Felt Bad, Feeling Better, Story???

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
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Snoozin' Bluezzz
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Felt Bad, Feeling Better, Story???

Post by Snoozin' Bluezzz » Wed May 17, 2006 9:48 am

I have raised this question obliquely a number of times with no answer or ideas and directly at least once with the same result. I'll try once more.

I have a number of interfaces and only one works consistently for me. The Swift. It gets to be a pain to have only one to rely on because, at times, it seems to develop a mind of its own and at other times my nose just gets tired and sore from it.

Because they are so comfortable I have tried the CL2 and the Headrest/Aura a number of times and for for some reason, after 4-5 days of continuous use, I start to feel crummy. I have resolved leaks and my AHI is good on these intervaces but...

The symptoms are:
  • shallow sleep
    night time waking
    fatigue the next day
    after 4-5 days morning headaches
Back on the Swift (after solving leaks)
  • deeper sleep
    less, or no, night time waking
    less and less fatigue the next day
    no headaches
    after 4 or 5 days sick of headgear confinement and sore nose.
I have not heard equivalent reports from other folks so it must be something to do with ME but I just don't have an idea what it might be.

Any ideas?

David


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Post by Guest » Wed May 17, 2006 10:15 am

Are you trying too hard? There are other factors beside the CPAP that can interfere with a "good" nights sleep ... stress at work, noisy neighbors ... and most of them you have no control over. It sounds like you have found what is most comfortable, now it give it some time and let it "work" for you. IMHO don't try to make it perfect sleep each night.


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Snoozin' Bluezzz
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Post by Snoozin' Bluezzz » Wed May 17, 2006 10:42 am

No, no other factors are changing. This has happened multiple times as I try to use these two interfaces, particularly Headrest/Aura. First day is fine except sleep is shallower, second day sleep remains shallower and waking/bathroom trips are more freqquent, third day next day fatigue is more noticeable, 4/5 day I have morning headache. I thought it was sensitivity to leaks around the pillow but leaks numbers are low and what leaks there were I solved with RG's additional "soft and stretchy" strap.

I don't understand. I was speculating on some exhaust/CO2 problem but I really have no idea, that's why I am asking.

David

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ozij
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Post by ozij » Wed May 17, 2006 2:03 pm

David,
Have you tried raising the pressure 1 cm when you switch interfaces?

I think the business end of the mask may produce different pressures depending on the masks flow characteristics.

It is just possible that the effective pressure coming out of the Swift is slightly higher than that from the other masks. It's concievable - to my unprofessional mind - that the slighly lower pressure from the Aura would result in arousals that will not necessarily be reported by the software.

You will even see companies informing you - sometimes on a temporary basis (pending further testing)- that this or that mask has not been OKayed for use on their own automatic machines (they never do the tests on someone else's masks, or machines).

You seem to report that you feel undertreated when you use the Aura and the CL2 - and I remember at least one poster -Jere? - who reported that raising the pressure for the Aura made his day.
O.


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Snoozin' Bluezzz
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Post by Snoozin' Bluezzz » Wed May 17, 2006 2:07 pm

I did do that. My titrated pressure was 8cm. When I tried the Headrest I raised it to 9. I have since left it there even on the Swift. Perhaps now that I solved the leaks I need to try 10cm. I'll wait until I overcome some of the sleep/malaise debt before trying that.

It seems strange though that my AHI (when I used the used APAP) is good on the Headrest. Under 1.5.


David


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ozij
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Post by ozij » Wed May 17, 2006 2:13 pm

Respiratory effort-related arousals (RERA) are secondary to subtle obstructions of the upper airway during sleep and can appear in the absence of a predominance of apneas and hypopneas, causing excessive daytime sleepiness.
http://www.ncbi.nlm.nih.gov/entrez/quer ... t=Abstract.


