Struggling to maximize CPAP therapy

[speedstream5621]

About me:

• 32 years old, male, fit, and healthy (no medications/supplements).

• Falls asleep right away, but wakes up multiple times throughout the night. Awake enough to check my phone.

• CPAP has definitely helped (started March 3, 2020), but not solved this problem.

• Primarily a back sleeper. My body won't stay on its side for long.

• Gets dry mouth with N30i and P30i with minimum pressure set to 8. Used tape to confirm this and don't want to use it as part of my therapy.

• Current pressure settings: 9-15.

• Lowering the Flex setting from 2 to 1 had no effect.

• Now using DreamWear FFM.

I have found the FFM pretty annoying to use, but I do believe it provides better sleep than both the N30i and P30i. The AHI data might tell a different story, but that's how I feel after waking up. I wake up with virtually no sinus congestion with the FFM. The first two nights with the P30i yielded an unforgettable amount of congestion and headache. I stopped using it after one week because I was still getting dry mouth like I did with the N30i.

I've updated this post to include 2 screenshots with the FFM and one screenshot with the N30i. Where would you guys go from here?

[Pugsy]

Welcome to the forum.

Try a minimum of 9 cm for a week....then try a minimum of 10 cm for a week.
See if your reports clean up a little and/or you start feeling any better.

Do you take any medications of any kind? If so, what?
Exactly what kind of symptoms are you having that you wish you didn't have that point to "unrefreshed sleep"?
Do you find that you wake often during the night? If so, why and how much?

[Julie]

Are you sleeping on your back most of the night?

[Goofproof]

Refreshed would be nice, but I'll settle for being alive anytime, which I wouldn't be with my XPAP. 16 years still ticking, keep working on your AHI. under 2 is what I consider as high as I will settle for, often 1 happens. Best of Luck. Jim

[speedstream5621]

I updated my orignal post based on your questions.

No medications/supplements, back sleeper, and waking up tired after 7+ hours in bed. It feels like fragmented sleep. Everyone I know using a CPAP is lights out and doesn't wake up until it is time to get out of bed.

[Pugsy]

It's normal to wake up after each REM sleep cycle. We just don't normally remember the wake up. So when some people say lights out and off to sleep and no wake ups until the next morning.....they actually probably has a few but don't remember them.
Obviously if we remember the wake up it's not good because that means we were awake long enough to formulate a memory.

We can also have arousals or awakenings and not remember them but they also mess with our normal sleep cycles. Lots of things can mess with our sleep quality and cause arousals. I always remember at least a dozen wake ups and from the looks of the flow rate have another dozen that I don't remember. I wake up tossing and turning secondary to pain though.

While your AHI is technically below 5....that's no guarantee of feeling any better or sleeping any better. Plus you are having quite a bit of other obstructive related stuff happening (snores, FLs) that could also potentially be causing arousals.
Let's try reducing the AHI more and also clean up that other obstructive stuff and see if you can maybe sleep and feel better.
More minimum pressure is needed though. The machine itself isn't increasing the pressure all that much for some reason or other so lets just help it out and start with a higher minimum and see what happens.

[zonker]

Everyone I know using a CPAP is lights out and doesn't wake up until it is time to get out of bed.

welcome to the zoo! allow me to introduce myself. i'm zonker. how do you do?

you now know someone using cpap(for five years) who wakes up multiple times during the night.

just so you know.


btw, listen closely to pugsy. she is one of the most knowledgeable folks on the forum.

good luck!

[Julie]

Back sleeping does encourage many more events, but while some people can manage to not do it in various ways, unless e.g. Pugsy reads your charts and says it matters - apparently it may not if other things are done properly - then you may not have to worry about it... but if you can, try some tricks to keep it from happening once asleep.

[speedstream5621]

Much has happened in the past five weeks:

1) Increased minimum pressure to 9, but soon discovered I started mouth breathing/lip fluttering at 8. I assumed the occasional dry mouth was due to lack of humidity, but increasing it had zero effect. Tape definitely helped minimize that issue, but I won't be using it as part of my normal routine.

