New to ACPAP/UARS

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
Seb-Sanfilippo
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Re: New to ACPAP/UARS

Post by Seb-Sanfilippo » Mon Jan 16, 2023 2:57 pm

I would suggest keeping a short sleep log where you track these things with a simple to use scale each day
Great idea!
The dry nose and throat issues may be related to something other than sleep disordered breathing
Actually I didn't experienced those symptoms since using CPAP. I got new ones, the dreaded dry mouth and aerophagia but they are manageable
You may also want to investigate sleep hygiene
That was suggested by the sleep doctor but my sleep hygiene is pretty good, at least it was really good when I started feeling fatigued. Now my anxiety is through the roof so bed time has become a bit of a panic inducing moment
How well would you say that you slept on that night in terms of your insomnia?
I slept most of the night but I did wake up a lot for brief moments, I didn't experienced insomnia

Seb-Sanfilippo
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Re: New to ACPAP/UARS

Post by Seb-Sanfilippo » Mon Jan 16, 2023 2:59 pm

I just want to say this is a great community, thanks for you support

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Miss Emerita
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Re: New to ACPAP/UARS

Post by Miss Emerita » Mon Jan 16, 2023 3:18 pm

Let us know how you do with full-time EPR. It’d be helpful if you stayed in this same thread.
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Pugsy
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Re: New to ACPAP/UARS

Post by Pugsy » Mon Jan 16, 2023 3:29 pm

Seb-Sanfilippo wrote:
Mon Jan 16, 2023 2:57 pm
I slept most of the night but I did wake up a lot for brief moments, I didn't experienced insomnia
Multiple wake ups during the night (even if we go right back to sleep) can potentially trash sleep quality in general.
With a lot of wake ups we don't have a chance to have the nice normal progression in each sleep stage as well as the needed amount of sleep in each sleep stage.

Read this paper and just ignore the part where it is talking about alcohol and substitute "anything" for alcohol because this paper explains why each sleep stage and the amount of time in each sleep stage, is so important to sleep quality.

https://www.sleepfoundation.org/nutriti ... -and-sleep

There are 2 kinds of insomnia
Sleep onset insomnia and sleep maintenance insomnia.
Sleep onset insomnia is where we have trouble falling asleep.
Sleep maintenance insomnia is where we have trouble staying asleep. We wake up frequently during the night and may or may not have trouble falling back to sleep. Sounds like you do have insomnia but the sleep maintenance variety. It's hard to fix because we don't always know what is causing the wake ups and even if we do know the cause it isn't always so easy to fix. I have this problem myself and even though I know the cause (arthritis pain) it isn't easy to fix.

Waking frequently during the night can sure cause us to feel fatigue, not rested, drowsy, etc no matter what our AHI might be and no matter if we have any sort of sleep disordered breathing problem or not.

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Seb-Sanfilippo
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Re: New to ACPAP/UARS

Post by Seb-Sanfilippo » Tue Jan 17, 2023 1:41 am

Hello,
I had a terrible night with very little compliance with the CPAP.
I was congested and couldn't breath through my nose. I had to use some nasal decongestant.
I also forgot to mention before that I wake up often with drool coming out of my mouth.
I read somewhere that some people tape their mouth or use a chin strap but I am afraid that if my airways are blocked I would suffocate with my mouth tapped shut.
Because I switched the whole night between using the CPAP and taking it off, I noticed that when not using the CPAP I wake up with a raging headache and a dry throat.

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ozij
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Re: New to ACPAP/UARS

Post by ozij » Tue Jan 17, 2023 3:20 am

If there are times you can't breathe through your nose at all, then you need a full face mask.

If you tape your mouth, and you can't breathe through your nose, chances are you'll wake up and tear off the tape long before you suffocate -- but, given the state of your nose, I see no good reason for you try taping.


Edited to correct typos in 1st line

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Last edited by ozij on Sun Jan 22, 2023 10:37 pm, edited 2 times in total.
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Seb-Sanfilippo
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Re: New to ACPAP/UARS

Post by Seb-Sanfilippo » Sun Jan 22, 2023 2:57 am

I've been using CPAP for another 4 days.
I changed from a nasal to a pillow mask which is more comfortable
I notice that my stats are getting worse by the day. I get more CA everyday.
Can CA be caused by the leaks? Or is it the other way around, as in when I have a CA event the CPAP increases the pressure and it leads to a leak?
Don't know what the data is telling me, I only know that I fully wake up 3 to 4 times per night and I have a hunch that I have a lot of micro awakening that I half remember. Also I still wake up unrefreshed and feeling like trash the whole day although I feel like the fatigue is marginally less severe then before using the CPAP. I've been using antidepressant for 3 weeks, I might feel a bit better because of the meds and not the CPAP. I don't want to stress too much about that but it might be a possibility.

