Tom’s (ev1) Therapy

Thank you for the resources and all who contribute to this forum. I've been reading and exploring for a couple of weeks now. How did I come to be trialing a CPAP? I am sixty years of age and do not remember ever sleeping consistently more than about six or seven hours a night. In July of last year two things happened. One is that I took on a technically challenging project at work, where I would also be acting as a mentor. The second is that I started an intensive period of reading, writing and study of non-work related material. As time passed, and as I became more engrossed in my studies, my morning wakeup time became earlier and earlier. I was feeling refreshed and full of energy, even as my sleep time dropped to about 4-5 hours per night. Then, one morning, after about eight months, I woke up at my usual 4:00 AM to read and then found myself waking up again at 7 AM with my book on my lap. This happened for a couple of nights in a row. Then the wheels fell off the bus.

After this, I could barely get out of bed in the mornings. My work schedule dropped from 40-45 hours per week down to about 20 hours per week. I slept at least 10 hours a night for almost a month before I started to regain mental clarity. I went to see my family physician during this time, complaining of being tired and not knowing why. She sent me to a sleep clinic where I was given some gear to take home to check for sleep apnea. The results indicated that I had moderate sleep apnea with an AHI of 16. I put off the clinic's follow-up appointment for a trial of a CPAP machine. My thinking was that I was now feeling better and thinking more clearly and that the sleep apnea was only just above the point where insurance would cover a CPAP machine. My wife recounted that she previously shared with me her concern that I sometimes stop breathing while sleeping, that I frequently snore, can't sleep on my back without choking, and sometimes flail about in my 'action' dreams. I agreed to make an appointment with the clinic.

As a six-week trial (now starting the fourth week) I was fitted a Philips Respironics Dreamstation Auto CPAP with heated humidifier and a N20 mask. The initial
Respironics DreamStation, PAP Mode: APAP (Variable), Min 5 Max 15 (cmH2O). Here's a screenshot (OSCAR collected data) of my second night. I slept almost nine hours. I was able to sleep some of the night on my back, for the first time in as long as I can remember. However, I didn't feel well rested or have the usual clarity of thought the next day.
On September 10, my clinician remotely set the pressure to Min 5 Max 10 (cmH2O) in order to reduce the events. He also asked me not to sleep on my back, if possible. Here are the results.
On September 12, my clinician remotely set pressure to Min 8 Max 8 (cmH2O). The pressure steering has remained at this point since then. Here are the results of last night's OSCAR plots.
I'm trying to increase my understanding of all of this. I've read about a third of 'Sleep Interrupted', and many of the sticky posts here in CPAPtalk. I have two to three weeks left of the trial. I'm not sure I notice any improvement in my sleep or in how I feel while awake. I'm actually waking up more now than I was at the start of the September 10 change to Min 8 Max 8. At this point, with my limited knowledge of sleep apnea, I don't know if the data suggests an improvement or not. I'm concerned that when the six-week trial ends, I'll be asked to make a decision on the purchase of a machine, and I won't be prepared to provide valuable feedback to my clinician or have the ability to know how best to proceed. I suppose I need to rely on the clinic for all of this, but I'm wired to seek knowledge and make informed decisions. Would it be detrimental to hold off on a decision until I have time for more reading and study?

Thank you for any feedback and encouragement.

Welcome to the forum.

Where are you located?
Your post makes me think you aren't in the USA and if that's the case it would be really helpful to know where you are at so we can have an idea how they do things where you live.

Are you spending much time awake with the mask and machine on?
Sept 23....what I am seeing makes me think that you weren't asleep for at least the first half hour of the night and maybe 45 minutes or so after the wake up in the middle of the night.

Where are you located?
Your post makes me think you aren't in the USA and if that's the case it would be really helpful to know where you are at so we can have an idea how they do things where you live.

I am located in B.C., Canada.

Are you spending much time awake with the mask and machine on?
Sept 23....what I am seeing makes me think that you weren't asleep for at least the first half hour of the night and maybe 45 minutes or so after the wake up in the middle of the night

Yes, last night I lay in bed for about a half hour before falling asleep. I sometimes awake in the middle of the night with a very dry mouth. I've been sleeping with my hand up against my chin, which helps somewhat. I've also recently read about a chin strap. I think I'll make one. This is what happened last night. I drank some water and read a book for about 40 minutes before going back to bed.

Some other details to fill out my situation.

I’m not sleeping very well lately. I’m sleepy during the day and often have a mild headache when I awake which sometimes persists into the afternoon.

For the N20 headgear to be comfortable when lying down, I have the straps extended to the maximum length. This sometimes results in the release of one side or the other. I've asked my DME if there's a larger headgear that I can try.

I’ve been cleaning the nasal mask every morning, but I’m developing pimples on my upper lip and a rash on my face to the right side of my nose, where the vertical portion of the mask rests. There might be more pressure on my right side since I typically sleep on my left side. Polysporin helps. Do you have any suggestions?

Wash your face really well before bedtime if you aren't doing that already. Will help with facial oil reduction which clogs the pores and causes pimples.

Also consider making or buying a mask liner. Get the silicone off the skin and it will help absorb oils and sweat and maybe help with pimple reduction.

You can make your own or buy them ready made....an old T shirt works great.
https://www.padacheek.com/mask-liners-nasal-masks
To give you an idea what they look like

Why is it you are feeling like you aren't sleeping well? Is this new and just started with the therapy or did you have that problem before?
Wake up often? If so, why? Any special reason?
How many hours of real sleep (not just laying there awake) do you think you are getting?

Thank you, Pugsy.

Why is it you are feeling like you aren't sleeping well? Is this new and just started with the therapy or did you have that problem before?

Sometimes when I wake up I feel like I'm out of breath. There are times I awake out of breath (or an impression that I was out of breath) and also with a dry mouth. These symptoms are new since starting therapy. Before therapy, I was waking from soreness of lying on one side or another or from action dreams. I would often roll from one side to another half a dozen times throughout the night. Both of these have decreased since therapy.

Wake up often? If so, why? Any special reason?

I don't toss and turn as often as before therapy. I have no other special reasons for waking up. If I can't fall back to sleep I usually get up and read a paper book under a incandescent light that's not too bright, until I'm tired enough to go back to sleep. I thinks it's more difficult to answer these questions than it should be...

How many hours of real sleep (not just laying there awake) do you think you are getting?

My sleep time has decreased since the change from variable pressure to a fixed pressure of 8. It also varies each night. Last night I probably slept about 7 hours total. The night before about 6, 3 with the mask on. I was sleeping about 8-9 hours a night during my first week of therapy. However, my clinical technician modified the settings in order to reduce the events. Since then, I've been sleeping around 6-7 hours.

Chin straps don't keep lips closed, so think about using tape instead (a forum search will give more info), a soft cervical collar can help, but a full face mask is the usual go-to for mouth breathing, which is what's drying you out and keeping therapy air from going down rather than out into the room.

Julie, thank you for suggestion. I'll have to wait until I hear from my DME about another appointment and it looks like I need a doctor's prescription for the full mask.

Pugsy, my comment about the questions being hard to answer is from being tired and a bit foggy.

Would it be helpful to have more back and forth discussion with the sleep technician at the DME during a six week trial period? Perhaps I should ask for an appointment before the trial period ends in 3 weeks.

Would my pressure have been fixed at 8 because the EPAP barely went about 8 when it was set to min 5 and max 15 and min 5 and max 10? If there is insufficient pressure, would EPAP max out at the upper pressure level setting?

Do I even need a CPAP machine? It doesn't seem to be helping very much.