Does CPAP not wok for me, as I'm dizzy again?

[colomb]

I'm a man at 53, 190 lbs, 5'10" tall. My OSA is severe per the sleep test with 52 apneas per hour. This seems worse than I was about 10 years ago. I tried nealy every possible treatments, including mouth piece, tongue restrainer, and even surgery - UPPP, except CPAP. It's five years since I had the surgery, but I felt very bad recently and made the decision to use a CPAP about one month ago. Kaiser precribed and ordered me the REMstar Auto CPAP Machine with A-Flex, which I've been using for more than two weeks. During the test and at the beginning to use my own machine, I felt great depsite of the discomfort of wearing a nasal mask. I didn't feel dizzy and my eyes weren't so dry! I felt so happy and thanked the technology from the bottom of my heart. I was ready to overcome any hardship arising from the use of the facility and kept using it every single night.

However, I tend to feel the problems are coming back recently. I started to be drowsy again as soon as I get up in the morning. I'm wondering if the machine really helps. I'm tring to figure out what happened. Is the pressure not high enough? I checked the machine and found the settings are 4/cm2 min and 14/cm2 max. Kaiser neither give me the sleep test result, nor did they provide me a copy of the prescription. I was only told the number of apnea and the type of my apnea - OSA, but not central apnea.

I sincerely hope that someone here might help me and make any recommendations as what to do.

Thank you.

[Wulfman]

Welcome to the forum.

If you're using a nasal mask and leaking your therapy air out your mouth during the night, that would account for what you're describing. In other words, there's a good chance your therapy is being compromised by mouth-leaking.
Try taping your mouth shut or get a full face mask.


Den

[Goofproof]

Add to what Den said, which is probably correct, your machine is set in failure mode, a range of 2 CM above and below your CPAP needed pressure will work best, maybe you can borrow or buy a pulse ox unit, and you really need the software to see what is going on with your treatment. You seem to have tried all the wish treatments, now you need to make XPAP the Gold Standard of treatment to work. Jim

[colomb]

Thank you so much, Den and Jim. Your findings and suggestions are very valuable. I myself never think of the mouth leaking problem, which is absolutely correct, as I used to open my mouth when sleeping. The reason I didn't consider this problem is that I felt there is a kind of absorptive force in my mouth when using CPAP, and I believe this will prevent me from openning my mouth. For your information, I have Septal Deviation and allergic rhinitis. Both of them contribute to my mouth breathing. I'll try to find a way to stop this.

As a newbie, I have no idea about what the "Pulse OX" software is. It seems there are so much to learn. I'll try all the solutions you recommended

Your help is highly appreciated.

[Goofproof]

You need to list your equiptment in your profile in text format not iconny. The software is for your XPAP, if you machine collects full data, it will allow you to see what is going on and when. The Pulse Ox is a O2 monitor, they come with the software to read your progress as far as O2 levels. Sometimes you Dr can set you up with a loaner, many here bought them for about $120 to 130 dollars, more important is the data from the XPAP, the O2 is just iceing on the cake. Jim

[Goofproof]

Also you might check you Blood Pressure, that can be useful too. jim

[napmaster]

colomb,
One of the things your dr or durable medical equipment provider (DME) will recommend for the mouth breathing is a chin strap. The only thing is, the one they will provide will probably do nothing. At least that was my experience. However, there are a couple of good ones that really work. My first choice is the PAPcap http://www.pur-sleep.com/products/prodD ... rch=&page=
My second choice is the Deluxe Chinstrap https://www.cpap.com/productpage/deluxe ... hleak.html
Both of these work well. I've done the mouth taping. It is very effective. However, I like the chinstrap better and found it to be just about as effective.
If you have an ENT (Ear, Nose, and Throat specialist), you might want to check into surgery on the septal dev, depending on how severe it is. As far as the rhinitis, have you seen an immunologist (allergy dr)?. I took allergy shots for several years and it did no good. Turns out, I have non-allergic rhinitis. So, I have to use a nasal steroid (generic Flownase). It takes a while of regular use to start seeing any results. But, I'm doing better now. On the dizzy thing, yeah, I've had that a couple of times in the last month. It was really bad and I felt tired all day. I think the cpap may be blowing and drying fluid around the sinuses where the equilibrium takes place. Anyway, it seriously messes you up.