I include the SleepHQ links here:
https://sleephq.com/public/cb47ada7-d34 ... b42e1619df
https://sleephq.com/public/022a2c3a-445 ... 1bd8036a8b
https://sleephq.com/public/aaf0951b-05f ... 8172ddcf6c
https://sleephq.com/public/5a614cb9-9ec ... 554888d462
https://sleephq.com/public/0beb4ebf-53b ... cd4b1b6f49
https://sleephq.com/public/bb13d4ef-e7e ... ccde2cf135
https://sleephq.com/public/c26ab28e-2ab ... a01d32b57b
https://sleephq.com/public/f994a245-405 ... 15a6899412
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robysue1
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Re: New to ACPAP/UARS

Post by robysue1 » Sun Jan 22, 2023 9:49 am

Seb-Sanfilippo wrote:
Sun Jan 22, 2023 2:57 am
I've been using CPAP for another 4 days.
I changed from a nasal to a pillow mask which is more comfortable
I notice that my stats are getting worse by the day. I get more CA everyday.
The number and distribution of the CAs scored on the data that you link to is not statistically significant. In other words, even the "worst" nights for CAs (Jan 20 and Jan 21) could simply be nights where you were a bit more restless durning the night for reasons that have nothing to do with your sleep disordered breathing problem or your CPAP therapy: We don't sleep exactly the same every single night and most of us see natural variation in the AHI numbers from night to night. But there's nothing to be worried about when you have a night with an AHI = 0.9 instead of an AHI = 0.2.

Can CA be caused by the leaks?
While there does seem to be a correlation between periods of higher leaks and CAs in your data, it's not as simple as "leaks cause CAs".

Real CAs of the sort that are scored on a proper (in-lab) sleep study are the result of the brain forgetting to send an "inhale now" message to the diaphragm when a person is genuinely asleep. But a lot of people will experience perfectly normal sleep transition "central apneas" during the transition from wake to sleep as the CO2 trigger for breathing is reset somewhat higher for sleep breathing. These sleep transition CAs are not considered part of sleep disordered breathing and they are not scored on proper in-lab sleep studies. Our CPAPs cannot definitively know whether we're asleep or not, and it's not unusual for them to score CAs during periods where we are transitioning to sleep or back to sleep after a brief wake during the night.

So anything that causes you to be restless and wakeful while using your CPAP can increase the probability that the machine will score some normal sleep transition central apneas. And in your case, I think what's going on is that the leaks are causing very short wakes and that the CAs that are scored are normal sleep transition wakes that occur as you are just about to fall back to real sleep.

If we zoom in on some of the centrals in your data, it's easy to see that you were already restless well before the CA is scored, and in the presence of the leak, it's reasonable to assume that you were just awake enough to be trying to fix the leak. Here's a particularly clear example of one of your CAs that is most likely a normal sleep transition central caused by your being half-wake, half-asleep fighting a leak and trying to get back to sleep all at the same time:

Image

All that ragged breathing during the period when the leak is at its worst looks like wake breathing, which is no where near as regular as normal sleep breathing is. The CA occurs right after you (temporarily) have the leak fixed and you're drifting back off to sleep. That points to this particular CA being a normal sleep transition CA that is nothing to worry about.

Or is it the other way around, as in when I have a CA event the CPAP increases the pressure and it leads to a leak?
There are a couple of misconnections here.

1) Auto adjusting CPAP machines do not increase pressure response to CAs being scored. And the reason why is simple: More air pressure is not going to prevent additional CAs because the problem is not a collapsing airway. In fact, for a small subset of CPAP users, additional air pressure can increase the number of CAs because more air pressure can encourage too much CO2 to be blown off during exhalation. When too much CO2 is blown off, that reduces the urge to inhale.

2) While increased pressure can lead to a mask springing a leak, CPAP machines do not increase pressure just because there is a leak. In fact if the leak is large enough, an auto adjusting CPAP is programmed to reduce the pressure in an effort to see if the seal can reestablish itself. CPAPs and APAPs do increase air flow into the mask during a leak in order to maintain the current set pressure: The larger the leak, the more air the machine must add to the leaky, "semi-closed" system comprising the machine, the hose, the mask, and your upper airway just to maintain the desired pressure.

