36 nights on APAP - still very poor sleep

[willl]

Hi all - thanks for taking a look, any suggestions welcome.


Quick stats about me:
33yo male
Normal BMI (6'2", 188lb)
Relatively active: 11-12,000 steps per day, dog-walking + swimming + yoga
Diagnosed with a deviated septum and enlarged turbinates.
Recent annual blood workup, no issues detected
Poor sleep for my entire adult life; wake up 3-5 times per night, rarely feel rested/alert despite 8-9+ hours in bed. No snoring.

WatchPAT results (July 2022):
9.5 AHI/hr
27.6 RDI/hr (includes RERAs)
minimum O2: 85%


CPAP Experience:
Using a ResMed AirSense 10 Auto, with the P30i nasal mask and ClimateLine heated hose. Default 4.0/20.0 pressure.

After my WatchPAT study, I was given a "loaner" Airsense 10 Auto, which I used for about three weeks. In that time, I noticed slightly fewer nights that were truly terrible, but still had pretty serious fatigue and interrupted sleep. Still, I decided to buy one out of pocket (no DME insurance) and hope it would get better.

It's now been about two weeks with my own Airsense 10 Auto, and I'm continuing to have a hard time of it. I'm experiencing some back pain, which is probably due to sleeping in a new position, but mainly I just can't seem to stop waking up every 60-90 minutes. Last night (9/10), I turned my CPAP on and off whenever I woke up, which you should be able to see in the flow rate chart. Tried buying the P30i mask, which didn't seem to make much difference - should I look into a full face mask for the deviated septum? Any thoughts on pressure adjustments? (I tried 5.0/20.0 for a few nights, but seemed to do more harm than good - didn't want to mess around further without a plan.) Given the high RERAs on my WatchPAT, would it be worth it to try to find a way to trial a BiPAP, or is it too early for that?

Kind of at the end of my rope, haven't had any decent sleep since August. Even with the RDI numbers seemingly way down, my sleep with the CPAP on is worse than with it off. Appreciate anyone who read all this!

   
   
   

[staceyburke]

Your numbers look good but I would try EPR and see how you feel using EPR.

SET EPR ON FULL TIME
SET MIN TO 7

I think this will help.

[willl]

Thanks! I'll give that a try - I should've mentioned, I do have EPR on 3, but obviously not as big a deal with min pressure at 4.0.

Here are some screenshots from when I tried a min pressure of 5.0, just in case anything jumps out - subjectively, the first night 9/2 was one of the better nights I've had on CPAP, despite the numbers.

   
   
   

[willl]

Definitely much better on 7.0/20.0 - got about four hours of sleeping like a log. (The RDI is bad because there are a lot of false-positives when I was falling asleep.) I didn't rest as well after waking up around 3:45, lots of rolling around and burping up air, but still a big improvement.

I've looked around the Wiki, but any risks I should know about associated with larger increases in pressure like this? Thanks again.

   

[willl]

I mean gosh, look how smooth the flow rate gets after it bumps up to 9...  
   

[KeepSmiling]

How are you feeling during the day.

When are you going back to the doctor. I would keep an eye on the CA.

Is your room completely dark, like you cannot see your hand in front of you. I found covering my eyes so total darkness, helps me with very early wake ups. I do not notice as many and feel like I was in a deeper sleep.

[clownbell]

Your tidal volume is very high. I have no idea why. Hope an expert comes along to address this.

Also, the title of the posts suggests you are just over one month in. For most, CPAP is not an overnight fix. In my case, it took about 6 months before I felt "really good." Patience and perseverance are keys.

[willl]

@KeepSmiling - I've kept my room pitch-black for years, blackout curtains, no little power LEDs or anything. Also use an eyemask and earplugs every night. During the day, I feel pretty exhausted and scatterbrained and grumpy, honestly. I get about one decent night of sleep a week, maybe, although that's been harder to come by with the CPAP. Still, sticking with it. (It's frustrating because I'm applying for jobs right now and need my energy, but long-term, I really want this dealt with.)

@clownbell - Good point on the tidal volume; my second night with the min pressure at 7.0, I also woke up with pain in my stomach and a shortness-of-breath feeling that lasted all morning. I saw some info about very high tidal volumes potentially causing lung damage, so I decided to ramp back down to 5.0 given the other side effects. 95% TV is still high, but I'm pretty tall and skinny so maybe that's normal?
I'm going to leave it here for a while and hopefully adjust. The clear-airway clusters are definitely for times when I was still awake, so not super worried about those. Also have a wedge pillow on the way that should help my back pain.

Here's the last night on 7.0, which wasn't super restful in addition to the above side effects:
   

And here's me back on 5.0, which did feel like a bit of an improvement rest-wise, and no chest pain or stomachache:
   

Thanks again for your thoughts so far, folks.

[Brazen]

Can I ask why you're keeping your max pressure at 20cmw?  It might not matter since of the charts you attached you never went over 10.5cmw.

I'm a newbie myself but I think the aerophagia (bloating/bleching) is caused by max pressure, not min.

Like I think Opal said, it takes time but, getting your settings correct is very important.

[willl]

Honestly hadn't thought about messing with max pressure - looking at the data, mine has never even hit 11, so I think I'm comfortable leaving as it for now. I've noticed it spike right before I wake up in the night, sometimes, but I'd guess that's probably just because of an OA?

Total sidebar, but I'm curious what people's thoughts are on septoplasty. The best nights of sleep I *ever* had were using the Mute brand nasal dilators, so I could actually breathe through both nostrils, but they absolutely destroyed the inside of my nose after a few days. I hear there are also some potentially nasty side effects to the surgery, and insurance would be fun to work with, but I'll look at posts and see if anyone's had lasting success with it.