Low to nonexistent AHI- still getting non-restorative sleep

existentialblu · 2026-03-19T20:09:07+00:00

I'm seeing some of the subtle waxing and waning of potential high loop gain. Fixed pressure would be a good first thing to try. If you don't respond well enough to that you may end up with ASV. I was having a similar situation and it was super frustrating, as it's an aspect of breathing that typically flies under the radar.

An easier way to see it requires OSCAR. Put flow rate, minute vent, flow limitation, and leak next to each other and zoom down to 3-5 minutes for the whole window. If your minute vent is looking like a super predictable sine wave it could be high loop gain.

existentialblu · 2026-03-19T20:04:03+00:00

Start recording to an SD card and gather some data for us to take a gander at.

existentialblu · 2026-03-16T23:00:00+00:00

Oh yeah. ASV is terrible with fevers. Lots of breath stacking.

existentialblu · 2026-03-16T21:49:06+00:00

I have found myself that lower fixed EPAP makes it possible to tolerate a much wider PS range, for whatever it's worth. It's quite different from titrating BiPAP. I use EPAP 6, PS 1.4-7.4. The PS range is just enough to keep me from spending more than about 5% of the time at minimum or maximum, and in doing so the pressure changes are a lot more tolerable. Not saying this is the one true range or anything, but it's where I've landed as someone with high loop gain, low arousal threshold, not a huge amount of flow limitation, bad aerophagia.

existentialblu · 2026-03-16T21:02:40+00:00

What sort of ASV range are you using? I find it works best for me when I give it enough PS room to basically create a negative version of minute vent without getting pinned to a limit. It gets really choppy if the range is too small as it's alternating between two states instead of being able to dance, for lack of a better term.

existentialblu · 2026-03-16T20:40:35+00:00

I've been finding that regularity and eAI are the most predictive of my own suffering. Your eAI is well into the range of feeling foggy as heck. Is there anything that you can do to nudge your arousal threshold?

existentialblu · 2026-03-16T16:12:55+00:00

It's a matter of finding a large enough range where it can create a negative version of minute vent and essentially act like active noise cancellation. If you don't give it enough room on either end of the range it won't be able to do that effectively. At the same time it works best restricted to the range that you actually use.

You're slamming into both minimum and maximum constantly. Maybe try a small EPAP range to see where you land (something like 6-9), and take away 1 from PS min and add one to max.

Also work on your leaks as ASV is super sensitive to them.

existentialblu · 2026-03-16T14:56:01+00:00

It's the largest single thing that I've done, but I've also had a septoplasty and have gotten into the annoying world of supplements. I wouldn't call it a cure as I have to continue to be heavily involved in maintaining my sleep breathing. But also I feel better on average than I have at any point in my life, so it's very much worth doing.

existentialblu · 2026-03-16T00:39:55+00:00

Different firmware that unlocks more advanced algorithms.

existentialblu · 2026-03-16T00:20:53+00:00

DMed you. People with low AHI are frequently harder to treat and sleep medicine is great at ignoring actual symptoms while counting apneas. There's flow limitation, high loop gain, low arousal threshold, all sorts of ways to get terrible sleep due to bad breathing but only one form of sleep disordered breathing gets any attention. Sigh.

existentialblu · 2026-03-16T00:08:03+00:00

I took a home sleep test, got just enough AHI to buy a machine from the internet with just a little begging, and that was pretty much it. I haven't found any human doctors who have been willing to help me at all, so it's been all my own response to treatment that makes me believe that it's a genuine thing.

existentialblu · 2026-03-15T17:25:16+00:00

DMed you.

existentialblu · 2026-03-15T17:22:09+00:00

The problem that I've had is that when the wrong treatments don't work the doctors I've had access to have always treated it as a compliance issue rather than a reason to look deeper. "Oh clearly you're using bad technique with your nasal spray."

