Need Help Interpreting Sleephead

I am new to CPAP therapy--15 nights. I am still waiting for the energy and mental alertness that my medical doctor said I was sure to feel. So far, I feel groggy, foggy and I look like crapola. I am 60 years old, but now I look like I am 160. I have HUGE bags under my eyes and swelling on the bridge of my nose. I have tried three different masks, all professionally fitted and all three have left me with eye swelling.

First it was suggested that I use the Amara View full face mask. That, my friends, is a medieval torture device. Then I tried the Nuance nasal mask that has nasal pillows. That was a BIG improvement. The hose being right in front, however, was a nuisance and I was always messing with the hose (maybe they misnamed the mask and it should be titled the "Nuisance" nasal mask). I only used it for two nights and then tried the DreamWear nasal mask. That was soft, and left no strap marks, but my eyes are still swollen. My belief is that the swelling is not resulting from the masks being too tight (with the exception of the Amara View which the tech smashed into my face), but air being blown into my sinus cavity and causing, what looks like "water blisters" under and between my eyes. I would love to hear if anyone thinks this might be the true cause?

I am going to give a screen shot of last night's sleep. If anyone can please help me wade through the data, it would be appreciated! I have used both nasal masks without chin straps of any kind and do not feel like I ever opened my mouth and broke the therapy field. I don't understand the data well enough to know if that is true.

https://imgur(dot)com/a/wPZef (I am still waiting for approval of my registration, so I am not allowed to post a link yet, so I was told by some very friendly and helpful people to do it this way.

Link's no good...

Here you go.
Julie, as unregistered, he couldn't post a link. He added a "Dot" to it so: https://imgur(dot)com/a/wPZef

https://imgur.com/a/wPZef
I'll let Pugsy, or someone else comment on the results, but they don't look too bad. AHI = 1.67 mostly hypopneas.

[quote="Jay Aitchsee"]Here you go.
Julie, as unregistered, he couldn't post a link. He added a "Dot" to it so: https://imgur(dot)com/a/wPZef

Thanks Jay! Oh, and I should have made some indication--I am a female.

Link is good if you hold your mouth right.

https://imgur.com/a/wPZef

Next time you do an image...omit the resp rate and snore graphs...not needed and not having them will allow you to resize the 4 remaining graphs to an easier to view size.
No need to re do this image though.

Are you waking often during the night? I see at least 2 breaks in therapy line so at least 2 times you woke up and turned the machine off and then back on again. Are there more wake ups?
How many hours of sleep are you averaging...be honest.
Do you take any medications of any kind? If so, what?
Any other health issues...pain, arthritis, diabetes...anything?

Your events graph isn't horrible but it could stand some cleaning up because there is some stuff there that isn't in the AHI that could be an indication that the pressures aren't quite optimal.

For right now...your wide open settings aren't doing you any favors...I think that something along the lines of 8 minimum would be a better starting point and should clean up that extra stuff (Flow limitations and snores) which point to the airway trying to collapse.
Going from a minimum of 4 to a minimum of 8 in one jump might be uncomfortable...so I would start slow and work up...might end up not needing the 8 starting point. Try 5 for 3 or 4 nights...then try 6 for 3 or 4 nights and so on.
Watch the events graph for FLs and snore...Your AHI is already fairly low so it probably won't change a lot.

Pugsy wrote:Link is good if you hold your mouth right.

Next time you do an image...omit the resp rate and snore graphs...not needed and not having them will allow you to resize the 4 remaining graphs to an easier to view size.
No need to re do this image though.

Are you waking often during the night? I see at least 2 breaks in therapy line so at least 2 times you woke up and turned the machine off and then back on again. Are there more wake ups?
How many hours of sleep are you averaging...be honest.
Do you take any medications of any kind? If so, what?
Any other health issues...pain, arthritis, diabetes...anything?

Your events graph isn't horrible but it could stand some cleaning up because there is some stuff there that isn't in the AHI that could be an indication that the pressures aren't quite optimal.

For right now...your wide open settings aren't doing you any favors...I think that something along the lines of 8 minimum would be a better starting point and should clean up that extra stuff (Flow limitations and snores) which point to the airway trying to collapse.
Going from a minimum of 4 to a minimum of 8 in one jump might be uncomfortable...so I would start slow and work up...might end up not needing the 8 starting point. Try 5 for 3 or 4 nights...then try 6 for 3 or 4 nights and so on.
Watch the events graph for FLs and snore...Your AHI is already fairly low so it probably won't change a lot.

