5 years on cpap, no improvement. getting desperate for some help.

[kc210]

sleep study my number was 122 (don't have the study on hand)
philips respronics remstar System One (7-15 pressure range)
Dreamwear Full Face. medium headgear, small nosepiece.
Heated Tubing on max 5 humidity
ambien 10mg/melatonin 10mg
Mostly side sleeper with body pillow, sometimes stomach
mouth breather

I've been on cpap for about 5 years, the very first night i woke up in the morning and felt great even went for a walk, after that it's been terrible. We've tried about 5 different masks types, I have deviated septum/bone spur so nasal is difficult. Currently using dreamwear full face which I like. I've never been able to tolerate or fall asleep with any mask, so i'm using ambien/melatonin to be able to fall asleep with it, i would always throw it off around 4 hours in. Recently I noticed when i threw it off i could remember having a dry mouth, so i got some xylimelts and that has seemed to help. I've tried diff pressures, humidity, wearing the mask before bed, adjusting the mask, even putting ice cubes in the chamber for cold air. Last week when I added the xlimelts i had another good night and seemed to get around 5 hours and almost felt like a human, but that was just one day, and judging by the data my ahi and other stats have actually went up since i started trying new things. Even when waking up from the 4-5 hours I feel worse than if i just took a nap without the machine. 

It's been 5 years, and I've run out of ideas. My sleep doc just mentions surgery and has never made any suggestions for changing any settings other than the pressure. I've lost weight and have actually used less pressure since my study. I've felt the positive benefits from it briefly so i know it's possible, i always feel like it's just out of reach. I wake up each day feeling terrible. I would imagine even with 4-5 hours of cpap use it would be better than none. Any suggestions I'm willing to try and should respond quickly if more info is needed.


Also, when I imported the data, oscar said it was reading things it had never seen before. Don't know if it's relevant or not;0 the last 2 weeks i've been trying different things, so there might be anomalies in the data.


Thanks for any help.

[SarcasticDave94]

Welcome to the Apnea Board.

A few things to help with this:

Try a standard not zoomed view of Oscar so we get a good idea of what is going on overall

You'll likely need a bit more pressure to deal with the hypopnea and other events as a short term answer

Since your PAP is 5 years old, it's time to get a new and better machine, the ResMed

[Sleeprider]

You are still using a 60 series Philips System One and might be due for an update. If so, do everything you can to get. Resmed Airsense 10 Autoset. It will treat the flow limits, RERA and hypopnea that stand between you and a good night sleep.

[kc210]

Welcome to the Apnea Board.

A few things to help with this:

Try a standard not zoomed view of Oscar so we get a good idea of what is going on overall

You'll likely need a bit more pressure to deal with the hypopnea and other events as a short term answer

Since your PAP is 5 years old, it's time to get a new and better machine, the ResMed

thanks for the reply. was in the process of getting a new machine, but insurance needed to wait for the full 5 years which woudl be now, but with my usual doc not seeing patients for covid going to have to wait a bit.

my starting pressure was in the 8-8.5 range for awhile, my doc suggested i lower it to 6 slowly which i did, the other night i even bumped it up to 10 just to try. actually felt worse i'll bump it up to 7.5 tonight.

i went into view and didn't see a standard view, a place to reset the graphs to standard. i even looked through the oscar screenshot posting guide from your signature. ive got the app open full screen, maximized, this is the most data i can get on the screen with these new screenshots. hopefully that's helpful.

   
   
   

[SarcasticDave94]

There we go, that's the view I was mentioning. I think the bump up may help some for now with the hypopnea count. And the AutoSet will be a nice step up once you get one. Just tell the doc it's time to upgrade to a new ResMed AutoSet.

[ardenum]

If it aint working it's time to have a jab at things like:

More pressure
Additional O2 from a concentrator
MAD
removing tonsils

[kc210]

If it aint working it's time to have a jab at things like:

More pressure
Additional O2 from a concentrator
MAD
removing tonsils

hah yeh i have large tonsils, neck, giant tongue, deviated septum with large turbinates and a bone spur. all the best qualities for sleep apnea. i'm not having any surgeries for the time being but i'll look into the other 2 suggestions. thanks

[Sleeprider]

While the post by ardenum has some merit, it is way premature. The minor problems that are apparent in the charts posted by kc210 are easily resolved by very reasonable pressure and pressure support which is available by using the EPR function of the Airsense 10 Autoset, or even more-so by the Aircurve 10 Vauto. The results are absolutely typical for a Philips machine with hypopnea and flow limitation, typical of upper airway restriction, that is especially poorly addressed by the Philips algorithm. With nearly any Resmed machine, this AHI would immediately drop to less than 1/hour with much greater comfort.

[kc210]

set my min to 8 last night, ahi went from 3.9 to 1.6. will post a screenshot. felt a little better, i did have a bit of feeling like i needed to catch my breath when i woke up, and still really tired eyes and yawning. of course ive been at that pressure before, but not since i added the xylimelt and max humidity for the dry mouth. 5 hours and 38 min is a record for me actually. although not sure how long it took me to fall asleep.

should i continue to increase say .5 each day and then check the data/how i feel and adjust accordingly or just bump it up to 9 or 10 since it says i'm at 9.8 for 95% of the time anyway?

thanks

[SilverSleeper]

Dry mouth, high leak rate... seems like a leakage problem, probably a mouth leak. Are you a mouth breather?