Indications for Positive Airway Pressure Treatment of Adult Obstructive Sleep Apnea Patients: A Consensus Statement
A respiratory effort-related arousal (RERA) is an event characterized by increasing respiratory effort for 10 s leading to an arousal from sleep but which does not fulfill the criteria for a hypopnea or apnea. A RERA is detected with nocturnal esophageal catheter pressure measurement, which demonstrates a pattern of progressive negative esophageal pressures terminated by a change in pressure to a less negative pressure level associated with an arousal. Novel techniques are available that may allow for increased technical ease in the detection of RERAs

As we can see, measuring RERA's is a real pain: it has to be done by measuring esopahgal pressure in the sleep lab... even less fun than usual.

O.


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Additional Comments: Machine: Resmed AirSense10 for Her with Climateline heated hose ; alternating masks.

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Snoozin' Bluezzz
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Post by Snoozin' Bluezzz » Wed May 17, 2006 3:00 pm

It would be interesting to know oxygen saturation levels associated with RERAs.

They sound so subtle that an APAP would not recognize and adjust for them.

Interesting. Is this the indicator for UARS?

David


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Post by Sleepless in St. Louis » Wed May 17, 2006 3:15 pm

David, I also use the Swift and I know that my sleep is not consistent every night. What size pillow are you using and did you try other sizes just to see if they work better/different for you. My DME started me on the large size and I moved myself to the medium which works much better for me for some reason. Also watch what you eat and when. Spicy foods, especially if I eat late, will make me sleep less deeply for some reason. What you are describing is odd, but there must be some sort of pattern. Maybe you could keep a diary of what you had to eat, when you ate, what time you went to sleep and things like that. Then rate how you feel on a number scale and record your AHI as well for that night. Maybe over time you'll see what variable in this complicated mess of information is the one, or among the ones, that are having the biggest impact on your quality of sleep. When in doubt, try to collect some data over time to try to make sense of it all.


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Snoozin' Bluezzz
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Post by Snoozin' Bluezzz » Wed May 17, 2006 3:39 pm

My problem is not with the Swift. I have that under control other than I would like an alternate to switch off with.

My problem is with Headrest/Aura and CL2, particularly the Headerst which I would like to be able to my primary. The problem has not been variable, it has been consistent. 4-5 days on the Headrest and I feel like crap. AHI is good, no leaks but I feel like crap. This makes no sense to me, it just doesn't. Perhaps RERA or UARS is the culprit. Perhaps going up one more notch in pressure might help.

We will see.

David


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Post by Gidgie » Wed May 17, 2006 10:15 pm

Some of us, I know, have had to search long and hard to find the right mask/interface for them.........this might not be what you want to hear......BUT......have you considered trying a different mask? One you can use successfully use night after night?

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not knowing what UARS was, I looked it up....

Post by brasshopper » Wed May 17, 2006 10:35 pm

Found this, which I thought was interesting:

http://www.ncbi.nlm.nih.gov/entrez/quer ... t=Abstract

Given the above, (and I think this is what was being suggested) the different masks might have just enough different resistances that they would cause disturbances.

I also wanted to understand the masks you were using; I think you did poorly with this one https://www.cpap.com/productpage.php?PNum=1717&PAID=215 and this one https://www.cpap.com/productpage/Comfor ... -Mask.html

while this mask works well for you: https://www.cpap.com/productpage/resmed ... ystem.html

I am not a medical type, but I was a scuba instructor. Were someone doing a dive and had they said, "Gosh, I couldn't relax and now I have a headache," I would have suspected hypercapnea (CO2 retention) which would cause both the tension and the headache and would have asked if they were forcing a deep breath occasionally to flush their lungs. Breathing while diving changes your buoyancy - by about a pound per pint of air - so people take shallow breaths so that they can maintain a vertical position in the water column. This turns out to be a bad habit - you need to breathe, as we all know.

Of course, you can't consciously take periodic deep breaths while you are sleeping, but one thing that I really think about is both retained dead space and the way the mask ventilates.

I actually thought I had better nights with the old nose mask if it leaked a little as long as the leak did not blow into my eyes - my thought was that the leak flushed the exhalation out of the mask.

I only own one of the masks you mentioned - the Swift. One thing I have noticed about it is that it just flat DUMPS air out those little holes - my old mask had a section of hard plastic tube with some angled cuts in it, and, well, it sort of leaked a little air by comparison. And the leaks were out past a fairly large tidal space - not a huge space. I sometimes wondered if it leaked enough volume to clear the tube of rebreathed air.


