The worst night in over a year!!! or "SDB is complicate

I had my worst night last night and just not quite sure why.
Some background will help put this all in perspective.

I have been on cpap for almost 2 years. My first 18 months were a struggle with compliance, denial, and 2 surgeries (UPPP & sinus turbinate repair). Finally, about 4 months ago I got with the program and became compliant and along the way discovered how very complicated this SDB can be. I bought software and monitor my progress daily. Recently, I have had my best results with AHI's averaging 1.4 for the last 30 days. Night before last my AHI was 1.2. I also try to read this forum daily.

I have experimented with several masks and have achieved my best results with the Activa, which I have been using the last few days. I also have PLMD and my doc is working on my dosage of requip. I have slowly been increased to 3mg and started that about 4 days ago. Since getting to 3mg I have felt I wasn't sleeping as well as I was on the lower dosage. I would say the 1-1.5mg was the best. I have learned though to be patient with the dosage as it seems to take some adjustment at the higher levels before sleep improves. I had this same feeling when I was at the lower dosage but had not adjusted to it.

I am currently on a respironics auto bipap with a max IPAP of 13cm and min EPAP of 9cm. My titration PSG was at 9cm. There was no evidence of mixed or central apneas at higher pressures. I just recently went to the max IPAP of 13cm from 14cm about 4 days ago. Additionally, I take flonase and allegra 60mg twice daily for allergies. This seems to work well. My sinuses are only slightly congested when I sleep. I mostly use a chin strap with very good results, but have tried poligrip and taping occasionally. Last night my mouth was taped and I wore no chin strap. Here is what happened last night.

I sleep very restless. This was similar to my worst days prior to cpap. There were several times when I felt I was not getting enough air. I also caught myself waking with a jolt and gasping for air at least twice. I thought there was something wrong with my machine but it was blowing fine. I also thought my nose was stopped up as I had my mouth taped, but when I checked my nose was clear with one nostril only slightly congested.

After going to sleep I woke after 90 minutes, got up and used the bathroom. I went back to bed and took a while to fall back asleep. This is not the norm for me as I go back to sleep almost immediately. I woke about 2 hours later and for some reason disconnected the mask from the hose at the quick disconnect and apparently fell back asleep for 1 hour and I awoke then and discovered the situation. I don't remember disconnecting the mask from the hose. When I got up this morning, I noticed that I had some congestion in my chest, as I coughed up some mucous.Here is the results from encore pro.

The first part of the night up until I discovered myself disconnected for 1 hour I had a AHI of 7.0 and this was mostly OA's. I had only a few hypopneas, a .07 flow limitation, a couple of VS and believe it or not 1 non responsive apnea. This was the first time I had one of these. This period of sleep was approximately 4 hours. I slept an additional 2 hours after my mask disconnect and my numbers were even worse. I had an AHI of 10 and this was mostly from OA's. With my mouth taped I had my lowest leak rate of about 32 LPM. Leaks were not a factor last night. My 90% epap was 11cm for over half of the sleep minutes. My variable breathing at 49 % was off the scale for me, as my norm is about 15-19%. I just wonder what the tonight holds for me. Boy is this SDB complicated. This one night has sent my AHI average from 1.4 to 3.0, all in one night.

I know this was a long drawn out story, but thought it was worth sharing. I am hoping some you with a lot of experience or not a lot of experience will comment as this one bad night should be analyzed for the benefit of others.

Like they say down here at the local cpaper corner. "May the best nights of the past be your worst nights in the future" This is what I am counting on and know is achievable.

Thanks in advance for your comments.

This is my post. I must have timed out while typing.

I think I finally got this right. This was my post, but I got signed out before i submitted.

curtcurt46 wrote:This one night has sent my AHI average from 1.4 to 3.0, all in one night.

That's one reason why I've never been interested in looking at long term trends through the software. I prefer just looking at each night individually over a long period of time.

