Daytime sleepiness returned after 4 months on CPAP

[Chrisf]

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9-14-2011 9-19-32 AM by chrisf220, on Flickr]

Ah, I see, Thank you.

[mayondair]

Yikes! You have a big leak problem! No wonder you feel bad, a lot of events and not effective therapy. , just a question, is your FF mask assembled properly, have you replaced the cushion/ seal recently? Maybe a diffent mask would work better. Nasal with chinstrap and or tape? The leak line should be relatively flat, not squiggly or spikey, if the machine scores large leak it really is large . The first step to feeling better is getting a mask that works for you. Work on that first! kathy

[Chrisf]

Its weird Kathy because I have been shaving before bed the last few nights and I've felt like I'm getting the best seals. Obviously if the numbers were wrong, I would feel better. But thats not the case. Do you have any recommendations for a stuffed nostril. Typically one of my nostrils is always clogged. I've been using a vicks vapor inhaler as a temporary fix.

[mayondair]

Lots here use netti pot or sinus rinses, stay away from Afrin except very short term , ( only a day or two) if it's allergies, try some claritin. Or ask doc for RX . You might try turning the humidity up or down.. Have you checked your hose for leaks? How about the connections? Have any cats in the house mine likes to play with my stuff . You really need to fix the leaks , then you will be able to tell if the pressure you are using is effective.

[Chrisf]

Yes, I have 2 cats. One is a new kitten. I thought the same thing. As soon as I got home, I checked the hose. However, I don't feel or hear any leaks. I just washed my nasal mask. We'll see how I make out. I'll definately be going to sleep early tonight. Driving home was uncomfortable to say the least. So, If I have another poor quality sleep night, I'll probably stay home from work. I'm more dangerous on the road at this point.

As far as the nasal rinses, I do use the netti pott occassionally. After I use it, I get the post nasal drip stuff for a couple of hours. You really don't want to use it and then go right to bed. So I need to be able leave enough time for that stuff to clear out.

[mayondair]

You can fill the hose with water and look for leaks. Cats can be trouble . I don't use sinus rinses, but I think some do use them more than once a day. Good luck tonight, post another graph tomorrow, if leaks are better then you could look at the number of events you are having. Try a chinstrap if you have one, or a self adhesive ace bandage as a cheap alternative.

[Chrisf]

OK. So I slept with the nasal mask last night. There were NO large leaks at all, however there were some leaks still. My AHI went down to 19 from 48. I don't think I feel as tired as I did yesterday. HOwever, I do still feel rundown, So I'm working from home today. Also, I have not used the nasal mask in a while. It was making this farting/flapping noise most of the night. I tried tightening the mask, then loosening the mask. Changing positions. I was holding it down for a while too. Not sure what was going on with that. However, it was loud enough to wake both myself and my wife up last night a few times. The nasal mask was a Gel mask that I got the night of my sleep study.

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9-15-2011SleepAp AM by chrisf220, on Flickr]

[jabman]

Your numbers do look better. It can take some time to feel better, you have what is known as Sleep bebt to pay off. For some it does not take to long but for others it can take a while.

Di you use a chin strap last night? I am not sure what the Farting noise is but would guess it is the pressure moving your mask. Your pressure though is not real high so I am not sure.

[Pugsy]

Way.....way too many clear airway events as well as all the other events.
You have appointment today with your doctor? Take this report with you.

Go back and look at your very first reports when you say you felt good and didn't bother to use the software.
How do they look? Take some of those with you to the doctor also.
Get copies of both your original sleep study and the titration sleep study. Look to see if either report mentions centrals.

While your first report did show bad leak, the leak was not the sole reason for the bad night. Your most recent report has a very acceptable leak and the report is still ugly.
With the high number of clear airway events we can't suggest a higher pressure. It might possibly actually make things worse.
Best thing is to discuss all this with your doctor.

