Decent AHI, but poor sleep quality --> palatal prolapse?

[aquamike]

Hey folks!

First time poster here- nice meeting everyone.

I’ve been on CPAP therapy for 3 months now. (resmed 10 autoset) and I’ve been experimenting with different settings- fixed, auto, different rates, etc.
I think I found a sweet spot, but still have poor sleep quality and wanted to get the community’s input on what might be happening.

I realized two days ago that I might be having a palatal prolapse when I exhale, based on the flow rate patterns. In fact, this even happens sometimes when I’m relaxing awake with my chin tucked on my couch- sort of a ‘reverse snore’ when exhaling. FYI- athletic, reasonable BMI, exercise, etc.

Then I realized that I had the EPR set to 3, which was allowing the soft palate to swing shut on exhale. I turned EPR off, maintaining therapy pressure on exhales, which it seemed to help, but still felt a bit crappy in the morning. I thought maybe this was because the pressure was too high, and reduced the min pressure, with the max pressure set the 95% mark.

Last night, nasal mask, mouth taped, Autoset 7-10.6, I’ve had the best AHI in 3 months, but still feel like I didn’t sleep well.
https://www.dropbox.com/scl/fi/4nj4dt20 ... 5ng4f&dl=0

I then zoomed in on the flow rate and identified 3+ areas that seemed funky. (see attached photos)

1:34:35-1:39-56 5 minutes
https://www.dropbox.com/scl/fi/10nlzn0q ... 5mi1g&dl=0
4:59:08-5:01:07 2 minutes
https://www.dropbox.com/scl/fi/xqtodvm1 ... rgfdf&dl=0
5:05:07-5:08:00 3 minutes
https://www.dropbox.com/scl/fi/n611kxoh ... uosau&dl=0

Based on the attached photos, are the flat spots between positive flow peaks palatal prolapses, and if so, what’s happening to my exhaled air if there aren’t any mask leaks? Is this pattern enough to ruin sleep quality and/or cause C02 rebreathing issues? Here's a snapshot of my REM breathing, fyi
https://www.dropbox.com/scl/fi/p64v9qse ... 5av1b&dl=0

What other factors could be contributing to poor sleep quality? Is the prolapse issue above enough to ruin a night's sleep, or maybe there's something the machine isn't picking up? I’m stumped. I just don’t feel right in the morning.

Thanks for your help!

Michael

[zonker]

no answer. just responding to bump the thread to see if others have anything.

good luck!

[lazarus]

What other factors could be contributing to poor sleep quality?

Once PAP therapy is fully optimized, great benefit can come from implementing all aspects of sleep hygiene:

https://www.sleepfoundation.org/sleep-hygiene

[aquamike]

no answer. just responding to bump the thread to see if others have anything.

good luck!

Cheers! thanks for the love.

I tried a fixed flow CPAP at 10.6 last night and it was even worse. I think the higher flow rate created more arousals, and I think the higher pressure made the expiratory block worse.

2 minute expiratory block with recovery breathing:
https://www.dropbox.com/scl/fi/b3w3veiq ... cer4h&dl=0

5 minutes with mask leak:
https://www.dropbox.com/scl/fi/gbpxyze8 ... jdj64&dl=0

5 minutes with recovery breathing:
https://www.dropbox.com/scl/fi/piz8gq0m ... 9b39f&dl=0

[aquamike]

What other factors could be contributing to poor sleep quality?

Once PAP therapy is fully optimized, great benefit can come from implementing all aspects of sleep hygiene:

https://www.sleepfoundation.org/sleep-hygiene

Thanks for the response. Ohhhh believe me- I'm on it. I'm definitely always careful about all the basics, but always good to be reminded, cheers.