If I keep seeing pretty much the same results, night after night over a long period of time, I'm not concerned with odd data like you just saw from a random night, other than mild curiosity about "why". If the next nights went back to what I normally was accustomed to seeing, I probably wouldn't give the odd night much more thought. If outstanding oddities occurred more often than, say, a couple of times a month, then I'd want to dig into it more.

Longterm averages might be helpful to others, but I'd just get confused with that. I like to save my data downloads one night at a time (or at most, about 5 nights in a row) and look at them as separate files.

Curt,

You mention trying other masks, but were they all nasal? any full face ones? I can't really offer great alternatives to full face masks as I have only ever tried two, the Ultra Mirage Full face and the Hybrid. Some people are dead set on not using full face, being too bulky or too much pressure on the nose etc.

The reason I ask is, back when I was using the Activa in the spring, I had tried the mouth taping, and I woke up a couple times gasping for breath. My nose was a little congested, not bad, but a little. You mentioned only one nostril being stuffy, I would imagine you are not getting enough air thru one nostril vs. two. Try plugging one side with your finger and breathing, then use both....quite a difference. Perhaps that was enough to wake you several times, and I remember the feeling vividly, it was enough to make me rip off the tape that night and say the heck with taping. Thats when I decided on full face masks.

You could always try a full face just for the times you are stuffy and then keep the activa for nights you aren't. Just a thought.

Wish I had more advice on your software data. Tweaking the data isn't something I have excelled at with my own sleep either!

Good Luck.

Suzy

Sorry to hear you had a bad night curt. A FF mask might be a wise investment as suggested by the others. I live with one, and for me, it is a must have! For you it could be an ideal backup for allergy days. For me, I wish there was a way to avoid sleep altogether - not because of the FF mask BTW.

Good luck and let us know how you go.

Suzy,
I started out 2 years ago on a full face mask when I could not breath through my nose. I used the UMFF with good success for many months. It hasn't been retired and waits for me if needed.

For the past 2 months, I have had a slight amount of congestion in one nostril or the other and have had great numbers with the swift and F&P 407, besides the activa. When I say slight I mean that the cpap probably causes most of this and I have no trouble breathing. I have had nights were the both nostrils would cycle from slightly congested to clear in an alternating manner. I have read that this is somewhat normal. My humidifier is set on 3 and this is about the highest I can stand as the air is quite warm. I might drop it down to a 2 to see how I do. As my ENT said my sinuses are clear enough to drive a truck through.

One new thing that I didn't mention in my above post is that I might have silent gerd. It wasn't until this bad night event that it made me think about some other factors. I have had many of the symptoms and will be investigating this further.
I may try the UMFF tonight to see what happens.
Thanks to you and the guest for the comments.

Follow-up report:

Here is an update on last nights sleep results. To make it easy to compare with my bad night I will make a chart. Boy, what a difference a day makes and oh how complicated these sleep disorders can be.

METRIC / 11/27/06 / 11/28/06

Sleep hours / 6.38 / 7.77

AHI / 9.2 / 0.8

OA's / 50 / 2

H's / 8 / 4

NR OA's / 1 / 0

VS's / 1 / 6

VB % / 43.37 / 26.2

Leak rate / 32.07 / 32.72

Total time OA / 882 sec. / 42 sec.

I used my activa mask that I had used from the previous night along with a chin strap. My 90% EPAP was 9cm and my 90% IPAP was 12.4.
I have started taking medication (proton pump inhibitor)(prilosec) to control GERD to see if my sleep improves. I need to give this about a week. I knew that GERD could cause sleep problems, but as always, I didn't have it or at least I had not given it much consideration. I have several symptoms that point to GERD. These are:
bad breath occasionally.
history of hiatal hernia with little symptoms.
heart burn a couple of times a week.
hoarseness in the morning.
hard to clear mucous from the throat.
hard to swallow sometimes.
unexplained congestion in my chest.

I hope my posting helps someone else think more clearly as they consider their own situation. Maybe they will discovers a new element of there own disorder and as a result be able to improve there quality of life.

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CPAPopedia Keywords Contained In This Post (Click For Definition): activa, AHI

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CPAPopedia Keywords Contained In This Post (Click For Definition): activa, AHI