Upalot,
I posted this in the other thread as well. Not sure which one you plan on reading so I decided to repeat my long response here as well.
Your leaks need to be worked on. On the graph that Kaisgram posted, she highlighted the "Large Leak"; my eyes say that your leaks are above that line for significant periods of time. It looks like there are three very significant periods of long, large leaks, each of which is between 45 and 120 minutes long. My eyes say that there's about 3 1/2 to 4 hours of very large leaks. My guess is that you see a lot of Mr. Red Frowny on the Sleep Quality Report on the S9's LCD each morning.
The data that you posted in the last post indicates that the S9 scored a significant number of unspecified apneas; these are scored when the machine cannot tell whether the apnea is an OA or a CA and the most common reason why the machine can't tell is that the leaks are too large.
Another thing that I notice is that during the periods of large leaks, the machine is not responding to apneas, most likely because many of them are scored as "unknown apneas." But it could also be that the machine is trying to NOT cause the leaking to get even worse.
So if this leak data is typical, it could be that your AHI is still too high because of one or both of the following:
1) Loss of therapeutic pressure when the leaks are (well) above 24 L/min. If the machine is having trouble maintaining pressure, you don't get the full benefit and your airway is more prone to collapse.
2) Your machine is having trouble responding appropriately to your events. Two things can contribute to this. First, the large leaks lead to many of the apneas being classified as "unknown" rather than OA, and the machine does not respond to "unknown" apneas. Second, the minimum pressure setting might not be quite high enough. Compounding the min pressure problem is that the machine is reluctant to increase the pressure further once the apneas start during the large leak periods.
Working on the leaks may go a long way towards fixing the AHI problem.
Upalot wrote:I should have listed my stuff. My CPAP is a Resmed R9 which is an auto usually leave it in auto but I think the surge of air wakes me sometimes. In fact probably more than sometimes. My humidifier is the Hfi, my mask is the Mirage Quattro.
Judging from your data, I suspect that the "surges of air" that wake you are very large leaks and NOT pressure increases.
So if you can get the leaks under control, then you might just wake up a lot less frequently.
my mask is the Mirage Quattro. It’s a full face mask. I am typically a mouth breather, Always have been.
Do you mouth breathe in the daytime?
If you are indeed a dedicated mouth breather, then I can understand why you are using a FFM. But you still are experiencing some excessively large leaks that are affecting the efficacy of your therapy. I would suggest that you do one or more of the following:
A) Review the fitting guides for the Quattro carefully. Also review JanKnitz's
Taming the Mirage Quattro fitting tips very carefully. It's a common error to over tighten the headgear and straps in an effort to keep this mask from leaking. But that prevents the mask's air cushion from fulling inflating, which in turn makes it more likely to start leaking once the machine starts to increase pressure.
B) Fit the mask at your full pressure and NOT the beginning ramp pressure. Masks are harder to seal at higher pressures, and since you need some pretty significant pressure at times, you need to fit the mask at those higher pressures.
C) Consider using mask liners, a chinstrap, or an anti-leak strap. The large leaks might be triggered by changes in your facial features once you are lying down and asleep. These may help the mask maintain its seal when those facial changes occur.
D) Consider an alternate size mask cushion and/or an alternate full face mask. If the Mirage Quattro is the only mask you've ever tried, it may be time to try another mask.
I used to get up about 2-3 or 3-4 times. But now it’s more like 6-8.
Fragmented sleep is adding to your problems. Of course you don't need to be told that. Question is: How to fix the fragmented sleep. And how to do that depends on what's triggering the wakes. Since you think that surges of air are a factor, there's some reason to be optimistic that if you can get the leaks better under control, that the number of wakes will start to drop.
I am overweight and I smoke. I am trying to quit smoking. I know it will kill me. It’s been very hard, right now I am trying a vapor pin, and it gives you nicotine but not the problems from the smoke. I am hoping to stop my smoking all together using it. I admit the smoking has been the most addictive thing I have ever done. It’s horrible;
Having lost my mother, my brother, and two uncles to smoking related lung cancer, I do wish you the best of luck in kicking the smoking habit. It is indeed insidiously additive and very, very hard for most to quit. However once you are finally off the smokes that too may help you sleep better.
