MrsDoc - Therapy Thread

[MrsDoc]

Hello.  I was diagnosed with severe apnea on October 26, 2024.  Ever since then, I have been using my CPAP machine off and on until recently.  I am Holydoc's wife who is also a new member on this board.  When he got diagnosed and received his machine, I started using mine more often and am hoping to be as enthusiastic as him.

It has been very hard for me to sleep at night.  I am slow to get out of bed in the morning and always feel a bit tired during the day.  I am hoping that the CPAP therapy will help me be more energetic in the morning and be able to get a good night's sleep.

I have been through several masks but have settled on the ResMed Swift FX Bella recently.  I have a phobia about having things tied around my head, so the Bella worked out well since it attaches to the ears.  I have tried also using a chin strap, but that was a failure due to my phobia. 

With Holydoc's help, I have posted my sleep study, first OSCAR analysis, and a zoomed in portion of the Oscar output for your help and analysis.  I do not know even where to start so all suggestions are welcome.  

           

[jdougc]

Welcome to the forum, 
Are you on any medications that may affect your breathing or your sleep?
Do you have any health issues that may affect your breathing or your sleep?

Your minimum is too low for an adult, set the minimum to at least 7 or 8 cm of pressure, also set the ramp pressure to 7 cm for 5-10 minutes, not "auto". You don't receive any therapy pressure increases during ramp time, but you also don't get events flagged during ramp. So the ramp feature can help to fall asleep without pressure swings.

Your flow limits are too high, you need a higher setting for EPR to fight that, use a setting of  EPR of 3. If you feel "airstarverd at EPR =3, bump up your minimum pressure 1 cm more. 
Most of you pressure increases were from the machine dealing with the flow limitations. This is very noticeable, since our obstructive events were well maintained. These machines aggressively treat flow limitations and these pressure swings can cause fragmented sleep. The increased minimum pressure should lessen both the pressure swings and the flow limitations.

Flow limitations can lead to daytime drowsiness.
https://pubmed.ncbi.nlm.nih.gov/38530665/


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

 I use mouth tape also, 2x5 strip of  Kinesiology regular original cotton elastic athletic tape would mostly eliminate your mouth leaks, but that is optional. Some use a barrier cream to protect their lips or skin from the tape.
Good luck and I hope you get some gentle rest.

[MrsDoc]

Thank you for the welcome,
No medications or health issues that affect my breathing or sleep. Thank you for the tips I will try them tonight. I appreciate the information on the SomNoSeal and the mouth tape as well as the barrier cream. I knew about the tape but not the mouthpiece. If setting up my machine differently doesn't work I will definitely give these a try. One day I will sleep well hopefully soon. Thank you again for your advice.

[MrsDoc]

Attached is my OSCAR report from last night.  We had one of our dogs going crazy so I took her out around 11:30.  I then tried to go back to sleep but ended up getting up 2 hours later with the dogs again.  In the beginning, I consciously paid attention to my mask placement and tightness before going to bed.  That probably explains why I had little leaks.  When I came back to bed I was just so tired I was happy that I even put my mask back on.
My husband made the changes that were suggested.  He set the minimum pressure to 7cm.  He set the EPR to 3.  He set the ramp time to 10 minutes.  Hopefully I will have a better report tomorrow with the new settings.

Please help with more ideas of improvement.

       

[MrsDoc]

Here is last nights OSCAR reports.  I had a stuffy nose but kept on my mask.  These are with the new minimum of 7cm.  A ramp time of 10 minutes and the EPR changed from 1 to 3. I will let you tell me what I need to change.

         

[jdougc]

How did you feel when you woke up, any drowsiness or headache? Make a note of how you felt during the day also.

I am asking the same questions that I asked your husband.

Are you are side sleeper or do you sleep on your back?
If you sleep on your back,  the tongue and soft palate, under the force of gravity, can fall back against the phalanx wall, blocking the airway.
There are experienced back sleepers here that can offer advice. 
I have become strictly a side sleeper since I waS diagnosed with sleep apnea.

Your flow limitations can lead to daytime sleepiness, but if they don't bother you then ignore them for now.  If the flow limitations bother you, you may need a bilevel machine.


Try raising your minimum pressure a bit 8 cm for a few nights and if that goes well, try 9 cm and post back if any issues.
Leave ramp at 7 cm unless you feel airstarved.

[MrsDoc]

I was a little drowsy to begin with but now feel good. A little headache as well. I sleep like a fish on land, start on my left side, then to my back, then to my right side. Ultimately I end up on my left side.
How would I know if my flow limitations bother me besides daytime sleepiness?
I will raise my minimum pressure to 8 cm and see how it goes.
Thank you again for your assistance

[MrsDoc]

This is the first night with my minimum pressure set to 8cm.  I felt I slept good but I woke up a lot.  I think it is due to my leaks and some sighing I was doing at night.  My zoomed in OSCAR shot shows what I am calling sighing that I did a lot during the night.  All suggestions welcome.

       

[jdougc]

You had gentler sleep after 1:30. 
As a test, lower your maximum pressure to what it was during that time, try 11 cm and see if you have less leaks. 
11 cm is near your median pressure.
It you have issues and hit the maximum pressure a lot, than raise it back.
Your flow limitations might go higher.
But sometimes these ResMed clap machines go after flow limitations too aggressively and we pay for the consequences with leaks and disrupted sleep.

[MrsDoc]

That was not a good night.  I woke up a lot and tossed and turned.  I finally took my mask off around 3:45am so that I could sleep.  I am going to raise my pressure up to 15cm to see if that helps since I constantly bumped the max at 11cm.  I posted OSCAR and a zoom shot of the leaking area.  Please give suggestions if you can.  No more bad nights.  LOL