5 months in....

[the guvnah]

   
Hello and thanks in advance for any insight and help you can provide. I was diagnosed with severe sleep apnea this year. I have gone from a full face mask to nasal pillow and now to a nasal mask. I slept the best with nasal pillow but had serious aerophagia issues which remain today with the nasal mask. Currently, I can only make it 3-5 hours most nights with the mask on before I wake up. Oftentimes this waking up coincides with pretty severe stomach/bloating pain and that keeps me up for a while. I rarely put the mask back after waking on since it seems like it caused the problem in the first place.

I am a side sleeper and trying to eliminate my mouth breathing. I've used nasal strips, mouth tape, and a chin strap. None have been very effective; I still usually wake up with a very dry mouth and stomach....issues. My doctor advised me not to reduce the pressure but I am swallowing so much air I am in pretty bad shape some days. I generally prefer being tired than being in pain and have started skipping days with some regularity.

Here is some info from my titration study if that is useful. And also my latest Oscar screenshot.

This patient has been previously diagnosed with severe obstructive sleep disordered breathing (HSAT on 1/25/22, AHI = 75.1,
O2 nadir 51 and the T<88% = 333.6 min).
1. CPAP titration was performed with pressures ranging from 6-12 cwp, however due to persistence of respiratory events, the
patient was transitioned to Bilevel PAP in S mode then started with pressures from 14/10 and titrate until 22/14 due to
presence of hypoxemia. Of note, REM sleep stage in supine position was not observed.

[Sleeprider]

You should start using a recording oximeter based on your titration results that found hypoxemia. The answer to improved oxygen perfusion is not pressure or pressure support but Positive Expiratory End Pressure (PEEP), or more likely supplemental oxygen bleed. For the centrals, I recommend changing the trigger sensitivity setting to high or very-high. Your pressure support is very high at 22/13 pressure it is 9.0 cm. This is more like ST settings rather than bilevel. I'd be very interested in doing a self-titration in Vauto mode and starting with EPAP min 12.0, PS 4.0 max pressure 25 and see what that actually looks like. Certainly likely we will raise PS, but we do need to have an idea of what is going on with your oximetry. Your settings look uncomfortable and result in high leaks.

We don't get flow limit data in S-mode. At the very least I would like to see you change to Vauto mode at EPAP min 13, IPAP max 22 and PS 9.0 to see what the flow limit data shows. That pressure support is ridiculous and your median tidal volume of 700 mL and minute vent of 8.4 are very abnormal unless you are some kind of giant. You appear to be using a bilevel pressure inappropriately to avoid supplemental oxygen, resulting in chronic hyperinflation and hyperventilation. I would still like to see you attempt to re-titrate and monitor oxygen.

[the guvnah]

Thanks very much for your insight. I am 6'1", 220.
    I tried to follow your instructions last night ("Vauto mode at EPAP min 13, IPAP max 22 and PS 9.0 to see what the flow limit data shows") but I'm not sure I changed the settings properly. I lasted a little longer than the night before but it was a mighty wind a-blowing all night.

[Sleeprider]

Not quite. We need to lower the Pressure support setting from 9.0 to 4.0. What you did was put the machine in Vauto mode rather than S-mode, so you're halfway there. The settings you ended up with were identical to what you had before, but Vauto mode. My thought is that the lower pressure and pressure support is going to be your magic moment. Should be much more comfortable and will still cover your pressure needs. So to be clear, your settings should be EPAP min 13.0, IPAP or max pressure 22.0 cm and PS at 4.0. The only change you should need is PS 9.0 to 4.0.

[taylorgtr]

If your problems persist, can you talk with another doctor to make sure you're covering all the potential issues?

[the guvnah]

   
Well that sure was a lot more pleasant. I think I got a good sleep! Thanks again for your advice. The lower settings unfortunately did not solve my air-swallowing problem/stomach pain like I'd hoped it would, but I'll go back to the chinstrap and mouth tape and see if that helps.