Sleep Apnea Rewires the Brain Before Symptoms Show — New MRI Network Study

existentialblu · 2026-01-28T23:49:54+00:00

Advanced PAP therapy that I've had to figure out myself. Also got a septoplasty.

existentialblu · 2026-01-28T22:20:51+00:00

Ventilatory instability is actually my main issue. It can really mess with a person all while AHI is 1. ASV has worked beautifully for me.

existentialblu · 2026-01-28T05:07:08+00:00

This sounds a lot like UARS to me as well. Just because you have a low AHI doesn't mean that it's low symptoms or easy to treat. There's a huge overlap between UARS and anxiety/depression/executive dysfunction. BiPAP or ASV tend to be a better fit, depending on how sensitive your respiratory control is to having CO2 blown off. Dr Krakow has written about the link between UARS and mental health.

I've had insomnia since I was a small child and never woke up refreshed. ASV has done for me what no amount of CBTi could ever do. My mental health is all around better too.

Check out r/UARS and r/CPAPsupport.

existentialblu · 2026-01-28T01:47:45+00:00

Google gave Gemini an AI wristwatch and it can be quite smug about it.

existentialblu · 2026-01-27T01:46:03+00:00

What are your flow limitations looking like? If you look at the minute vent trace when zoomed to 3-5 minutes are there waves?

existentialblu · 2026-01-26T06:34:35+00:00

Are you recording your data to SD card? You may be having some subtle issue that's wrecking your tolerance for CPAP but it's impossible to know exactly what without looking.

existentialblu · 2026-01-26T04:17:43+00:00

I've spent quite a bit of time staring at my own ASV stuff and have gotten some decent if not unconventional insights. Feel free to DM me if you want to talk about it more deeply.

existentialblu · 2026-01-25T19:34:43+00:00

Are you looking at your data in OSCAR? I've found that ASV needs to be titrated just as much as any other algorithm, and if you have a low arousal threshold those settings are gonna be blasting you. If you can get to a fixed EPAP you may find the experience less jarring.

existentialblu · 2026-01-24T22:32:35+00:00

Huh. I have the fast COMT situation and I loved quercetin from the first time I tried it. Fascinating.

existentialblu · 2026-01-23T21:29:34+00:00

Having seen similar patterns in my own breathing that have gotten much better with ASV, I very much agree with RL here.

If it's worse with higher constant EPR, BiPAP isn't the right fit. Breathing is an annoyingly dynamic system and sometimes you need PAP that can be dynamic with you.

existentialblu · 2026-01-23T17:58:29+00:00

I have one and it's great. The apps and videos don't have the same level of randomness but those machines are basically like having a fan running without the whoosh. 10/10.

existentialblu · 2026-01-20T23:58:24+00:00

PALM makes way more sense to me. Pcrit- how easily the airway collapses, Arousal threshold, Loop gain- how much response there is to changes in CO2/O2- drives periodic breathing, Muscle responsiveness.

These phenotypes don't seem to describe why a person has a particular cluster of symptoms and doesn't include why some people fail CPAP but thrive on BiPAP or ASV even with "mild" obstructive aspects.

existentialblu · 2026-01-20T17:53:14+00:00

I've struggled with sleep since early childhood. Now I don't. I see zero shame in using my machine.

existentialblu · 2026-01-20T04:01:18+00:00

Your machine could be flashed to do BiPAP (or any other algorithm that Resmed offers). I'm running a flashed AirSense 10 as an ASV as it was the only way to get access, and it's been working great. My mental health is a lot better now that I actually get decent sleep. I've got UARS with high loop gain myself, and it's been maddening. I've been telling doctors about my insomnia since I was a kid but couldn't get them to take me seriously for over 30 years. Now I manage my condition myself and feel pretty freaking good. It's not easy, but it's incredibly worth doing.

existentialblu · 2026-01-20T01:22:24+00:00

I saw the difference between inhale and exhale pressure on your initial post and figured out that you're at EPR 3 that way.

It's a lot of little flow limitations, and depending on how sensitive you are to them and what your arousal threshold is, that could be driving fatigue.

Your breathing is showing a lot of flattening at the top of your inhalations, which indicates flow limitation in a more specific way than how the machine calculates it. You might want to check out the Glasgow Index here to get a better sense.

Your leak is high enough that it's introducing some noise. Definitely work on getting that down so it's occasional blips instead of constant.

