9 months in with no meaningful change

[johnald]

   
Hi all! Thank you all for the time you put in to this forum and for helping people like me try to get their stuff together.

I'm exactly 9 months into CPAP and am still struggling to make this all work. Some snippets:
- I use nasal pillows and actually find them pretty comfortable
- I am able to fall asleep immediately most nights, but come 2-3 hours in and my mask is stripped off
- I recently took a video of me sleeping and found I was tossing and turning for a while before the mask came off, not sure if it fell off naturally or if I subconsciously pulled it off
- I've played around with different settings both per my doc and with guesswork, haven't noticed a trend (but am also new to OSCAR)
- As a plus, I find I rarely wake up to use the bathroom in the middle of the night anymore. However I still feel exhausted when waking and throughout the day, have poor focus, poor short term memory, etc.
- Lastly, I was just started on a prescription of Adderall 15mg (starting at half that to ease in) and today is day 2


Hopefully we can find something that works. The attached image is from last night (8/15/2024) which I would consider to be an average night's rest. Thank you all in advance

   

[Narcil]

can you post a few more nights of data? and make sure you include the flow rate graph too plz.

That one night it looks like you took it off after mouth breathing got a bit out of control. never have dry mouth when waking up? have you considered something to help with mouth breathing? a chinstrap, soft cervical collar or mouth tape?

settings look pretty good like that in my opinion, machine only increases pressure when you have mouth leaks.

[johnald]

Thank you! Here are the previous 3 nights attached. What are the typical indications for mouth breathing? I thought pressure would go up anytime there is an increase in pressure/resistance, not a decrease (which is what I would expect with mouth breathing). 

I typically wake up thirsty (although I'm always thirsty) and without a dry mouth.

Fixed the screenshots to have not scrolled down and they include flow rate

           

[staceyburke]

It looks like you only have the machine on for 1 to 2 hrs a night?   The flow rate is missing during the other time the machine is on.  Are you taking the mask off?  You can't expect the therapy to work in that short of a time each night.

[johnald]

Yep, I’m not able to keep the mask on throughout the whole night. It seems like I do well with it on, keeping my AHI below 2-3 most nights. I’m hoping to get more insight into why it’s not staying on. It’s comfortable when I fall asleep with it on

[staceyburke]

6 min is really low and most adults would need more than that not to feel like they are air starved.  I personally need 10 to 11 or I take my mask off during the night. So with that in mine I would raise the min to 8 and put the EPR to full time EPR 3 and see if that helps.

Min 8
EPR full time
EPR 3 

If that does not help raise it the next night to Min 9 keeping everything else the same.

[Deborah K.]

You need to turn ramp off.  You get no real therapy during ramp, and you don't need it.  Also, every time you remove your mask then put it back on ramp runs again, robbing you of valuable therapy.

My guess is that you are mouth breathing during your sleep, thus causing your high leaks.  The easiest and surest way to fix this is with mouth tape.  I thought I would hate it, but once accustomed to it you won't even notice it.  You need good tape.  I started with one that was very comfortable, but then realized I was still having a lot of leaks.  Lots here like Cover Roll Stretch tape or Hypafix tape, and they both work well.  I like Theraband Kinesiology tape as I find it more comfortable, but it does cost more.  As Queen of the Wimps, I found good tape painful to remove.  Then I found that spreading Milk of Magnesia onto my skin where the tape will go, then letting it mostly dry before placing the tape on saved me from the pain.  Yay!  I just mention it in case you too find tape removal painful.  

You should turn your starting pressure up to 8 as Stacey says.  You'll get better therapy.

You would benefit from using EPR full-time, set at 3.  This will lower your flow limits, which are like small apneas, and should be kept as low as possible.

As to keeping your mask on, some use tape attached to both sides of their mask and attached to their cheeks.  That way, if you reach for the mask in your sleep, the tape will pull a little and alert you to leave it alone.  I understand that it does work and that people who use it don't need it very long.

Best of luck with improving your therapy and comfort!  

[johnald]

Thanks for the suggestions everyone :') I'll give a few of these a try over the next 1-2 weeks and report back!