Therapy Thread - Budgie123

[Budgie123]

Hey everyone,

Having some pretty major issues with my health related to sleep. Been on CPAP since 2018, had a few years (2018-2020) where I felt well rested and great, but the benefits tapered off and my overall health is concerning me. Back to feeling like a zombie.

In the past I functioned great with pressure setting min 5.5 fixed, no ramp. This is low for an adult, but I felt very well rested with an average AHI of 1.4, and any higher pressure (past 6.5) I'd wake up from constantly swallowing air and my AHI would increase to 6+. This is why I kept the pressure fixed, because on the rare occasion it would spike up past 6.5 I would either wake up feeling like I was suffocating, or I would subconsciously rip my mask off.

Over the years my AHI has gradually increased and air hunger has become a problem. I bought an AirFit P30i last month and greatly increased the pressure to 8.5, which has definitely helped. My air hunger is much lower at this pressure and I feel like I'm sleeping a little bit better, but definitely not perfect, and around 2 days of the week I have very bad nights of sleep that leave me feeling like a zombie. Better than 7/7 nights of bad sleep though, how it was before I made these adjustments and got a new mask.

Due to the increase in pressure, I'm experiencing a lot of leaks through my mouth (that can be seen on the chart) that then dry my mouth out so bad it's difficult to sleep. But I definitely feel this pressure treats my apnea better than before.

To reduce the leaks through my mouth, I've tried:

• Taping my mouth shut - tape does not hold the entire night, gets covered in drool, and the inside of my mouth still dries out (not quite as much) because the air pushes past my tongue and inflates past my gums.
  
• Athletic tape chin strap - mouth/lips stay closed, but air still leaks past my tongue like with the mouth tape.
  
• EPR 1-3 - Even setting EPR to 1 increases my Clear Airway events substantially, from 1-3 per night to 12.
  

While I'm sleeping a little better on average (AHI average down from ~6.0 to ~2.6) with higher pressure settings, I'm now suffering from significant leaks into and sometimes through (past my lips) my mouth that are frequently waking me up. I feel like I'm stuck between a rock and a hard place and I'm not sure where to go from here.

I do not currently have a doctor, and it is unlikely I'll be able to get one for at least a few years due to a shortage of medical professionals where I live.

Attached are screenshots of before getting the new mask/changing pressure to 8.5, after (with EPR set to 1), after (with EPR off), along with pictures of my sleep study from 2018. It appears I need to have four posts to be able to show links, and I've hit my upload limit for attachments.

I am on a very low dose of Hydroxyzine (7.5mg), cycling on and off with melatonin, which I need as I have sleep onset insomnia.
 

Any help would be appreciated!

   

   

   

[Budgie123]

I forgot to mention and I don't see an edit button, sleeping on my side reduces my AHI. My sleep study from 2018 says:

Arousals:

(Type/# of Arousals/Arousal Index)

Respiratory/48/7.5
Limb/0/0
Snore/1/0.2
Spontaneous/26/4.0
Total/75/11.6

SLEEP SUMMARY:

Total Sleep Time: 6.44 hrs
Number of Awakenings: 16
Total Time Awake: 54.0 min
WASO: 48.5 min
Sleep Efficiency: 87.7%

Mild sleep fragmentation was noted with an arousal index of 12 events per hour. The majority of these events were related to respiratory arousals.

The overall AHI was 7 events per hour. REM AHI was 12 events per hour. Supine AHI was 7 events per hour.

The overall RDI was 9 events per hour. REM RDI was 13 events per hour. Supine RDI was 9 events per hour.

0 obstructive apneas, 46 obstructive hypopneas, 1 central apneas, 0 mixed apneas and 11 respiratory effort related arousals were noted.

ECG: Normal

EEG: Abnormal: possible pseudo spindles/alpha intrusion

EMG: PLMS: No, REM Atonia preserved: Yes, Bruxism: No

Snore: Yes, Volume: Mild and rare.

AHI at 2AM: 1.5
RDI at 2AM: 8.5

OXYGEN SATURATION:

Total Number of Drops > 3% of Baseline: 12.00
Lowest SpO2: 95%
Mean SpO2: 98%
ODI: 2.3

[Budgie123]

Last night was fairly bad compared to previous nights (AHI 4.15 + lots of positional apnea clusters from rolling around), leaks over 50% of the time and had dry mouth the entire night. The next few nights I'll lower my pressure to try to find a middle ground between treating my apneas and preventing leaks through my mouth.

It's primarily the mouth leaks that are waking me up. Still feel better than when my pressure was at 5.5-6.5 but I definitely don't feel "treated" yet, not even close.

[Budgie123]

I decided to try my older mask, a DreamWear full face mask, but this time I shaved my facial hair which seemed to greatly reduce the leaks. At least that's what I thought.

Before shaving, there would be an obvious leak almost constantly from the left side. After shaving, it was difficult to even force a leak. But after trying this mask again last night, my leak graph is through the roof. Is it because my jaw is relaxing and breaking the seal around my mouth?

This is confusing because the leak rate is egregious, but the seal feels good around my mouth and nose and the mask fit check passes.

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Chart:     

[Budgie123]

If anyone has advice it would be appreciated. It's difficult to juggle all of these variables in my head when I'm feeling exhausted. I think I'm on the right track but I'm definitely not a professional, just know a few things from having to self-titrate and what to look out for in graphs.