For brand new PAPers, the emergence of a few CAs here and there is not considered a serious problem, and they usually resolve all by themselves after a few weeks of therapy. For a very small number of new PAPers, the number of CAs is both significant and does not resolve with time. These unlucky folks are the ones who wind up with a diagnosis of either Complex Sleep Apnea (CompSA) or machine-induced centrals. But there is nothing in your posted data to suggest that you are dealing with a potential CompSA: Your CAs are far too few in number and they appear to be associated with restless periods where you are likely awake or semi-awake from fighting leaks.

Don't know what the data is telling me, I only know that I fully wake up 3 to 4 times per night and I have a hunch that I have a lot of micro awakening that I half remember.
Yep. That does not surprise me at all. When scrolling through your data there is plenty of evidence that you are arousing or awaking briefly a lot of times during the night. The thing is, we don't typically remember wakes if they are shorter than about 5 minutes in length. But it's a very bad idea to try to keep yourself awake long enough to remember the wake when you find yourself awake in the middle of the night. (Lots of insomniacs do that, however, by staring at the clock worrying about how little sleep they've gotten since the last time they woke up.)

If you want to investigate more carefully how many times you are actually waking up during the night, there are a couple of things you can do.

First, if your machine is easy to turn off and back on from bed, just get into the habit of turning the machine off and then immediately back on whenever you are conscious you are awake in the middle of the night. Don't try to figure out when or how many times you've turned the machine off and back on when you're in bed: Looking at the data in SleepHQ or Oscar will definitively answer those questions. If you've got a FitBit, AppleWatch, or some other wearable that claims it can measure sleep, it can also be useful to go through that data and compare it to the data gathered by your CPAP machine. In other words, see if there is a strong correlation between restless breathing patterns in the CPAP data and "wake" periods flagged by the wearable device. Don't expect the correlation to be perfect: None of the wearables can definitively track mini-wakes and arousals because they don't have the EEG data needed to properly track sleep cycles. Still, they're better than nothing at trying to figure out how many times you might be arousing during the night.

Second, don't worry excessively about brief wakes that are at roughly 90 minute intervals: It's not uncommon and not particularly destructive of the sleep architecture to have a very brief wake at the end of each full sleep cycle.

Third, look for correlations in your data between restless periods in the flow rate graph and largish leaks in the leak graph. When you have a lot of restless periods in the flow rate graph that correspond to noticeable leaks, that's a sure sign that the leaks are what's triggering the restlessness and the arousals and micro-wakes. Fix the leaks, and your sleep should improve.

Also I still wake up unrefreshed and feeling like trash the whole day although I feel like the fatigue is marginally less severe then before using the CPAP. I've been using antidepressant for 3 weeks, I might feel a bit better because of the meds and not the CPAP. I don't want to stress too much about that but it might be a possibility.
Both antidepressants and CPAP therapy are processes.

In other words, it takes a while for both of them to work.

If you've been fighting both clinical depression and obstructive sleep apnea for a long time, then it's going to take getting both the depression and the sleep apnea under control before you will feel substantially better.

It sounds to me like you are on the right track: The antidepressant is starting to lightening the fatigue and mental fog caused by the depression now that you've been on it for 3 weeks. And your CPAP data indicates that your obstructive sleep apnea is being well controlled by the CPAP. The remaining piece of the puzzle is giving your body the time it needs to learn how to sleep well with the CPAP. Right now, you're still dealing with fractured sleep and a lot of wakes & mini-wakes/arousals, which are most likely being caused by fighting with leaks for large stretches of the night.

My advice is to work on fixing the leaks and see if that helps to fix the fractured sleep. And once the fractured sleep is less fractured, then my guess is you will start feeling better in the daytime than you currently are feeling.

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Seb-Sanfilippo
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Re: New to ACPAP/UARS

Post by Seb-Sanfilippo » Sun Jan 22, 2023 10:34 am

Sincerely appreciate the feedback
If you've been fighting both clinical depression and obstructive sleep apnea for a long time

I haven’t been fighting either for a very long time. I started feeling very fatigued in September 2022 and it progressively got worse until December when I finally consulted a doctor because I couldn’t work anymore and was understandably depressed about that. His first reaction was to prescribe antidepressants and dismissed my concerns about OSA and UARS. I felt so awful the subsequent week that I went back and begged for a PSG and a CPAP.
I realise writing this that I am being a bit defensive about having a depression, might be a sign that maybe there is a psychological dimension to my sleeping troubles.
My advice is to work on fixing the leaks and see if that helps to fix the fractured sleep
I am conflicted about the leaks, should I go full face mask or tape my mouth?
Only think is I am terrified of tapping my mouth and the sleep technician is telling not to go full face mask and that I will eventually stop opening my mouth.

