CPAP results advice

scottjamesrichards · Post by **scottjamesrichards** » Thu Jun 18, 2020 6:45 am

Good afternoon,

I am new to this group, so first of all a big hello to everyone!

I have been reading many threads, and have taken on board so much advice from others, but i feel it is my time to ask for help before i yet again approach my sleep clinic for help!

I've had a failed turbinectomy, septoplasty and sinus surgery in 2017.

To cut a story short, i have now had an official diagnosis for OSA in december 2019.

Had an overnight polysomnography with MLST which showed;

31.6 AHI / hour
29 RERA events / hour
26 leg movements / hour
Sleep latency of 5 minutes 42 seconds

i do suffer with tourettes syndrome also, however after being with my partner for over 5 years she hasnt reported any form of night time twitches ever, and neither has any other partner i have had since i was 18, and i am 31 now. So having a leg movement score of 26 / hour is very puzzling.

I have been using a Dreamstation machine since october, with varying results, it has taken a fair while to get used to the machine, pressure adjustments, mask adjustments, and my AHI is under 4 per hour, however, this is my dilemma. I still feel like utter shit. I'm still napping during the day, feel unrefreshed almost every day. I have my good days, and my bad, however 5 out of 7 is bad.

I have included some screenshots of sleepyhead, which i find amazingly useful for information, i have not yet learned what off of it means, but i am getting there. I am hoping someone can shed some light of what the readings could suggest.

The hospital is rather baffled on why i am still feeling like garbage, and have raised the idea of another sleep study, but with a cpap machine to understand if anything else is happening which could explain how i am feeling!

If i have missed anything out, please let me know and i'll fill it in as soon as possible.

Many thanks in advance

Scott

scottjamesrichards · Post by **scottjamesrichards** » Thu Jun 18, 2020 7:46 am

I have now downloaded OSCAR which i believe may have some better charts for results.

So have uploaded the same dates as before just with OSCAR instead.

Many thanks

Scott

scottjamesrichards · Post by **scottjamesrichards** » Thu Jun 18, 2020 8:11 am

Also for clarification, my results have got better over time, with pressure increases, but still the results in how i'm feeling do not change.

This shot was from my first week , with a much lower pressure. And a much higher RDI.

Thanks

Julie · Post by **Julie** » Thu Jun 18, 2020 8:13 am

Could you explain, if possible, what the large gaps in some results (if not the latter 3) halfway through the night are - intentional mask removal for e.g. bathroom breaks? Unintentional mask removal? Something else?

And btw, Reras and limb movements are not normally related to Tourette's, so I wouldn't expect yours to be either - more incidental than anything if you have Tourette's (is it usual for it to be active when sleeping?).

There are others who are more knowledgable about Reras so hopefully they'll input here soon.

scottjamesrichards · Post by **scottjamesrichards** » Thu Jun 18, 2020 8:17 am

Hi, thanks for your reply, i didn't realise i had large gaps!

The only one i do is the first image after sleeping 5 hours in the afternoon also overnight too!

I switch on when i get into bed and turn off when i wake up. Anything that happens in the middle i cant help with, sorry!

The hospital was pointing towards the tourettes but i wasn't convinced based on what partners had said etc it's not usual for any night time activity at all!

Now that large gaps have been brought to my attention, i have scrolled through the last month of data on oscar and EVERY night has gaps in pressure at least 2 or 3 of them???

Thanks

Pugsy · Post by **Pugsy** » Thu Jun 18, 2020 8:28 am

Could you do me a favor please? Consolidate your graphs in the format here so that you have one image per night.
viewtopic/t158560/How-to-post-images-for-review.html

You are including graphs which really aren't needed and make evaluation more difficult.
No need to redo these but I mention it for further posting.

Do you take any medications of any kind? If so, what?

How is your sleep quality? Are you waking up very much during the night? Do much tossing and turning?

scottjamesrichards · Post by **scottjamesrichards** » Thu Jun 18, 2020 8:32 am

Hi,

Ok thanks i will in future!

