Advice for troubleshooting when CPAP stops being effective?

Hey all, I was active here a few years ago while trying to get a working treatment. Recap: I have UARS; low AHI but poor quality sleep; spent ~10 years trying different things, not being sure if I had apnea, getting MMA surgery, tonsillectomy, turbinate reduction, trying dental device, trying an old brick CPAP but not giving it months of effort, trying lots of non-apnea related treatments that did nothing (vitamins, exercise, calming rituals, CBT, etc). Finally about 3 years ago, based partly on what I read here, I got a new CPAP and spent months to get used to it; and had significant, noticeable relief but still moderately bad sleep. I went to Dr. Krakow's clinic in New Mexico, got a titration & prescription for ASV, and for the last 2 years have finally had decent sleep (woohoo!).

Until a week ago: went to a desert city for the holiday, and my sleep regressed to the pre-ASV (CPAP) level; waking up suddenly with my heart pounding several times a night, etc. Last night my partner said I was snoring loudly through my mask (I hardly ever snore on CPAP). I've had it happen for a night here and there, but never 3 nights in a row, let alone the 5-6 it has been now. My nose does tend to be sensitive to the dry desert air; and nasal congestion definitely affects my sleep quality, but my nose was only mildly congested there, and I have been back for several days. My mask, tubing, headgear seem fine. After the first night of bad sleep, I did one adjustment: my elbow connector between mask/hose fell out several times during the night and so I superglued the elbow to the hose. But I don't see how that would make things worse; and last night I changed to a brand new mask and an old (non-ClimateLine) extra tube & elbow connector, and my sleep was equally bad. I have been slowly gaining weight the last 2.5 years; but I'm still well below my high and I started out quite slender; my BMI is 23 which I wouldn't think would be a problem. It's also weird to me that it started so suddenly; especially when it persisted after coming home.

I have a set of CPAP supplies coming; so I will be able to switch to a brand new tube, connector, and headgear this week. But I'm somewhat stumped otherwise. The only thing I can think of is that perhaps I need a higher titration for some reason. Dr. Krakow did suggest I come back in a year or two for a re-titration. Also, I know I should be looking at my data in SleepyHead for clues as the first step, but I seem to have lost my SD card reader, so I will have to pick one up later & then I will post if anything stands out there.

Any advice; or pointers to old threads on this? I didn't see anything on the Wiki about when cpap stops working. As I'm sure y'all will understand it is critical to my life to get my therapy working again and horrifying to be sleeping poorly and exhausted again.

When the elbow came off ... did you lose the anti-asphyxiation valve from the elbow?
Or possible disable it with the super glue, this would allow all the pressure to escape. I would think you would notice that.

The opening in the elbow is unaffected - I only glued the part of the elbow that inserts into the tube, so that it can't come on or off, shouldn't change airflow (except not having the *((*) hose pull off in the middle of the night, which was why I glued it). And I tried an unglued elbow/tube last night (will keep trying it).

Here are my Sleepyhead summary stats:



My pressure settings: Min EPAP 8.0 Max IPAP 27.8 PS 4.0-12.8 (cmH2O). I replace my masks every 30-45 days, headgear/tube every 3 months (based on insurance).

Comparing "last week" to "last 30 days" should be pretty reflective of whatever is going on. I don't see much difference, except that Min IPAP has jumped from 4.66 to 6.24, and AHI is up quite a bit from last 6 months (0.25 vs 0.07 - but note that as I have UARS, these AHIs don't mean much).

Let me dive into the daily overview data...there is a bit of a pattern of the last 5 days being worse, but it is not hugely pronounced and I'm not sure how to interpret it. Max leak, max minute ventilation, tidal volume, and total time in apnea are all high in 4 of last 5 days, vs. 1/3 of days normally that high. But none of the results are out of the range of what I see over the last 30 days...

Ok, I finally found one thing that stands out. I have two "User Flagged events" set up, because A/H doesn't capture my UARS very much. UF1 is a 20% Flow Restriction for 5s, UF2 is a 50% Flow Restriction for 8s. (I think these are the defaults). For the last month of hi-res data that Sleepyhead just imported, my UF1 and UF2 were 0 events per night every single night until 11/25 - the night the bad sleep started. Since then, UF1 has been 6, 6, 5, 5, 5, 0 and UF2 has been 8, 8, 11, 11, 0, 10. Unless there is something weird here like "Sleepyhead only does user flagging of events for past 6 days", this is a huge change. If these events are even a half-decent approximation of A/H for a UARS person, it's like my AHI suddenly going from 0/night to 5-10/night.

Why, I have no idea. But it's nice to see some confirmation of my data in the experience (though it is a bit suspicious that UF1/2 are always exactly zero before this - makes me worry they aren't being calculated for earlier dates).