HuffDog's Therapy Thread - Optimizing my therapy

[HuffDog]

Ok, so I've been on APAP for about a week now. Starting to get used to this alien stuck to my face at night.

Overall, I'm starting to feel much better in pretty much all aspects. Waking up more rested, not dreading get out of bed, etc. But I'm still waking up multiple times during the night. The last two nights I recall waking up probably 6 to 8 times, but I fall back asleep quickly. I'm guessing it's a result of getting used to this new hosehead life and not quite having my therapy zeroed in to where it should be.

Attached are reports from my last two nights. I'm a side sleeper using a full mask, so this may or may not be helping me out. I also have a nasal and nasal pillow, but breathing just does't feel as comfortable in those as with the full face.

This first one resulted in a bit better sleep than the following one. My leak rate doesn't seem too far out of line, but higher than the 24 that I've seen recommended. Could my sleep quality and AHI be improved by working to seal the mask a bit better, or is this still within the acceptable range?

screenshot-20190824-103518.png (236.23 KiB) Viewed 817 times

This second one has a bit higher AHI. I bumped the minimum pressure up to 8 from 7.5, thinking that most of my events were happening at 7.5 or below based on the screenshot above. So I figured bumping the pressure a tad may help. This time my mask leaks were a bit higher, but not sure why. NOTE: the big gap at around 00:20 occured because I took my mask off in my sleep and woke up later to put it back on. First time that's happened! Maybe the increased pressure? Or perhaps just tossing and turning more made it not seal as well?

screenshot-20190824-103448.png (241.72 KiB) Viewed 817 times

Overall, I'm wondering if the experts here recommend that I try to optimize my current mask or if I should try and adapt to a nasal type mask. Also, please let me know if there's anything you're seeing in this data that I might be missing, or haven't thought about.

[Pugsy]

The 24 L/min leak number is a ResMed line in the sand number. ResMed machines report leaks differently than Respironics machine.
You can't be comparing your leak numbers to ResMed numbers.
ResMed number are excess leak only....Respironics reports total leak which is the expected leak/vent rate PLUS any excess leak.
Your Respironics leak number will likely always be higher than the 24 L/min because of the vent rate if nothing else.

The vent rate or expected/intentional leak will vary with the pressure. Higher pressures will mean more vent rate so your increase is to be expected with the slight increase in pressure.

Your leak in terms of excess leak....extremely minimal. Whatever you are doing in terms of mask adjustment to control leaks...it's working very well. Unless those teeny tiny leaks wake you up you have no problems with leaks at all.

Quit worrying about them. There are full face mask users who would give their left you know what to have an excess leak line like yours (that bottom leak line that you can barely see sometimes).

I suspect that your wake ups are either normal post REM cycle wake ups (did you know that it is normal to wake after a REM cycle) or perhaps just the brain still learning to be okay with the alien strapped to your face. It took me nearly 3 months for my brain to be okay with that alien. It frequently woke me up just to point out "dude, do you know you got this weird alien stuck on your face blowing air up your nose). The wake ups do mess with our sleep quality though...so we like to keep them to a minimum.

I see no reason to use the higher minimum at this point but it's not really that much higher. Hurts nothing.
Your machine doesn't seem to want to need to vary the pressure much during the night.
The little pointy spikes in the pressure line are just the pressure test probes testing the waters. Those are the saw tooth looking spikes and unrelated to any potential airway issues.

AHI numbers can and will vary from night to night even with no changes in anything. We simply don't sleep the same each night.
You might have had that higher AHI even if you hadn't changed the pressure minimum.

[HuffDog]

Ok, looking for some advice/opinions.

I've had a few more nights of pretty good sleep. The pressure is still at 8/13. Flex is at 3. Graphs and AHI look pretty much the same as in my original post, so I'm not adding more at the moment.

Here's the rub...while I'm feeling much better than pre CPAP, i feel like my sleep still has room for improvement. I'm alert and able to get through a whole day without much fatigue, but I still find myself yawning and feeling a bit tired around early evening.

Should I tinker with my pressures or flex now, to try and make small improvements? Or should I be patient and wait another week or two or more? I'm still fairly new at this and have no doubt that my body is still adjusting. I dont want to just chase a lower AHI if all I need to do is be more patient.

[Pugsy]

You want to tinker to see if it will change anything....so go ahead and tinker.
I have been in your shoes...some years ago when I was new to this therapy I was doing fairly well, not perfect but fairly well.
So I decided to experiment with more minimum.
I was using 10 minimum and 20 maximum...AHI running about like yours. Feeling better in general but there was always that nagging question "would I feel even better with more minimum". So I decided to increase the minimum 0.5 cm for a week at a time to see if it made any difference in anything.
Over 6 weeks I went up to 13 minimum...After a week at 13 I sat back and looked at my results. Nothing changed....AHI didn't change...how I slept didn't change...how I felt didn't change. But I answered that question and decided not to pursue any further increases. Went back to the 10 cm minimum.

More pressure isn't the miracle fix that people sometimes think it is. Sometimes there are other reasons why maybe our sleep quality is lacking or we get a bit drowsy in the afternoon besides the OSA stuff. We can't always fix all our problems with little tweaks on the machine because the problem can't be fixed with the machine because it simply isn't related to something the machine can fix.

Only way to answer that question though...give it a try.
Make sure you do it like a real experiment....log everything and keep records so you can review the results accurately. Don't trust your memory.

[HuffDog]

Thx Pugsy. You're awesome!

[HuffDog]

My next question relates to dreaming.

When I was younger, I would dream a lot. Vivid dreams that I could remember the next day. As I grew older the dreaming stopped, presumably as my sleep apnea got worse.

I anticipated that dreaming would come back as I optimized my therapy. But it hasn't. My AHI is quite low on average, and I feel tons better since I started CPAP. Or maybe im sleeping deeply and just don't remember my dreams.

Just curious about other's experiences here.

[Pugsy]

Actually remembering a lot of dreams isn't a good thing.
We dream in all sleep stages and not just REM. We don't remember a dream unless we wake up during it. Obviously wake ups are unwanted because it disturbs the needed normal sleep cycles.

It is normal to wake up briefly after the completion of a REM cycle. So there is a chance of remembering a dream at that time.
Most of the time we just roll over and go back to sleep and weren't awake long enough to formulate a memory.

So not remembering dreaming doesn't mean we aren't having any....just means we aren't waking long enough to remember them and that's a good thing.

[Holden4th]

My next question relates to dreaming.

When I was younger, I would dream a lot. Vivid dreams that I could remember the next day. As I grew older the dreaming stopped, presumably as my sleep apnea got worse.

I anticipated that dreaming would come back as I optimized my therapy. But it hasn't. My AHI is quite low on average, and I feel tons better since I started CPAP. Or maybe im sleeping deeply and just don't remember my dreams.

Just curious about other's experiences here.

My dreams came back and yours will too. I found that it took a few months of effective therapy for this to happen and when it did I knew that this was working for me. After optimising my therapy and seeing good numbers I still didn't feel as if PAP was working for me then one morning I woke up and knew I'd had a great nights sleep. It was full steam ahead from there. This will happen for you.