Regression in Treatment

[michgol]

I started CPAP in late Nov. It was OK. Towards the end of Jan my provider made some adjustments based on a really in depth discussion with him that this forum really helped me with. Things were going very well. In fact in March I was to the point where I would on a bad night see an AHI of 2 and many nights <1. I was not waking in the night. Things were really going well. I was feeling good and as a cyclist who tracks where I am I was seeing improvements to my HR based stress scores.

Then around March 12th things went really wrong. I am having a very difficult time staying asleep and being comfortable. My nights lately are terrible with me unable to fall asleep for hours. High AHI with clusters while I appear to be sleeping..... After several weeks of as what was I think about as good as it could get I am now a few weeks with very little sleep I would love some help figuring out what went wrong and how I can get back where I was.

Here is what early March looked like

GoodNight.png (95.7 KiB) Viewed 1426 times

Here is last night

LastNight.png (98.98 KiB) Viewed 1426 times

Nothing really changed. The only change is that I have tried to adjust the humidity to see if that can help with nasal congestion.

[Miss Emerita]

You’re right to note clustering, which is apparent for OAs, Hs, and FLs. One possible culprit is sleep position, e.g., starting to spend more time on your back. Another is changes in pillows, e.g., using several pillows when you had formerly used just one.

And yet another is tucking your chin toward your chest. This tends to narrow your airway, which makes it a lot easier for these obstructive issues to arise. Many people see dramatic changes when they start using a soft cervical collar at night, which keeps their head/neck/chin properly aligned. Definitely worth a try.

I'm curious also to know why you had those breaks in therapy.

[Janknitz]

Leaks seem high at the same time. Is your cushion or headgear wearing out?

[michgol]

Thanks for the thoughts.

I have used the same pillow through this and have been sleeping on my back since Jan so no changes there. One note is that I cannot sleep on my side. I have a neck injury and the main reason I am on CPAP is to allow back sleep to resolve the neck issues. While I know sleeping on my back is worse for apnea I was doing great on my back from when my provider made some tweaks to pressure late Feb through middle of March.

The breaks in therapy are me not able to sleep and getting up.

It is possible that mask wear is an issue. I have been on the same mask and cushion since mid to late Feb when I moved to a different type. That puts it at a bit over 2 months old. From what I have read that is on the early side of wear. I do not see any visible degradation in the cushion compared to a new one. However, I will switch tonight and see what happens.

[Julie]

Gained any weight lately?

[chunkyfrog]

Headgear is funny--it needs to be kept fairly clean.
If it loses its stretch, maintaining good fit becomes progressively more difficult.
Some users can make the same one work a long time---but not everybody.

[jimbud]

The only change is that I have tried to adjust the humidity to see if that can help with nasal congestion.

Those flow limit spikes would be waking me up:
March - 95% at 0.05 Max. at 0.35
up to
April - 95% at 0.22. Max. at 0.95

Big difference.
Spring allergy season kicked off where you are?

Also:
Sometimes too much humidity is just as bad as not enough.

Good Luck.

JPB

[michgol]

My weight has actually been down a few pounds the last month. This is mostly me returning to normal after gaining a few holiday pounds and getting a bit better about my meal schedule.

Allergy season is definitely here. One thing I do not really understand is what the flow limits are and how those correspond to apneas.

I will also look at new headgear to see if that is the issue. I do clean mine weekly with a soak in soapy water and then letting it dry out. This headgear is about 2.5 months old so I hope not an issue.

[zonker]

My weight has actually been down a few pounds the last month. This is mostly me returning to normal after gaining a few holiday pounds and getting a bit better about my meal schedule.

Allergy season is definitely here. One thing I do not really understand is what the flow limits are and how those correspond to apneas.

I will also look at new headgear to see if that is the issue. I do clean mine weekly with a soak in soapy water and then letting it dry out. This headgear is about 2.5 months old so I hope not an issue.

the forum software no longer shows equipment with every post. (or any post.)

what mask are you using?

[jimbud]

One thing I do not really understand is what the flow limits are and how those correspond to apneas.

http://www.apneaboard.com/wiki/index.ph ... limitation

That will give you a quick intro.

JPB

[michgol]

I am using a dreamwear full face mask with a resmed autoset 10 machine.

[Miss Emerita]

Will your neck injury allow you to wear a soft cervical collar at night? Something's causing that clustering, and it'd sure be good to know what it is.

I suppose you could also try raising your minimum to see if that helps. I'd suggest 9 to start with. I'd also suggest shortening or eliminating the ramp.

Keep us posted, would you?

[Pugsy]

Any meds being taken?
Or maybe a change in dosage of old meds maybe?

[michgol]

On meds I take very little. I have Zyrtec and Flonase for allergies and Hydroxyzine (as a help get me used to CPAP by sleep Dr). I have been taking all of these since Nov and have not had any changes. My plan when things were great in early March was to get off the Hydroxyzine (which is what the sleep Dr wanted as well).

The good news is that last night I switched to a new mask cushion and cut back on the ramp time by using their auto ramp. I had a good nights sleep with AHI of <3. I will stay with this for a few nights and see what happens.

I thought about the suggestion of turning off ramp. However, I tried this back in December when I started and that did not go well as the machine was deciding I was having apneas while I was awake and blasting me with high pressure and preventing me from falling asleep. I will likely turn off the ramp, but want to ease into that given a past bad experience.

[michgol]

I thought I would post a follow-up. Things are a bit better. However, not nearly as good as where they were. I have been trying different ramp settings. Mostly a short ramp, off or auto. Having less ramp does appear to help. Ramp all the way off and I do not get along well as for some reason the machine thinks I am having apneas when I am wide awake and ratchets the pressure really fast. I seem to need/want a few minutes to relax into bed before the treatment begins.


Right now what I want is to go back to where I was early March. At that time the Dr made pressure adjustments as recommended from here (he came to the same conclusion on his own) and I was in a very good place.

My problems appear to be triggered by allergies. Seems like I need that to be more under control.