Why have my results changed?

[Brennie]

Hi, all!

I had been having a period of great results from therapy. I woke rested and felt great.

For me, that meant that my AHI was well under 1. That's when I feel good.

Now, it has gone up to 1.5, and I wake up unrested, and need the crash naps, just like before starting CPAP.

I do not know what has gone wrong.

I am attaching a BEFORE and AFTER screen shot of when I felt great, and of last night.

Thanks for your input!

Brennie

[Nightynite]

The 2 things you have too much of is flow limits and leaks.

[staceyburke]

The shaded gray are are when your leaks as so high that the mask can NOT give you enough pressure, you are loosing to much pressure.  Your leaks are mouth leaks and you have to control how much air you are losing from your mouth.  You can see a mouth leak by a flat area in the leak graph. (like a plateau)   Many people have them some my use taping to stop the leak.


I would also suggest using auto instead of 13 cpap.  Let me give you these setting and see if that helps.


mode Autoset
Min 7
max 13
EPR full time
EPR 3

[SarcasticDave94]

Later of the 2 charts:

Your several mouth and possibly mask leaks in the leak chart are working against you. Also Flow Limit is too high as a second source of need to address.

[jdougc]

When you have such large leaks and your CAP therapy is compromised, it may be hit or miss if you have a good night.
You had a many flow limits, restricted breaths, not long enough for and "Hypopnea or Obstructive events". 
But these Flow Limits can cause arousals.  
Your deep sleep, around 2:25 AM was likely disrupted by a few flow limits.
Resmed uses EPR to reduce flow limits, but you ae at the max level of EPR.
Also if you go to APAP mode as suggested the pressure will swing wildly due to these flow limits, which cause the pressure to increase
Also SarcasticDave94 noted that you have mouth leaks, this usually happens once we fall asleep.
Are you using a chin strap to help keep your mouth shut, if so make sure the chin strap pulls straight up, not pulling back at all which would make you apnea worse.
Consider using a mouth tape to stop this leaks. You can tape a bit during the day to help with any anxiety. Use 2"x 5" strips for good results.
[attachment=77065]
Finally since you are at your max limit of EPR and your flow limits are not under control, you may have to switch to a bilevel machine. 
There is a chance that fixing your major leaks could make a huge improvement in your therapy.
Good luck.

[Brennie]

To all who responded:

I thank you so much for your input. This forum has helped me so much.

I used big tape for a long time, but that did not stop the mouth breathing. I would bubble right through it. LOL! .Chin strap did not make a difference.

Do you think a full face mask would help?

And what is involved in getting a bi-level machine? Do I need a doctor's order? My NP has not been much help through this process.

Thank you all so much.

Brennie

[jdougc]

Chin straps need to pull straight up from under the chin to the top of the head, not back at all , which makes the apnea worsen .
Have you tried a soft cervical collar?

[Nightynite]

In order to find a mask that works , the only thing you can do is keep trying different ones. Most people probably end up with a box full of mask that didn’t work until they find the golden goose so to speak.

[SarcasticDave94]

Your doctor should be able to order a bilevel. Chat with them about the CPAP not being as comfortable as you'd like. It may be possible your primary care will do it, their order carries same weight as medical professional. The sleep specialist isn't at all required, and many times hinders good therapy success, because they think they know better than you about your therapy.

You can also mention better therapy, but the comfort aspect might be enough. This comfort aspect leans on your subjective portrayal of the therapy. Not saying be dishonest, but probably play into the negatives more.

[jdougc]

Zoom in on your breathes in the flow rate chart and see if the tops of the breaths are flattened. Post a few of these.
EPR is already maxed out at 3, so you may need a bilevel.
I am testing with a lightly used one and am seeing some benefits.