You definitely want to take care of the mouth breathing issue. You will get a lot better results with that fixed.

[Pugsy]

Are you aware that there is software available to use to maybe see a reason why things aren't going so well now? Respironics on screen data is sorely lacking and it would be useful to take a look at that leak line and event line to see if there is anything that needs to be improved on. That 4 cm minimum pressure could simply be too low to be able to respond to the events in time if you need a higher pressure to prevent events. So the pressure line seen on the graphs could also give you an idea what is going on.

EncoreViewer 2.0 is the patient version, available for $99, I don't know of any freeware site for it.

EncorePro 2.4xx is the doctor/office version, available by asking for information to where it can be found.

Both require Windows OS. There is a 64 bit version of 2.4 available. Mac and other OS users can sometimes use workaround if they set up a Windows environment.

[colomb]

Thank you so much, Jim, napmaster and Pugsy.

Your suggestions and recommendations are so valuable and I'd like to try them from the easiest.

I never expected I could get so much help here. It's really cost and time saving, like a shortcut to success.

God bless you all.

[Janknitz]

I don't know which Kaiser you are using but the RT's at my local kaiser clinic are very helpful, too. If you ask for an appointment, they will take a look at your data and if you are mouth breathing they have lots of samples they will give you for free that may help--chin straps and full face masks to take home and try. They will also tweak your machine settings if that will help, too. Here in Santa Rosa they are really helpful and love working with interested patients.

And you can go to medical records and request a copy of the full and complete sleep study. They may charge you a copying fee and it may take a while to get the copy, but you should have it.

[Samba]

colomb, what is your AHi ?

[Pugsy]

colomb, what is your AHi ?

Samba, colomb's machine only gives a weekly and monthly AHI average on the LED screen. No breakdown to nightly or even different events. Pretty much useless unless the average is way out of line. Columb just recently got the software and as soon as he/she figures out how to use it he/she will be able to see and report what the data for each night is.
Then we can have an idea what is going on with the nightly AHI numbers, leak, etc.

[Samba]

OK, but a weekly AHI is better than nothing especially if it's low. I only have detailed dailies myself on the S8...

[colomb]

Thank you, everybody here.

I'm sorry that I respond rather late as I just learned to use the software "Encore Pro 2". In order to solve the problem of mouth leakage, I've been mouth-taping for a week. Nothing uncomfortable with the tape and no more serious leaking. However, I still feel drowsy all the day, as if something inside the top of my head. When taking a shower, I found I lost much more hair than I used to. My therapy pressure was set to 4 cm2 to 14 cm2. I tried to adjust them several times and finally set at 5-15. I here list the important CPAP data as below.

Average 90% pressure: 12.5
Average CPAP pressure: 9.9
Clear CA Index: 0.7
Average OA Index: 0.5
Average Hypopnea Index: 1.9
Average RERA Index: 0.9
Average AHI: 3.1
Average VS Index: 17.9
Average % Night in Large Leak: 1.4%
Average Large Leak: 5 min
Average Usage: 5 hrs 51 min 12 secs

Please help me find what I need to do.

Good night!

[Janknitz]

Columb, you need to get to the daily details graphic charts on Encore to see what's going on. The averages are not much help. If possible, it would help if you can post some of the daily detail pages.

Have you called the Kaiser sleep lab clinic for help?

One thing that occurred to me (and it looks like to Goofproof as well) is that you need to check your blood pressure. Especially if you are on blood pressure medications. My blood pressure went down A LOT fairly quickly using CPAP. It may be that your medication dosage needs to be adjusted accordingly, if you're on BP meds. Don't do this yourself! But check your pressures or make an appointment at Kaiser to get them checked and then discuss it with your doctor if your BP is low. That may explain your dizziness (dizziness can also be caused by getting used to the pressure changes in your ears from the CPAP pressure, but you should check your BP).