Advice requested to improve treatment

[Rainmom17]

Hi, I've only been at this 2 1/2 weeks, but I'm looking to optimize my treatment. I feel maybe a little more energy during the day, or at least fewer times my energy completely bottoms out during the day. I am frustrated with too many wake-ups during the night. My mask is now leaking less, so that's a plus. I am thinking I need to raise my starting pressure and would like some advice on this. I was given a range of 5-15 pressure (my AHI in sleep study was 20). I have changed the minimum to 6. I don't use the ramp any more. I have found that my pillow makes a difference. I was recently in a hotel with a very puffy pillow which felt heavenly, but my AHI was 17. The next hotel had a much flatter pillow and my AHI dropped below 5. So that's something. But, I'm still looking for how I can adjust my settings to be recovering better. Here are 3 recent graphs for you. And thank you! (Oh, I also want to add that when I wake with a leak, I turn off the machine to fix the leak then turn it back on. That is shown by the breaks in the graph.)

[Julie]

Have you not tried e.g. 7 for even a couple of nights to see what happens?

[Rainmom17]

I was on vacation for the past week and didn't want to try any tweaks. But now that I'm back I'm ready to experiment a bit.

[lliann]

How do you like your FF20? Is there a reason why you are preferring a full face mask?

[Rainmom17]

I've always been a mouth breather so I didn't even consider something other than a FFM. they started me off with the memory foam mask, which was super comfortable, but I switched to silicone which seems to leak less for me, although it is not quite as comfy.

[Pugsy]

When you fit your mask at the beginning of the night what pressure are you using?

Frequent wake ups no matter what the cause will mess with our overall sleep quality and we won't feel the good numbers no matter how low the might be.
If leaks are waking you up then they need to be fixed somehow. You do have some periods of large leak and you also have obvious periods where the leak woke you up but you didn't hit large leak territory. Either way they need to be worked on.

It looks like the leaks aren't so bothersome until the pressure starts going up. Some parts of the night the pressure doesn't do much increasing and then sometimes it wants to increase a lot. Usual suspects are sleeping on your back or REM sleep or a combination of both. With either it is common for OSA to worsen and/or need more pressure to hold the airway open.

Last night's report actually looks really good.
Do you have more night's like last night or the other nights?
Any thing that you did different last night???
Have you tried using a mask liner to help with leaks?

Next time you post a screen shot hide the calendar and turn off the pie chart (Peferences/Appearance tab, remove check mark) and this will bring the statistics up into the viewing area so we can see some averages and overall numbers.
Don't need the snore graph or the resp rate graph...just make the other 4 graphs a little larger to make for easier viewing.

[Rainmom17]

Thanks, Pugsy. Last nights graph was one of my best. AHI is usually in the 5-7 range. But, even though it was a good graph, I feel horrifically sleepy today. Hard to keep my eyes open.
My mask is adjusted at pressure of 6.
i try really hard to just sleep on my side, though I may roll onto my back without knowing it. And every know and then I'll just say screw it and sleep on my back, because I want to vary my sleeping position!
Thanks for the posting advice. It took me awhile to figure out how to do it, but now I'm good to go.

[Pugsy]

When you fit the mask at 6 and it goes to 10 for whatever reason then it is going to have more problems sealing at the higher pressures.
You need to fit it at higher pressures pre-emptively.

Also maybe try a smaller range of pressures. Leaks and pressure changes are one of the potential drawbacks to auto adjusting pressures.
What seals good at one pressure doesn't seal so great at higher pressures.

You might look at mask liners for the little leaks that wake you up but don't make it to large leak territory. Some swear by them and others found it made things worse. Another one of those YMMV things that all cpap stuff gets stuck with.

It's really hard to evaluate your pressure needs with the leaks and breaks in therapy messing with the continuity of things.
I don't know how much of the higher AHI is simply Sleep/Wake/Junk from the leaks waking you up or causing arousals.
I can't see the statistics either to help get an idea what is going on number wise.

Unless someone really wants to try to stay off their back for special reasons I don't advocate doing anything special to stay off the back.
If someone needs to sleep on their back because they can't sleep on their side....then sleep on their back and let the machine sort it out.
Now I do know some people whose pressure needs are so significantly different that they make a special effort to stay on their side and I can't say as I blame them. I know one person who can get by with 9 cm on his side and needs 19 on his back. Don't blame him at all for wanting to stay on his side.
Now REM pressure needs are also sometimes significantly different. We can't do anything about REM so we have to let the machine sort it out.
I fall into that category. Sleeping position really never has seemed to impact pressure needs but REM sleep sure does.

As to why you feel like crap today despite a good looking report....good numbers don't guarantee anything but a nice math score. There's so much more to feeling the good numbers than just getting them.

How many times do you think you wake up last night? I see one long break and one short break in the therapy line so at least 2 wake ups. What took so long to go back on the mask with that first break in therapy?

Do you take any medications of any kind and if so, what?

