CPAP not helping?

[PorcoRosso]

Does this help?



Thanks again

[Pugsy]

At 04:49:00 there was something that happened...minor flow reduction followed by a gulp of air. Recovery breath maybe which points to
being airway related and "real".
Hard to say for sure...then 2 minutes later the OA flag...which is probably a real asleep event.
It's kinda iffy but whenever flagged events are "iffy" I always treat them as real to be on the safe side. I would rather err on the side of caution. It's not always possible to know for sure if these flagged events are real asleep events or false positives.

The flagged stuff that comes after that probably "real" event....looks more like irregular arousal breathing to me than it does asleep breathing. So probably not as ugly as it looks but the fact that the potentially real event caused such an arousal (if that is all arousal related) points to some disturbed sleep.
I would increase the minimum just to hopefully prevent that first OA which lead to the ugliness of the irregular breathing which is likely a symptom of the arousal. Still unwanted.
And if by chance so of that stuff is real...more pressure should help with it as well.

In other words if this were my report....I would be thinking the first flagged OA was likely real and the subsequent stuff that was flagged would be suspect for being arousal related. False positives.
If that first flagged event was followed by sleep...I probably wouldn't worry about it.
BUT....it seems to have cause a substantial arousal from sleep and that is unwanted for sure and for that reason I would maybe try to kill it with more pressure if I saw this often.....doesn't matter to me if it is supine related or REM related....I would still try to kill it.
Then I would take that other cluster into consideration. I suspect it is real..

So I would try more minimum to break up the clusters and hopefully prevent future arousals.
The centrals...for sure arousal related which then of course means any OAs flagged at the same time of the centrals are going to be arousal related.

If by chance I am wrong in my assumptions...more pressure would still help those OAs that I thought weren't real.
I could be wrong...this sort of evaluation isn't really what this data was designed for so as best I can I am making educated guesses.
If I am wrong...more pressure won't hurt anything anyway so why not try it..

IMHO though....the bulk of that last cluster of flagged events was more arousal related than airway related and a symptom arising from a real OA event. This is how OSA messes with our sleep and we end up feeling like crap....we have a real apnea and it causes arousals and we have poor sleep quality as a result...and we feel like crap.

I would at least try more minimum to see if I could have less of whatever those clusters are pointing to...real or arousal. Extra caution just in case. Hurts nothing to try it. More minimum to help hold that airway open a little better and maybe not let that first OA that caused the arousal to happen in the first place.

[PorcoRosso]

Got a new mask (DreamWear Full Face Mask) and tried it on last night for the first time. Feels more comfortable than the Amara View I have, but hasn't had a noticeable impact on my sleep results.

Had an AHI of 5.80 last night despite a minimum pressure of 10 and 90% pressure of 14.5. I had a cluster of 15 apneas within 20 minutes between 7:00 am and 7:20 am, and woke up from it (found myself lying on my back). By now I've identified that I almost always wake up from these clusters and find myself lying on my back. The higher minimum pressure doesn't seem to mitigate these very well. Should I be thinking of other mitigation strategies at this point? I have an appointment with my sleep doctor next Tuesday and plan on showing these graphs to him.





Thanks, everyone.

[Miss Emerita]

I'm not sure you've really ruled out chin-tucking at this point, so I do think it'd be worth experimenting with a cervical collar, just to see if it makes any difference.

In any event, it seems you would benefit from trying to stay on your sides. People retrain themselves in all kinds of ways: wearing a tee-shirt with a pocket sewn onto the back containing a tennis ball; using strategically placed pillows, using a lightweight backpack with stuff in it. On Amazon, try searching "Preventing back sleeping," and you'll find several ready-made products that might help.

[zonker]

I'm not sure you've really ruled out chin-tucking at this point, so I do think it'd be worth experimenting with a cervical collar, just to see if it makes any difference.

In any event, it seems you would benefit from trying to stay on your sides. People retrain themselves in all kinds of ways: wearing a tee-shirt with a pocket sewn onto the back containing a tennis ball; using strategically placed pillows, using a lightweight backpack with stuff in it. On Amazon, try searching "Preventing back sleeping," and you'll find several ready-made products that might help.

just to tag along with this, jnk...has recommended an infant sized bicycle helmet.

[PorcoRosso]

Thanks for the tips. Just got something from Amazon to help with the positional therapy. I may try to wear my bike helmet on my back until then haha

[PorcoRosso]

Hi again everyone,

I've gotten AHIs of < 2 for the past 3 nights by keeping a plastic bottle under the back of my shirt (gotta improvise until I get the actual product I ordered from Amazon!). Strangely enough, though, last night I woke up with a bad headache in the middle of the night, which thankfully went away quickly. The headache was also gone in the morning. My AHI was a mere 1.32 according to OSCAR, so I was surprised by the headache. The only apnea cluster I had was a cluster of 5 events. This is a much smaller cluster than some of the ones I was getting before, so I'm wondering if it could really be the culprit behind the headache. Thoughts?

[Pugsy]

I seriously doubt the cluster caused the headache...

The more likely suspect would be the plastic bottle you used and may have lain on.
Most likely a muscle tension headache caused by sleeping in a weird position or pressure on shoulder or neck muscles getting in a bind.

Sometimes I wake up and my neck, head and shoulders are just about tied up in knots and that always gives me a headache...it usually fades fairly quickly.

I call them neck headaches because when I have one of those headaches I will also usually have some neck muscle or shoulder discomfort.
It's quite common for muscle tension or tightness in the cervical spine or shoulders to trigger a headache.

