super7pilot wrote: ↑Tue Nov 26, 2024 11:12 am
Well, That was a regressive night. Went to bed with the nasal pillow P30i. Something I noticed that was strange. And this was the bouncing I could feel in the hollow mask frame.
Could it be that with EPR-3 (at the start of the night) that as I exhale then right after that exhale starts the machine then drops the pressure. Thus creating a rebound/bouncing? It was very disconcerting to say the least
That's exactly what it is: The hollow mask frame conducts the noise of the airflow directly into your inner ears, and the "bouncing" effect is indeed caused by the change in airflow (and hence noise) every time the machine changes the pressure. And with EPR=3, that 3cm change in pressure between inhalations and exhalations is being magnified by being conducted directly into your inner ears through the bones in your skull.
And yes, it can be very disconcerting.
The first part of the night I was doing ok. Then the nose started in at just past 2am, went away and returned at 3:45 At about 4:05 I had a bathroom break. That lasted until 4:15 when I took off the P30i and put on the F40i and went to 100% mouth breathing and EPR-2. That went for about 20 minutes when I (purposely) for the first time in DECADES. Turned onto my back. And it all went off the rails. Although my numbers were still not nutty high at AHI 5.68 for the night. Had it not been for the craziness at 4:40 to 5:08. My numbers would have been just slightly over my recent average.
Were you on your back in the snippet that you showed us:
The interesting (and frustrating) thing about this snippet of data is all the CAs mixed in with the handful of OAs. While backsleeping might make OSA worse, it's not supposed to trigger a boatload of CAs.
The 4cm increase in pressure between 4:50 and 5:00 is tied to the handful of OAs in that cluster of CAs. (It would be easier to interpret the pressure increases if you showed us the
Pressure graph instead of the
Mask pressure graph. The Mask pressure graph shows the individual pressure changes due to EPR being turned on and it makes it more difficult to see the pressure increases due to the Auto algorithm kicking in.)
But given the very ragged breathing in this whole snippet, one has to ask:
Where you ever asleep during this time frame? If you were asleep, what's triggering the CAs? And does the pressure increase aggravate the CAs? In other words, are the CAs scored after 4:50 being caused by pressure increase? Is there a chance that the OAs are mis-scored CAs? (This happens in my data when I am awake and hold my breath---almost always those "wake holding breaths" get scored as OAs instead of CAs for me.)
As for the leaks during this period: The vertical scale make these leaks appear a whole lot worse than they actually are: The highest the leaks get is about 12 L/min, and that's well under Resmed's definition of an official Large Leak, which is 24 L/min. In other words, those leaks are small enough for the machine to compensate for. The leak abruptly ends at 5:18. And by 5:22 it looks like you have gotten back into a decent quality sleep.
So this begs the questions: Given the overall pattern of breathing, were you
awake and
aware of and
being bothered by that persistent leak between 4:48 and 5:18? Or were you asleep and that persistent leak was disturbing your sleep and you finally woke up and fixed the leak around 5:18 and then fell back asleep?
Overall: If this kind of thing is a rare thing in your data, it's ok to write it off as a visit from Pugsy's aliens. Sometimes we just can't tease out from the data exactly what happened. And in this case, it doesn't much matter: Being sort of awake for a 30 minute period fighting leaks can leave you exhausted in the morning. So can a 30 minute period of actual sleep filled with a whole bunch of unexpected events. So which happened? No-one can really answer that question.
Very frustrating. But I'm quite sure the basis of my issues with not getting restful sleep is a combo of the nose congestion and perhaps an intolerance to the aggressive pressure changes being made. Esp on EPR. I'm not sure what to think now.
If nasal congestion is a problem, then you need to take care of it. In addition to using something like Flonase, it's also worth considering using a netipot or nasal rinse an hour or two before bed.
As for "an intolerance to the aggressive pressure changes being made. Esp on EPR", I wouldn't jump to that conclusion (yet) based on one snippet of data. Now if this kind of pattern recurs every time you see a 3 or 4 increase in pressure due to OAs or Hs (or flow limitations) being scored, then you've got a real problem. But if it occurs randomly on a few bad nights every now and then? It's a visit from Pugsy's aliens.
Notably, on this stretch you had EPR = 2. But you also seem to indicate that your breathing was better (in terms of no funky chain of events) when you had the P30i on with EPR = 3. So, I'm not inclined to blame those CAs in this snippet on EPR. When EPR triggers CAs, it tends to trigger more of them at EPR = 3 than EPR =2.
I really need to get into the ENT Dr. and have some sort of roto rooter on my nose to fix the deviation & congestion. Even though I don't like to, I may try a shot of afrin one night to see how that effects my restfulness.
Unless the deviation is particularly severe, it's probably not the source of the problem. Most people have mild deviations that never cause serious problems and don't need to be "fixed" through surgery.
As for the congestion: Any chance it's caused by allergies? If so, treating the nasal allergies through an antihistamine and flonase and nasal rinses is the long term solution.
If you know the congestion is not allergy related, then you also need to consider your heated humidifier setting and the hose temperature if you have a heated hose. Many people assume that they need to crank the humidifier up to it's max setting (along with the hose temp) in an effort to combat congestion problems. But some noses don't like all that excess humidity and they respond to it by becoming more congested.
And for extra insult. I do have a wicked case of dry eye in my left eye and it burns to no end. That certainly doesn't help with getting to and staying asleep.
Report this to your PCP, your sleep doc, and your eye doctor. And do it
today.
The most common cause of this kind of problem is a leak that blows into the eye. It can be an unintentional leak from around the mask seal, but it can also be caused by the intentional exhaust venting bouncing off the bed covers and back into the eye. In that case, the best "fix" is to use a eye mask to protect the eyes.
But your symptoms of a burning dry eye that is really wicked can also be a symptom of other eye problems that may have nothing to do with your CPAP therapy. One of my medical conditions is a congen problem with the corneas of my eyes that lead to period "erosions" or small tears. They typically happen at night and they hurt like the devil when they occur. Other than eye drops to keep the eye properly hydrated, there's not much that can be done, but the tears heal on their own and don't create long term problems with vision. The first time it happened to me was long before I was diagnosed with sleep apnea and started CPAP therapy. So get that eye checked out---there could be something wrong with it that is not at all related to your CPAP struggle.
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