[CPAP] First Post - Can't stay asleep with CPAP

[DKane]

Hi everyone, 

I was recently diagnosed with SA, with an untreated AHI of 26.2. I use an F20 full face mask and have been on CPAP therapy for 4 weeks. My doc started me out at the default 4-20 pressure which did not stop my obstructive apneas, so I have raised the pressure to a point that corrects most (sometimes all) of them. 

I've fixed issues with leaks and rainout as far as I can tell but am still having trouble staying asleep and mostly feel like a drunk zombie the following day. I had my best night - which I unfortunately don't have the data for - a few nights ago. Pressure was 10-14 with an AHI of 1.3 and no obstructive apneas. I woke up *only* 3 times that night but it was one of the best nights of sleep I've ever had. Then the next night was one of the worst with the same settings and plenty of obstructive apneas.

I finally got an SD card and have posted last night's charts. I looked at the charts myself but am not as well versed as some of you, so if anyone could help I'd greatly appreciate it.

Thanks for reading!

[SarcasticDave94]

I'd try EPR, full time, 3 might be best. EPR is Exhale Pressure Relief, meaning the number of 1, 2, or 3 is the actual cmH2O pressure it drops on exhale.

You may have to try each of the 3 pressure settings in EPR, and it may mean changing your therapy pressure as well to match effectiveness. You'll very likely gain a better feeling therapy from this.

[DKane]

Thanks for the response. I was initially told to keep EPR off as it may increase central apneas, which I seem to be having regardless. 

It's not necessarily a comfort thing, I don't have much issue falling asleep. I just wake up every 1-2 hours and it's getting exhausting. 

I'll try an EPR of 3 tonight and see what happens. 

Any idea what's causing the central apneas and hypopneas?

[SarcasticDave94]

Hypopnea can sometimes be Central based, however they will be Obstructive based in most. Hypopnea can be thought of as a half restricted Apnea, and if obstructive based, needs more pressure.

There's another aspect for some, positional apnea. Here in the context of this board, positional isn't meaning back or side sleeping, but a sleep position where your chin tucks in towards your chest and kinks the airway, very much like your garden hose. Positional Apnea needs a physical item called the soft cervical collar, like for neck injuries but not to prevent all movement.

Central Apnea is a pause in breathing over 10 seconds. Some that use a CPAP now have more carbon dioxide exhaled than they're used to, and this will cause a breath pause (central). Others like myself have centrals that were present before CPAP, which requires a more expensive machine. You're far more likely to be in category 1, where the CPAP or positional apnea have increased sleep breath pauses.

[DKane]

Thank you for all of this. I'm a back sleeper and am most likely positioning my head and neck in such a way that causes obstructive apneas.

I set my machine to an EPR of 3 last night and I'm not sure what to make of the data. The first 2.5 hours felt like very deep sleep with a minimal AHI. Then I had trouble falling asleep and staying asleep after that. Both central and obstructive apneas increased after that and I'm not sure why.

Again, I appreciate the help. I'm very tired this morning and am trying to leave out information that isn't helpful.

[SarcasticDave94]

OK, despite lack of notable improvement, which was more comfortable? Not trying to give a doctor whitewash, with AHI under 5 which you're getting, the goals you're likely going to want will be to maximize comfort, be able to sleep and gaining rest, possible minimizing sleep disruptions and CPAP interruptions.

You've already got the AHI of less than 5, so one part is obtained. Now it's just tuning it to get the rest.

It's your therapy, so like I said above, are we headed to being more comfortable when EPR is added? You decide, so there's no wrong answer. Best for you settings will maximize comfort and keep therapy working.

I think the Central component will diminish with more time. You're at 4 weeks I think.

[DKane]

I appreciate the advice! 

There's a marginal improvement in comfort with EPR. I could wear the mask all day if needed and not be too bothered by it. The most frustrating thing about this is a lack of consistency with results. I'm sure there's a reason for all of it but I don't understand why I'd have relatively zero events through a couple sleep cycles, then multiple events through the rest of the night. 

I can try the same settings again tonight and see if anything improves. I may later raise the minimum and maximum pressure a single degree to see if obstructive apneas improve. 

Also, any idea with leaks? It may be due to me adjusting the mask but I'm not sure.

[SarcasticDave94]

On leaks, it's possibly as you say, adjustment movement stuff. Basing off this most recent chart it has several sharp quick spikes. To me, this points to mask movement as possible. Leak numbers overall really good though. Address as you see fit, but don't sweat over this too much.

[DKane]

Some leaks are definitely from mask movement. I woke up last night on my side with a mask leak. A little better than the night before though. I was exhausted and fell back asleep without reconnecting the hose after 1am HA

Some RERAs here and there but getting better. Still can't seem to stay asleep - hopefully that improves.

[SarcasticDave94]

It doesn't look terrible on the chart, probably a time issue getting used to CPAP thing.

The cluster of CA around 2:45 was likely SWJ, meaning sleep wake junk. SWJ is caused by alternating between sleep and wake, confusing the breathing control systems. Remove that are of CA and is not a bad look.