New Member needs help for improvement

[CPAPJonathan]

Happy Valentine to all,

I was diagnosed with mild OSA and has been using CPAP for 2 years, however my sleep apnea symptom have not improved yet.
I was always having trouble keeping the mask all night so my average usage is 5 hours and AHI is 4.
I have been trying to keep the mask longer and hopefully I will see the improvement, but I never know about adjusting the pressure until 2 weeks ago when I posted my condition at reddit to look for recommendation. Then one member recommended me to check the pressure range and introduce me this forum. I am so fortunate to find you all to share experience and recommendation.
I learnt how to check the pressure range and found out that it was 4cmH2O - 20cmH2O. I read one of the thread and attempt to change the Min to 8 and 9, then my AHI lower significantly. I can keep the mask all night and sleep deeper. My symptom has improved a little. I think it will take me at least to few month to get back all the sleep that I lost.
I attached my daily view for the last couple of days. Would you mind take a look at it to see if I need to make any changes to optimize my cpap treatment.

I wish I found this forum 2 years ago, my treatment has been much better.
My life has been horrible for the last couple of years. I am always tired, low performance at work, anxiety, etc.

Thank you in advance.

[Pugsy]

Welcome to the forum.

We don't really need the snore, AHI or time at pressure graphs. Snores are seen on the Events graph and we can eyeball the AHI and time at pressure data easily and don't really need those graph.
So omit them and make the other more useful graphs larger.
Events
Flow rate
Pressure
Leak

No need to redo all of them but would you mind doing the report from last night the 13th? It's the worst and even then it isn't horrible.
The CA/Central apneas seem to make up not quite half your AHI last night....we just ignore the centrals unless you are having much more of them than we see here. More pressure won't fix them.
I don't think that you really need to do any more adjustments at this time since you are finally sleeping better and feeling better.
Once I see last night's report with those tiny graphs enlarged a bit I will have a little clearer idea.

[CPAPJonathan]

Hi Pugsy,

Thank you so much for your insight. I uploaded the graphs from last night.
The Flow Rate chart, some days I see it, some days I don't. I am not sure what the cause is.

[Pugsy]

You probably didn't have the SD card inserted in the cpap machine on the nights where there is no flow rate graph.
You don't get a flow rate graph without the SD card being in the machine when it is in use because the machine writes the flow rate graph directly to the SD card and doesn't store it in its internal memory. It's a really big file and the machine just doesn't store it like it does the other data.

Why the wake up in the middle of the night?
Did you have other wake ups but you didn't turn the machine off?
Is it common to have the wake ups and/or turn the machine off?
Approx how many times do you wake up during the night?
This night shows a little over 8 hours of use....were you asleep for the bulk of those hours or awake for a lot of the night?
Are you averaging 7 to 8 hours of sleep using the machine now or was this night a fluke longer night?


Have things improved with the change in minimum to 9 cm or are you still have some unwanted symptoms that you would like to see gone?
When did you make the change to 9 cm?
If so, exactly what symptoms?
If so, do you take any medications of any kind and if you do...what are they?

[Miss Emerita]

Happy Valentine's Day to you too, Jonathan. I'm glad you found your way here. You are in the best of hands with Pugsy. And you're on a forum with a lot of people rooting for you to see major improvement.

You are right, it can take a while to pay back the "sleep deficit." And although this may sound odd, I think sometimes when we sleep badly for a long time, bad sleep sets in as a kind of new normal, so that we get accustomed to tossing and turning, waking up and drifting down, never really relaxing and letting go. (I have chronic pain during the second half of the night most of the time, and on the rare nights when it leaves me alone, I still wake up over and over to see whether it has set in. Grrr.) So it may take a little while for your mind and body to realize there's no need to keep fussing.

Looking forward to hearing more from you about how it is going.

[CPAPJonathan]

Thank you Pugsy and Emerita for you reply.
Haha I never think about the SD card. I have the SD card out most of the time and only insert to the cpap to export the data.
That night was a bad sample because I had a stomach pain so I was up for about 30 mins and the machine was off.
On average, I think I wake up about 3 times and the cpap still on.
I think my wake up time is about 30 mins every night, usually at the end of the sleep (6am or 7am). I usually wake up around 8h30
My average sleep now is 7-8 hours
I have changed to 9 about 1 week and my symptoms has slightly improved since then (fatigue, headache and brain fog, dizziness).
Also, my red blood cell is higher than the range limit and my doctor said SA caused it. Since my SA is now treated probably I will do the blood test in 3 months to see if the RBC decreases.
Like Emerita mentioned, I think my brain needs some time to get used to a good sleep.
Currently, I take the medication for my cholesterol, fish oil and vitamin D3 to improve sleep quality.

[Pugsy]

Leave the SD card in the cpap if you want flow rate graphs. The machine has only so much internal storage though and when it gets full it starts overwriting stuff internally and if you go a long time between downloads you might lose more than just flow rate.