I have no such worries with the swift - in fact, sometimes I feel like there is almost too much air dumped. The swift also has the holes right near the nose piece - meaning that there is almost no additional unventilated tidal volume.

The swift also seems to breathe freely. How do the other masks compare in regards to dumping exhalations, free breathing, and unventilated tidal volume?

When I first started this, I was told that there were two alternatives for exhalation air - one was a valve that was set to your pressure and which would dump when the circuit went overpressure - which would happen when you exhaled.

There was a bit of hysteresis in the valve - that is, the pressure to keep it dumping was not as high as the pressure to open it - and then, as soon as you started inhaling, that allowed the valve to "snap" shut and completely seal.

I was told that those valves were technically better - but fragile and not usually recommended because of the fragility - or the fact that a little dirt on the sealing surface would cause them to leak, and no matter what they died after a year or two. I don't see anyone selling anything I recognize like that at all these days. Also, they needed constant cleaning.

The other was the type I had where there were constant dump slits.

Now, back to the Swift - I also believe that it is an irritating nose thing to use. That hose hanging off to the side is sort of odd. It tends to blow air right in your nose and all that, and to blow hard. The first night, it was incredibly comfy, and then, well, frankly, it got less comfy. I'm find I'm blowing an interesting and colorful assortment of ooze out of my nose in the morning. I find that changing the nose piece to one that is a different size every couple days helps. All that is to say that I really understand why you want to change out of it after a few days,

But I can tell you that the way I sleep with my nose mask and with the pillows seems different. If they could titrate you endlessly, it might make sense to try you in different masks - but there is a payback point.

If this makes any sense to you, then you might look at the masks and decide which ones have a larger unventilated tidal volume. Try leaving a tiny leak to make the whole mask ventilated. Maybe, if you have a teeny tiny drill bit, you could make a teeny tiny hole that would allow more of the mask to be ventilated - if it is a bad idea, you can probably patch the hole with a bit of paper and some superglue. If it is a good idea, you might try plugging a couple of the holes in the mask and making some holes where more of the mask is ventilated - so that you end up with more or less the same leak area and a better ventilated mask.

Different people really are more or less sensitive to retained co2. One of the good things about those old Mike Nelson two hose regulators is that they inhaled from one side and exhaled from the other (and when Mike cut the bad guy's air hose to disable him, he always cut the exhalation side) so you were breathing in hardly any of the air you breathed out. But this big old regulator that sits in your face, well, you inhale and exhale through that same volume, and it means that there is a regulator full of exhalation you are gonna inhale - and the exhalation is probably only 10% O2 rather than the 21% you breathe in. And that little bit of air, well, it has the CO2 you just exhaled - and you breathe that in too.

Some people didn't notice the little extra CO2 - most people didn't - but some people were sensitive to it.

There were low volume regulators, and sometimes a change to a low volume regulator would cure post dive headaches - just because the diver would be pulling in less air that they had just breathed out. Good luck.


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Snoozin' Bluezzz
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Post by Snoozin' Bluezzz » Thu May 18, 2006 7:18 am

Some of what you said made some sense to me. I think, bottom line, you said that perhaps, for a sensitive type like me (maybe) that the Headrest and CL2 may not be exhausting as much exhaled air as "I" need and that too much CO2 is being retained, which I am rebreathing, and this may be way I feel crappy - which is what I was beginning to suspect. What I didn't understand is why it doesn't seem to bother other but you report that some are more sensitive to the CO2 than others which could explain my problems. I wonder what the nature of this insensitivity is?


Again, I need to say, I am not unhappy with the Swift per se, I just would like a mask that works for me to put in rotation. Some folks seem to be OK with one mask all the time, I am not. I get "tired", for want of a better word, of the Swift after 5, 6 or 7 days. My nose gets a little sore and the headgear starts feel quite confining. Most nasal masks are not an improvement to this feeling, they are as bad or worse hence my desire to make the Headrest or CL2 work but...

I don't think I am going to lab rat exhaust holes. Way beyond my comfortable level of competency.

Thanks for the feedback. It was helpful

David