Not adjusting to CPAP, TMJD and sinus problems, seeking advice

[sleepy-programmer]

Tried APAP 4-8 to see what happens. Barely had it on more than an hour when the pressure went up a bit past 5, and I apparently nope-d the f--- out. Woke up 6 hours later with the mask off. Sigh...

I'm still seeing controlled OSAs. 0.0 here. At 4.0 pressure, though I was titrated at 8. Is it possible my OSAs only come out in deeper sleep phases? I have a month of data to go through but I've never managed more than 3-4 hours a night with the mask on.

Screenshot (11).png (97.5 KiB) Viewed 5462 times

[Pugsy]

Is it possible my OSAs only come out in deeper sleep phases?

It could be positional....like on your back you have OSA significantly and on your side you don't.
It can be related to sleep stages...worse in REM and very mild or non existent in non REM.
My own OSA is 5 times worse in REM than in non REM. In non REM I think my OSA was on the low end of moderate with around 11 or 12 AHI but in REM it was 53 AHI. Supine sleeping for me was never much of a trigger but can be for others.

REM normally has the first cycle about 90 to 120 minutes or so after sleep onset....so when looking through your data look for chunks of time where you were asleep at least 90 minutes to 2 hours.
Obviously 1 hour isn't enough to hit REM. Not many people will go into REM the first hour. It can happen but those people usually have some other sleep issues.

Google "sleep stages" and look at the normal hypnograms to get an idea how REM cycles around. Usually first REM comes around about 90 minutes or so after sleep onset and then as the night goes on REM starts coming around more frequently and lasts longer.
Greatest amount of REM is in those wee hours of the morning.

Your zoomed in on CA....obviously not real. Most likely the leak caused an arousal and you woke up (may or may not remember awakening) and you paused your breathing a bit and then probably rolled over and went back to sleep.

[Jay Aitchsee]

The CA in the above example is a classic example of an arousal followed by holding one's breath. The spike in Flow Rate preceding the event likely indicates an arousal. This event typically would not be scored as a Central Sleep Apnea in a lab setting.

Yes, many find that their OSA occurs during different sleep stages, often REM which is typically seen 90 to 120 minutes after sleep onset and periodically thereafter. Others find OSA to be position dependent, with supine often being the worst offender.

You seem to have more than the average number of problems. I suggest you follow KT's suggestion and work on them one at a time. Start with getting comfortable with the therapy. Forget the results temporarily, pick a pressure that seems comfortable (maybe around 6.0) and see if you can wear your mask through the night. After that, work on your pressure to minimize OSA, if needed. Don't worry about CA. They are likely due to arousals caused by pain, discomfort, etc. As you become accustomed to the therapy, they will probably diminish. Don't expect immediate results, but rather a slow improvement.

I see Pugsy has posted while I was composing. My comments are similar to hers.

[sleepy-programmer]

The CA in the above example is a classic example of an arousal followed by holding one's breath. The spike in Flow Rate preceding the event likely indicates an arousal. This event typically would not be scored as a Central Sleep Apnea in a lab setting.

Yes, many find that their OSA occurs during different sleep stages, often REM which is typically seen 90 to 120 minutes after sleep onset and periodically thereafter. Others find OSA to be position dependent, with supine often being the worst offender.

You seem to have more than the average number of problems. I suggest you follow KT's suggestion and work on them one at a time. Start with getting comfortable with the therapy. Forget the results temporarily, pick a pressure that seems comfortable (maybe around 6.0) and see if you can wear your mask through the night. After that, work on your pressure to minimize OSA, if needed. Don't worry about CA. They are likely due to arousals caused by pain, discomfort, etc. As you become accustomed to the therapy, they will probably diminish. Don't expect immediate results, but rather a slow improvement.

I see Pugsy has posted while I was composing. My comments are similar to hers.

Thanks Pugsy and Jay. Clarifying my intent: I want to wear my cpap mask for more than 3 hours a night. I’m unconcerned about my arousals, Pugsy helped clarify that they’re not actual centrals. I appreciate you came to the same conclusion.

I adjusted pressure because I’ve tried humidity and temperature settings and I can’t find the magic spot.

I actually find the mask comfortable. My sinuses reject it nightly.

I’ve been looking at the charts for clues why I take my mask off, my guess is sinuses.

Tonight’s test will be sleeping inclined.

[sleepy-programmer]

Oh another thought. Perhaps I tape the mask to my head?

[Pugsy]

When you have time please clarify exactly what you mean by your sinus issues.
Also exactly what you tried in terms of humidity and temperature and how long with each trial.

And yes...we do suggest people tape the straps to their face often when they wake up in the morning and the mask is off and they don't ever remember taking it off. The idea is that hopefully the minor discomfort from the tape pulling on the cheek will cause them to wake up enough to stop the unwanted behavior of taking the mask off.

[sleepy-programmer]

When you have time please clarify exactly what you mean by your sinus issues.
Also exactly what you tried in terms of humidity and temperature and how long with each trial.

