2 weeks on CPAP alternating between amazing and horrible

I started using my dreamstation with nasal mask on the 5th of Aug. First 3 days were amazing, I haven't felt like that in years, so much energy from the time I got up until the time I went to bed. It's only after you feel better you realise how bad I felt, If I did not get 2-3 hours sleep after work I couldn't function so I would just lie on the couch, no interest in doing anything. Even with a nap I would still be lethargic but I could at least concentrate somewhat on more complex things. My sleep test showed an AHI of 10 which is only mild but I feel like my symptoms were severe. Now my AHI is always under 1 and usually under 0.5

Then after the first 3 days came a few bad days, then 1-2 more great days and I basically seem to be getting a few bad days where I feel exactly like I used to, then 1-2 good days where I want to climb a mountain, take on the world with the energy I have. I was reading the success stories and it seems to be either slow and gradual, instant improvement or no improvement. I am wondering since I am having amazing days and then bad days is there something happening during the night that is causing it like leaks or something as I haven't seen reports of switches between bad and good within the same week over and over.

I tried the triangle pig nose type nasal mask initially but it was quite sore the next day and I found when I sleep on my side and the pressure increased I could feel a tiny leak so I tried this one: https://m1cdn.thecpapshop.com/m1_prod/c ... le=Default and I really like it as I can toss and turn without feeling like I am wearing a mask but I still notice when I lean into the pillow when I am on my side it feels like it is slightly leaking and then as the pressure mounts when I sleep, its much more noticeable and I think that might be waking me. Maybe someone has a solution to this, tried a pregnancy type U pillow but the same thing happens.

If I sleep on my back it fits much better but I seem to mouth breathe a lot on my back so I try to stay on my side, could never sleep on my back before CPAP. Anyway, I am posting the last 2 Thursday and Friday sleep results from Oscar, the previous week I was wearing the piggy triangle (dreamwear wisp maybe, where the hose comes out at the nose not the head) and this Thursday/Friday I wore the new under the nose model.

1 - Is there anything obvious with these that might indicate a problem with leak or otherwise, the dreamstation app always says 100% mask fit, never even hit 99% but yet the graph shows leaks, not sure if they are within range or something?
2 - If I was mouth breathing, could this lead to me having AHI's because my mouth is open and the pressure is not been maintained.
3 - I've read about using mouth tape to keep it closed, is that dangerous, could I smother if the machine stopped or something like that?
4 - I know I should probably be more patient but the fact I am going from amazing to 0% back and forth makes me thing its working some nights but not others and I so need to get back that other person, I don't even need that amazing energy, just not needing a nap every day or two and feeling like crap along with headaches would be enough.

I wear my mask 100% of the time when I am sleeping, I generally get around 6.5-7 hours weekdays when I work and 8-9 on the weekends. I even wear the mask when I take naps. Images attached which have the dates top left:

And here is the previous Thursday and Friday on the old mask

morny wrote: ↑

Sat Aug 22, 2020 11:47 am

I started using my dreamstation with nasal mask on the 5th of Aug.

welcome to the zoo! while we wait for someone with more expertise to come along, i'll point out something that is obvious to me.

see your pressure graph? the machine is set to a minimum of four. but it goes quickly past that and stays in the neighborhood of a minimum of nine. if you would increase that minimum to nine, the machine could react more quickly to quell your events. and that will lower your ahi.

good luck!

You don't even appear to have obstructive apnea, but snore like a train. Have you ever tried to not sleep on your back - to keep it from happening even when you're asleep by keeping something behind you, wearing a backpack til you get used to it, etc. etc?

Were you actually diagnosed (in a lab or at home) with obstructives?

Oh, and it would help if you'd identify masks, etc. by name rather than a picture with no ID, or calling one a 'pigmy' something or other... there are hundreds of masks out there and it's hard to guess what you have.

morny wrote: ↑

Sat Aug 22, 2020 1:53 pm

1 - Is there anything obvious with these that might indicate a problem with leak or otherwise, the dreamstation app always says 100% mask fit, never even hit 99% but yet the graph shows leaks, not sure if they are within range or something?

!00% mask fit means no excess leaks beyond a normal venting leak. All masks vent and have an intentional/vent leak rate.
If you don't see anything flagged up on the LL line in the events graph then you didn't hit large leak territory.
Respironics machines report Total Leak and the total leak is the expected vent rate plus any excess leaks. The vent rate will vary as the pressure varies....more pressure equals more vent rate so we expect the leak line to move as the pressure moves up and down. Normal.
At your pressures with your mask...large leak territory is going to be upwards around 80 L/min. It's hard to set a fixed red line for a Respironics machine because of the variability of the numbers. Unless leaks are waking you up...they aren't a problem. You are well within the machine's ability to compensate for minor excess leaks. Just watch the LL line...if you don't see much up there flagged that is prolonged then you don't have a problem. Heck, even minor short lived excursions into Large Leak territory aren't the end of the world.

