[Treatment] Why does my breathing suddenly become a mess

[schettino]

Every night, regardless of the settings, something happens at some point and my breathing becomes unstable for the rest of the night. Even when I come back from a bathroom trip, put the mask back on, and fall asleep again, the irregular breathing picks up exactly where it left off. I can’t understand it, I can’t fix it, and I hate this.

Please, help me demystify this. I’ve attached the last two nights of OSCAR data. Here’s a quick summary of everything involved:

  • First night, I used the P30i. Mouth taped with a good waterproof tape, but it didn’t really work. In the second half of the night, I woke up multiple times mouth-breathing through a small opening. I hate myself for this. On top of all the micro-arousals I already get, the leak also wakes me up.

  • Second night, I tried two things: F40 mask plus mouth tape, and I reduced PS from 4 to 2. Still had frequent arousals, but none were leak-related. The graphs show some constant leaking, but I never noticed any seal issues. No dry mouth either.

  • Now I remember why I never set PS or EPR to 1 or 2. It messes with my sleep even more. I know it because I always wake up feeling worse than a strong hangover.

  • I’ve also tried fixed pressure. I usually can feel better the next day, but then I have to deal with leaks, mouth breathing, flow limitations, and congestion. When those things don't happen, then maybe I might just a nap in the afternoon and enjoy the second half of the day as I still get frequent arousals because of the unstable breathing perhaps. I don't know.

  • But maybe most importantly, no matter the mask, position, tape, fixed pressure, APAP, or VAuto, you name it, the night can start well with stable breathing, but eventually something gets triggered and it all turns into a complete mess.

Please, I need some insight. I really want to know if there’s a light at the end of this tunnel.

   

   

   

[Dormeo]

For those following along, here's schettino's earlier thread:

https://www.apneaboard.com/forums/Thread...erapy-help

A small bookkeeping matter: could you update your profile to show your new VAuto machine?

It's perfectly normal to experience arousals throughout the night. I'm seeing arousal breathing in the zoomed-in views. It tends to be deeper and messier-looking than regular asleep breathing.

Although brief arousals are normal, the big question is whether your arousals are interfering with your ability to feel rested then next day. How would you assess this?

When you get up to pee, do you have an urgent need to go, or is it just that you've woken up and figure you might as well go? If the latter, do try just rolling over and going back to sleep.

By the numbers, you're doing well. Your AHI is enviable, and with PS of 4, your flow limitations are good. You could try using a steady pressure all night long, in case pressure changes are bothering you. I would suggest min EPAP of 8, max IPAP of 12, and PS of 4, which appears to be what you used during the second part of the night on the 17th.

Leaks may be bothering you too. With the FFM you're currently using, do have the sense that leaks interfere with your sleep? If they don't, your leak levels are fine.

In your earlier thread, you said this: "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." Do you continue to feel that anxiety? It can make good sleep even more elusive, so if you can try to pull your thoughts away from fretting about the next day, that could be a help.

[Deborah K.]

You need to raise your upper pressure limit to 15, as you are maxed out on pressure almost half the night.

It would help if you would fix your chart.  Even when I enlarge it and use a magnifying glass, it's still difficult to read.  Press the F12 key to copy the chart (FN+F12 for Mac).  This usually gets it right.  Make sure we can read to the bottom of the flow limits.

Best wishes for achieving great therapy and comfort!

[Dormeo]

Hi Deborah, I think the OP changed his settings partway through the night, so we're seeing fixed pressures where he seems to have maxed out.