On CPAP - AHI is a little high and still snoring?

[Gekko]

I've been on CPAP for about 1 1/2 years now. I use a F&P ICON Premo and a Quattro FX (full face) mask. When I was first diagnosed I was diagnosed with severe sleep apnea (AHI of around 60 and longest apnea was almost 60 seconds!!)

Historically, I had allergies as a child and developed polyps in my nose. I also had a deviated septum. As a child I remember having long periods of time (when allergies flared up) where I would have trouble breathing through my nose, but being a kid, I never really told anyone, for fear of being taken to the doctors I just learned to live with it. Occassionally people would make comment about me having my mouth open (which must have made me look like an idiot), but I just brushed it off. I also remember being told I snored from a very early age (around 15 or so). However, from accounts at the time, I don't think I had sleep apnea, because no one remembers me not being able to breathe... rather it was just rhythmic noise making

By 2005 (age 31), the polyps had got to a stage where they blocked 100% of one nostril and about 75% of the other nostril. I also suffered constantly from low grade sinus infections. I went to see an ENT specialist and he recommended I have surgery. He cut out the polyps, straightened my deviated septum and also reduced my turbinates. Surgery and recovery went very smoothly. For a while it felt very weird to be able to breathe through my nose. However, having polyps and a blocked nose for most of my life, I was so used to breathing through my mouth that it is a habit I've found very hard to shake! It didn't change my snoring habit at all.

So, onto 2009, I was told I was choking and spluttering in my sleep (when I wasn't snoring very loudly!). I was also at a point in my day to day life where I could hardly stay awake and I had no energy or motivation. It got so bad that I could hardly get out of bed in the morning. I took the plunge and had a sleep study done. Sure enough, sleep apnea. I was given a pressure of 14.0. At first I struggled with the machine (usual problems... suffocating feeling, mask leakage issues, etc.) but after about 1-2 months I settled into a routine. I slowly started to feel better, to the point where I now feel absolutely shattered if I have to sleep a night without CPAP. I was told I still snored occassionally, but it seemed to be confined to times when I rolled onto my back.

HOWEVER, over the last few months, it appears that old habits have crept back. I've been told that I'm now snoring on my side. I've also noted that my AHI has crept up (I used to get 1 on a good night, 4-5 on a bad night), but now it seems to be fluctauting between 10-30! I don't feel any different (still wake up feeling OK), but it's obviously becoming a problem, so I need to address it.

I've tried chin straps, but they just don't hold my mouth shut!! My reflex to open my mouth is so strong (from so many years of conditioning), it even overcomes a chin strap. I already use a heated humidifier and a full face mask, so that's not the problem. I don't believe I've got any leak issues, since my leak rate is within the acceptable rate for the pressure I'm using. I've noticed I still tend to get low grade sinus infections (no symptoms other than yellow/green mucus). Is the infection the problem? Should I be rinsing out my nose every night (I was using Neil Med saline rinses, but I never really used them on a consistent basis).

I tried dialing the pressure up to 15, but that doesn't seem to have changed the snoring (of course, I'm relying on anecdotal evidence here).

It's also useful to know that I am overweight (at the moment BMI of 30), but I am on a diet and losing weight. I will say, however, that historically, even when I've been at my lightest (BMI of 21) I was still known as a snorer! So weight loss alone will not cure the snoring.

Any tips/ideas/thoughts/experiences greatly appreciated!

[SleepingUgly]

Your mouth didn't open with CPAP before and now it does? You may be leaking your therapy out of your mouth... Do you have data that says how bad the leaks are?

[Gekko]

Sorry, I should clarify:

1. I've always snored (before and after CPAP);
2. Due to my "open mouth" problem, I have used a full face mask from day one of CPA treatment;
3. When I first started CPAP, I still snored, but only when I rolled onto my back, and even then, it was a "soft" snore;
4. Recently, the snoring has started to become a problem again - I snore on my back, my side, and it is louder than before;
5. I've already tried a chine strap (in the hope that a closed mouth will reduce the snoring), but it seems that my jaw just forces itself open!

So, what I'm asking is whether someone else has had a similar experience and whether there is an obvious solution to this problem

[SleepingUgly]

IMO, You need another sleep study, ideally, and short of that, you need data and to try to titrate yourself (ideally with the aid of an APAP).

[jamiswolf]

Gekka,
This isn't really rocket science. If you're still snoring (and you're sure it isn't artifact) then your pressure is too low. Would explain rising ahi too.
J