Hey Folks,

My CPAP therapy has had pretty mediocre results since April of this year. Initially thought it was mask related and have been on a mask hunt since then. I consider the Swift LT to my back up. Leaks are controlled and my AHI tends to hover between 2-3. Regardless, I feel okay at best even with these numbers. Every mask I've tried since then has had problems with leaks and/or has been painful in one way or another. In addition, I've been waking up with headaches (that go away after a few minutes), dark puffy eyes, and significant fatigue. Sometimes, I've been waking up during obstructions.

So I decided to give myself a break last night and use my Swift for a night. I also decided to increase my pressure a little to see if may be that would help decrease the obstructions. I was titrated at 11 so I decided on a small increase and went to 11.6. I woke up with an AHI of .9 (all HI) and tongue was in place. But I had a big headache and my eyes were puffy though not dark. Since it was pretty late in the morning, I decided to experiment again and lowered my pressure to 10.4. As soon as I had my mask on, the pain began. It began at the outside corners of my eyes, then to my forehead, and then the crown. I took off my mask but this time, it took longer for the pain to subside.

Wanting a little more sleep, I got up with my pillow and went to the couch. On the couch, I can position myself so I don't sleep on my back as my apnea is entirely positional. I woke up 2.5 hours later with no headache but puffy eyes unchanged.

What is going on here???

all new masks, airhoses and headgear should be soaked and gently washed in warm water and mild detergent then rinsed and dried before use

pressure from the mask or headgear on face or head may be causing the headaches
puffy eyes can be caused by airleaks from top of mask

How tight do you have the headgear? It should be loose enough as to not cause pain, but tight enough to allow it to seal. Try to loosen it a bit and see if that helps.

Another thing you may want to have checked is for carbon dioxide build-up in your house. If you use gas for any of your appliances have your house checked for leaks as well. A few years ago, for several months different visitors would complain that our house smelled of gas odor (the chemical they add to natural gas to alert for leaks). We poohed poohed everyone and stated we couldn't smell it. Neither my husband, nor my son or I smelled anything amiss. One day a family member was here and insisted I call our local gas company to have our house checked for leaks. During this time I had often complained of headaches and body aches, along with my hubby and son. Sure enough the gas company came out and his meter started registering about 30 feet from our house. The closer he got the more it registered. He was absolutely amazed that our house was still standing as we had a major leak in one of our gas lines under the house leading to our gas dryer. He shut our gas off and tagged it and told us to open our windows and leave the house until it was aired out. A few hours later we came home and repaired the line.

Another thing you may want to have checked is for carbon dioxide build-up in your house.

I presume you really meant carbon monoxide...

T

sleepycarol wrote:How tight do you have the headgear? It should be loose enough as to not cause pain, but tight enough to allow it to seal. Try to loosen it a bit and see if that helps.

Another thing you may want to have checked is for carbon dioxide build-up in your house. If you use gas for any of your appliances have your house checked for leaks as well. A few years ago, for several months different visitors would complain that our house smelled of gas odor (the chemical they add to natural gas to alert for leaks). We poohed poohed everyone and stated we couldn't smell it. Neither my husband, nor my son or I smelled anything amiss. One day a family member was here and insisted I call our local gas company to have our house checked for leaks. During this time I had often complained of headaches and body aches, along with my hubby and son. Sure enough the gas company came out and his meter started registering about 30 feet from our house. The closer he got the more it registered. He was absolutely amazed that our house was still standing as we had a major leak in one of our gas lines under the house leading to our gas dryer. He shut our gas off and tagged it and told us to open our windows and leave the house until it was aired out. A few hours later we came home and repaired the line.

We have a couple of carbon monoxide detectors in the house so all is well there. In addition, the headgear for the Swift is plenty comfortable. Your suggestion got me thinking about oxygen and carbon monoxide levels. I set my pressure to 11.8 and enabled the EPR to the 1 setting. I really like how it felt. Woke up this am feeling decent. Not good or great but decent. My numbers were:

0.00 L/s
AHI 2.3
AI .1
HI 2.2

So I think I'm heading in the right direction.

Went with a pressure of 12, EPR of 1 (originally titrated at 11)

Leak 0.00 L/s
AHI 4.4
AI .1
HI 4.3

Feeling pretty refreshed. Yesterday was the first day in a while that I did not feel the need to nap or have caffeine in the afternoon. Today, I'm feeling better. I think I'm gonna leave it here for a week and catch up on some rest before making any adjustments.

Update time:

Had a repeat with a pressure of 12 and EPR of 1; virtually same results. Dropped to 11.8 for a couple of nights and didn't feel much better. I normally wait for the weekend to experiment with masks but since Friday was an admin day, I decided to wear my UMFF Thursday night.

Leak was .16L/s with an AHI of 5.3 (AI .1). It was worse when woke up at 3 am; AHI of 6.3. So I shut off the EPR and it brought the AHI number down as well as the leak number. Even with this, I did not have a headache and didn't get the yawns until noon. I was moderately productive. Bridge of my nose was red but not bad and it went away after a few hours.

Last night, I started at 11.8 with no EPR. I seated the UMFF a little lower risking an irritated nose bridge. Woke up at 5:30 feeling pretty rested. Checked the screen: Leak was .14 L/s with an AHI of 1.6...Nice..Slept a little longer. Got up at 7, bridge is a little red but not too bad. I think the redness will dissipate. No headache and I'm feeling good.

As comfy as it has been, the Swift LT was not for me. I think the major problem was that I could not exhale against it. With nasals and full face masks, this is not a problem.

Looks like you've been really successful at keeping leakage low. And I guess you're in the tweaking phase now. Hang in there. Seems like you're on the right track. Someone with a lot more experience will hopefully chime in with some suggestions.

GaryG wrote:Looks like you've been really successful at keeping leakage low. And I guess you're in the tweaking phase now. Hang in there. Seems like you're on the right track. Someone with a lot more experience will hopefully chime in with some suggestions.

Well, it's funny that you posted that. The following night, I had a leak of .34 L/s with an AHI of almost 5. I cinched down the bottom straps a little last night and woke up with this morning with a leak of .02 L/s and an AHI of 4 with an AI of .2. I woke up at ~3 am and for some reason, lowered my pressure to 11.6 and woke up with the exact same number. BUT, I had a nice red mark on my nose and a wicked case of aerophagia (which I'm vulnerable to when I sleep on my left side). Both have cooled down since first thing in the morning. I've got a little red spot and I may give my nose a rest tonight and wear the Swift LT. We'll see how I feel and look by the end of the day. When I do wear it again, I'm gonna loosen the lower straps just a touch.

The headaches could also be caused by mask pressure against sinus cavities. During my years of Cpap therapy, I've found that if there is any nasal/sinus congestion during the course of Cpap use, the mask can make sinusitis worse. Just another thing to consider--if you do get a cold, it is something else to watch. My solution for this issue was Nasacort, and it worked well.