I own a business and have a lot of stress so that does not help my sleep either. It has progressively gotten worse over the past few years.
Stress does aggravate sleep problems. And the combination of having never really gotten your PAP therapy truly optimized and work related stress easily explains why you're not feeling any better.
Everyone else talks about the benefit of CPAP treatment. I cannot really comment on it, it has never really made me feel better. Just different levels of shitty.
You've never really gotten the CPAP therapy genuinely optimized since you say your long term AHI is still about 10 on CPAP. And your leaks are significant. So the CPAP isn't doing its job as well as it should be (probably because of the leaks) AND the leaks are most likely waking you up.
So again, it comes back to
Fix the leaks FIRST and see how much that does to address the AHI problem and the too many wakes during the night problem.
I would greatly appreciate any help I can get. If my AHI gets better will I wake up feeling rested? Do all you folks feel good in the morning? I never do, and half the time right now I sleep some crazy hours, way too long. I think I am starting to become depressed with all this and that is affecting me also. It’s been terribly stressful just trying to get some rest at night. I always wake up tired and do not feel like I have much energy. I hate it. To make matters much worse I am a type a guy and all this has really affected me from a mental health standpoint.
It's hard to tell exactly how much better you will feel if the AHI gets better. Once the AHI is consistently below 5, some people start feeling better almost immediately. Others? It takes time before they notice much of a difference. It all depends on how much else is affecting the person's sleep AND how many other health problems the person is dealing with.
Think of it this way:
Good sleep is
necessary for feeling good in the day time with enough energy to do what you want to get done every day. But good sleep by itself may not be
sufficient to guarantee that you'll feel good during the day with enough energy to do what you want to get done every day. Other health conditions and STRESS can wipe you out even if you get good sleep night after night. So you'll need to deal with anything else that is causing daytime fatigue as well.
And optimal CPAP therapy is
necessary for good sleep since you have severe sleep apnea. Once your CPAP therapy is truly optimized (the leaks are under control and the AHI is consistently less than 5), then your sleep will no longer be constantly interrupted by too many apneas and too many Large Leaks. But optimal CPAP therapy by itself may not be
sufficient to guarantee that your sleep will be good. If you continue to have problems with fragmented sleep once the leaks and AHI are under control, your sleep may still feel bad and fixing that bad sleep will require more than just fixing the CPAP therapy.
So getting your CPAP therapy optimized is
necessary if you want to have a chance of fixing the sleep problems and feeling better in the daytime. And getting your CPAP therapy optimized means fixing the leaks and getting the AHI down to where it needs to be.
Now to focus on just a couple of other things more carefully:
and half the time right now I sleep some crazy hours, way too long. I think I am starting to become depressed with all this and that is affecting me also. It’s been terribly stressful just trying to get some rest at night.
Sleeping crazy hours suggests that you may have some additional sleep issues beyond the inadequately treated OSA.
How would you describe your sleep hygiene? Cleaning up the sleep hygiene may help the sleeping crazy hours problem. And a more normal sleep schedule may be critical in making you feel more rested in the morning after you do get the CPAP therapy optimized.
And stressing out about sleep often adds significantly to the problems of both getting to sleep and staying asleep. Which in the long run makes you feel worse not better. But it's hard not to "worry" when it seems as if everything is going to hell in a handbasket when you're lying in bed trying desperately trying to get to sleep.
So you may need to work on trying to destress about the sleep. (And I say that as someone who has had to spend a large part of the last 3 years learning how to NOT stress out about my own sleep.) It helps to have a nice relaxing bedtime routine. And it's critical to learn how to draw some closure to the day.
To make matters much worse I am a type a guy and all this has really affected me from a mental health standpoint.
Sounds like the combination of bad sleep and stressing about the bad sleep and the Type A personality are all causing a lot of additional stress in your daily life and that it's really taking a toll on you.
What kind of things do you do when you want to relax? You need to take some time each day for conscious relaxation and destressing. You also need to work on making bedtime as unstressful as possible. If you don't have a relaxing bedtime that allows you to put the day behind you AND does not cause you to start focusing on your sleep problems. (And yes, I know that's hard too.)
Best of luck
