Puzzling decline in therapy quality

[cinephile]

*Since I’m new to this board, I’d like to make sure I filled out my gear correctly before I ask my questions. I think I did, but I was unsure about what to put for the software. So I’ve included two pics to help identify my software: the tag for my machine, and the tag for my humidifier.

My background: I’ve been on CPAP now since March of ’14. Originally diagnosed with severe OSA (AHI 60, with O2 sat dipping into the 70% range), I was prescribed a pressure of 10. Up until the end of this May, I was using a Resmed SwiftFX Nasal Pillow, but eventually felt I just wasn’t getting the results I wanted. I still woke up tired, anxious, and burned out. I had a strong suspicion that I was mouth-breathing: my mouth was very dry in the morning, and a few times I was half asleep and could hear myself mouth breathing.
So I tried a FFM (Resmed Quattro Air) and it was a revelation. The next morning I felt the best I’d felt in probably over 15 years, even though I was sick with a cold that day! I felt wide-eyed, refreshed, and felt like taking on the day as soon as I woke up. Best of all, though, was my horrendous hyper-vigilance was gone: my wrecked nervous system could finally restore and I could relax. I can’t tell you how amazing it felt to finally relax and be in my body and be in the moment.

This substantial boost in therapy lasted for about 5 weeks. But, then for seemingly no reason, my results started to backslide. In the last couple of weeks I’ve felt like my bad old self: waking up feeling fried, anxious, and having zero motivation. I’m puzzled why this is happening because nothing in my lifestyle or CPAP setup has changed. I thought maybe it was because of a bad seal on the mask (I have always felt some air blowing around the bridge of my nose when I wake up), so I ordered the RemZZZs mask liners and have been using them for about a week. I think they help make for a better seal, but it certainly hasn’t made an impact on how I feel during the day.

So I’ve come here to post my sleepyhead graphs for three nights, hoping that the kind members here can give me some clues. The three nights are:
1) My best night (5-25); first set of graphs (three screenshots)
2) Another good night (6-17); second set of graphs (three screenshots)
3) A recent bad night (7-13); third set of graphs (three screenshots)

The graphs raised these questions for me:
-How could May 25th be the best night ever and I still had a very high AHI and bad leaks?
-Theory: I was sick with a cold that night, and perhaps I was so exhausted from the cold I slept much more deeply, and the new addition of the FFM allowed me to mouth breathe as much as needed. Perhaps the combination of deeper sleep (lesser tossing and thus lesser arousals) and the new FFM somehow made a difference, even though the AHI was so high.
-Does anything major jump out at you? How do the graphs for each night compare? I’m struck at how unique the pie chart for 5/25 looks. It’s just all Hypopneas. Does the fact there were no RERAs or Obstructive events for this night help explain why I slept so well?
-If you don’t find anything obviously bad in the charts, that’s not really a bad thing – it’s still feedback I can use for my next visit with my sleep doc.

Thanks so much in advance for any help you can provide!

Machine Tag:

Humidifier Tag:

5-25 Graphs:



6-17 Graphs:



7-13 Graphs:

[chunkyfrog]

This is not unusual. Our recovery and healing rate is not continuous, not all one speed.
---Some of us experience the "end of the honeymoon", when our health plateaus, and improvement seems to stall.
Weight loss does the same way--the slow parts are so dang frustrating.
---Inspect/clean equipment; stuff gets old, healthy skin makes oil.
Your minimum pressure is too low, making the response to events too slow. And you spend a lot of time at your maximum.
I would raise the minimum to 6 or 7, and the max to 11 or 12. Then check your pressures after a few days.

[BleepingBeauty]

Your minimum pressure is too low, making the response to events too slow. And you spend a lot of time at your maximum.
I would raise the minimum to 6 or 7, and the max to 11 or 12. Then check your pressures after a few days.

CF, he's running in fixed pressure mode @ 10. Looks like ramp for about 15 minutes in the beginning of the pressure graph, and then it stays at 10.

To the OP: If the time is correct on the graphs, you appear to be going to sleep in the wee hours. I'd advise that you work on better sleep hygiene (better sleep habits) and to get more than just the few hours of sleep you're getting based on these nights of data. The short hours (5-6 hours a night) won't help you feel better. I believe the current wisdom is that we should be getting 7.5 to 8 hours every night.

On nights where you show lots of large leak, the data can't really be relied upon, as the machine gets confused by the leak and can't report events accurately. The most recent night's AHI is decent, and no large leak, so I'd say you're on the right road. Just work on the sleep hygiene, and that should help.

[chunkyfrog]

Good catch! Several of the more recent statistics panels show 4 as the min,
but now I see the machine was on cpap mode all the time.
In the same situation, I think I would try apap mode with a range to try to find the best pressure.
But that is just me.
Sleep hygiene is a good point, though not always popular--"---grown-ups being told when to go to bed?"
Important to put all the excuses for staying up late in perspective. A personal thing some will heed, but only some.

[BleepingBeauty]

Sleep hygiene is a good point, though not always popular--"---grown-ups being told when to go to bed?"
Important to put all the excuses for staying up late in perspective. A personal thing some will heed, but only some.

Yep. The concept wasn't appealing to me at first, either; I'd always been a bit of a night-owl. Live and learn, though.

