In need of some assistance

Good morning,

I was diagnosed with obstructive sleep apnea almost 5 years ago. I gave it a shot for a month, but would keep waking up gasping for air and the medical equipment folks weren't much help, so I gave it up.

A little over a month ago, I started having enough apneas that they were waking me up in the middle of the night multiple times. This caused all kinds of fun things like heart palpitations, exhaustion, and brain fog. I pulled the cpap back out after I found this site. Upped the starting pressure and shortened the auto ramp feature, which kept me from gasping for air. I also tried a couple of different masks and found the one that works best for me.

The issue I'm having now is it feels like I can't get enough air and exhaling is difficult. This causes me to wake up and makes it where I can't go back to sleep with the mask on. I've also had two panic attacks when waking up (though I think these are from a combination of personal issues and having a hard time breathing, not just the cpap).

So my questions are:
1) Should I go get another sleep study done?
2) Should I get a newer device (don't think the humidifier is actually working as I wake up with a super dry mouth and throat)?
3) Do you all have any advice based on the above and the two charts I've attached from OSCAR (first from last night, other from "best" night)?

Thanks so much for this site and everyone that volunteers their time! Wish I would have found it earlier.
*edited to make pictures legible

Last night: Best night:

Welcome to the forum.

Some questions for you
1....are you using any water at all out of the water chamber? Is the water level changing at all?
2....have you tried increasing the Flex level from 2 to 3? Have you tried both C Flex and A Flex to see if one feels better than the other?
3....is 3 to 4 hours of use about all you can master? Why?
4....what position are you sleeping most of the night and/or starting out the night?

So answer those questions please so I can fine tune my response.

But I don't see what a new sleep study would gain you at this point. It's easy to see that you need more minimum pressure because the pressure goes up and stays up for the most part.
Are you totally comfortable with the 6 cm starting pressure? Any stifling or suffocation feeling going on with it?
Using the ramp starting at 6 cm and having the minimum starting pressure be 6 also is sort of a waste of time. It's already starting at where it is going to be going to. Might be more useful to use it if you need it with the minimum of around 9 to 10 ish which is more in line with what you need all night.

At this point I don't see the need for a newer model machine unless you continue to have problems exhaling against the pressure that you need. If considering a newer machine....I would be thinking bilevel so you can get more exhale relief than you are getting now.
The most exhale relief or drop during exhale with a Respironics machine is 2 cm even at that max Flex setting of 3.
With bilevel you can get more drop during exhale which would be more comfortable exhaling.

Thanks!

In response to your questions:

1) Very little over a week. I would have expected to need to fill it or the chamber to be half full. In a week it used less than 1/10 of the water.
2) I have changed the flex level, but not from A to C, will give that shot.
3) Either my mouth and throat dry out so bad that I can't swallow, or having issues exhaling. I've had a long running sinus infection, hence the mouth breathing.
4) Typically on my right side. I prefer my stomach, but haven't found a good way of doing that without causing leaks.

At 6, I'm comfortable. I'll bump it up to 9 tonight to see what happens.
Thanks for the advice on ramp, that should help me when trying the higher pressure.

Can a primary care physician write a prescription for a new device?

Thanks so much for the help!

Yes, anyone who can write prescriptions can write a RX for a machine...primary care doctor, NP, PA, dentist...even a vet.
Are you going to want insurance to pay for a new machine or are you willing to just pay for it yourself?

One more question...where do you live and what is the relative humidity in your house? Is it raining a lot where you live?
If the humidity is high in the bedroom that will affect water consumption. More moisture in the air means that the humidifier doesn't need to use much water.

So unless your ambient humidity is high....the machine should be using a considerable amount of water at the setting of 5 over a week.
Heck, I used almost all the water when I used a 60 series machine in just one night and my ambient humidity never goes below 40% inside my house. I have a little gadget that I use to check ambient humidity and room temp.

It is entirely possible that the humidifier isn't working properly. Test it by turning the machine on and letting it run for about 15 minutes then stop it and pull out the water chamber and place your hand on the bottom of the water chamber....if it's cold it isn't even trying to heat up.

All that said....dry mouth isn't always fixable by maximum humidity even with a full face mask. There are lots of reasons for dry mouth and while mouth breathing is the most common reason ...it isn't the only reason. Some people just get dry mouth easier than others and we have a lot of full face mask users here who have to add some sort of mouth hydrating agent to battle the dry mouth and they are using maximum humidity.
Obviously though we want to at least give the humidity a chance to fix it and want the humidifier to be working properly.

That's good to know. If I find the exhale still is too much, I'll get my PCP to write me one.
I'd be willing to pay for it if there's benefit to doing so. Actually leaning that way, because "compliance" on my insurance is 4 hours a night.

I live in GA, but we have a newborn and run a humidifier all the time, so that makes sense now. I was hoping the humidifier ran no matter what. I'm pretty sure it is working as there was some condensation the morning I checked it in the chamber.

I'll look into the hydrating agent. Once I can breathe properly through my nose, I'm sure the issue will go away.

Pugsy, thanks so much for your help. I was getting really fed up with the issues and was wanting to walk away again, but all of the information you've given me is the kick I needed to keep pushing.

I think there may be a way to make the humidifier bypass the humidity sensor and crank out more moisture.
By default it comes from the factory with the humidification set up for the "new humidification system" which uses humidity sensors in the machine to determine ambient humidity and then if it senses a high enough humidity it won't heat up the water chamber and add more moisture.

There should be an alternative humidification choice called "Classic" mode which essentially takes the humidity sensor out of the equation and just adds heat continually to the chamber which will continually add moisture to the air.
Drawback to this system is a high chance for condensation to happen in the hose or mask depending on how cool the ambient house temp might be.

So go into the clinical menu set up area and find the humidity selection choice and change it to Classic mode and see if that adds enough moisture to help out without causing a lot of annoying condensation...we call it rain out. Won't hurt you but it is highly annoying.

Awesome! Will check that out.