Sudden stop of positive CPAP therapy effects

Hoeksel wrote: ↑

Mon Dec 27, 2021 6:42 am

Oeps, I did try to follow the guidelines but missed these. I will follow these guidelines with my next upload. Thanks!

that's quite all right. i didn't get it "right" the first time either. and prolly not even the 10th time!

Miss Emerita wrote: ↑

Mon Dec 27, 2021 11:11 am

Hoeksel, go into your settings and turn on the setting for antibacterial filter. I don't know that this will make much difference, but it'd be good to take care of that.

I think it will be valuable for your to stick with a given setting for at least a week so you can really see how it works for you. Sleep is so variable from one night to the next; it can take a while to spot a trend.

I would strongly recommend that you use EPR of 3. It seems to help your flow limitations some, and the FLs might be contributing to your feeling that you aren't getting enough air. if you like a fixed pressure, there's nothing wrong with that. I'd suggest the 8.4 that you seem to find comfortable.

I hope you can get your nose unstopped soon. Some people keep a full-face mask as a backup to use when they have trouble breathing through their noses; just a thought, in case this is a regular problem for you.

Hi,

Thanks for your reply. As for setting the AB filter, that is not what I should do in my opinion. This setting is intended for the anti-bacterial filter at the exhaust, so after the pressure sensor, to compensate for the flow limit. What I have are hypo-allergenic filters at the air intake, so before the pressure sensor, so it will not impact the flow to the mask. You can try it on your Resmed, if you set AB filter on without AB filter breathing will be very hard....I know because I made the mistake while learning about the Resmed 10;-).

As for EPR 3, I tried that, and it gave me the worst night in 5 months of CPAP therapy. Not blaming you! I would have tried anyway . I read later some people respond with central apneas to high EPR, and I am one of them. I got like 12 events within 1.5 hour (up to 30 seconds) and when I woke up as a result I had to deal with the worst atrial fibrillation. So this taught me that not sleeping with CPAP is not an option for me. I was finally rid of Afib by stopping sports and reducing alcohol intake (even before CPAP).

My nose cleared up, sleeping is still terrible. For the first time in my life I resorted to sleeping pills and I will try that starting tonight. Not that it will solve my issues, but I need some more sleep than 2, 3 or 4 hours per night.

In 4 weeks (pfff, so far away) I will get a second PSG at home with my CPAP, as the hospital is also clueless as my AHI numbers are great and my sleep is deteriorating every week. Hopefully this will show what is going on, if they remain clueless, we have specialized sleeping centers that will probably take over my case. But they have a huge waiting list......

So now that my experiments with pressure have all failed and I even gave myself an Afib attack, I decided to (at least for some time) revert back to the settings that some months ago did work for me. CPAP mode at pressure 5.0, no ramp, no EPR.

Here my second try (with the tips given) to show the data of last night. So the events are clearly visible, but here is the thing. I woke up around 04:00, 05:30 and 06:15. There is no event according my CPAP. In all 3 arousals that I am aware of, I was in the middle of dreaming (REM phase). I checked the data from my Garmin Forerunner 745 and found this:

- The timings I remember as an arousal are all at te start of a REM phase (assuming Garmin is reliable)
- The measured stress (based on HRV, Heart Rate Variability) increases significantly during the arousal (assuming Garmin is reliable)
- At the start and during this arousal phase my heart rate increases (assuming Garmin is reliable)
- At the last and strongest arousal my respiration rate went up as well (assuming Garmin is reliable)

Normal for me during sleep is a stress-level between 0-25; heart rate typically 50-60; respiration rate during sleep 14 and while awake 13.

Arousal #1 at 04:00: stress level 38, heart rate 69.
Arousal #2 at 05:30: stress level 51, heart rate 72.
Arousal #3 at 06:15: stress level 73, heart rate 81 and respiration rate went up to 21. I was sweating and felt like hyperventilating, it was a typical arousal where you know sleeping will not happen anymore.

Especially the last arousal felt like an apnea, but was not detected as such. Interestingly my Garmin measured more events like these, but I am not aware of them. I have no idea if this is significant, but I put a notebook next to my bed to write down arousals when they happen so I can check with my Garmin.

Here the OSCAR of this evening:

Hoeksel wrote: ↑

Thu Dec 30, 2021 9:28 am

I woke up around 04:00, 05:30 and 06:15

Counting the 1+ hour nap, by 4:00, you had slept 5.5 hours. Much of any sleep debt had been paid back. It's normal to have several arousals during the night. Did you fall asleep quickly after the arousals in question?

