3 months in, day to day feels like a roller coaster

[Trekkiegirl]

Hi everyone, 
I was diagnosed with sleep apnea in March and did the tritation study with about 7 AHI a night. I'm 28, average fit, and a women so the doctors originally assessed me with narcolepsy but instead was sleep apnea. 

I'm currently on a Resmed Airsense 11 with Phillips Dreamweaver Full face mask medium and medium. I'm also a stomach only sleeper which complicates my life.

I honestly hate wearing the mask but up until recently I felt so much better during the day that it was acceptable, but now it's swinging around drastically depending on the day. I get daytime sleepiness again but not to the extent pre cpap. 
I think I am sensitive to any AHI but I've just now seen that clinician mode can let me see events in the sleep view so more data is required.

I get between 8 to 10 hours of sleep if work allows.
I purchased a cpap pillow with the cut outs I am trying to get used to. 
When I wake up in the morning I need at least 20 mins of snooze sleep w no cpap to be able to function. I am too groggy to wake up and get moving. 
On weekends, I'll naturally wake up about 8AM and then sleep another hour or two without the mask to feel human. 
I used to wake up with congestion that has now cleared with the use of the cpap. 
I had deviated septum surgery last year with full recovery (I have been told at least). 
My nose still collapses in daily breathing, that is another surgery required. 

I am waiting on the nasal mask from Phillips to arrive from my DME to try that model out with mouth tape but I think with the stomach sleeping/nasal problems it will not be what I hope for. 

I'm curious to see if I can get my AHI down to lower and if that will improve anything? Is there anything glaring in the documents?
 It honestly feels like my doctor doesn't care that I'm below 5 AHI and nothing can be done to lower that number, but I don't know if that's true or matters?

Thanks,

[super7pilot]

Well, You had my attention with Trekkiegirl. I will assume that you did mean Star Trek.

What so many folks don't realize is that pap therapy is more than just the therapy. It took me a while to finally start getting proper sleep. My sleep Dr. told me that at first I would likely feel pretty bad as we humans are not meant to breathe high pressure air. And it takes time to adapt. And any sudden pressure changes can very often be the sole reason we wake up while on the pap hose.

It's why we always say close the gap between min pressure and median pressure. The closer we can get to limiting the rise in pressure. The better chance we have at not being disturbed those increases. Your min pressure is 7cm, but you spent most of the night at 8cm. So you should make this your minimum. As you were bumping against your max pressure of 12cm. You should raise it to 13cm.

You have too high a level of flow limitations. the flow limitations are what the Resmed programing uses to increases it's pressure to the mask.

Yet other things can have a negative affect. And that would be outside of therapy issues like medications and general aches, pains and noise that disrupt ones sleep. At 28 your aches and pains shouldn't be too bad. At least I certainly hope you don't have everyday aches and pains.

Good news is that your OA's and H's are well controlled. The CA's are likely treatment emergent from breathing all that air and flushing out Co2. They will normally start to go away to some degree
Try not to concentrate on just a low AHI. If my maths are correct that chart shows 1.94 (ish) AHI. You should gauge your treatment success on how you feel not just a low number
I felt really bad and my AHI was mostly under 1 from the start. My sleep problem after treating my apnea's were a rip roaring case of dry eye. They were what was awakening me at night. Once I got that under control. My sleep improved dramatically.

So to close. Increase the minimum to 8cm and increase the maximum to 13cm. And give that a few days as you don't want to change too much at once. And hopefully that new mask will work.

[Trekkiegirl]

You indeed would be correct! I grew up on TOS and TAS on VCR, and kept the name ever since. 


I think I took your suggestions and adjusted from there. I did get the nasal mask and mouth tape. It is so much more comfortable to sleep on but I'm getting bad dry mouth even with the tape so I will have to work on that. My events started at 4.5 and gradually have gone down to the following. 

How does the data look?

[jdougc]

Please post a copy of your sleep study with your info redacted.
Did you have central apneas during the study?
If not these CAs, might just be treatment emergent and nothing to be concerned with as they diminish on their own.
Please hide the calendar, we need to see the device settings.
Your flow limitation are high and need EPR to treat them.

Consider using a SomNoSeal device,a soft, flexible mouthpiece that prevents mouth breathing and dry mouth during sleep. 
https://www.youtube.com/watch?v=1u_S1ADwVmA

Make sure to use lanolin when using the nasal pillows to protect your nostrils.  

Also consider a Hose holder to stop the weight of the cpap hose holder from pulling on the mask.

[Trekkiegirl]

I use just the nasal, the nasal pillow was uncomfortable. 

I have EPR on 3 full time, and have been. What else can do I for the flow limitation? Is my stomach sleeping blocking the hose potentially? I have learned I'm a 'middle of the pillow' sleeper so the indents on my cpap pillow are not placed well for me. 

I've thought about the hose holder but I travel a lot for work and moving that around seems to be difficult?

I did hide the calendar on the 2nd image, I apologize. 
I'll check into the mouthpiece but that sounds like a torture idea.  

[jdougc]

We need to see all of the devices settings, is ramp on?

I use this easy to mount and flexible hose holder.
https://www.amazon.com/dp/B0BQBJFSSS?ref_=ppx_hzsearch_conn_dt_b_fed_asin_title_1

I drooled a bit at first, but the SomNoSeal is very soft. I use a 2x5 strip of the Kinesiology cotton elastic athletic tape also.

Your Flow Limitations are too high.  You might need to raise your minimum pressure to help, since EPR is maxed out.


Flow Limitation Is Associated with Excessive Daytime Sleepiness in Individuals without Moderate or Severe Obstructive Sleep Apnea.

https://pubmed.ncbi.nlm.nih.gov/38530665/



O

[super7pilot]

Looks like those CA's are in fact treatment emergent they tend to go away and are not the harmful variety. Our studies are similar in that I also had 2 centrals total in my study and I had 3 OA's but a lot of Hypopneas. 2 centrals it is not a significant level. Also looks like you should be side sleeping.

An unfortunate reality with pap therapy is that it can take some time to find your best settings and then get used to them. Most of us have gone through some form of, My AHI isn't bad but I feel bad. I was rubbish for 6 months until I fixed an outside of therapy issue. Then therapy got much better and restful.

The goal of therapy is to control our apnea's with the lowest possible pressure needed to do that. But it can take some time as you should not adjust the pressure every night. Give each adjustment a few days to stabilize.

[ejbpesca]

Your Med (Median) pressure under Statistics suggests raising the Min to 8.  That is not a drastic change that may improve your AHI.  I did not see a pressure settings prescription on your Sleep Study report.  Did you get your settings as prescribed from the Sleep Study?

A Nap Study can be done to diagnose narcolepsy.  It is a series of short sleep studies.  If the patient goes into REM sleep quickly, the diagnosis of narcolepsy is made.

[Trekkiegirl]

I was not told my cpap settings, it was set by my DME as seen below (note the wrong mask was selected). 

I had a horrible month without much support from my DME until I sough out online. The EPR was off reddit and changing masks 3 times was the only reason I was able to finally get some sleep. I did not have a great tritation study compared to what I have been told. I was given 1 mask and no options to try any others. 

"A Nap Study can be done to diagnose narcolepsy.  It is a series of short sleep studies.  If the patient goes into REM sleep quickly, the diagnosis of narcolepsy is made."

This was what they assumed I had, but since my daytime sleepiness "mostly cleared up" they said the nap test would be inconclusive. 


I have never been a side sleeper but I can give it a try. It feels like my body doesn't produce melatonin til I am on my stomach.

[ejbpesca]

Your mask info to the left says FFM, another post says pillows, and another says nasal.

What happens in an in-lab sleep study is that a nasal mask is first used.  If the patient mouth-breathes, then the patient is woken up and a full face mask is exchanged for the nasal mask.  Pressures are determined for therapy and sent to the DME of your choice.  It is from the prescription that the DME sets the pressures.  You can ask your DME for the prescription or ask the sleep lab for it. 

In the office of the DME you go for a mask fitting to determine the size needed for your face.  You are also giving a choice of various mask brands and styles, all full face or, of late, an inclusion of full face hybrids that are nasal masks that also cover the mouth.

If you have not received these services from your DME, you may want to seek out another and ask for them up front.  I have had 5 DMEs over the years, and they all include 30 trial on a mask with exchange if it does not suit you, free shipping, free insurance filing, and zero other charges except for insurance deductible and/or copays. DMEs are also available online.  Dealing with all five of mine has been frustrating, but with perseverance, you can get them to do what they are supposed to do.  Some national franchises carry a very bad reputation for service.  My current local one has made many mistakes in shipping the wrong items, but always lets me return the mistakes for correct gear and allows me to exchange any item for another brand/model within 30 days.  NONE of them have offered, nor do I believe they know how to offer,  any expertise in PAP therapy.  My doctor offers no advice either.  It is only here and other online resources is where I have gotten help with therapy.

Now you are trying 8 min.  It will be interesting to see if your therapy improves. I use EPR, but I find it increases my CAs, so I use EPR 2. Any sleeping position is fine as long as Large Leaks and positional apneas that therapy cannot address are not an issue. Dealing with a tube had become easier for my side and stomach sleeping due to a short, thinner, and very flexible hose between the mask and main hose that is part of my F40 gear.

CAs can be hard to understand. They come and go for me without explanation. If you have been using OSCAR very long you can look back to see if CAs are the main contributors to your AHIs. There is a discussion on videos that shows CAs can be mislabeled OAs. An examination of the breaths before the event by an expert can reveal some CAs as actual OAs. This is done by zooming in on the Flow Rate graph to see the up and down lines of the inhaling and exhaling of individual breaths. Lanky Lefty, a YouTuber polysomnographic tech, has videos on the topic. I tire of his attempt at being a comedian, and for me, he is hard to follow, but bits of good information are found within his videos. His personal setting is Fixed mode as opposed to APAP. CPAP Reviews is another YouTube source for tips concerning CPAP/APAP therapy.

The OSCAR you posted looks like you are getting effective therapy that could use some fine-tuning, which I see has been done a bit by the narrow gap between Min and Max pressure. 8 - 12 will bring them a bit closer, which is the goal. It is from the expert on CPAP Reviews, YouTube, part of Sleep HQ, is where I learned about using the Med pressure for the Min pressure and the 95% pressure for Max.