Almost At My Wits' End

[zonker]

wiki/index.php/Sleepyhead:Organize

Unfortunately, "they" broke the wiki after i made that page.

Better to point people to the link that pugsy did that's in the sticky you already pointed OP at.
[/quote]

<sigh> see? i SAID i wasn't an expert!

thanks for the correction, i'll try to remember better for the next time.

[Dan_McD]

Are you having any mask related issues at all?
Comfort? Leaks? Anything that we could maybe fix with the mask itself.

Well, the mask is as comfortable as a mask could possibly be, I suppose. I am due to get a new one the first of February, and thought I'd try the new full face mask I heard about that has a small profile. Not that the Dreamwear is huge, but it isn't my favorite. It was just the least evil of all the masks I tried on.

Do you normally breathe through your nose just fine during the day?

Yes.

How come they gave you a full face mask?

The pressure from nasal masks pushes my mouth open, and I cannot tape my mouth shut (adhesive allergies) nor use a chin strap (TMJ). As it is, I usually wake up with a completely dry mouth from it being forced open from the pressure.

I've been scanning my SleepyHead daily files, looking at the Flow Data. If anything other than the rhythmic breathing patterns equate to an arousal, I'm waking up alllllll night long.

Sigh.

I'm going to take a guess here and guess your mouth opening and dry mouth is not caused from "Pressure", but rather from 'jaw drop'. I had the same problem. When I changed to the Quattro Mirage FFM.... it covered more of my chin and kept my mouth closed. I don't have any more dry mouth or sore throat now. Also, contradictory to many beliefs, the larger mask worked better for me and once I learned how to adjust the seal below the forehead I have fewer mask leaks.

You haven't referred to any oxygen levels. What were your oxygen saturation numbers in the sleep study and have you checked them since?

[greenjelloland]

I'm going to take a guess here and guess your mouth opening and dry mouth is not caused from "Pressure", but rather from 'jaw drop'. I had the same problem. When I changed to the Quattro Mirage FFM.... it covered more of my chin and kept my mouth closed. I don't have any more dry mouth or sore throat now. Also, contradictory to many beliefs, the larger mask worked better for me and once I learned how to adjust the seal below the forehead I have fewer mask leaks.

Unfortunately, that mask hooks around the occipital area of the skull, which then when you tighten it down, forces the jaw backwards. (Someone needs to design a mask that can be used by people with TMJ.)

Probably a combo of the pressure/jaw drop, since I have a connective tissue disorder that makes all my ligaments lax. But the pressure will force my jaw down when I'm awake, so I try to go to sleep on my side with a hand under my chin to keep my mouth closed. If I roll to my back, all bets are off.

You haven't referred to any oxygen levels. What were your oxygen saturation numbers in the sleep study and have you checked them since?

My oxygen sats were only low during REM sleep, when I had 95% of my events. The doctor has not checked my oxygen since.

[palerider]

wiki/index.php/Sleepyhead:Organize

Unfortunately, "they" broke the wiki after i made that page.

Better to point people to the link that pugsy did that's in the sticky you already pointed OP at.

<sigh> see? i SAID i wasn't an expert!

thanks for the correction, i'll try to remember better for the next time.

And send a note to the powers that be and tell 'em to fix the bloody wiki.

[Pugsy]

Your REM dependent OSA is being well taken care of with cpap therapy.
I don't think we can come up with some miracle setting that is going to fix your primary issue which is probably crappy sleep in general.
The REM crappy sleep...that's been dealt with.

There's a remote ....very remote...chance that the flow limitations you are seeing are playing a factor in your sleep quality issues and we can try more pressure on the off chance you might get lucky and it will help.
Worst thing that might happen with using more pressure is maybe some aerophagia (air in the gut issues) or you simply can't handle more pressure. So it's something to try...chances of it being much help...to be honest slim and non IMHO but I have been wrong before and nothing would make me happier than to be proven wrong here.
FLow limitations "can" disturb sleep...but usually you would see RERAs flagged if that was happening...not always but usually.
It's not a given that FLs always disturb sleep.

What kind of sleep studies have you had....at home??? In a lab setting with tech in attendance??

And you may very well be right....the bulk of the flow rate you are seeing could very well be arousal related if it looks junky just like the guy's report I posted above. He didn't even have REM dependent OSA though...his in lab sleep study showed no desats and an AHI of 0.8...he didn't even remotely have OSA to blame his crappy sleep on.
Now he was taking a medication that has an ugly side effect of messing with sleep but he wouldn't listen to me about going down that road just to see if maybe his crappy sleep was related to medications.

More likely your other health issues are a significant factor...pain especially...been there and going through it right now myself.
And I know for sure it's messing with me and I still can't fix it adequately.
You are super sensitive to medications so doping you up so you can better sleep through the pain probably isn't an option and it's not a great option anyway...but sometimes we gotta do what we gotta do. I have been down that road too.

One thing I might suggest and I really don't like it myself but it works for some people in terms of helping with jaw draw....one of those foam cervical collars. Nothing rigid or huge...just something for a gentle support to the lower jaw to keep it from dropping back or down and causing leaks and/or you having to be half awake to try to hold it in place.
It's a cheap enough experiment to try. Just because I wouldn't like it for myself doesn't mean much....I don't like a lot of things that other people like. Means nothing.

So maybe a little more pressure just to see if the FLs reduce and sleep quality improves...you don't need it for the AHI but you might benefit from it from the FL standpoint.
And maybe consider one of those foam cervical collars that just wrap around the neck.

[greenjelloland]

Follow Up:

My sleep doc sent me back in for another titration study. During the study, every time I started into REM, I would have a partial type event that would immediately knock me right out of REM. These events were not considered significant enough for the CPAP machine to register something, but the technician was carefully watching and manually adjusting pressures as needed. He was surprised to see my REM cycles abruptly end over and over.

No wonder I've been out of my mind crazy and feeling worse than ever. I was moved from an 8 pressure to an 11, which is quite a big difference. This allowed me to move into REM finally.

Moral of the story: If you are not feeling better after months of CPAP therapy, even though your AHI is low (remember-- mine was almost always under 1), GO BACK IN FOR ANOTHER SLEEP STUDY.

I've been on the new pressure for about two months, and I'm actually beginning to feel human again.

Hope this update is helpful for someone else reading through old posts.

[kteague]

Thanks for posting an update. Will make a mental note to think of this possibility when people are seeing a good AHI but still feeling bad.