Yes, I wake up to use the restroom and turn off the machine. I can't stand to put it back on my head when the air is blowing. I prefer to turn it off and then start it up again.

I try going to bed so that I will get 8 hours of sleep, but I would only get that if I fall asleep immediately, lol. I think I average 7 hours a night on the CPAP. I have been 100% compliant all 17 night now, even when I was sobbing in frustration the first week with the Amara View mask and had 13 disconnects in one night when I was fighting the mask.

I do not have diabetes, but do have some shoulder pain. I have high blood pressure and high cholesterol and take meds for both and both are well controlled and normal with the meds.

I asked my medical doctor to please let me have more air, so the minimum pressure I start with now is 7. I am so sorry I forgot that when I was posting my "stats." This graph is actually with the minimum set at 7. I felt with a 4 that I was gasping for air.

OK--so if the graph indicates I am snoring--that means I am breaking the therapy seal and opening my mouth?

xxyzx wrote:

Lahree wrote:I am new to CPAP therapy--15 nights. I am still waiting for the energy and mental alertness that my medical doctor said I was sure to feel. So far, I feel groggy, foggy and I look like crapola. I am 60 years old, but now I look like I am 160. I have HUGE bags under my eyes and swelling on the bridge of my nose. I have tried three different masks, all professionally fitted and all three have left me with eye swelling.

First it was suggested that I use the Amara View full face mask. That, my friends, is a medieval torture device. Then I tried the Nuance nasal mask that has nasal pillows. That was a BIG improvement. The hose being right in front, however, was a nuisance and I was always messing with the hose (maybe they misnamed the mask and it should be titled the "Nuisance" nasal mask). I only used it for two nights and then tried the DreamWear nasal mask. That was soft, and left no strap marks, but my eyes are still swollen. My belief is that the swelling is not resulting from the masks being too tight (with the exception of the Amara View which the tech smashed into my face), but air being blown into my sinus cavity and causing, what looks like "water blisters" under and between my eyes. I would love to hear if anyone thinks this might be the true cause?

I am going to give a screen shot of last night's sleep. If anyone can please help me wade through the data, it would be appreciated! I have used both nasal masks without chin straps of any kind and do not feel like I ever opened my mouth and broke the therapy field. I don't understand the data well enough to know if that is true.

https://imgur(dot)com/a/wPZef (I am still waiting for approval of my registration, so I am not allowed to post a link yet, so I was told by some very friendly and helpful people to do it this way.

============

your numbers look good
the RR looks high which is not necessarily a problem but could be related to why you are still tired

there are many other things that can mess up sleep
with the AHI down low you need to find out what else is causing the problems

looking at the data you might benefit from a little more pressure
but the machine was set to 20 and did not go past 13 and was set on auto
so the machine didnt think so

Does RR = respiratory rate? If it is high, then does it mean I am gasping for air and that's why I could still be tired?

Any suggestions on where I should start investigating on why am I still tired? My medical doctor was stumped and suggested that I try a different mask (which I did) and then if that didn't fix it I should go to a doctor who specializes in sleep disorders.

Lahree wrote: My medical doctor was stumped and suggested that I try a different mask (which I did) and then if that didn't fix it I should go to a doctor who specializes in sleep disorders.

By all means find a sleep doc and if you are not happy with him/her find another. Asking here might help you find a good one as the sleep business is full of less than adequate sleep docs and DMEs. Avoid any doc who has a financial interest in your DME or sells the equipment.

Spend some time searching this forum there is a lot of very good info.

Your respiration rate is about normal. Not high...the max was 26..maybe it was a bad dream or something..doesn't mean it was that all night.
The 95% number...that is NOT where it was at for 95% of the night...90/95% numbers just mean where you were at OR BELOW for 95/90 % of the night.

Overall average is around 16 which is pretty much normal for just about anyone unless they have some sort of lung issue.

Lahree wrote:If it is high, then does it mean I am gasping for air and that's why I could still be tired?

No...your RR isn't all that high and if it was it wouldn't necessarily mean gasping for air.

Guest wrote:OK--so if the graph indicates I am snoring--that means I am breaking the therapy seal and opening my mouth?

No, it just means the airway tissues are vibrating...you may or may not be opening the mouth. A person can "snore" with the mouth shut. The leak rates during snoring don't point to excess leaks that we might see if the mouth was open.
A snore or airway tissue vibrating means the airway is trying to collapse. It may not grow up to earn an OA flag but it is trying to collapse. Points to sub optimal therapy.

Approx how many times do you remember waking up during the night?