2) I now have a DreamWear full face mask with two nights of data included below. I would say overall sleep quality has improved slightly, but I really do hate having my mouth covered. It provides a better seal when seated properly, but it seems like I have to make at least one major middle-of-the-night adjustment requiring my full attention each night - very disrupting!

I am reluctant to try a different FFM because I believe they all have the tube connecting at the mouth instead of at the top of the head. Part of me wants to try nasal pillows (P30i) to get a better seal than I was getting with just the cushion (N30i), but is that a waste of time knowing that my lips flutter? I don't think the chin strap is an option - I couldn't bring myself to try even one night with the N30i. Way too hot and uncomfortable and didn't seem like it would address lip fluttering anyway.

What would you try next?

[Julie]

A reminder that chin straps don't keep your lips closed... though tape does.

And back sleeping is probably responsible for all that snoring, so while it might not be a major factor in AHI, if you can find ways to not do it when sleeping (many have) I would want to pursue that.

[Time will tell]

Hi,

Been on cpap 2 1/2 weeks, it is a challenge. A mask change has helped, as well as changing humidity etc, but the problem I already had with falling asleep and waking frequently got worse. After trying a new mask and different settings, internet searching gave me a helpful answer. My machine is on a wireless network to send data to my healthcare provider. That and my phone sat close to my head. I cover both with foil at night and now fall asleep in short order, and on the few good nights so far I seldom woke up. For me this has helped. It isn’t mind over matter as I’ve tried many things over a long time, before cpap. Apparently back then my phone was enough, my sleep did get worse when I upgraded from a five year old phone early last year. Adding the cpap machine increased the problem. If you are sensitive like I am, any electronics nearby can affect your sleep. It’s an easy thing to try, you just need foil.

[speedstream5621]

Funny you should mention the cell phone. I've been looking at a PEMF device to assist with some periodontal treatments. One of them is called EarthPulse and uniquely marketed towards improving sleep (thought they all do the same thing at the cellular level): https://earthpulse.net/

I am definitely guilty of being on my cell phone before bed, but I've always thought it a non-issue because of how quickly I fall asleep. I'll try putting my phone on my dresser tonight and see if that changes anything. I do have an air filter with WIFI + cell phone + CPAP all in the same room.

[speedstream5621]

Eliminating the cell phone had no effect, but I've had success wiping the mask and especially around my upper lip/nose at some point during the night to remove excess moisture. I'm no longer waking up to sounds of leaks or air blowing where it shouldn't, and I've been able to increase the amount of side sleeping. AHIs have dropped, and I think sleep quality has improved.

Anyone tried Pad a Cheek as an alternative to the nightly wiping ritual? https://www.padacheek.com/product-page/ ... -full-face

Is there any reason not to bump the minimum pressure to 11? I'm not entirely sure what to make of my leak-rate data.

[Miss Emerita]

I can take a stab at one of your questions: there is no harm in raising your minimum to 11 to see what happens. You'd be looking for a downward trend in your OAs and Hs, with no upward trend in CAs, leaks, or air in your belly.

Reading through the thread, I have a couple of questions for you.

Why do you prefer the long-hose attachment on the top of your head? Is it to keep the hose out of the way? If so, have you ever tried a hose lift (hose stand)? You can use those with any mask that has a fairly flexible short hose.

And what exactly was unappealing about using tape on your mouth to control the flutter?

[speedstream5621]

I can take a stab at one of your questions: there is no harm in raising your minimum to 11 to see what happens. You'd be looking for a downward trend in your OAs and Hs, with no upward trend in CAs, leaks, or air in your belly.

Reading through the thread, I have a couple of questions for you.

Why do you prefer the long-hose attachment on the top of your head? Is it to keep the hose out of the way? If so, have you ever tried a hose lift (hose stand)? You can use those with any mask that has a fairly flexible short hose.

And what exactly was unappealing about using tape on your mouth to control the flutter?

I didn't know about the hose lift or F30i FFM when I made that comment, but I have an angled headboard that creates a perfect space for the hose just behind and below the top of the mattress. I can flop around all I want without issue.

I found the Micropore tape decently effective, but too annoying to remove in the morning. I had to wet it with water and then contend with sticky residue. I much prefer the FFM at this point: no congestion, no dry mouth, and a better seal while side sleeping.