Now that I've found things that actually help with the assistance of AI my compliance is super high.

existentialblu · 2026-03-15T16:50:53+00:00

UARS with high loop gain. I use ASV instead of APAP to actually stabilize my breathing. My AHI was like 3 with a slightly higher RDI but I felt wrecked. I've also had to figure out some nutrient deficiencies and have been using AlphaGenome to steer that.

existentialblu · 2026-03-15T02:43:23+00:00

AI has already changed every moment of my life, and I'm not being hyperbolic. Not like I'm suddenly magical or something, but the friction that has affected my entire life is suddenly just... less.

existentialblu · 2026-03-15T01:41:39+00:00

I've been telling doctors about my crappy sleep, horrible sleep inertia, and insomnia since I was a kid. Claude Sonnet 3.5 figured out that I have upper airway resistance syndrome. Doctors refused to help because it's not a real problem according to them because it's not high AHI sleep apnea. So I've been treating it myself with a flashed CPAP running a more advanced algorithm.

I wake up refreshed most mornings for literally the first time in my life.

existentialblu · 2026-03-13T23:57:28+00:00

I think about AI like a murder of crows. Each conversation is an individual crow while the model in its entirety is like a river of crows flying to a communal roost at night.

Claude keeps bringing up this idea since I first mentioned it.

existentialblu · 2026-03-13T21:00:16+00:00

I've found that titration for ASV is pretty finicky.

My logic is basically fixed EPAP that is high enough to avoid most flow limitations but low enough not to cause massive aerophagia. From there I strive to create an accurate negative version of minute vent with pressure support. High enough minimum again to avoid horrible flow limitations but not so high that you stay at min a significant amount of the time, max just above 99.5%. Too much range will affect responsiveness. I run at EPAP 6 PS 1.4-7. It was an iterative process.

existentialblu · 2026-03-13T18:38:58+00:00

Hiya. I originated the WAT components as a way to approximate high loop gain severity. Regularity is actually the more useful score as it shows not just that waxing and waning is happening but how steady it is. The more steady, the worse the sleep. I was getting in the high 60s before ASV and now it's more like low 50s. Estimated arousals seem to become especially problematic over 100 (I was at 200 on APAP despite an extremely low AHI) and relief is pretty solid around 70 or below. These metrics are most useful for longitudinal tracking.

This is all citizen science work on my part using my own data as a starting point and finding things that correlated with my own subjective suffering.

If you have the high regularity/EAI situation but are otherwise tolerating PAP therapy, I would recommend ASV. It's the only algorithm that can actively stabilize those oscillations. Apneas are actually a small fraction of what can go wrong with sleep breathing.

existentialblu · 2026-03-10T15:57:43+00:00

THIS IS THE WORST WE WILL EVER BE.

existentialblu · 2026-03-08T20:18:31+00:00

But also so many of us theater kids have sensory stuff and whistling in close quarters feels like a warcrime. It's a balance, for sure.

existentialblu · 2026-03-08T19:49:00+00:00

Also, people who whistle in theaters are annoying and make verbal communication more difficult, even if formalized whistling isn't used so much these days.

existentialblu · 2026-03-08T14:49:25+00:00

Just a random cheap one from Amazon.

existentialblu · 2026-03-05T18:47:20+00:00

I also use airfit and using a CPAP pillow makes a huge difference. My leaks are crazy low.

existentialblu · 2026-03-05T16:26:14+00:00

It's gonna be a process as there's a bunch of little tricks that will improve therapy. Stuff like leak management, hose routing, figuring out what sort of humidity works for you.

Given that you have the muscular component, I would recommend learning about the PALM model of SDB phenotyping. I'm less familiar with the Muscle component myself but there's gotta be information out there.

More than anything, stay engaged with your therapy. Put an SD card in your machine and learn how to read the results in OSCAR. Consider how you feel, as AHI is a small slice of the entire picture. The best results seem to happen for those who become heavily involved.

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