[DaveLP]

I agree about consulting the sleep doctor, but isn't your machine an auto? If it is, why are you sticking to a fixed pressure. My thoughts are that if you set it in a range from 10-13 you would see rises in pressure responding to the apnea events. You can try smaller ranges, increasing the max pressure until you no longer have flat tops in the pressure graph. Some experimentation could help decrease your apnea.

Be aware that raising the pressure can also aggravate leaks. I'd see the doctor to determine whether you mask is a good fit for your facial shape. Another thing I noticed is that you are having lots of central apneas (If CA = central apnea).

[Pugsy]

but isn't your machine an auto? If it is, why are you sticking to a fixed pressure. My thoughts are that if you set it in a range from 10-13 you would see rises in pressure responding to the apnea events

Dave with Chris's number of clear airway events using APAP mode may not be the best thing right now. The increase in pressure needed to deal with the obstructive events could possibly make the centrals much worse.
We haven't seen what the original 9 cm pressure did. Were there less clear airway events at 9 cm?
This number of clear airway events is much more than our normal random or sleep onset clear airway event.

This really needs to be evaluated by his physician. We don't have enough information with these 2 reports.
An increase in pressure is probably needed for the obstructive events but with this number of clear airway events we may be dealing with complex sleep apnea and APAP could make it worse. For this reason I don't advise much dial a wingin and instead advise an in depth discussion with physician including a look at the first initial reports when he reported feeling better. If these are pressure induced centrals any increase in pressure could possibly make things a whole lot worse. When we see this number of clear airway events or centrals...best thing is to talk to doctor. CPAP may not be the best choice of machine and neither is APAP mode.

[Chrisf]

Honestly, It looks like I didn't give the pressure of 9 enough time before I cranked up to 10. I think that after a week when I didn't feel better, I just convinced myself that higher pressure meant better sleeping. Typical inpatient person. so, there really isn't much data using the pressure of 9. Then, there was only a few weeks of using the pressure 10. There is no data for the whole months of June and July. I don't know what happened. All I have is the months of August. However, in that time, the CA was very low. Below 2 most of the time. The AHI was always in the 7-25 range. Also the Vibratory Snores were always high, typically in the upper 100s to lower 200s range. I don't know what this is however. Then, in the end of august and the beginning of september, you can see the full face mask slowly falling apart. Everyday there was a lttle increase in large air leaks. Then almost a week ago from today, you can see mostly large air leaks. This is when I started to really get tired. Last night was the first night where I had no large air leaks. Also, my vibratory snores were low. This is also the first day that my CA was high. Even a week ago, my CA was only 3.2. Could this be just my body getting used to a new mask?

[Pugsy]

High VS numbers usually indicate not enough pressure especially if you see obstructives along with it.

AHI of 7...is too high...and above that obviously too high.

New mask the cause? I don't know but since you have appointment with the doctor already...good idea to bring this up.
You are seeing pulmonologist? Is he your sleep doctor or do you have respiratory problems?

Anytime I see clear airway events to this magnitude it warrants caution. It may not mean anything but better to play it safe. Since you report this report is unusual for you perhaps not so alarming but still something is not right. AHI needs to be less than 5. Tis no wonder you feel awful with this type of report. Something is not working as it should.

Is it possible that these events are worse because of sleep position? REM?

If you didn't have these centrals I would say increase the pressure but I can't offer that suggestion because I am not comfortable with it in view of what is shown here. You are feeling worse and your reports leave a lot to be desired. Time to discuss all this with sleep doctor.

[Chrisf]

I never had a sleep doctor. I went to my regular GP and was setup with an appointment with the sleep lab. The sleep doctor that read the initial report is a pulmonolgist and unfortunately is not in my insurance plan. So I just found another pulmonologist. If he recommends an actual sleep doctor, than I will go to him. I think I definately feel a little better than yesterday, but by no means good. I'll re-update what the dr says this afternoon after the appointment.

[Pugsy]

The new pulmonologist should have a pretty good handle on understanding these reports if he has any sleep study knowledge at all.