Can't get rid of the apneas

[mmiller5373]

I've been struggling with CPAP for a few months now. To make a long story short, my first sleep study in August said I had an AHI of 32 and 30 arousals per hour. The next night I had another sleep study with the CPAP and they titrated me at a pressure of 7 with a nasal mask; the results that night came back as an AHI of 4 with 16 arousals per hour. I started CPAP therapy at home with a nasal mask and within a few days I realized I wasn't feeling better, probably because I'm a mouth breather (my nose is always congested) and the air kept leaking through my mouth, waking me up at night. I switched to a full face mask to stop the mouth leaks, but things haven't gotten better. I'm still feeling exhausted and my concentration is GONE. The doctor has changed my pressure from a 7 to a 9, from a 9 to an 11, and then from an 11 to 13 because he figured I was still having apneas because it wasn't enough pressure. About a week ago, I finally bought a card reader and the encore software to figure out what's going on. It looks like I'm still having OSA's. What do you guys think is going on? Here's the results:

http://youngcritic.110mb.com/encore.pdf

[tattooyu]

I'm not sure what the leak rate for your mask is supposed to be, but I think you're having some leak problems.

[silence of the hams]

I would see an ENT and find out if you have a deviated septum;if so,that can be corrected though surgery. It may not stop snoring or apnea, but it will take care of the nasal congestion.

[2ndGenCPAPgal]

The user guide says the leak rate for 15 cm h20 should be 43, so you are having some leak issues. The manual is here: http://www.fphcare.com/userfiles/file/O ... ctions.pdf

The charts also seem to point to leaks being at least part of the problem. Note that when your leak line is jagged, you have more OA's and when it is flat you have fewer. I'm not familiar with the mask so I don't have any tips for fixing it.

Did your sleep study show if you had more events on your back vs. your side? How do you normally sleep? It is common to have more events while sleeping on ones back, so if you can sleep on your sides that may help.

[jweeks]

The charts also seem to point to leaks being at least part of the problem. Note that when your leak line is jagged, you have more OA's and when it is flat you have fewer. I'm not familiar with the mask so I don't have any tips for fixing it.

Hi,

I also noticed that pattern in the numbers. It looks to me like at least a good chunk of the events are correlated with spikes in the leak line. But also, a good chunk of the events are not correlated with the leak line. In fact, they appear to occur in clusters.

Did your sleep study show if you had more events on your back vs. your side? How do you normally sleep? It is common to have more events while sleeping on ones back, so if you can sleep on your sides that may help.

That was my first thought, too. It looks like the poster might be moving into a position that makes events much more likely to happen, and then moves and spends time in a better position. The other thought was a sleep structure related issue, such as having lots of events at certain sleep levels. I'd be curious to see what happens if he sets the upper pressure level very high, and see if the machines goes after these event clusters. I wonder if his MD would be game to give that a try? A better idea might be to go for yet another sleep study, and see if they can replicate this in the sleep center.

Even the way things are at right now, he appears to be much better off than without treatment. It is also encouraging that his MD seems to be engaged in his case and is working to solve this issue.

-john-

[flylow]

Your leak rates mostly do not look that bad. Mostly flat line with dips associated with apneas. My guess based on very low VS is that your pressure is too high (inducing centrals). I would like to see what things look like at lower pressures. Where do the snores start picking up. Your struggle is the same as mine where you are into manual titrations. It sucks and takes a long time to find the right pressure.

[mmiller5373]

The charts also seem to point to leaks being at least part of the problem. Note that when your leak line is jagged, you have more OA's and when it is flat you have fewer. I'm not familiar with the mask so I don't have any tips for fixing it.

Did your sleep study show if you had more events on your back vs. your side? How do you normally sleep? It is common to have more events while sleeping on ones back, so if you can sleep on your sides that may help.

The mask seems to leak a lot at higher pressures. I'm using the largest size because I do have a large head/face.

I don't have a copy of my sleep study but they told me to try to sleep on my back those nights, plus with all of the wires and equipment, it was tough to sleep on my side. I normally fall asleep on my side, but I do move around a lot during the night, so who knows where I end up.

I'd be curious to see what happens if he sets the upper pressure level very high, and see if the machines goes after these event clusters.

What do you mean? Just increasing the pressure?

Your leak rates mostly do not look that bad. Mostly flat line with dips associated with apneas. My guess based on very low VS is that your pressure is too high (inducing centrals). I would like to see what things look like at lower pressures. Where do the snores start picking up. Your struggle is the same as mine where you are into manual titrations. It sucks and takes a long time to find the right pressure.

I've uploaded another report from encore, which includes trend data since my first day of therapy in August. You'll notice I started off at a 7, but had mouth leak issues with the nasal mask. I've tried increasing and decreasing the pressure to see what was happening, but maybe I should try it again? Take a look...

http://youngcritic.110mb.com/encoretrend.pdf

[Sleeprider]

Your results look best at about 12 cm-H2O. You are having significant maximum leaks, but your average leak looks okay. With the episodes of AHI your problem may be positional, and you might consider asking your doctor for an auto-PAP which would change pressures as needed. If you were on APAP, I would suggest running a minimum 9-10 cm-H20 and a maximum around 15 and see what happens, but you don't have that capability.

[Julie]

Mmiller - they tell you to sleep on your back so they can get a worst-case scenario for their records (and should explain it to you, though they never do), but that's not to say you should sleep that way otherwise as it's the worst position for inducing apneas. Try to sleep on your side or front or something - use fat pillows behind you to keep you from rolling back if you have to.

[track]

Several of us on this board have chosen to prevent back sleeping instead of having to endure high pressures of over 15. It's not uncommon to be able to get effective treatment at half the pressure if you stay off your back. Personally I wear two Underarmour t shirts..one size smaller than normal. The UnderArmour is stretchy..I then stick a hard ball down my back between my shoulder blades...and keeps the ball in place. Every time I roll on my back in my sleep I feel that hard ball and reposition onto my side. It works like a charm and enables me to operate at a much lower pressure than normal and it's no problem at all. At a lower pressure it's much easier to control leaks so you get better treatment.\\

I think your leak line looks fine..there are always going to be a few ups and downs...I never have a perfect leak line that is straight with zero leaks. I don't know how anyone would at that pressure given one moves around at night.

[williamco]

mmiller5373 : I don't think you have a leak issue but unfortunately XPAP treatment doesn't eliminate apnea for some people I think because of anatomical problems that XPAP can't overcome. for example a tongue going backword XPAP can't do any thing about it. the more XPAP open the soft tissue of the throat, the more the tongue can slide backword. so some people need an extra therapy along with XPAP.
you need to try these:

1- hard raised pillow (I made pillow of several towels at bottom and only 1 pillow at top) so your head doesn't sink during sleep. that reduced my apnea 30%

2- back sleep with a ball in your back

3- going back to nasal mask: clear your nose by Afrin at night (just for experiment) and tape your mouth shut to prevent leak

4- blowing in Didgi (just blowing no need for circular breathing - the cheapest one $25) will reduce apnea

5- Using Jaw advancing device.

Good luck