And yes...we do suggest people tape the straps to their face often when they wake up in the morning and the mask is off and they don't ever remember taking it off. The idea is that hopefully the minor discomfort from the tape pulling on the cheek will cause them to wake up enough to stop the unwanted behavior of taking the mask off.

I have woken up a few times barely able to breathe out of my nose. Taking the mask off resolves this. The stuffiness has no nasal mucus or nasal drip, feels more like dried out sinuses and swollen turbinates. I suspected low humidity at first, had troubles with rainout, resolved with a humidifier in my room. I'm not 100% sure about the sinuses the past couple weeks because I haven't woken up when I take my mask off.

Mind if I just post trial data here for awhile? Will stick with one pressure, 6 I guess is fine. Here's the past three nights:
- Feb 10. Humidity: auto. Heat: auto. CPAP 5.0. Hours of sleep w/ mask: 4hr interrupted. 2 hours on, 1 off, 2 on again.
- Feb 11. Humidity: auto. Heat: auto. APAP 4-8.0. Hours of sleep w/ mask: 1hr 26min.
- Feb 12. Swamp mode. Humidity: 8/8. Heat: 80. APAP 4-8.0. Hours of sleep w/ mask: 1hr 33min.

[Pugsy]

Yes...keep things in this thread. Will be easier to follow when not having to bounce around in multiple threads.

Hose temp...comfort and rain out prevention.

Need more than an hour or 2 to really know what your nose needs...
humidity of 8...that's pretty high though especially compared to auto which is roughly equal to a 4 maybe 5.

My suggestion....try 6 humidity and whatever hose temp feels okay and if you get some condensation then increase the hose air temp.
A lot will depend on just how cool your bedroom ambient temp is.
And let's hope you can get more than an hour so we can best judge what the nasal mucosa wants or needs.

I use 6 humidity and 86 for hose air temp but I keep my house temp on the cold side at night...like 60 degrees or so at night.
In the summer I can use the 6 setting and turn the hose air temp way down because the house is a lot warmer.

Also watch the water level...is it going down much?
But we need more than an hour or so to be able to tell much about your humidity needs.

[sleepy-programmer]

Lost about 1/4th the tank last night maybe less. Hose had condensation not surprising I went swamp-level max humidity.

I also like it colder in my room. I’ll try humidity 6 and a higher temp tonight.

[Jay Aitchsee]

Some people, counter-intuitively, find the added humidity from the machine causes nasal congestion. Some people use no humidity, I.e., no water in the tank, no heat. Many people, including myself, use "pass over" humidity, that is, water in the tank, but no heat.

Just sayin'...Something else to think about.

[babybear]

Hello

May I suggest the EnduriMed pillow. Its sold on Amazon for $60.00. The reason you might like it is because it has large cutouts on each side, bigger than any other cpap pillow I have seen. I actually sleep with my face in the cutout instead of placing my face on the edge of the pillow and have my mask hanging off the edge. I do it because I have discovered it reduces my face from being mashed in my pillow, and best of all, it helps lower my AHI for some reason. I have tried both ways such as using the pillow as it was intended however, sleeping in the cutout really does lower my events. I believe It would help reduce pressure on your jaw when sleeping on your sides as I have TMJ and my jaw does not hurt in the morning. As for the surgeries some of them sound beneficial however I have heard from many sources including my ENT doctor that the Uvuloplasty has a low success rate and could cause choking with food and feeling like you have something caught in you're throat as well as compromising the immune system. A dentist suggested the Uvuloplasty because of a extra long uvula but after hearing so many negative stories and the ETN advice I decided against it as once its done, there's no turning back. I did have my septum fixed and that did help. I wish you luck

[babybear]

I forgot to mention nasal pillows might work better than FFM because the FFM could press against your jaw. Something to consider

[Pugsy]

The reason I didn't mention the less humidity option was because the OP was talking more about everything feeling dry and uncomfortable.
He didn't really complain about the usual allergy like symptoms which is what people have when the humidity is too high but I was going to mention it.... if once he could use the machine more than an hour and was still having problems then talk about it.

The stuffiness has no nasal mucus or nasal drip, feels more like dried out sinuses and swollen turbinates

At this point simply not enough time using the machine to be able to tell which way to go with humidity.

[palerider]

Some people, counter-intuitively, find the added humidity from the machine causes nasal congestion. Some people use no humidity, I.e., no water in the tank, no heat. Many people, including myself, use "pass over" humidity, that is, water in the tank, but no heat.

Just sayin'...Something else to think about.

I'm one of the "don't need any humidity"... normally... but then I know there's lots of people that like LOTS of humidity, so I just tell people "experiment and find out what works for you, from 'dry' to 'swamp'. (Pugsy's setting)

[SDBud]

Dentist recently says when I had braces, I had 4 molars removed, which shrank my jaw and gave my mouth no room for my tongue.

THAT is complete and total nonsense, you need a new dentist!!