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Having a lot of difficulty
#1
Having a lot of difficulty
I had a sleep study in September after all of the usual symptoms (fatigue, cognitive issues), and was diagnosed with Sleep Apnea.

Hoping for some help - having a tough time with my CPAP therapy.  When it works well, it's fantastic.  Most of the time though, I hate it.

I've had an APAP since November.  Some nights I feel like it works really well (usually with a correspondingly low AHI score from the machine), and other times, not at all.  I've only only had one follow-up with Sleep Clinic since getting the machine.  In January, Min/max pressure was tightened slightly and was put in for a titration study (which I finally completed two weeks ago, after about a 5 month wait).

However, the clinic remains backed up, so next my appointment isn't until late October.  I just downloaded OSCAR and started looking over things, and when I compare them to what a lot of folks have posted here, my results are unimpressive.  I've been in the menus a few times to experiment a bit with pressure and EPR, but it's mostly guesswork.

I'm a mouth breather when I sleep.  I had a septoplasty in April, but not sure I've noticed an impact.  I'd like to eventually get to a nasal-only mask, since I frequently find it hard to tolerate the FF and hybrid masks. But, as soon as I fall asleep, instantly back to mouth breathing.  I've tried tape and a chin strap (separately and combined) with mixed results.

I've attached summarized results from my two sleep studies, along with two nights pre surgery (before and after clinic follow-up).  I'll post more recent post-surgery results right after this.

Some additional nights post-surgery.


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#2
RE: Having a lot of difficulty
Summary view.


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#3
RE: Having a lot of difficulty
The single biggest thing I see is Central Apnea.  It is not uncommon to see this in new CPAP users.  Typically this occurs because CO2 is flushed out of your system to below your apneic threshold resulting in central Apneas, frequently in clusters.

A characteristic of Central Apnea is that it is consistently inconsistent, it bounces around irregularly

Typically this treatment emergent central Apnea will disapate over 2-3 months as your body gets used to it

To reduce it you need to reduce EPR to 1, maybe turn it off, but one step a time.

A 10 minute view of the central Apneas can help confirm this theory.
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#4
RE: Having a lot of difficulty
Ok, here's the 16th with closeups; I tacked on 10 minutes during the CSR period as well.

Here's last night as well.  Went to sleep without issue and found mask on the floor.  Looks like I took it off after about two hours.  Tacked on a 10-minute closeup there as well.


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#5
RE: Having a lot of difficulty
Would you please elaborate a bit about the 'mixed results' over chin strap and tape, even combined?
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#6
RE: Having a lot of difficulty
Didn't find I could tolerate it all combined at night.  Mouth taping was best, but I found myself waking up trying to breathe through the tape.

The chinstrap, along with a mouthpiece, made my jaw and teeth hurt.

I seem to fight against it as soon as I fall asleep.
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#7
RE: Having a lot of difficulty
Did you try a cervical collar? I started using it to prevent positional apnea, which it does an amazing job at, but after a couple of nights noticed that I could sleep with my mouth closed which was totally novel for me. (I would always have to open my mouth to breathe once I got drowsy, before I was even asleep.)

I don't think you have to worry about the positional apnea, but it was a great cure for the mouth breathing for me, too.
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#8
RE: Having a lot of difficulty
I'll suggest going back to basics. Where's the full, detailed sleep diagnostic? Your summaries don't mention any Apnea types. Just a guess, there might be CA.

So go get the detailed reports. You may have gotten summaries just fine, but if the doc gets ruffled feathers and refuses, mention HIPAA law permits you to request and receive it. Your health is more important than doc's feelings.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#9
RE: Having a lot of difficulty
I tried a cervical collar; whatever one I grabbed from Walgreens wasn't tolerable to sleep in.

I don't always tolerate the full face mask well, but it's a necessity.  I've tried nasal-masks (and I keep working at it) and while they're easier to tolerate, the moment I begin to drift off, I start mouth breathing.  I've tried to acclimate to it by doing other things during the day while wearing it, but haven't made much progress. 

A septoplasty was supposed to help with this, but at best it's been no improvement, and maybe made things worse.  With nasal masks in particular, I notice a lot of pressure in my ears that's difficult to relieve.  Doesn't seem to be a problem with hybrid masks, even when using mouth tape to force myself to nasally breathe.

Up until reviewing OSCAR data in the last few days, I don't think I had a good grasp of what exactly was happening.  As I posted, all I've seen are the summaries and I haven't been to the clinic for nearly six months.  Next appointment - which is still three months away - is supposed to review the results of the titration study.  Tired of being tired, and don't want to wait until then to try and get it right.

It's a military facility, so records requests aren't always as simple.  I definitely plan on asking for the records next time I'm there.  The best and most detailed I have now and in the foreseeable future are from OSCAR.

I've been using CPAP as much as I can tolerate for nearly 9 months now; Is it expected to still have therapy-induced CAs for that long?
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#10
RE: Having a lot of difficulty
TECA for 9 months? No IMO this is unacceptable. And I copy on the records issue. OK that's fine. Consider doing this in this case.

Get pen and paper, and write down the CA that shows consistently inconsistent, that you believe these are cause for poor treatment and sleep, and you'll then fill in the blanks on symptoms and complaints about lack of well rested, poor sleep, discomfort, and so on. And when you present this to doc, you'll need to attain a negative attitude about treatment so far. Highlight only the negatives.

BTW there's 3 CA types I know: treatment emergent due to PAP, pre-existing or pre-dominant meaning they showed on a sleep study diagnosic, and idiopathic meaning unknown cause but aren't treatment emergent, the last is a catch all, ones that didn't show on diagnostic but didn't go away in 3 months, possibly this last is you.

You will want to ask for an ASV titration if CA still ruin sleep.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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