Anything more to tweak?
Hi all, I've been using a CPAP machine for seven weeks now, and things seem to be going quite well. I thought I'd relate my story to see if there's anything further you think could be tweaked.
I first had a sleep study 9 years ago at age 51 and tried a machine but had trouble tolerating it. At that time they said my apnea was mild and I didn't absolutely need to be treated, so I didn't pursue anything further.
As I turned 60 this year, however, my wife reported more "apnea events" (stopping breathing at night, followed by a sudden noisy inhale). Also, I found myself very tired during the day, with difficulty staying alert even during morning meetings. So I had another study (this time with a device at home), and they reported my AHI was 29.9.
I was given a Philips-Respironics 60 Series REMStar Auto machine with heated humidifier and a mask with nasal pillows to try. With this gear, my wife said there were long periods where I was making a whooshing sound (i.e. mouth hanging open and air leaking out). So the clinic changed me to an Airfit F10 full-face mask. They set the air pressure to 4-20 cm variable. I also got a copy of SleepyHead and started looking at my data.
I noticed a big difference between sleeping on my back vs side. When I slept on my back, my AHI for the night even using the machine was up in the 8 to 11 range. If I stayed on my side, it was down around 2 or 3. I asked the clinic about the numbers from my sleep study this year. It turned out that when I slept on my side during the study, my AHI was 0. However, when I slept on my back it was 59.8. Since I spent half that night on my back vs side, my total AHI came out to 29.9. (For what it's worth, I'm 6'1" and 180 lb, so weight doesn't appear to be an issue.)
I therefore started making an effort to stay on my side as I used the CPAP machine. The full-face mask was a reasonable fit, but I found it hit the pillow as I stayed on my side. Also, my nose gets kind of itchy, and to itch it with a full-face mask I have to stop the machine and take off the mask. The clinic therefore gave me a ResMed Mirage Liberty mask to try -- this combines nasal pillows with a cup-type shape that fits over the mouth. I had a hard time breathing through my nose with this mask, however, so I didn't stay with it long. It appears there is a second set of nasal pillows included with it, so it's possible I could improve it if I experimented with it. Meanwhile, though, I went back to the F10 full-face mask and found myself getting used to it.
Around this time I also got a CMS 50D+ oximeter to check out my oxygen as I slept. I smoked for 15 years as a young adult, but quit 25 years ago; now at age 60 my oxygen % is typically around 96 both day and night. The oximeter showed that when I slept with the CPAP, it would hover mostly around 96, only occasionally dipping to 94 or so, never lower than 92.
Now in my seventh week of using the machine, things are going well. I'm used to sleeping on my side (though I turn a couple of times each night to alternate the side), and the F10 mask seems fine. This week I've been getting AHI numbers for the night for the first time under 1.0 -- the lowest ever was 0.58, and other nights it's been 0.72 and 0.90, though it's gotten up to 2.05 and 2.19 a couple of nights. I hardly ever have any Cheynes-Stokes breathing -- the main thing seems to be hypopnea and RERA events. I feel alert during the day, and my wife says she doesn't hear me and she sleeps better than she has in years.
So I'm tempted to call this a success story and just go into cruise mode with this current configuration. But there are a couple of points I've wondered about:
-- Some CPAP users tell me it's difficult always to sleep on their side, and they think it's better to adjust the machine in order to hit good AHI numbers regardless of their sleeping position. Some have suggested trying a higher minimum pressure (on my machine the minimum is currently 4 cm). Does this seem worth pursuing, or if I'm happy sleeping on my side is it important?
-- Although the F10 mask seems pretty fine now, I still wish I could itch my nose during the night without a lot of re-rigging. I hear about other mask options, such as some designed for mouth breathers. However, my clinic has a limited number of masks to try, and after several requests I haven't been able to get them to give me a written prescription so that I can buy my own if I want to.
Thanks for any thoughts on the above, or anything else that might be worth discussing from my story.
(This post was last modified: 12-21-2014 11:55 AM by Dyssomniac.)