So leaks aren't your problem unless small leaks are disturbing your sleep and waking you up. Anything that disturbs our sleep is unwanted.

I see no reason for you to consider having to tape your mouth shut.

What I do see mainly is a lot of snoring which are early warning signs that the airway is trying to collapse. Now they aren't growing up to be very many full grown apneas as evidence by your rather low AHI but there's enough of them happening that they could be affecting your overall sleep quality.

Anything that can affect overall sleep quality or wake you up is unwanted because if we don't sleep so great we don't have much chance of feeling so great.

I suggest that you increase the minimum pressure to 7 and sleep in whatever position allows you to get the best sleep and with the mask that you like the most....and then see how you feel. Increasing the pressure should clean up those snores quite a bit and lets see if you sleep a little better and hopefully feel more good nights than bad nights.

Oh...the usual questions....are you waking often during the night for any reason and are you taking any medications of any kind? If so, what?

Why do you think I don't have it from the graphs, is there something that indicates that? But yes, was diagnosed in a private clinic in an overnight sleep study with an AHI of 10 so it is just mild sleep apnea but the symptoms are severe IMO. The fact I felt better than I have for years after 1 night on it gives weight to the apnea being the cause of feeling terrible and tired all the time. Now I just want to get some consistency really.

The dreamstation I am currently renting for 3 months then I have the option to buy so I believe they have all the settings locked or is there a way around this so I can change the starting number from 4 to 9? I had a look previously and the only thing I was able to change was the ramp time which was at 20 mins and I put that down to 10 mins, would changing the ramp time to 1 minute be better so it will increase quicker if I cant change the settings?

In my sleep apnea test all the results were in the yellow/orange zone, AHI etc but my snoring was rated as severe and in the red zone. I see all the snoring markers but my partner said she rarely hears me snore now unless I am on my back but even then she said it seems mild compared to what it was. I bought a U shaped pillow to stop me rolling onto my back and tried it for a few nights, only difference it made was gave me a creek in my neck, still felt like crap the next day. Last 4-5 days have all been crap days so I am probably due a good one.

The current mask is: Philips Respironics DreamWear Nasal CPAP Mask which I posted the image of, the old mask was the philips wisp mask shown here: https://www.directhomemedical.com/wisp- ... onics.html

Not taking any medications, usually get off to sleep fine, I get less sleep on workdays as I have to getup early but I do find myself getting up 1-2 times a night as you can probably notice on the graphs where there is cutoffs. More so with the old mask as it felt a bit hard to breathe so I would take it off for a few minutes and go to the toilet and then pop it back on. When I do wake up, I always seem to notice a leak and adjust the mask, the leak itself isn't big but it makes a funny noise when leaking that might be waking me.

Really appreciate the responses, the main part that is confusing me is why I am going from good days to bad days even though I am not changing much in the use. That made me think I might be experiencing leaks or opening my mouth and I was having apneas due to the pressure going out my mouth instead of down my throat but the comments seem to suggest that is not likely. Maybe I am not getting enough deep sleep or something and I should concentrate on getting through the night without waking up by find the right position that doesn't push the mask off my nose or as you said maybe its the snoring that is causing me not to sleep properly.

Also in the sleep apnea test I did have multiple apneas on my back and sides so it wasn't just on my back I was getting them but I do believe they are worse on the back.

You might be surprised how much snoring impacts overall sleep quality and cause even minor arousals which does indeed mess with the sleep stages and you end up not getting the needed sleep stages in the needed percentages for the restorative powers of sleep to work their magic.
There is a reason these machine will increase the pressure trying to kill snores...they are an indication of sleep disordered breathing and while they might not grow up to earn a more than "mild" category diagnosis of OSA....they can still make our sleep quality be in the toilet and thus we feel like crap during the day. We might get a lot of hours of sleep but it's not "good quality" sleep.

Now...you didn't get this way overnight and while we read about people having the overnight miracle and feeling like superman or superwoman after one night....that's a rarity and those people are really lucky. Most of us it took some time to start feeling the benefits.
Heck...just waking up often from the mask being on the face took me about 3 months and I had no problem with the mask at all except my brain thought it was an alien on my face that didn't need to be there.

Now little leaks...they can wake us up and while not really big enough to impact the therapy quality itself...they can sure mess with our sleep and that's something we want to avoid. Frequent wake ups mess with the normal sleep cycles and yes...we can end up not getting enough deep sleep or REM sleep and we need all the sleep stages.