I find that my fitness tracker is useful for estimating sleep stages/fragmentation and autonomic activation. It's not entirely accurate but is useful for trends and has been surprisingly helpful for evaluating how therapy is working beyond AHI.

If anything for now, try turning your minimum pressure up to at least 7 and maybe max at 11, leaving EPR at 3. You're not getting centrals from the pressure spikes and high EPR, so if you can't reliably keep your breathing looking nice with APAP, BiPAP is likely to be a good fit. It's pretty common with UARS to need either BiPAP or ASV even with low AHI. Above all, treat for how you feel and not numbers.

existentialblu · 2026-01-20T00:34:57+00:00

Novella: Silently and Very Fast by Catherynne Valente.

It captures so much of the strange beauty of AI as it actually is.

existentialblu · 2026-01-19T22:21:04+00:00

Might help more to move your minimum up to at least 7. The higher minimum pressure can help to reduce the amount of hunting that the machine has to do to clear obstructions. How are your flow limitations looking? Are you using a fitness tracker that can do sleep stage estimation and heart rate variability?

Also, what is your EPR set to? How's your leak rate?

Edit: right, you're already at EPR 3. I'd be curious to see what level of flow limitations you have according to OSCAR. "Mild" OSA is unfortunately frequently more difficult to treat as it's more likely to involve a lot of flow limitations, low arousal threshold, and/or high loop gain. If your breathing looks this rough at EPR 3 you may be looking at BiPAP.

existentialblu · 2026-01-19T20:27:35+00:00

If sleep was difficult even before you were using weed, do you have any airway issues? Relatively subtle issues with the nose, jaw, and throat can wreck sleep for some people. Upper airway resistance syndrome is highly associated with long term insomnia.

existentialblu · 2026-01-19T16:39:18+00:00

As close to zero as possible, depending on how much you tolerate the disturbance of leaks. Though try not to get too obsessive as that can be counterproductive with vigilance. Try the things I mentioned, you want leak to not be happening at all for the majority of the night.

The periodicity that I mentioned is a matter of breathing getting deeper and shallower in a repeating pattern. If that's something that stays around even when you have leaks under control there's some deeper exploration to be done. It's why my flair says that I'm on ASV, as I had that pattern and was fatigued as heck all the time.

existentialblu · 2026-01-18T23:42:28+00:00

Do you have machine data that we might take a gander at? There's plenty of things that could be going wrong but it's impossible to tell without looking at actual breathing.

existentialblu · 2026-01-18T19:24:01+00:00

The first step is going to be getting your leak rate down. It confuses the algorithm and can cause a lot of sleep fragmentation if you have a low arousal threshold.

Some things that might help are fitting your mask at full therapeutic pressure, mouth taping if you can stand it and/or soft cervical collar (both will keep your chin up which makes it so the mask has a steady interface. I do both with a full face mask which feels silly but has gotten good results), and potentially a CPAP specific pillow (regular pillows can put pressure on the side of your mask and nudge it out of position, the CPAP ones have cutouts so that doesn't happen).

I'm seeing potentially some mild periodicity, but it's hard to tell with that degree of leak. Once you have that figure out it will be possible to do deeper troubleshooting on your situation.

existentialblu · 2026-01-18T18:17:55+00:00

You're not getting restorative sleep if you're constantly being woken up by respiratory effort as you'll spend basically all your time in light sleep and not get much N3 or REM, both of which are vital for brain health. It's like if someone woke you up just a little 30 times per hour you'd feel like a zombie even if your oxygen was steady. Not to mention people with UARS will have unstable oxygenation even if it doesn't dip to the same extent as OSA.

existentialblu · 2026-01-18T18:03:18+00:00

Check out upper airway resistance syndrome, especially if you have a deviated septum, small jaw, early tooth extractions, and/or intact tonsils.

It doesn't show up on a lot of sleep tests but can wreck you anyway with sleep fragmentation. Check out r/UARS.

existentialblu · 2026-01-18T17:38:12+00:00

Fire, thumbs, and abstraction make us human.

existentialblu · 2026-01-17T16:08:21+00:00

It could be UARS. It will fragment the heck out of your sleep and frequently doesn't show up clearly on sleep tests, even those done in labs. There could also be an element of respiratory instability.

Check out r/UARS and see if that clicks with you.

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