Aside from other problems I had when I started therapy (pulling off the mask in my sleep, etc., sore nostrils from the pillows/straps being too tight, sore bridge when I tried a few FFMs, sub-optimal pressure/therapy, etc.), solid sleep hygiene made a big difference for me.

Even when everything else was under control (including other aspects of good sleep hygiene, like maintaining a dark and comfortable room, going easy on caffeine, not eating anywhere near bedtime, etc.), I was still going to bed too late and getting up too early. For me, just 5-6 hours of sleep a night definitely wasn't enough. When I forced myself to go to bed earlier and got into that habit, I started to sleep longer hours and feel better. So for me, good sleep hygiene definitely did make the difference.

[Madalot]

I'm going to jump on the sleep hygiene bandwagon as well.

I was staying up really late, getting up early, etc. Starting last Fall my life changed (no more kids in school) so I didn't have to get up early. I found that getting MORE sleep (I need around 9 hours to get refreshed, probably because of muscle disease) helped me feel a lot better.

Now, I know that I need to go to sleep between 10 - 11pm and get up between 8 - 9. When I do that (which I do almost every night now) -- I feel my best.

[Strict Compliance]

cinephile

For future reference, instead of posting screenshots on the forum, you can just post the links to your reports like so - http://i.imgur.com/ldVcytY.jpg

They are easier to read in imgur and then your thread doesn't get so long.

[ChicagoGranny]

Speaking of sleep hygiene, here again are my basic rules for all CPAP users,

- Practice good sleep hygiene (Google it and read several sources)
- Eat a good diet
- Have a regular, moderate exercise program
- Practice total abstinence of caffeine including sources like chocolate
- Review all medicines, vitamins and supplements you are taking to make sure none are interfering with sleep
- Optimize emotional stress in your life
- Use CPAP software to make sure your therapy is optimized

[Sonya]

Oh there's my nemesis - Sleep Hygiene! There was a great article (posted here somewhere I think, but I can't find it now) about how people with OSA will tend to be night-owls as a subconscious resistance to sleeping. I am a total sleep avoider. I hate sleeping. Sleeping can be painful and annoying and not something I enjoy, so I avoid it.

Now that I've got the CPAP machine, I need to be sure to get that 4 hours to keep the doctor happy. That means I have to go put the mask on and get to bed earlier. I set an alarm so my fitbit vibrates if I'm not in bed by midnight and that's helping me not to spend the night on the couch sans machine. But it's a slow process for me and one I really struggle with. I do find that bratty teen-aged me shows up and says "You can't tell me it's my bedtime!" But then I remember I'm trying to get well here and sometimes the teen isn't the one who gets to make the decisions.

[Pugsy]

FWIW....I prefer images of the reports embedded in the body of the text instead of having to click on a link if at all possible. It's faster and requires less effort on my part and it helps when reviewing back when composing a reply if we can easily see the image at a glance.
There's a reason that the instructions on how to post images are so detailed so that the image shows up straight away. Most of us prefer images instead of links.
What isn't needed most of the time is a quote of an entire text that we are responding to each and every time we respond to something.

Also what isn't needed are all those extra graphs that SH gives us. Most of the time those are not particularly useful and if we need one of them we can simply ask for it.
One screen shot with the basics is really all that is needed.
If one uses the large thumbnail trick on imgur it really isn't all that big and takes up very little space and sometimes the large thumbnail is of a size that we can see all we want to see without clicking on it to make it larger.

[OkyDoky]

cinephile

For future reference, instead of posting screenshots on the forum, you can just post the links to your reports like so - http://i.imgur.com/ldVcytY.jpg

They are easier to read in imgur and then your thread doesn't get so long.

Or better yet, use the large thumbnail and copy the LinkedBBcode into your message. That way we can see the thumbnail and are able the click on it to enlarge the screenshot. Here is a link that shows you how. https://sleep.tnet.com/reference/tips/imgur

[palerider]

For future reference, instead of posting screenshots on the forum, you can just post the link

for future reference, it's better to do it like this: https://sleep.tnet.com/resources/sleepyhead/shorganize and post it like this: https://sleep.tnet.com/reference/tips/imgur that way a quick overview is visible on the forum, with detail available via clickthrough.

[chunkyfrog]

" . . . Abstinence . . . chocolate . . "
We are so very different, my friend!

[tedburnsIII]

For future reference, instead of posting screenshots on the forum, you can just post the links to your reports like so - http://i.imgur.com/ldVcytY.jpg

They are easier to read in imgur and then your thread doesn't get so long.

I have to disagree. It was 'refreshing' to have those graphs in front of me without having to do all that clicking.

Thanks, cinephile!

[Sleeprider]

It's interesting that early in your therapy you had very high AHI consisting of Hypopnea, but a 0.00 RERA. Excess leaks may have obscured events as you had large leaks most of the night. Later as you felt more tired, your AHI fell to less than 2, and your RERA shot up. The most recent image your leak rate finally dropped to reasonable levels. What changed? How did you get the leaks under control?

Respiratory Effort Related Arousals (RERA) have always been more disruptive to my sleep than a reasonable AHI. I think the comments on sleep hygiene might help, I also agree, there is no harm in trying to use Auto mode and see how you feel. By the numbers, you are being better treated recently than when you started, and you made great progress on leaks. So, your sense of being more tired, while treatment has improved suggests the problem may not be the CPAP therapy.