sleep time during night; luckily I have some 90 min to 120 min blocks, rarely 180 minutes blocks during the night. Since 1.5 year ago, I adotted a sleep pattern, including staying in bed for 9hrs (midnight to 9;00 am), no matter what happens; it is a time allocated for me, when I practice Energy and Psycology Medicine, meditations, etc;

good luck