On the brink of desperation - Can not stay asleep still

[koy23]

Admin note:  attached screenshots from this post have been removed

[attachment=9607][attachment=9608][attachment=9609][attachment=9610][attachment=9611]First post here and thank you for valuable info you post here. I have been having some sort of apnea for almost 5 months, i started waking up in the middle of the night ( not gasping for air) just my eyes open, and it took me all 4 months to figure out it was related to my acid reflux causing throat inflammation causing sleep apnea ( specially on my back) i did not suspect apnea first because i wasn't gasping for air but rather sometimes hear myself snore right before i wake up.
After i failed home study a lab sleep study showed 17 AHI with following data :
total sleep time : 321 mns
Sleep efficiency : 61.25%
23 arousals/hr
13 arousals associated with Apnea & Hypopnea
6.5 RERA/hr
3.5 spontaneous/hr
Delayed REM onset
SPO2 duration of less than 90% was 0.4
Lowest SPO2 waas 88%

I got the Resmed airsense 10 autoset, tried first night the P10 mask but could not handle the nose pillow. tried the Dreamwear nasal, and when changing the frame to large it was good, very minimal leaks and comfy.
My problem is i still keep waking up at night, which makes me very groggy in the morning and sleepy although my AHIs are all low ( below 1) i can not figure out why i wake up, from the graphs i see that a sudden increase in pressure wakes me up, i restarted the machine each time i wake up to mark the time, and i tried adjusting the pressure, it looks like most of my pressure is around 5-5.5 nut then machine increase sometimes suddenly, i suspected this is because i'm a side sleeper and maybe i tuck my face in the pillow which closes the air ? also tried without EPR and it woke me up, i have to set the EPR to on full time and to level 3 and ramp time has to be very close t min pressure otherwise the sudden increase wakes me up.
the Only thing i did not try is a CPAP pillow which is coming in a week, but i wanted to show you the screenshots to see if i missed something or if you see something else.
It's been almost 5 months of horrible sleep quality so i was really hoping the CPAP will fix it, but now i'm loosing hope..
thanks you

[Sleeprider]

Your current settings appear to be 5.4 minimum to 8.0 maximum with EPR 3. You appear to have used ramp early on but more recently it is off. You have essentially no apnea or hypopnea events current. To avoid the sleep disturbance, I think you should consider setting fixed pressure and less EPR. You appear to tolerate a pressure of 7.0, but often break therapy when things get above 9.0, however you seem sensitive to pressure changes of any kind. I recommend a CPAP pressure of 7.0 and EPR at 2. Used fixed pressure and see if that helps avoid the sleep disturbance. I don't see anything that looks like a positional apnea, so just get comfortable and sleep, then keep the disturbances from pressure change to a minimum.

[koy23]

Thank you, I am using ramp each night for 45 mn now I set it at 5 and min pressure at 5.4.

I tried EPR off and could not sleep with pressurized mask when exahling, it woke me up. EPR 3 seems comfortable. But I did not try EPR 2.
I understand you want to make the pressure change the least possible.

I could set it at constant 7 but when I look at the median pressure and my air flow curves they seem to be best at around 5ish untill the machine decides to raise pressure which I don't know why( mask instruction from pillow? )

[Sleeprider]

First of all, turn off the ramp. You don't need it at these low pressures and it interferes with data collection. If you MUST use ramp, put it on Auto. The reason Things look so good up to 5 cm is nothing is being recorded during ramp. Secondly, with EPR at 3, you almost never realize a synced inhale and exhale pressure. Only the inhale pressure increases and the exhale pressure is stalled at 4.0 until the inhale pressure reaches 7.0. I think this is part of the problem. If you think low pressure is your friend, then set CPAP at 6.0 and EPR 2. Let's get a look at what happens without ramp and at steady pressure. Even if you were using auto pressure, I would recommend a minimum of 6 and maximum of 8 with EPR 2, mainly to ensure IPAP and EPAP move together.

[koy23]

ok so try min 6 to max 8 with EPR 2 and ramp auto
then next night constant 6 with epr 2 and ramp auto
then constant 7 epr 2 and ramp auto.
correct  ?
also is there a way that the graphs show if my pillow is causing air cutout ? i'm thinking i need to get a cpap pillow now bc maybe the machine keep increasing the pressure because i bury my nose inside the pillow when i sleep. is there a something i can look at in the graphs to validate this ? i can only see flow limit sometimes increase without any apneas or snoring or leaks, is that the indicator ?

thank you for your insight

[Sleeprider]

Those are all good choices considering your complaint and current results. If something works feel free to stick with it. What I notice is that when your pressures are low, the flow rate looks erratic and tidal volume is low for a male adult. As pressures increase, your breathing seems to smooth out and look fulle4r and more event; however pressure increases appear to disrupt your sleep. Try all three options, but feel free to loiter if you find a comfortable night.

[ardenum]

get the right pressure and take one of the z-drugs to put you to sleep.

[AlanE]

A CPAP pillow may help. I have a buckwheat hull filled pillow now for a couple of years (I think) and it works wonders.

As for your current pillow blocking your air, I assume you are referring to exhalation. That could be a very real problem. I had a, issue with this recently but not from my pillow blocking air, instead it was when my mask 'filled' with water. The so-called rain out. The P10 has very fine mesh screen in the front where your exhaled breath is washed out of the mask. When it gets clogged with water, you basically breath out into the tube and then inhale that back into your lungs. O2 drops and you wake up. Followed by water spitting all over your face. Turned out my issue was the climate line hose. No matter what setting I used from auto to full on/off and in between, I got rain out. I'm now back to using the slimline hose and no longer have rain out. My pillow, if it blocked any part of the mesh it usually is just on one side of the mask. Enough air gets washed out of one side at my settings that I don't worry.

[koy23]

I was considering buchwheat but decided to go with memory foam CPAP pillow with the cutouts. Waiting for it still.
No I did not mean exhalation, I don't k is if you know how dreamwear nasal mask looks like, but burying my nose into the pillow (left side) kinda blocks the air from reaching my nostril as without burying it, so I think mask pressure drops, and CPAP compensate for the air lost. I will see if any changes happen when I get the CPAP pillow. 
Thanks and happy new year

[AlanE]

Ah ok. yeah, I didn't understand until I saw a pic of it. then I got it right away.