AHI & CA Climbing, Mask Fit Declining, Feeling Awful

I'll include as much info as seems reasonable below. I've been really struggling with therapy for the last month and feeling run down, poorly rested, and like I don't know what to change to get back to the better-rested feeling I had before. Feeling pretty desperate to get some relief and a good night's sleep again.


Stats: Male, 36 years old, 6'2", 215lbs.
Diagnosis: Mild/Moderate OSA via 2 in-person sleep studies in December 2016. Positional component to my OSA-- much worse on my back. No centrals or other complicating issues.
Therapy: started June 7 2018. Immediately noticed an increase in feeling rested. I was waking up before my alarm, noticed that I didn't feel exhausted all the time, etc. I saw my sleep specialist a month after starting therapy and everything looked good in terms of my numbers. My RXed pressures are 5-15, but as you can see below I've tweaked that a few times.

Current Issues

• Starting in August I began experiencing poorer sleep. My numbers began to climb, and I also started suffering from sinus congestion.
• I did not change mask types during this time.
• My body weight has not changed either.
• My CA index has climbed a lot as well.
• I feel like garbage in the morning. So even though I'm waking up before my alarm, it's not because I'm feeling rested.
• When I test my mask fit now using the Run Mask Fit option in the menu, I get the red frowny face on the INHALE, but not on the exhale. I'm not sure whether this could be caused by sinus congestion, but this was not the case earlier in my treatment. Additionally, when the pressures ramp up higher during the test, the red frowny face happens less often. So I suspect I have a mask seal/fit issue inside my nose but I can't figure out what to do.
• I've changed hoses, headgear, pillows, and the connector piece between the main hose and the nasal pillows. All these changes in the last few weeks have not helped the fit issues.
• I tried a different mask (Phillips Dreamwear Nasal Pillows) and saw similar leak issues on the Run Mask Fit test on the inhale portion. The ResMed mask appears to be worse at the moment.
• I've tried treating the congestion with a Neti pot, Claritin/Allegra, Flonase and Nasalcrom spray. None of them seem to make a long-term change. I was taking Claritin/Allegra earlier in the summer when my numbers were better, so I've gone back on Allegra and will be seeing a sinus specialist to determine whether I have underlying issues.

Here are my statistics from SH on a monthly basis: Here is my pressure history: Here is my overview:



Here is what last night looked like, leaving my feeling like utter garbage today:


Here's an average "good" night from back in June when I was a few weeks into therapy:



A few questions:

• Why might my centrals be climbing when I wasn't initially diagnosed with central apnea?
• How can I understand the change in mask fit, specifically why I'm getting the frowny face on the inhale but not the exhale? Is this attributable to my chronic nasal congestion I've been battling the last month?
• What changes can I make to my therapy to try to get back to the good zone I was in in June/July?
• Any questions I should bring to my sleep specialist/CPAP coach?

Thanks so much for any help.

Please read viewtopic/t172378/Sticky--Newbies-PLEAS ... STING.html and redo your charts, so as not to waste your time further, or ours.

palerider wrote: ↑

Sun Sep 23, 2018 4:42 pm

Please read viewtopic/t172378/Sticky--Newbies-PLEAS ... STING.html and redo your charts, so as not to waste your time further, or ours.

Done, thanks for the heads up.

Have you tried turning down or off the EPR?

Julie wrote: ↑

Sun Sep 23, 2018 5:00 pm

Have you tried turning down or off the EPR?

Hi Julie, at my best the EPR was at 3, last night I had it turned down to 1, and on Thursday I had it at 2. This is Thursday's graph.

I'm also adding this historical view if it is at all helpful.

Have you tried turning down the humidity - it's not 'therapy', but a convenience, and if it makes you congested, cut it out or at least down... esp. with allergies, it can help or mess up. I never use it (live close to the ocean).

Julie wrote: ↑

Sun Sep 23, 2018 5:51 pm

Have you tried turning down the humidity - it's not 'therapy', but a convenience, and if it makes you congested, cut it out or at least down... esp. with allergies, it can help or mess up. I never use it (live close to the ocean).