Pugsy wrote: ↑

Sat Aug 22, 2020 4:10 pm

Now...you didn't get this way overnight and while we read about people having the overnight miracle and feeling like superman or superwoman after one night....that's a rarity and those people are really lucky. Most of us it took some time to start feeling the benefits.

I was lucky and adopted to cpap 'instantly, but the only immediate benefits I had were:

• I didn't wake up at night to pee.
• My partner list the urge to strangle me from lack of her own sleep.

Feeling more energized, etc., took quite a bit longer...

Yeah that makes a lot of sense, I managed to find a video which shows me how to get admin access to change the settings so I have it set to 7 now as the minimum. I often find the first few minutes I have to take deep breaths at 4 so maybe 7 will make that easier too but since I still seem to snore even when it is above 9 it probably won't cure the snoring but ill see how it goes and have a bit more patience. Appreciate all the advice.

Sometimes with a more optimal minimum the machine doesn't need or want to go as high if things are better prevented to start with.
You might need more minimum but a jump from 4 to 7 is a big enough jump as it is. Maybe we can get lucky with the higher minimum and not need as much pressure. I have seen it happen before.

khauser wrote: ↑

Sat Aug 22, 2020 4:26 pm

Pugsy wrote: ↑

Sat Aug 22, 2020 4:10 pm

Now...you didn't get this way overnight and while we read about people having the overnight miracle and feeling like superman or superwoman after one night....that's a rarity and those people are really lucky. Most of us it took some time to start feeling the benefits.

I was lucky and adopted to cpap 'instantly, but the only immediate benefits I had were:

• I didn't wake up at night to pee.
• My partner list the urge to strangle me from lack of her own sleep.

Feeling more energized, etc., took quite a bit longer...

You do know that I will likely send my alien friends to your house and mess with you.... and don't forget I do know where you live.

I also had the nocturia go away pretty much immediately once I got my pressures adjusted a bit to deal with the REM stuff. That took about 2 weeks I think....back then it took a while to get the software to evaluate things. Not like it is now.
And I no longer woke up with massive killer headaches from lack of oxygen.
Otherwise...I still don't feel like superwoman but I have had some good days or better than it was pre cpap.
But we all know that's not because of OSA or sub optimal therapy. Getting the good numbers is the easy part....the really hard part is feeling them. Mother Nature is a real Bitch sometimes.

Pugsy wrote: ↑

Sat Aug 22, 2020 4:48 pm

You do know that I will likely send my alien friends to your house and mess with you.... and don't forget I do know where you live.

You're way too nice to do that. And if I gave the impression I no longer have sleep issues ... well don't I wish!
I still have some insomnia and it seems I still need more sleep than the average bear, but I'm certainly better than I once was.
I have great numbers, but that's as far as it goes. Not complaining though.

Morny, it sure would be great if you could get more consistent good results. Any chance you could get a different machine as your "keeper"? I ask because I see you have a fair amount of flow limitation flagged, and I think the ResMed Airsense 10 Autoset For Her will do a better job of helping you with that, and maybe the snores too. Its algorithms are more responsive to those kinds of events than the PR, generally speaking.

Oh, and when you have a chance, could you put your machine and mask info in your profile? That way it's always there when people read your posts.

I'm stuck on a 3 month rental contract so I have to see that out but I have heard a few people recommending the Resmed, I am male though so not sure the 'For her' version will be the best choice but I was planning to purchase a Resmed at the end of the 3 month contract since they are looking for crazy money to buy it out through them, they want in the region of €1600 for the dreamstation which I can pay over 5 months but I can probably get a Resmed for €600-700 I beleive.

I upped min to 7 and this was my results, ok day today. Do not feel like crap but not full of energy which I will take any day as my bad days I feel terrible but will probably need a nap. Might try keeping it at 7 for 2 more days, then 2-3 days at 8 and then 2-3 at 9 to see if I notice any difference. My VS2 has been consistently around 15-20 lately and that was down at 10, my 2 lowest before that was 14 and 16 so even though the graph looks busy and looks like lots of snoring still there was a noticeable improvement in VS2 and VS was rarely below 2 and it was 0.76.

I always seem to see the same pattern though, when I do wake up fully its usually preceded with an increase in pressure, when the pressure remains below 9 or so, I never seem to wake and when I do wake I notice the masks seems noisy from leaking even though there is very minor leaking. Maybe its that which wakes me, maybe its the snoring or maybe the extra pressure but interesting result in moving the min pressure so will see how maintaining and increasing that goes.

The 'For Her' model is not just For Her - it's the best all around and the name is just unfortunate - many men use it.

But again, have you tried ways to not back-sleep? It really should make a difference to snoring and that's the worst of your situation.