[zonker]

Hi again everyone,

I've gotten AHIs of < 2 for the past 3 nights by keeping a plastic bottle under the back of my shirt (gotta improvise until I get the actual product I ordered from Amazon!).

congrats-sparkle.gif

[happypappy]

I've read this thread with great interest, as we have some common issues.

1) Nasal congestion: This has been a lifelong problem for me, so I have to be methodical in my use of APAP to remain clear enough to breathe through my nose. In addition to a generic Flonase (fluticosone), I enthusiastically recommend a nasal spray called "Xlear". Xlear is a simple solution of xylotol, which is essentially grapefruit extract, and saline. It can be used as much as you like with no fear of dependency like Afrin, and has been very effective for me and others to whom I've suggested it. I spray two or three pumps into each nostril a few minutes before bed, and let it remain in there for a couple minutes without sniffing it back. After letting it work, I sniff it back vigorously, one nostril at a time (blocking the opposite nostril), and spit the result into the sink. Be ready at the sink! It will be surprisingly productive. The decongestant effect will continue for several hours, and again, you can use as much and as often as you like. The one drawback is that it can sting when first applied, quite a lot if your nasal tissues are inflamed, but this diminishes after a minute or so. It's not easy to find, but Amazon has it for about $14 for the larger size.

2) Moisture: I think we all crave a fair bit of moisture, but I have found that too much, and too warm, can contribute to congestion. A coolish wet mixture works best for me. In winter time I set 4 moisture and 0 hose heat. In warmer weather I set moisture to 3, mainly so it doesn't get too warm. I wish it were capable of a cooler, wetter mixture, but physics intervenes. I have no use for the heated hose at all. I've never had a rainout episode.

3) APAP pressure settings: I've found that in order to get the best AHI (I'm averaging about 2.5), I have to set the minimum pressure just below the 95% average. My 95% average pressure is 9.5 or 10, so I've set the minimum to 9. If I lower that minimum to say 7, my AHI will inevitably increase to around 5. I also use the lowest setting of the Flex feature.

FWIW, I use the Dreamwear nasal cushion with the Dreamstation APAP machine.

It looks like you're making good progress, well done.

[PorcoRosso]

Thanks for your suggestions, @happypappy. I will definitely be looking into Xlear. Could you also tell me what kind of nasal congestion you have? Mine seems to be purely inflammatory, so there is nothing to "flush out" per se. I've tried saline solutions, Flonase, Nasacort, Azelastine, Montelukast, and Afrin. I was recently prescribed Atrovent by my allergy doctor, which I just started using the other night.

I've managed to stay consistently below an AHI of 2 for the past week after implementing the suggestions from people on this thread. Here's last night:



Also just spoke with my sleep doctor a few days ago, and had an interesting conversation. He discouraged me from tweaking my minimum pressure, which is currently set to 8 (I brought it down from 10 because I was getting aerophagia at that setting). I tried to make the case that I've been getting longer nights and lower AHI with the new minimum pressure of 8, but he insisted that he doesn't see the need for a higher pressure (I started at 5). I pointed out that I was getting worse clusters of apneas at lower pressure, but his point was that I had to keep using CPAP for a while before its cumulative effects kicked in to prevent those clusters, and that simply raising the minimum pressure wasn't necessarily the best solution.

I'm feeling very comfortable at my current settings and am not super keen on changing them again, but was wondering what the thoughts of people in here are.

[Miss Emerita]

Your doctor sounds misinformed. Time could help if you were primarily having treatment-emergent central apneas, but that does not appear to be an issue for you, or if it ever was, it has now resolved. Time would not help in reducing obstructive events. In your place, I would continue using the settings that are giving excellent therapeutic results and avoiding problems like aerophagia.

Congratulations on your impressive improvement!

[happypappy]

I will definitely be looking into Xlear. Could you also tell me what kind of nasal congestion you have? Mine seems to be purely inflammatory, so there is nothing to "flush out" per se.

My congestion is often composed of both inflamation, and "stuff". I'd say that Xlear helps with both conditions. I've used it when I was already pretty clear of congestion and it made my sinuses even freer. It's a pretty benign substance according to its manufacturer, so may be worth a shot.

[PorcoRosso]

Hi everyone,

A quick update/question since my last post. I bought a shirt with a zippered back pocket/sleeve from Amazon about a month and a half, and have been wearing it to bed every night since with a plastic water bottle inside the sleeve (I've found this better than a tennis ball). My average AHI has dropped from 5 to 1 with this, and I feel so much more refreshed in the morning.

One small issue that I'm still trying to solve is the fact that I will occasionally wake up to switch sides (from sleeping on my left side to sleeping on my right side, or vice versa) and experience a light headache. As I make the effort to switch sides, I almost always experience a light headache that goes away within less than a minute. I also experience the same headache sometimes upon waking up in the morning. My own personal hypothesis is that this is a tension headache, as my jaw muscles feel a bit "tired" when I wake up (I suspect I'm keeping my jaw muscles too tense while sleeping). This doesn't feel at all like the headaches I used to get during the entire morning or course of the day due to poor sleep the night before, and I get these light headaches even when my AHI is below 1.

Has anyone experienced this? If my hypothesis of these being tension headaches caused by tense jaw muscles is true, what kind of options do I have to help mitigate the problem?

Thanks, and I hope everyone here is doing well!

[Miss Emerita]

It's great to hear you're doing so well! Have you experimented yet to see what happens if you don't wear your water bottle contraption? I wonder whether at some point your body will have retrained itself to the point where it doesn't need assistance. About the jaw hypothesis: you might try a soft cervical collar or an Eliminator collar to see whether the support the collar gives to your jaw reduces your tendency to clench. If you try either of those, I'd be curious to know the results.