I don't know how much of an impact on things the little bit of FLs and snores are maybe making on how you feel.
It may just be that you need more time.

What meds are you taking...names please.

Does your shoulder pain impact your sleep or sleeping position at all?

Is your main complaint daytime fatigue..lack of energy type of complaint?
Or excessive sleepiness during the day with strong need for a nap?

As pugsy said, you need to increase your pressure floor - slowly.

Pugsy wrote:Your respiration rate is about normal. Not high...the max was 26..maybe it was a bad dream or something..doesn't mean it was that all night.
The 95% number...that is NOT where it was at for 95% of the night...90/95% numbers just mean where you were at OR BELOW for 95/90 % of the night.

Overall average is around 16 which is pretty much normal for just about anyone unless they have some sort of lung issue.

Lahree wrote:If it is high, then does it mean I am gasping for air and that's why I could still be tired?

No...your RR isn't all that high and if it was it wouldn't necessarily mean gasping for air.

Guest wrote:OK--so if the graph indicates I am snoring--that means I am breaking the therapy seal and opening my mouth?

No, it just means the airway tissues are vibrating...you may or may not be opening the mouth. A person can "snore" with the mouth shut. The leak rates during snoring don't point to excess leaks that we might see if the mouth was open.
A snore or airway tissue vibrating means the airway is trying to collapse. It may not grow up to earn an OA flag but it is trying to collapse. Points to sub optimal therapy.

Approx how many times do you remember waking up during the night?

I don't know how much of an impact on things the little bit of FLs and snores are maybe making on how you feel.
It may just be that you need more time.

What meds are you taking...names please.

Does your shoulder pain impact your sleep or sleeping position at all?

Is your main complaint daytime fatigue..lack of energy type of complaint?
Or excessive sleepiness during the day with strong need for a nap?

This is all so interesting! Thanks for helping me so much!

I wake up numerous times during the night. Since CPAP therapy started, I am blissfully down to 1 to 2 trips to the bathroom at night instead of once every hour or once every two hours but, my body tells me numerous times during the night to change positons and that wakes me up. I sleep on either side and avoid sleeping on my back because I can feel my face muscles start to relax and my mouth will fall open if I do that.

I take Losartan for BP and Pravastatin for cholesterol.

My shoulder pain only allows me to sleep on my left side for short intervals, but my body compels me to sleep on that side anyway because I get stiff and sore if I just sleep on my right side. I have had my hand fall asleep several times over the last couple of nights because I am smooshing it and that wakes me up also.

My complaint is that I feel so groggy--not necessarily sleepy if that makes any sense. I feel foggy-brained. I certainly don't feel energized or feel well rested when I wake up. I was hoping for unicorns and rainbows. I feel that way all day.

I also look horrible. I have HUGE pockets under my eyes in the morning that look water filled--like water blisters. My eyes also swell at the inner corners and between my eyes. I have had more people than I can count tell me it's MUST be because I have a mask leak, or my mask is on too tightly, but, since I have not used the Amara View --which WAS on too tight--I can feel absolutely no leaks and my stats don't show any either. I used to have horrible strap marks with the Amara View and I don't have any of those any longer, but I still have the swelling in my eyes.

I have read online articles (yes, I know--I am trying to earn a "googleologist degree) that suggest that sometimes eye swelling is being caused by air being forcefully blown into sinus cavities. That makes sense to me, given how a CPAP machine works, but I would love to know if there is any validity to that theory. I feel VERY self-conscious. I have tried various creams and cold masks in the morning, but the bags stay pretty much all day.

Thanks again for taking the time to read my thread and helping me!

Edema in the face isn't from the cpap air but more likely a circulatory issue.

If it wasn't for facial swelling issues...which mask lets you sleep the best?

Oh, to clarify--I take Losartan HCTZ for BP--it has a slight diuretic.

Lahree wrote:Oh, to clarify--I take Losartan HCTZ for BP--it has a slight diuretic.

Yeah...I take it also so I am familiar with it.

Pugsy wrote:Edema in the face isn't from the cpap air but more likely a circulatory issue.

If it wasn't for facial swelling issues...which mask lets you sleep the best?

I like both the Nuance mask and I LOVE the placement of the hose on the DreamWear mask. I never have to fight the hose! Both of those nasal masks let me actually SLEEP. I will never go back to a full face mask unless someone can convince me it will save my life!

I didn't have any swelling under my eyes before the CPAP therapy started. If it's a circulatory issue, does that mean the mask is on too tight or I wonder if it is because I am a side sleeper and I am smooshing the mask into my face when I sleep on it and it decreases the circulation?