Fragmented sleep - therapy help

[schettino]

Hi,


I’m 9 months into therapy. It went well for the first 5 months and now I’m having consistently bad sleep. Worse than before.

Diagnosis was 15 AHI. Most events were hypopnea, no centrals. Prescribed pressure was 6 to 9. It worked really well in the beginning. For two months, I used 9.4 (fixed) with EPR set to 3, which helped me with congestion and air starvation in the winter. Now none of the original settings seem to work anymore though. I tried so many combinations in between and no matter what, my sleep is more fragmented than ever. Especially in the second half of the night, I wake up every few minutes, briefly open my eyes, and then go back to a very light sleep. Sometimes, taking off the mask helps me fall back asleep after an arousal. I sometimes change settings in the middle of the night because I get desperate. I do not think I ever had any problem with adaptation, aside from an itchy nose in the first few weeks. I use a nasal pillow, P30i. AHI reported is usually below 1, but I feel tired. I need a nap every day. It is a drag until nap time and then, if I am successful, the day gets a little easier.

I have had problems with leaks. I do mouth tape most nights. I also got a cervical collar and that solves the problem completely. However, nights with the collar and no leaks were some of the worst nights in terms of waking up not feeling refreshed at all. I could go on and on with more information about what I have tried so far.

I tried to learn everything I could, but I just cannot anymore. I need help. Please see if you can spot something I am missing. I can share more images, and I also have data I can share from SleepHQ. I do not think I can post links here just yet though.

Appreciate any help or feedback.

   
   
   

[jdougc]

Welcome to the forum,
I am very confused, are you changing the mode form cpap to apap or visa versa in the middle of the night, on the 2nd?
CPAP mode should not have those pressure swings?
You zoomed in chart clearly shows the class 6 flow limitations, chair looking, delay inhalation. These machines miss them.
If your night is full of them and many gasps then you might need a bilevel, if EPR is not helping.
You had EPR set for ramp and ramp off one night. So no EPR then. 
I have made mistakes in the middle of the night before.
You have too much leakage for a pillow mask, your latter sleep is compromised.  You might be mouth breathing.
Have you tried sports mouth tape cut into 2x5 inch pieces?
There is also a thin pliable device that fits between your teeth and lips called a somiseal
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[attachment=77562]

[Deborah K.]

I think you'd feel better using EPR full-time set at three. Your CAs might increase a little, but I think lowering the flow limits is more important and likely to help you feel better.

[schettino]

@jdougc I have an AirCurve 11 now and I’m going through the process all over again. I’ll resist.
Sometimes I change the settings when I’m not able to fall back asleep. I can get very anxious about the idea of feeling sleep-deprived the next day. So the pressure readings can be more accurate in the charts and not so much on the left side. The night I had EPR on ramp only, I was actually trying to turn it off but couldn’t read well which setting I was changing. Fortunately, it worked since I have the ramp-up feature off. I’ll have a look at that tape too. I have one, but it can be breathable through it. Thanks for the suggestion.

@Debora K. and @jdougc Yes, I think I had okay sleep with some consistency when EPR was set to three, but I can no longer replicate that. I used to wake up feeling refreshed on APAP with no EPR, but that happened mostly in the beginning and rarely after. I’m hopeful that the extra settings available on the AirCurve will help me.

[jdougc]

Have you been cleaning the exhaust ports?

https://www.youtube.com/shorts/zR9UDExl26Y

[schettino]

I changed the nose pillow a couple of weeks ago. I’ve now ordered a brand new mask altogether because it’s time. That’s good info though, I’ll swap the filter every once in a while. Thanks for that.

I’m trying to dial in the settings for the bilevel machine, but I don’t know where to start. I read through Debora’s thread and was green with envy for that first night. For me, it still feels like I’m rolling the dice.

So far, I think I’ve been trying to somehow replicate the settings I had with the CPAP with small tweaks. Sleep is still bad, so maybe that’s the problem. It’s really hard navigating through all of this alone, I should’ve reached out much sooner.

[schettino]

I tried starting with EPAP 4, max IPAP 12, and PS 3, just to see where that could land me, but it turned out to be another frustrating night with very fragmented sleep. So I couldn’t get any insight from that.

Then, the following night, I tried PS 4 over 7.6–13.6. My reasoning was that without EPR, my best results showed a pressure minimum around 6.5 and 95% at 8.6. But that was a disaster. I woke up less than two hours in. I felt so frustrated with how everything was going that I didn’t put the mask back on at all.

I can see some repeating patterns happening right from the beginning. Does that mean high loop gain? I also noticed that I usually take a weird deep breath before a lot of my arousals or awakenings. Sometimes I feel like I’m breathing too fast, so maybe that’s my body trying to compensate for CO2 levels?