Most people notice changes gradually in terms of how they sleep and feel. I know we all read about the one night miracles but those are actually rare. Our bodies simply need time to heal and get used to this new way of sleeping. In time the brain comes to view the alien on the face as its new best friend but at first the brain just doesn't know quite what to do about it.
Frequent wake ups even from just the brain saying "hey, dude, do you know there is this weird thing on your face blowing air up your nose"...mess with the normal sleep cycles that we need to get optimal benefits from the restorative powers of sleep.
We need the nice normal progression of the stages and in the nice normal percentages to even stand a chance of feeling better.

If the stomach pain persists...it might be aerophagia and there are things that can be done to reduce that problem.
We don't want belly pain from cpap messing with sleep or how we feel the next day.

[CPAPJonathan]

Wow, I did not know about aerophagia. I got the stomach pain last night at almost the same time and I was up for 30 mins.
Should I make any changes?
Also one more question. I have tried to sleep on the sides but my lower nose got blocked completely. If I turn to the other side, the congestion move to the other nose immediately. So sleeping on my back is the best balance, but it is not ideal for SA. Do know if there is anything I could do to improve this as well.

Thank you so much for you reply on the weekend.

[Pugsy]

Might read this
wiki/index.php/Aerophagia

First thing we usually do is add in more exhale relief but it appears your Flex setting is already set to the max of 2 cm relief during exhale.

Your pressure is hitting only around 11 cm at the max and even that is very short lived.
We don't know if it is the constant minimum of 9 that is the primary culprit in feeding the aerophagia monster but it would be my first suspect since your range is actually quite small.
A reduction in the minimum might help but in doing that it might allow some apnea events to sneak past the defenses.
But sometimes we just have to make a decision as to which is worse....a few more apnea events happening and being able to sleep all night without belly pain... or keeping the apnea events low but having the belly pain and the issues with sleep disruption.
Sometimes we have to make compromises.

Your nasal issues sound like normal nasal cycle issues.

https://en.wikipedia.org/wiki/Nasal_cycle

Caught between a rock and hard place....side sleeping causes congestion which disrupts sleep but it might help ward off the aerophagia monster....or sleeping on your back which keeps the nose open but invites the aerophagia monster in.

I don't know if more humidity will help or not but it might be worth trying it to see if congestion lessens.

I think what I might try is taking the higher pressures out of the equation so that I could figure out if it is the 9 cm that is the problem or the higher pressures...in terms of the aerophagia.
Still use auto mode but set the minimum to 9 cm and the max to 9 cm and see what happens both in terms of AHI and belly issues.
If it is really bad...might end up needing a different machine but there are some things you can try doing before worrying about doing that.

[CPAPJonathan]

I think what I might try is taking the higher pressures out of the equation so that I could figure out if it is the 9 cm that is the problem or the higher pressures...in terms of the aerophagia.
Still use auto mode but set the minimum to 9 cm and the max to 9 cm and see what happens both in terms of AHI and belly issues.
If it is really bad...might end up needing a different machine but there are some things you can try doing before worrying about doing that.

Hi Pugsy,

I have tried the fixed pressure at 9 for a few nights. The first night I took off the mask without knowing it, I felt like I need more pressure.
Then, I replaced for air filter and was able to keep the mask on all night, however, I woke up more and does not sleep well.
Would you please check my graphs to see if it indicates anything?

Thank you

[Pugsy]

Please review this thread for graph formatting examples. You've included some that aren't needed which made the graphs needed way too tiny.
viewtopic/t158560/How-to-post-images-for-review.html

I am not sure what to make of the VS2 snores.
Scroll back up to the top and read what RobySue has written
viewtopic.php?f=1&t=155478&p=1182872#p1182872
The machine doesn't respond to VS2 snores.

How do you route your hose? Does it touch anything that might create some noise if it rubs against it...wood, metal, etc?

If the VS2 snores are real and indications of the airway trying to collapse then more minimum pressure should reduce them. They do seem to be lessened with the change in minimum to 9 cm from 8 but that also could just be a normal nightly variance as well.

You didn't mention if you had aerophagia or not with the 9 cm fixed all night.......That was the primary goal of this experiment.
Find a line in the sand where you had no aerophagia issues at one pressure and work up to figure out what pressure triggers the aerophagia issues.

[CPAPJonathan]

My bad, I fixed the graphs and attached them again.
I route my hose between my night stand and bed head. I will remove it to see if it clears the VS2 snores.
My aerophagia improved significantly with fixed pressure at 9. I only has a mild stomach pain in the early morning.

[Pugsy]

You might try minimum and max to equal 9.5 cm and see how you do.

[palerider]

My bad, I fixed the graphs and attached them again.

They're still messed up.

[CPAPJonathan]

Good morning everyone,

My aerophagia competently went away so I have been staying with min 9.5 and max 20 for about 2 weeks.
However my AHI was not so great, it has been fluctuated between 2 and 3.
Would you mind take a look at my charts of the last 2 nights to see if I should make any adjustment.
Some days I feel more refresh than the others. I think when my AHI hits 3 my fatigue get worse.

Thank you so much in advance