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+--- Thread: [Diagnosis] CPAP not working anymore (/Thread-Diagnosis-CPAP-not-working-anymore)
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CPAP not working anymore - A.G. Layton - 02-03-2020
Hi,
I was diagnosed with OSA (AHI=30) in 2018. I was given a CPAP machine : no more sleepiness, 10/10 energy during the day !
However, 8-10 months in, I developped intense neck pain and couldn't use CPAP anymore due to the mask straps pulling against my neck.
With a mix of physical therapy and pain meds, I'm able to use my CPAP again. But the extreme fatigue is back, with its tiring brainfog and migraines.
Pre-diagnosed apnea symptoms are back too.
I had a lot of flow limitations and an erratic respiratory rate.
Using wiki advice, I set EPR to 3 and saw great improvements in both respiratory rate and flow limitations. I feel slighlty more alert now, even with a higher AHI.
Before EPR=3 :
[attachment=19649]
After EPR=3 :
[attachment=19650]
I'd love to hear some insight on what I can tweak to have a restful night again.
RE: CPAP not working anymore - Sleeprider - 02-03-2020
Nicely done, implementing EPR to reduce the flow limitations and smooth out pressure fluctuation. It's too bad neck pain kept you from using therapy. The obstructive clusters in your most recent chart look like the positional problems that we have found respond to a soft cervical collar. The apnea events alone are not so bad that you need to correct them, but I wonder if a soft cervical collar could double to keep your neck stable and protect from strap pressure. See the link in my signature. There are many masks that use straps over the top and back of the head, however I think all of the hybrid masks use a strap around the back of the neck. If you think you might tolerate nasal therapy, relatively few nasal pillow masks use a strap at the back of the neck, and the lighter interface should impose less strain on your neck.
RE: CPAP not working anymore - Geer1 - 02-03-2020
I see most of your apnea events are centrals and am curious how bad they are on average. If you look at summary sheet it should give you averages for past periods, let us know what they look like (if there are obvious differences in obstructive apnea numbers that would be good to know too).
Your graph shows what appears to be a fairly obvious correlation with increased flow limitations and respiratory rate occurring in rem sleep. I say obvious because it is happening periodically and approximately every 90 minutes which is the pattern that rem sleep occurs in. Rem sleep is notoriously bad looking (flow limitations, oddly spaced breaths, rough jagged looking breathing) even in people that don't have sleep disordered breathing. That said your breathing did noticeably improve with EPR, probably for 2 reasons a) Increased flow from EPR reducing flow limitation effects and b) With no EPR your flow limitations are shooting pressure up to max making it even harder to breath out.
I would stick with EPR of 3 and I might even consider trying a lower pressure. Have you tried lower pressure before and if so were obstructive apneas a problem? Lower pressure would probably help reduce the centrals and may possibly help with the flow limitations as well. A test would be to lower min pressure down to say 8 and see how the machine reacts, if you are having obstructive apneas it will increase pressure quick to compensate.
I also assume you have tried nasal or pillow masks but they don't work for you due to mouth breathing etc?
RE: CPAP not working anymore - Marillion - 02-03-2020
Good tips above for sure. I would also recommend you take a look at your pillow. Something that is too high and soft could also be contributing to the clusters of events. Try to use something a bit lower and firmer if possible for a pillow.
RE: CPAP not working anymore - A.G. Layton - 02-05-2020
Thanks for your feedback. It means a lot to me.
Regarding masks and collars :
I've tried nasal masks (e.g. bleep dreamport). I mouth breathe and i can't wear cervical collars or chin straps due to my neck pain.
Definitely first thing I'll consider once I'm through with this neck pain.
Regarding apneas :
Those central events appeared 8 months into CPAP therapy. Here is the average :
[attachment=19706]
(02-03-2020, 02:56 PM)Geer1 Wrote: Your graph shows what appears to be a fairly obvious correlation with increased flow limitations and respiratory rate occurring in rem sleep.
You might be onto something. I very often wake up after vivid dreams, so in REM state.
Might it be UARS ? I definitely am sensible to flow limitations waking me up.
I wonder if I can further optimize resp. rate and flow limitation. As per wiki says, maybe a BiPAP would be a good option.
To sum up :
I see 3 main points on which I can act :
- faint Central apnea presence : lower min pressure
- flow limitation and resp. rate, waking up in REM sleep (UARS ?) : switch to BiPAP for more pressure range
- neck pain, apnea clusters : try new pillow. Try cervical collar when I can tolerate it
What do you guys think ?
RE: CPAP not working anymore - Geer1 - 02-05-2020
Most of your apneas are central in nature and the frequency of which they are occurring is not inconsequential. I don't know exact dates but you started CPAP in 2018, 8-10 months later started having neck pain issues for an unstated reason and as of now have been having central events for the last 8 months. The start of central events seems to have possibly started at roughly the same time as the neck pain issues and that may not be coincidence.
I would like you to look through your data and see what you think caused the centrals apneas to start. Did you make changes to CPAP settings at that time? Does it in fact correlate with the neck pain issue and if so what is the cause of neck pain (or what do you think might be the cause) and do you believe it affects your sleep?
The statistics page shows when settings where changed and what the AHI was at those settings. If you have tried some different settings I would be interested to see what you have already tried.
Bilevels help with flow limitations but they also can make centrals worse if the centrals are due to cpap treatment so that path can be a double edged sword.
Answers to my questions above may influence my thoughts but what I would like to see is how the machine responds if you lower min pressure to 8 cm and leave EPR at 3. Try that for a couple nights and then post OSCAR results.
RE: CPAP not working anymore - A.G. Layton - 02-06-2020
Looking at data since I began using the CPAP, I stand corrected : I always had central apnea.
[attachment=19721]
My neck pain appeared over the course of one month. My PT thinks it's a combination of muscle loss, stress, and cold (winter was harsh in Quebec). A bad fall on my back while skiing sealed the deal.
I spent most of the time awake at night because of the pain, so it definitely had a big impact on my sleep. Using the bleep nasal mask helped tremendously in restfulness, even with the mouth leaks.
Here is what the majority of my central events looks like :
[attachment=19724]
I wonder if these are real centrals. They look more like brief awakenings if I'm to trust this info : youtube.com/watch?v=xallwxPCg84 . It correlates with my impression of awakening many times during the night. What do you think ?
This one seems to be a real central : [attachment=19725]. This pattern makes for 1/4 of my central events.
I had my first night with a min pressure of 8, and saw improvements both in AHI and restfulness. It's too soon to draw conclusions, and I'll keep you posted once I have more data.
RE: CPAP not working anymore - Geer1 - 02-06-2020
Yeah those centrals appear to be post arousal so don't really count. The more real version might be you changing position (arousal a few breaths before then not actively breathing while rolling onto side or back etc). I am not too worried about the central apneas and they don't appear to correlate that much with your pressures you have tried in the past. The question is why you are having the arousals.
I like the new settings in regards to what I am seeing you have tried in the past so it will probably be worth sticking with it for a while. I have a feeling any other issues are not CPAP related and am curious if you believe you have any issues with leg movements (PLM) etc in sleep?
RE: CPAP not working anymore - A.G. Layton - 02-07-2020
Yeah I do move a lot when asleep. Sleep study didn't show any PLM though.
RE: CPAP not working anymore - Geer1 - 02-07-2020
There is a lot more to movements then just PLM. PLM requires periodic leg movments (hence the name), there are a variety of other movements that can occur and for different reasons. Then there is also the question are the movements causing arousal or are they post arousal in which case they aren't the problem (for example changing position, hypnic jerks when falling back asleep etc).
Was your sleep study an in clinic polysomnogram?