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ozij
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Re: New to ACPAP/UARS

Post by ozij » Sun Jan 22, 2023 11:25 am

Seb-Sanfilippo wrote:
Sun Jan 22, 2023 10:34 am
Only think is I am terrified of tapping my mouth and the sleep technician is telling not to go full face mask and that I will eventually stop opening my mouth.
The sleep technician has a bad case of wishful thinking, or selective attention. Some people never stop opening their mouth.

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Miss Emerita
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Re: New to ACPAP/UARS

Post by Miss Emerita » Sun Jan 22, 2023 11:46 am

What is it about mouth-taping that you find upsetting to think about? If that's something you can analyze, perhaps people can give you some different perspectives on it.
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Re: New to ACPAP/UARS

Post by Seb-Sanfilippo » Sun Jan 22, 2023 12:23 pm

What is it about mouth-taping that you find upsetting to think about
Death by suffocation!

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ozij
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Re: New to ACPAP/UARS

Post by ozij » Sun Jan 22, 2023 10:36 pm

ozij wrote:
Tue Jan 17, 2023 3:20 am
If there are times you can't breathe through your nose at all, then you need a full face mask.

If you tape your mouth, and you can't breathe through your nose, chances are you'll wake up and tear off the tape long before you suffocate -- but, given the state of your nose, I see no good reason for you try taping.


Edited to correct typos in 1st line
If you don't want to make your own decisions, ask your sleep tech how long he/she thinks "eventually" should be, mark it in your calendar, and wait with buying a full face mask till you've discovered if you need one.

Alternatively, ignore your sleep tech, buy a full face mask, try it for a month and see what it does for you.

What you do to optimize your therapy is really up to you.

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Mask: Bleep DreamPort CPAP Mask Solution
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And now here is my secret, a very simple secret; it is only with the heart that one can see rightly, what is essential is invisible to the eye.

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Seb-Sanfilippo
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Re: New to ACPAP/UARS

Post by Seb-Sanfilippo » Mon Jan 23, 2023 12:15 am

What you do to optimize your therapy is really up to you.
I mouth tapped last night and I am still here!
But doesn't seem to have stopped the leaks.

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robysue1
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Re: New to ACPAP/UARS

Post by robysue1 » Mon Jan 23, 2023 8:25 am

Seb-Sanfilippo wrote:
Mon Jan 23, 2023 12:15 am
What you do to optimize your therapy is really up to you.
I mouth tapped last night and I am still here!
But doesn't seem to have stopped the leaks.
Post the data please.

Note also: In the previous data you posted, your leaks were under Resmed's definition of "Large Leak." They look large because of the y-axis range that Oscar chose to display the leaks. In other words, if there were no hard evidence that leaks are waking you up, then you would not need to be overly worried about them.

But you are experiencing fractured sleep and many of the documented wakes (places where you turned the machine off and back on) correspond to places where the leaks were present and often at their worst. Hence it's reasonable to conclude that the leaks are a probable cause of your restlessness.

It is possible that your leaks are caused by something other than your mouth opening. What position do you sleep in? Is there pressure on one side of the mask caused by the way you are lying on your pillow perhaps? I'm a side sleeper and occasionally I will wake to a small leak where one of the nasal pillows has been very slightly jarred out of position by my movement in bed. Because I'm a side sleeper who typically stays on one side, I've also found that when I tighten the straps of my nasal pillows mask in an asymmetric fashion, I get better stability for the mask.

Since the leaks persisted with mouth tapping, it's also worth inspecting your equipment carefully looking for tiny pin-hole sized tears. Also make sure that the mask is assembled correctly.

_________________
Machine: DreamStation BiPAP® Auto Machine
Mask: Swift™ FX Nasal Pillow CPAP Mask with Headgear
Humidifier: DreamStation Heated Humidifier
Additional Comments: Also use a P10 mask
Joined as robysue on 9/18/10. Forgot my password & the email I used was on a machine that has long since died & gone to computer heaven.

Correct number of posts is 7250 as robysue + what I have as robysue1

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