Removing mask unconsciously after 1–3 hours despite low leaks and good AHI

[cpapusern30i]

Here is my Diagnosis study-
Note that it did not take me that long to fall asleep, I just had my lights off way later than they were supposed to be.

[Pugsy]

I don't feel well so it will have to be tomorrow before I try to make any sense of those documents and I will be honest....some of that stuff is above my pay grade and the one person who I trust to understand it hasn't been around much lately.


But Ritalin is a likely culprit in some of your arousal issues.

Two main kinds of arousals....respiratory related and spontaneous. CPAP only fixes or tries to fix arousals related to sleep apnea and the not breathing. Won't do a damn thing for spontaneous arousals and most likely the bulk of any arousals you seem to have are spontaneous.

Now the REM/supine issue and pressure needs question....My OSA is documented 5 times worse in REM and I needed twice as much pressure in REM than I did in non REM sleep to eliminate the bulk of the apnea events I was having....in non REM I needed about 8 cm pressure but in REM I needed 14 to 16 cm.
For me supine was not the issue but REM sure was.

You have a sleep problem (beyond the OSA) for sure but until you can keep the mask on all night and sleep without a gazillion arousals.....we are really limited in what to offer except WAGs...wild ass guesses.

[cpapusern30i]

Next 3 screenshots below:

[cpapusern30i]

Last two here
Thank you again for anyone willing to help; I am very grateful

[cpapusern30i]

The first one looks like another OA but the other two look like post arousal CA’s. Basically you “wake up”, breath deeper and then when you drift back to sleep you stop breathing so your co2 levels get back in sync. You do this while awake too you just don’t realize it. If you take a few deeper breaths while awake you will pause your breathing for a second to stabilize. Keep in mind the machine won’t pick up every disturbance. The threshold for an event is static and if you miss it by a second then it won’t flag it.

Look at the breaths on your first pic, some of those peaks are flat which signals a partially blocked airway.

Interesting, I really appreciate the insight. I attached all of my diagnostic and titration study screenshots below in this thread for more context.

One thing I am honestly trying to figure out is how much of these repeated arousals and mask-removal episodes may actually be modifiable through machine settings versus being part of a broader sleep fragmentation issue. Do you think this seems more directly related to things like pressure range, EPR, and AutoSet response behavior, or do the flow patterns/arousals suggest something more complex going on beyond the PAP settings themselves?

Thank you again for taking the time to look through all of this, I really appreciate the advice.

[cpapusern30i]

I don't feel well so it will have to be tomorrow before I try to make any sense of those documents and I will be honest....some of that stuff is above my pay grade and the one person who I trust to understand it hasn't been around much lately.


But Ritalin is a likely culprit in some of your arousal issues.

Two main kinds of arousals....respiratory related and spontaneous. CPAP only fixes or tries to fix arousals related to sleep apnea and the not breathing. Won't do a damn thing for spontaneous arousals and most likely the bulk of any arousals you seem to have are spontaneous.

Now the REM/supine issue and pressure needs question....My OSA is documented 5 times worse in REM and I needed twice as much pressure in REM than I did in non REM sleep to eliminate the bulk of the apnea events I was having....in non REM I needed about 8 cm pressure but in REM I needed 14 to 16 cm.
For me supine was not the issue but REM sure was.

You have a sleep problem (beyond the OSA) for sure but until you can keep the mask on all night and sleep without a gazillion arousals.....we are really limited in what to offer except WAGs...wild ass guesses.

Feel better soon.

Interesting, I will definitely keep looking into the pressure/REM aspect. My REM AHI was about 3 times higher than my overall AHI as well.

Regarding the Ritalin, I actually went back on a very small dose mainly because of the fatigue and daytime functioning issues. For a while I thought all of this might have been related to ADHD medication withdrawal, but I was still having these sleep problems before and after restarting it. I also cannot remember whether I even took Ritalin on the study days, and if I did, it would have been many hours beforehand.

Thank you again for taking the time to look through everything. I really appreciate the help and I look forward to hearing your thoughts when you feel better.

[Mguitar]

All those pics really come down to is "You have sleep apnea, and it's pretty bad". Your oxygen only went down to 93% which is not that bad. My AHI was only 3 but my oxygen dropped to 89%. But you have a pretty high amount of events caught in your study.

Your original post's pic only shows half an hour but within that 30-40 minutes you only had one event which is a huge and great improvement. That runs at about 1-2 events an hour. Not perfect but it's a lot better than 27 or whatever those pics you just sent said.

You might be taking the mask off during the arousal because it feels suffocating. Is it a full face mask or just nose? Are you comfortable with it while awake or does it bother you or give you anxiety?