[Rainmom17]

How many times do you think you wake up last night? I see one long break and one short break in the therapy line so at least 2 wake ups. What took so long to go back on the mask with that first break in therapy?

Do you take any medications of any kind and if so, what?

I think I woke about 5 times. The long break was me waking up and turning off the machine. Guess I removed the mask too (I was stuffed up last night and that was bothering me), and then I must have fallen back asleep because I woke up later with the mask sitting on my head.
I woke up some times later but didn't turn the machine off. I felt very restless all night.
I take thyroid med every morning and warfarin every night. Both for many years. I really don't think they're a factor. Both are monitored and at correct levels.
I'm attaching a graph from my worst night, which was my first night of vacation. I was in a very comfy bed with big wonderful pillows, and I had a neck kink which made sleeping on my side difficult. So, I mostly slept on my back with my head propped up quite a bit. I think this graph shows that is NOT a good position for me!

[Julie]

Just try raising your min. pressure by 1-2 for a couple of nights - you're at a very low level now and obstructives are clearly a problem. That raise for 2-3 nights will not cause any damage and in fact you're likely in future, when you feel more confident, to want to raise it even higher. You're looking all over at other things, which may not be invalid, but that's a fairly basic, major thing to address and may be all you really need.

[Pugsy]

I think I woke about 5 times. The long break was me waking up and turning off the machine. Guess I removed the mask too (I was stuffed up last night and that was bothering me), and then I must have fallen back asleep because I woke up later with the mask sitting on my head.
I woke up some times later but didn't turn the machine off. I felt very restless all night.

If you remember waking 5 times or so there were probably more than that. You slept with the mask off for a period of time...so you have some time during the night where the apnea went untreated. You also admit to just having a "restless" night. Probably poor sleep quality in general for whatever reason. Add all those together and it isn't surprising that you don't feel the good numbers.

Your worst night report with AHI of 17...the timing of those clusters coincide with probable REM sleep stages...so maybe you were on your back and in REM and got the double whammy. Check your sleep study report to see if your OSA is worse in REM. Mine is so I have lots of experience with seeing reports like yours. Now for me sleeping on my back never seemed to make me need any more pressure (I built a wall to make sure I was always on my side and I still saw the clusters and the need for significantly more pressure in REM...like 6 to 8 cm more).

Google "sleep stages" and look at the hypnograms for normal sleep stages and you will see what I mean about the timing of those clusters.

I had similar clusters until I increased my minimum so that the machine could get to where it needed to be to hold the airway open better.
If your nights were all like last night I wouldn't do anything but if the norm is worse then I would increase that minimum a bit.
You might actually sleep a little better too. Worth trying and you have lots of room to increase that minimum.
I like to be conservative with pressure increases...it's an easier adjustment for one thing and sometimes we get lucky and find that we don't need as much pressure as originally thought. Usually 0.5 to 1.0 increase at a time unless there is an urgent need to go much higher faster because the AHI was way too high. AHI of 4 or 5 isn't horrible and I would increase the pressure slowly if it were me.

[Rainmom17]

Thanks Julie and Pugsy. I'm gonna be a bit conservative and bump up minimum by .5 and see how that goes for a couple of nights.

[Rob K]

I had a lot of leaks when I started out with a full face mask. Sometimes hard to find one that fits your face well. It can take a lot of trial and error. Doing much better now since I switched to nasal cushions and nasal pillows along with a chin strap to keep the mouth closed. If leaks are waking you up consider switching to some type of nasal mask. Basically the smaller the cushion the less surface area that has potential to leak. If you have frequent congestion or get a cold you'll still want the full mask since you won't be able to breathe through your nose. I still keep a full mask around for when I have a cold and need to mouth breathe. Another nice thing about the nasal masks is that they let you sleep in more positions without leaking. Thus making your type of pillow less critical. At least that's what I found. Airfit N10 and P10 both will allow me sleep in any position, even with my face crammed in normal non-cpap pillow. Everyone is different though when it comes to masks.

[Rainmom17]

OK, so I did raise my minimum a smidge to 6.5,and so far it's good. AHI of 2.4 the first night, 3.3 last night. This is much better than the usual 4-7 range I was getting. I'm thinking I should keep bumping it up a bit. Here's last night's graph. I could have predicted it would look exactly like this. When I woke at around 1:15, I thought I had probably had quite a few events. So glad to see the remainder of my night went well (although I do feel like I had too many wake-ups during that time to count as awesome sleep).

I know 3.3 is good for AHI, but there's no reason for me to stop there. I'd like to do all I can to get the best sleep I can.

[Pugsy]

I think another small bump is in order.
Even though the overall AHI isn't that bad...the density of the cluster is uglier than I would like to see.
This is where I talk about "breaking up the clusters". Random isolated events spread out through the night isn't likely to make much of an impact but you have a whole bunch of these things within a relatively small time frame and it's not good on the body/sleep/whatever.