No i've not taken medication since i was 17, it's quite mild so more than manageable by itself.

Quality is not great it takes me less than an hour after i have woken up to be tired again, constant yawning and fatigue.

Yes i toss and turn a lot, some nights i wake up once or twice and drop straight off, usually i'm out the whole night.

Thanks

Pugsy · Post by **Pugsy** » Thu Jun 18, 2020 9:06 am

Okay. Thanks for the additional information.
Your AHI part of the RDI isn't horrible but it does have room for improvement and the RERA flagging points to some possible airway issues (that haven't grown up to earn OA or hyponea flag) still so lets try increasing that minimum pressure to 13 from the current 12 for a few nights and see what happens.

scottjamesrichards · Post by **scottjamesrichards** » Thu Jun 18, 2020 9:11 am

That's not a problem at all,

I have permanent congestion now post surgery, hence the need for a full face mask, as using a nasal mask did almost nothing, breathing through my nose even in the day is a challenge!

I'm not a very good mouth breather at night, is there a way i can train myself to be?

I will change to 13 from tonight and go from there.

Thanks

Pugsy · Post by **Pugsy** » Thu Jun 18, 2020 9:45 am

I don't know of any way to train the body to do something that is more of an automatic reflex like breathing. In general the body wants to nose breathe because that's how we were made and the mouth breathing comes about more out of a physical thing...need to because the nose breathing doesn't move enough air or maybe the mouth just falls open due to gravity or something.

When I don't or can't breathe through my nose I sleep horribly. Wouldn't matter if I had a full face mask or not. I simply wouldn't sleep well and when we don't sleep so great we don't feel so great during the day. You remember tossing and turning a lot and I am betting you have more awakenings or arousals and simply don't remember them. Overall sleep quality probably less than optimal. Now as to what is causing it...that's the million dollar question. Not all bad sleep is related to sleep apnea but cpap can only fix sleep apnea related bad sleep.

Some of what we are seeing on your software reports could be nasal related. More pressure is unlikely to help nasal issues but it's worth trying more pressure since we don't know for sure why your sleep is less than optimal.

The RERA flags...could be secondary from the nasal surgery thing...when was the surgery? You may have mentioned it above but I forget and no time to go look for it.

When you have time go here and watch the videos so you can learn to zoom in on the flow rate and evaluate your breathing so you can identify awake/arousal breathing from asleep breathing. I have a feeling you are going to need to learn the difference.
Remember your machine doesn't have any way to know if you are awake or asleep. It only measures air flow and sometimes awake/arousal breathing fools the machine into thinking it needs to flag something. If you aren't asleep...it isn't sleep apnea related.
http://freecpapadvice.com/sleepyhead-free-software

I have crappy sleep quality issues from other health issues. I sometimes go look for arousals since I know I do a lot of tossing and turning.
I might remember a half a dozen awakenings but when I go look at the flow rate I can usually spot at least 20 to 25 arousal related breathing segments. Means my sleep quality isn't optimal and when I see a lot of those I can usually tell I feel like crap during the day.
Good sleep quality can be really elusive and it isn't always something cpap can fix and a nice low AHI doesn't guarantee you will feel it.

But in your situation...let's at least try reducing the AHI and RDI and see if it helps or not. Worth trying.

Miss Emerita · Post by **Miss Emerita** » Thu Jun 18, 2020 9:54 am

Aside from the nap gap in that first chart, I'm not seeing any gaps. When the pressure stays down at 12, the pressure line blends into the bottom frame-line for the pressure graph.

khauser · Post by **khauser** » Thu Jun 18, 2020 9:57 am

I have no experience with what you are encountering, but I have two bits of information:

When I use a Nasal mask (NOT pillows), the pressure on the outside of my nose seems to compete with the pressure inside. This is just like having no xPAP, except for the lack of supportive pressure within the body. So if your nose tends to be clogged like that, nasal pillows might be the way to go ... they eliminate the external competition.
Towards that point I thought I'd suggest looking at hybrid masks (http://www.cpap.com/cpap-masks/hybrid-cpap-mask). You'll get the benefits of a full-face mask without the external pressure on your nostrils.