[cpapusern30i]

All those pics really come down to is "You have sleep apnea, and it's pretty bad". Your oxygen only went down to 93% which is not that bad. My AHI was only 3 but my oxygen dropped to 89%. But you have a pretty high amount of events caught in your study.

Your original post's pic only shows half an hour but within that 30-40 minutes you only had one event which is a huge and great improvement. That runs at about 1-2 events an hour. Not perfect but it's a lot better than 27 or whatever those pics you just sent said.

You might be taking the mask off during the arousal because it feels suffocating. Is it a full face mask or just nose? Are you comfortable with it while awake or does it bother you or give you anxiety?

Currently I use the AirTouch N30i. It’s actually pretty comfortable for me and I don’t really have anxiety with it. My cushion size is kind of right between medium and large, but I use medium because it seals better and leaks less. It’s not too tight either.

If it bothers me during the night, it’s usually more of a minor adjustment thing where I reposition it a little rather than feeling like I need to rip it off.

[cpapusern30i]

I don't feel well so it will have to be tomorrow before I try to make any sense of those documents and I will be honest....some of that stuff is above my pay grade and the one person who I trust to understand it hasn't been around much lately.


But Ritalin is a likely culprit in some of your arousal issues.

Two main kinds of arousals....respiratory related and spontaneous. CPAP only fixes or tries to fix arousals related to sleep apnea and the not breathing. Won't do a damn thing for spontaneous arousals and most likely the bulk of any arousals you seem to have are spontaneous.

Now the REM/supine issue and pressure needs question....My OSA is documented 5 times worse in REM and I needed twice as much pressure in REM than I did in non REM sleep to eliminate the bulk of the apnea events I was having....in non REM I needed about 8 cm pressure but in REM I needed 14 to 16 cm.
For me supine was not the issue but REM sure was.

You have a sleep problem (beyond the OSA) for sure but until you can keep the mask on all night and sleep without a gazillion arousals.....we are really limited in what to offer except WAGs...wild ass guesses.

Hi Pugsy,

Just wanted to follow up and see whether you happened to get a chance to look through the studies/screenshots yet. No rush of course, I know you mentioned you weren’t feeling well before, so hopefully you’re feeling better now.

Thanks again, I really appreciate the help.

[Pugsy]

So I looked at those documents and really all they do for me is make me wonder where they came up with their computations.

None of that explains any possible reason for your current premature mask removal though at least to my mind.

Your overall sleep efficiency was in the toilet for sure. Oxygen desats at the worst was just 93% which is minimal. Mine went to 73% to give you a comparison.
They did say that you made it to REM during the titration but it wasn't for very long at all. The fact that your titration study didn't spend any time at 14 cm doesn't really mean all that much. We have no way to know what pressure any REM related events might actually needed to be prevented. Not every one needs much more pressure in REM though it is common for some people to need more....doesn't mean everyone needs more. Same thing with the supine thing.

I go back to what I said before.....to see whats going on NOW and not micro analyze the diagnostic or titration studies we need complete sleep data with mask and machine on all night and even then it's not necessarily clear cut.
So....that problem needs attention first before we can even make a WAG as to what is or isn't going on with your therapy.

For sure you have some sort of sleep problem but it may not be something that we can place all the blame on OSA.

You need to be talking to your doctor.

[cpapusern30i]

So I looked at those documents and really all they do for me is make me wonder where they came up with their computations.

None of that explains any possible reason for your current premature mask removal though at least to my mind.

Your overall sleep efficiency was in the toilet for sure. Oxygen desats at the worst was just 93% which is minimal. Mine went to 73% to give you a comparison.
They did say that you made it to REM during the titration but it wasn't for very long at all. The fact that your titration study didn't spend any time at 14 cm doesn't really mean all that much. We have no way to know what pressure any REM related events might actually needed to be prevented. Not every one needs much more pressure in REM though it is common for some people to need more....doesn't mean everyone needs more. Same thing with the supine thing.

I go back to what I said before.....to see whats going on NOW and not micro analyze the diagnostic or titration studies we need complete sleep data with mask and machine on all night and even then it's not necessarily clear cut.
So....that problem needs attention first before we can even make a WAG as to what is or isn't going on with your therapy.

For sure you have some sort of sleep problem but it may not be something that we can place all the blame on OSA.

You need to be talking to your doctor.

Hi Pugsy,
Thank you very much for your response. I would like to clarify that the sleep latency was so high because I went to bed way later than was supposed to, and it took 81 minutes once I was asleep to go into REM. Yes, I totally agree about the pressure, thank you for letting me know that it doesn't mean everyone needs more. Yes, I will keep the machine's current settings for a couple nights and try my best with all the materials I have, and am considering a followup.
Thank you very much for your advice, I will post some screenshots in the thread after my 3-day experiment has concluded.
Thank you so much.