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[Treatment] 28 days into CPAP - OSCAR feedback please!
#1
28 days into CPAP - OSCAR feedback please!
Wave Hiya from Arizona,

I'm 28 days into CPAP therapy and need help optimizing treatment. 

44yr old male, 5ft'9in / 167 lbs

My presenting complaint @ sleep study: 
- tired most days w/ brain fog (for a few years)
- ever-hungry for one or two more hours of sleep, but rarely able to resume sleep after the ~ 6 hour mark.

Lo and behold, the one-night (split) polysomnography yielded an OSA diagnosis with an AHI of 26 (worst on back, then left side, lowest on right side - AHI 10). 

Provider said I had significant disruptions in sleep stages during first 2 hours baseline: my N1 was good but I lingered longer in N2 and N3 and never progressed into REM at all, due to apnea. Disruptions lowered my oxygen to 78% at times (total time below 88% was 2.4 min). 

Lots of movement in limbs during baseline 2 hours. Then, AFTER CPAP added - (nasal pillows), next few hours were API 2.0 and complete resolution of limb movements, heart rate and EKG variability was normal, and I entered REM for 15% of the remaining sleep time on nasal pillows pressure=7.

Got my Airsense 10 shortly after the sleep study and have used it nightly for 28 days with varying subjective results. Mouth-opening has been a problem for me. Chin strap didn't work. Mouth tape mitigates the disruptive sounds of mouth-opening, but when the back of my tongue or jaw relax in the slightest, the lip seal isn't enough to keep me asleep; I sense the air accumulating and exiting my mouth (softly, through the porous tape, but enough to arouse). This, combined with a night or two of "rainout" in the hose, caused me to go into the clinic and try a mask with greater coverage than the Airlift P10's. 

The respiratory therapist gave me a Fisher & Paykel Evora Full Face Mask (cradles under the nose, with mouth coverage)--similar to F30. 

I've had mixed quality nights on this mask, mainly due to strap-adjustments and such. I finally have a knack for fitting it properly now. 

There was condensation in the mask last night, which hopefully resolves tonight w/ the addition of a warming hose (I keep my room very cool).

I'm open to all general feedback. But my specific questions are:

1. OSCAR SEPT 15 ATTACHED: Last night (Sept 15) - I increased my pressure from 7.0 to 7.6, hoping to lower my API's which have varied from 3 to 11 (generally under 6). I've inferred that the second half of my nights typically have higher API's than the first half. I know this because when I wake up to pee at the midpoint of night (less often now, since CPAP), my API is one thing, and by morning it's twice what I saw, or even more than twice, meaning the second half of the night must've been considerably higher to push up the average by double. 

I went to bed last night with my Airlift P10 pillows and couldn't fall asleep. 90 minutes elapsed. So I switched to my face mask and from that point slept 6 hours.

I noticed the machine displayed an AHI of 11-12 at the 90 minute mark on the pillows. But I hadn't fallen asleep yet (to my knowledge). 

What went WRONG with the first portion of my sleep/non-sleep (nasal pillows)? 

Maybe the extra coffee at Noon (bad!) delayed sleep onset? I normally don't have trouble with onset. 

What is that cluster of clear airway events as I was trying (but unable to) fall asleep?

What went RIGHT last night with the second portion of my sleep (face mask)? That part felt restful! I would like more good segments like this.

Note: when I switched out the pillows after 90 minutes of no sleep, I took a second low-dose Lorazepam (0.50mg). I normally only take one before bed.

Tonight, I hope the slight increase in pressure I made to 7.6 + more familiarization with the new mask + the warming hose (starting tonight)--will allow this restful six hours to be replicated, and elongated.

2. OSCAR SEPT 14 ATTACHED: Night before last (Sept 14) - this represents a typical night with the Airlift P10 during the first ~28 days of my CPAP journey. First half of the night is OK, both AHI-wise and subjectively, but when I fall back asleep for "round two" my sleep is plagued with more events and wake-ups (from what I perceive as numerous jaw relaxation episodes that cause noise or sensation-based wake-ups). What do you see in the data? Does it support my perception?

Thank you very much!


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