I have absolutely no idea if this will benefit you, just thought I'd offer my thoughts.

Pugsy · Post by **Pugsy** » Thu Jun 18, 2020 10:04 am

Miss Emerita wrote: ↑
Thu Jun 18, 2020 9:54 am
Aside from the nap gap in that first chart, I'm not seeing any gaps. When the pressure stays down at 12, the pressure line blends into the bottom frame-line for the pressure graph.

My thoughts also. The pressure line does bottom out and stay bottomed out with none of the usual pressure probes to show it is blowing air but the rest of the graphs show uninterrupted data so there's no real gap except for the one with the nap.
There is the appearance of a pressure line gap due to the pressure being stuck at 12 and no pressure probes to break the line but the pressure was still there and data is still there. People have to look at the other data points and not just the pressure line.

Now as to why the pressure line didn't move. I tend to agree with PR...we see pressure probes when things are going well and we don't when things aren't going so great but still maybe not bad enough to earn a flag of some sort.

scottjamesrichards · Post by **scottjamesrichards** » Thu Jun 18, 2020 11:00 am

Pugsy wrote: ↑
Thu Jun 18, 2020 9:45 am
I don't know of any way to train the body to do something that is more of an automatic reflex like breathing. In general the body wants to nose breathe because that's how we were made and the mouth breathing comes about more out of a physical thing...need to because the nose breathing doesn't move enough air or maybe the mouth just falls open due to gravity or something.

When I don't or can't breathe through my nose I sleep horribly. Wouldn't matter if I had a full face mask or not. I simply wouldn't sleep well and when we don't sleep so great we don't feel so great during the day. You remember tossing and turning a lot and I am betting you have more awakenings or arousals and simply don't remember them. Overall sleep quality probably less than optimal. Now as to what is causing it...that's the million dollar question. Not all bad sleep is related to sleep apnea but cpap can only fix sleep apnea related bad sleep.

Some of what we are seeing on your software reports could be nasal related. More pressure is unlikely to help nasal issues but it's worth trying more pressure since we don't know for sure why your sleep is less than optimal.

The RERA flags...could be secondary from the nasal surgery thing...when was the surgery? You may have mentioned it above but I forget and no time to go look for it.

When you have time go here and watch the videos so you can learn to zoom in on the flow rate and evaluate your breathing so you can identify awake/arousal breathing from asleep breathing. I have a feeling you are going to need to learn the difference.
Remember your machine doesn't have any way to know if you are awake or asleep. It only measures air flow and sometimes awake/arousal breathing fools the machine into thinking it needs to flag something. If you aren't asleep...it isn't sleep apnea related.
http://freecpapadvice.com/sleepyhead-free-software

I have crappy sleep quality issues from other health issues. I sometimes go look for arousals since I know I do a lot of tossing and turning.
I might remember a half a dozen awakenings but when I go look at the flow rate I can usually spot at least 20 to 25 arousal related breathing segments. Means my sleep quality isn't optimal and when I see a lot of those I can usually tell I feel like crap during the day.
Good sleep quality can be really elusive and it isn't always something cpap can fix and a nice low AHI doesn't guarantee you will feel it.

But in your situation...let's at least try reducing the AHI and RDI and see if it helps or not. Worth trying.

Surgery was 2017, build of crap, to ease congestion and open up my airways in my nose, it worked for a week and has come back worse. So that's a chronic rhinosinusitits diagnosis I forgot to mention!

I'll take a look at the videos tonight, thanks for your input

Pugsy · Post by **Pugsy** » Thu Jun 18, 2020 11:06 am

Ah, okay, thanks. I didn't know if it was recent and we were still in the healing process to consider. Obviously not related to tissues needing time to heal.

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