Thanks for clarifying about the AB filter -- you are right. And what a shame that EPR of 3 was such an epic fail. I hope the pills get you caught up on sleep.

For what it's worth, I'd be a little skeptical about the ability of the Garmin to detect sleep stages. Even the Dreem headband, which has a bit of an EEG capacity, messes that up fairly regularly.

I'm sorry the next home PSG is so far off, but at least it's scheduled. Does it use EEG leads?

I realize the Garmin is not perfect, but it does seem to reflect very well how I feel and also the data in OSCAR. I can't help it, due to education and character I am very data driven and looking for logic and correlations. Probably too much sometimes, but can't help it .
On the other hand, without this drive I would not have had the diagnosis and still be in the Dutch medical jungle.

Yes, the sleep test will be with EEG. And the sleeping pills help, especially to recuperate my body and make my day shorter. But I hate having to take them....

Next week I will start my fight to be appointed to an actual sleep center. I have realized my current hospital is good for people that respond well to CPAP (basic OSAS), but not for special cases like me. While there is the best sleep center of the country less then an half hour drive from my home. That would be my goal...

I really hope you can get in at the top-notch sleep center. I went back and read your original post. Your initial good period on CPAP was for 3-4 months starting in June. So in perhaps October you began to wake up in the middle of the night and found you could not get back to sleep. This is making it hard for you to function during the day. Right picture?

I'm sure you've thought hard about this, but what changed *at that time*? New pressure at work? Stress in personal relationships? Changes in drinking habits? Changes in exposure to daylight? Other aspects of the way your body functions? Or??? If you can put your finger on anything that also happened right around the time you started having insomnia, that will help the sleep clinic to help you, I suspect.

Thanks again for taking time to help!

I thought about changes a lot, indeed. And the only things on the CPAP side are 1) a power out on November 14th and 1 week later I called in sick for work and 2) end of October I swapped the normal air intake filter for an anti-allergenic filter. I am told both should not matter, the power-out did result in me waking up smothered around 04:00 so I was about 2 hours breathing through my N20 mask without power to the ResMed, and having a serious off day the next day.

For me personally, bit more work pressure and a bit more alcohol but both minimal. Currently no work (for 5 weeks) and no alcohol (for a week, I planned this anyway but especially now with sleeping pills), but under sleeping pills so trying to recover my body until I will go off them soon. Curious what will happen then....

So during the good part of my therapy, I noticed the usual but also my jaw and legs stopped hurting (unexpected nice effect). In the bad part of my therapy my jaw has started hurting again, and some nights my legs. So I am pretty sure my body is struggling with apnea but the ResMed is not registrating them. Especially my jaw seems a good indicator for how well the therapy is doing. And now I feel it every day.

This morning I noticed I had small leaks through my mouth, never noticed before, and again not noticible on the ResMed. Could it be (part of) the explanation? Just to be sure I ordered a chinstrap to at least exclude it as a root-cause.

But now that I understand more and more how to look at OSCAR data, and what apnea/UARS is, I am pretty sure I have a flow limitation issue in my upper airway. I can clearly see this in my flow profiles. I will post images later and show what I mean.

Thanks again and have a good day!

Yesterday I tried slightly different settings, from CPAP 5.0 (no ramp/EPR) to APAP 4.0 - 6.0 (no ramp/EPR 2) as I notice more and more I have trouble exhaling. I have a lot of data now from different pressure settings (between 4.0 and 8.6), but my flow profile seems to not change that much (compared to the one I show here). At exhale there is always this small dip just before it goes through zero, and my inhale flow is always "split"; along the inhale it seems my airway "pops open" and the Resmed 10 needs more flow to compensate. This does not match the theoretical ideal flow images often shared on this forum.

The good news: I slept short (just below 6 hrs) but I had no awakenings I am aware off and I do not feel completely broken. Quite pleased actually! Please notice I am on sleeping pills (10 mg Temazepam).

BTW: The series of CA's around 23:20 are false flags (I am awake at that point), the one at 00:26 is preceded by a big inhale, the series around 02:02 preceding the hypopnea are most likely real (normally I do not suffer from CA's but I did notice the first 1 or 2 days on a new setting I always have more CA's).

I wonder what you guys and girls think of my flow profile. It looks very wrong to me, is that the case and if so, what would be the approach? To me it feels I need much higher pressure for inhale, but it will suffocate me at exhale.

Another question on the Resmed 10 AutoSet: I did read it automatically tries to adjust to flow limitations when used in APAP mode. Is that correct and does this mean that if I would set a really high max. pressure it would enforce a nice inhale flow pattern?

Overview last nght: Details of typical flow: