Machine or man?

TL;DR Therapy has worked before but stopped working, do I need to try more machines for success?


Was diagnosed some time ago and never got on with CPAP. My first machine was not even a CPAP, it only gave me air when I breathed in but I found it too noisy and disturbing to sleep with it (memory fuzzy, about 7 years ago) I think I might have also had a nasel mask which would have been totally unsuitable as I'm definitely a mouth breather.

Went to a different sleep center some years later. First machine was a fisher and paykel model which never worked as before. I would find the experience so disturbing to my sleep that a few times a week was all I could tolerate until I gave up. Over the years I have occasionally had different masks and tried a splint without success. The sleep centre gave me one or two studies but never one with the machine on, my sleep pattern and sensitivity was so bad that a few of the studies gathered next to no data as I slept barely at all. It's the kind of place where you call them, and keep calling until they relent! (public health, previous was private and no better).

However near the end of last year I was getting more desperate than usual and asking for more treatment and options from the provider. Was given an automatic fisher and paykel and used it with a previous mask. Another detail to my story is that I have a flat face which makes mask fitting very difficult, I can breathe through my nose but will *always* open my mouth even if I tape it.

For a short period (about 3 weeks in January) the therapy started to work. I was bowled over. As I am sure many of you can testify, having the continual burden of fatigue lifted off your back is an absolute joy. I was using a Quattro FX medium mask which was just about doing the job, the small mask meant my mouth would pop out from under but the medium rides under my eyes and can also leak easily unless shoved on there. But it worked! and I was pretty happy for those weeks until it just started to stop working. It actually stopped on the day I saw my sleep doctor and proclaimed mission accomplished! The next week I phoned the provider in a panic and asked what to do.

I had started to wake up from the noise of the air blowing through my mask which was strange as nothing was different. As the therapy progressed I was sleeping deeper so was even starting to not need earplugs in the noisy environment I sometimes slept in during the week. I got a new mask seal, and even a whole new machine. Stil no joy. I went back in the following weeks and tried yet another mask (F&P SImplex) which was an OK fit sometimes but did not help, the machine was also recording that my AHI numbers were fine which may be true but I still felt my old self with tiredness throughout the day and extremely difficult to maintain sleep cycles.

Now on a Resmed S9 Auto. Have been trying it for about 10 nights now and have not had one good night. I seem to just wake up after falling asleep and it is one of those wakes that can sometimes keep me up the entire night. On the few nights I have managed to get down to sleep with either mask I have not managed above 4.8 hours which is probably too low for me to notice anything.

Got a new mask today, the Innomed hybrid. The fit seems good, but I have been woken up again after nodding off! My awake time was only 12 hours after 5 hours of sleep the day before so that is not ideal, but it is very hard to maintain exact 16 hour cycles off treatment, of course when treatment worked my sleep cycle went rock solid immediately, I even found most nights I was only getting 5-6 hours yet feeling fine throughout the day.

So what next? I am a very sensitive sleeper when I am in my OSA/fatigue mode. The slightest aberration can cause me to wake, so for now I am back to wearing earphones or earplugs at night so thatisn't that reason. Is the S9 waking me up? I am not sure. The masks are not ideal and I really want it to work as the other machine seemed to stop being effective. I might have to relent soon and go back to F&P Icon auto soon but my real question is, should I be looking into something like Bipap which from my very brief reading seems to sometimes suit those which are more sensitive?

I am also using EPR on the S9 now but truthfully I never had any exhalation sensitivity, I think I am more sensitive to sudden gusts of air which I suspect the S9 might be laying on me. I certainly had fewer wakes on the F&P, but not sure that likes me much anymore!

What are your pressure settings?
Sounds like you may be using a range of pressures and the pressure changes are waking you up.
You may want to try a single pressure (CPAP mode) and see if that helps.


Den

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Low pressure is 6, high is 17. Current data suggests upper limit is going to 7.66 average and 95 percentile is 10. I'd have more data but the machine keeps formatting the SD card each time I remove it and put it back in, lost a few nights because I was experimenting with it.

Overflow wrote:Low pressure is 6, high is 17. Current data suggests upper limit is going to 7.66 average and 95 percentile is 10. I'd have more data but the machine keeps formatting the SD card each time I remove it and put it back in, lost a few nights because I was experimenting with it.

I'd suggest a single pressure of 10 or at least moving the minimum to 9 and setting the maximum to 12 and see what happens.


Den

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Overflow wrote:Low pressure is 6, high is 17. Current data suggests upper limit is going to 7.66 average and 95 percentile is 10. I'd have more data but the machine keeps formatting the SD card each time I remove it and put it back in, lost a few nights because I was experimenting with it.

Make sure that you set the read only switch when taking out the SD card and reading from it and then reset it to read-write before putting it back.

Don't take very long with the card since there is some thought that elapsed time out of the machine may have some bearing on the reformat issue.
Even with reformatting, there shouldn't be much data loss.

Thanks for the hints. I lowered the max rate and turned on write protect with sd card before inserting in computer. Stats weren't wiped this time.

Had the longest sleep I've had on the new machine last night, about 7 hours. I did wake a few times, once for the toilet and second time the mask was getting too noisy.. not sure why that was really as couldn't detect any leaks. Turned the machine off and on again which reset it.

Woke feeling very tired which is usually a sign it didn't work. Might try another night and then go back to F&P to see how that fares with new mask if it is still unsuccessful.

Not an expert with graph interpretation, but the respiration rate should have some lower sections indicating deep sleep? (forum is cutting off the right edge, please click to view).

• Channel Min Med 95% Max
  PressureTherapy Pressure (cmH2O)
  W-Avg: 6.75 6.00 6.50 8.14 8.84
  EPAPExpiratory Pressure (cmH2O)
  W-Avg: 4.50 4.02 4.46 5.71 6.04
  Minute Vent.Amount of air displaced per minute (L/min)
  W-Avg: 6.25 1.25 6.12 7.50 13.12
  Resp. RateRate of breaths per minute (Bpm)
  W-Avg: 13.78 6.80 12.60 20.80 27.60
  Flow Limit.Graph showing severity of flow limitations (0-1)
  W-Avg: 0.01 0.00 0.00 0.05 0.15
  Leak RateRate of detected mask leakage (L/min)
  W-Avg: 5.05 0.00 4.80 8.40 9.60
  Insp. TimeTime taken to breathe in (seconds)
  W-Avg: 2.44 0.20 2.36 3.68 4.28
  Exp. TimeTime taken to breathe out (seconds)
  W-Avg: 1.62 0.10 1.60 2.48 3.00
  Tidal VolumeAmount of air displaced per breath (L/min)
  W-Avg: 466.71 60.00 500.00 600.00 860.00

It was suggested that you raise the low pressure setting, not lower the upper one.

I lowered the maximum setting which was also suggested. I kept the minimum where it was as I find it hard to get to sleep sometimes with higher pressures, and the ramp can often wake me up as well. I might try raising the lower value still though, just wanted to see if I could sleep with this new mask on the machine.

Do try raising it, even if only by .5% for a few days at a time - 6 is so low lots of us have trouble inhaling at it, which can skew results.

Julie wrote:Do try raising it, even if only by .5% for a few days at a time - 6 is so low lots of us have trouble inhaling at it, which can skew results.

Will do, I'll try 7 tonight.

I find that with the resmed the mask almost warps when I have a large breath even with 6, which the F&P never did. Maybe it is quickly jumping past 6 to give me enough breath? It did this even with EPR off, I have EPR on 3 now to see if that will help with my sensitivity to the machine. As I managed 7 hours last night perhaps this is the right direction.

The S9 has a feature where you match the mask (yours would be one of the options I think) to the air pressure - don't have that machine or mask tho' - and I wonder if you should look at those settings to see if your machine was not set for a diff. mask at the dealer's for some reason.

Can you post a recent report and include the items that I show in this report ....plus can you include Flow limitation graph?
I don't need respiration rate or volume or anything but
The stuff on the left side of SleepyHead like mine
and these graphs on the right side of the daily detailed report
Events
Pressure
Flow rate
Leak
Flow limitation

You can turn off AHI graph and mask pressure graph in Preferences/Graphs tab...they aren't needed.
You can resize the graphs if you wish so that all graphs appear in one screen shot. Just hover the mouse over the bottom line of the graphs till you see a little short double line...then click and drag to resize.

Your pressure needs appear to be quite low...I don't think bilevel would be that big of a help at this point.
Mask leaks that wake a person up...even if they don't go to large leak territory need to be fixed.
Anything that causes sleep disruption is unwanted.

What symptoms during the day are you having now that were initially resolved but have returned?
Do you take any meds? Even OTC?
How many hours of sleep are you averaging?
How many wake ups during the night that you remember?

Thanks for replying Pugsy. Here is info from 21st:





And to answer questions:

What symptoms during the day are you having now that were initially resolved but have returned?

Fatigue, awful sleep patterns

Do you take any meds? Even OTC?

No. Only some mild painkiller at the moment for some muscle problems I am dealing with.

Flow limitations aren't horribly exciting.
Leak line shows some activity but not a lot in large leak territory but might be enough to disturb sleep.

Pain meds for muscle pain? How long has this pain been present? Is it a disturbing factor to sleep?
Do you toss and turn a lot because of pain?
What is the name of the pain med? How long have you been taking it? When do you take it?

How many wake ups do you think you have each night?
How many hours of sleep do you think you average each night?