Interesting, I'll try turning it off. I called the CPAP coach at the DME provider and she suggested turning it up. I live in San Diego and the air is pretty moist, but we've been running the A/C at night to make it cooler for sleeping.

I'm looking more closely at the centrals I'm having, and I'm wondering if these look like "true" centrals or if they may be SWJ stuff. There's a similar pattern in the flow rate before all the flagged central events. Can anyone weigh in?

Every one you zoomed in on looks like post arousal

palerider wrote: ↑

Sun Sep 23, 2018 6:37 pm

Every one you zoomed in on looks like post arousal

Thank you. A few questions: I just reviewed all 28 clear airway events last night, and every one has that little jagged section before what's flagged as the CA event. If those look like post-arousal ones to you and that's not a "true" central event, what can that number of arousals tell us? Could it indicate issues with the equipment, or with my body (I have been having back pain lately), or an uncomfortable mattress? I'm not sure how to understand these as post-arousal events in terms of addressing them. Thanks for your help!

eyeheartny wrote: ↑

Sun Sep 23, 2018 6:54 pm

palerider wrote: ↑

Sun Sep 23, 2018 6:37 pm

Every one you zoomed in on looks like post arousal

Thank you. A few questions: I just reviewed all 28 clear airway events last night, and every one has that little jagged section before what's flagged as the CA event. If those look like post-arousal ones to you and that's not a "true" central event, what can that number of arousals tell us? Could it indicate issues with the equipment, or with my body (I have been having back pain lately), or an uncomfortable mattress? I'm not sure how to understand these as post-arousal events in terms of addressing them. Thanks for your help!

That stuff is bothering your sleep, No issues with the equipment... but pain can certainly explain it... you're in pain, that rises to a level enough that you have to shift position, take a few bigger breaths, you move, settle, during that time you're holding your breath either because those bigger breaths drove your co2 down a little too far, or you're turning over, etc... and you get a central recorded.

Post arousal 'central's are just the machine recording your breathing stopped *AFTER* something else, non breathing related, bothered your sleep.

palerider wrote: ↑

Sun Sep 23, 2018 7:29 pm

That stuff is bothering your sleep, No issues with the equipment... but pain can certainly explain it... you're in pain, that rises to a level enough that you have to shift position, take a few bigger breaths, you move, settle, during that time you're holding your breath either because those bigger breaths drove your co2 down a little too far, or you're turning over, etc... and you get a central recorded.

Post arousal 'central's are just the machine recording your breathing stopped *AFTER* something else, non breathing related, bothered your sleep.

Thanks. The next thing I need to figure out is the large leak events. Any idea why when I run the mask fit it shows the red frown on inhale but not exhale? What doesn't make sense is that if the mask is fitting poorly, I would imagine there would be a bigger leak on the exhale. Is there any way to tell from SH data whether the leaks are open mouth or a mask fit problem? Or could the nasal congestion be interfering with the mask seal in some capacity?

The machine only knows there's a leak, but not from where.

And congestion may interfere with any stage of breathing in general of course... try low or no humidifier for a couple of nights (to give it a chance to get better). If your local climate is not - now - relatively dry, why use it? If when the weather changes and you feel a need for the hum., try it again, but don't just use it 'because'.

Julie wrote: ↑

Sun Sep 23, 2018 8:19 pm

The machine only knows there's a leak, but not from where.

And congestion may interfere with any stage of breathing in general of course... try low or no humidifier for a couple of nights (to give it a chance to get better). If your local climate is not - now - relatively dry, why use it? If when the weather changes and you feel a need for the hum., try it again, but don't just use it 'because'.

Thanks Julie. Will do. I've also turned off EPR to see how that works for me for a few nights. I'm feeling a little more relieved that what appear to be centrals may just be post-arousal events rather than a treatment-caused central issue. Any other suggestions based on my charts? Pressure changes, taping my mouth, etc? I'm desperate to get good sleep.