ASV with Oxygen Drops, leaks and aerophagia

[redking2436]

First of all thanks again for the help from Jay51 and Sleeprider helping to adjust my machine settings so I could sleep with the darn thing, 

However things still arn't improving symptoms wise, I've had maybe a few good day's in the 7 months since properly focusing on getting the sleep apnea treated, unfortunately in the 10 months I've had the machine i haven't once had an opportunity to speak to a professional with only 3 monthly check-ins with a nurse who seems to just want the phone call over and not do anything such as try different masks etc.

So far I've bought the large version of the F20 mask as after using the guide realised when my mouth opens when asleep it caused the mask to leak, wasn't too expensive as I only bought the mask part.
I tried a chin strap but can only breathe through one nostril reliably, so losing mouth breathing hasn't gone well.

I wake up some days feeling like a balloon, and it can be quite painful, I've dropped my settings to Epap 5-7.2 and PS 3-8 and have been constantly trying new settings and then trying for a week to see if things improve.

I purchased a wellue sleep ring as it seems very highly recommended on this forum and i wanted to see if oxygen was having any impact, my o2 stats


A good day when I felt amazing was Thursday the 18th yet have felt fatigued and beset by mind fog on the days since, it in some ways made it worse as it let me remember what normal was like.

O2 stats seem to sit around 96 which i believe is fine, but there are multiple drops going down to the high 80's which i don't think is right. I have a bad habit where I will feel like I'm suffocating upon waking up and take the mask off only to then fall asleep, which is why there are gaps where the ring is still reading but no CPAP data.

Attached are the last 3 days inc o2 data,

Any advice on whether the o2 drops are red herrings and whether I can do anything about the aerophagia would be much appreciated.

[Jay51]

You are welcome, redking2436.  I think the place where the SPO2 drops so low is when you take off the mask and breathe room air.  

A few things on your charts.  Good idea reducing pressure some to at least be able to get to sleep and stay asleep.  As you get acclimated to this, you may be able to increase your pressures some in the future also.  

"I have a bad habit where I will feel like I'm suffocating upon waking up and take the mask off only to then fall asleep, which is why there are gaps where the ring is still reading but no CPAP data."   Many members here have described this same feeling, and it usually occurs when pressure is too low.  You are kind of in a catch 22 though, in that you still need the lower pressures to get and stay asleep, but they seem to wake you up at times with feelings of suffocating.  

Your heart rate charts shows a lot of spikes during the night, too.  Normal is usually more flat, straight across with very little, or small spikes every once in awhile.  Just something to keep an eye on.  

Kind of another catch 22 with the aerophagia.  Pressure needs to be high enough to be therapeutic and keep you from feeling like you are suffocating, but not too high as to cause a lot of aerophagia.  

I guess the only thing that I can think of is trying both increasing pressures slightly and then decreasing pressures slightly and taking note of what that does to you.   Not bad therapy right now, even with some aerophagia and a few instances of taking off the mask.  Probably a lot better than nothing.  But I applaud you for trying to optimize it more for both better therapy and comfort.  

If anyone else has any suggestions, please post also. 

[SarcasticDave94]

If you feel you didn't have enough air as your base, as in upon exhaling, try increasing EPAP slightly. You're seemingly at 5-7.2. Maybe just push the EPAP Min to 6, leaving EPAP Max as is. Try it and report back.

EPAP Max might need to go up as well, but consider EPAP Min first.

Next, on PS range, your 3-8 could go up or down as you see fit. Lowest allowed PS range will be 0-5. Your choice on mixing or matching this. Not sure how it'll affect therapy though.

Worst case if it goes bad after the edit, change it back ASAP.

[redking2436]

Sorry it took so long to reply, I managed to get the nurse i speak to quarterly to finally let me try a new mask so now have a Mirage quatro and it took time to get used to. But i find the mask far less claustrophobic than the F20 but getting it to sit on the face without leaks has been hard.

I raised the low 02 with her and she said it wasn't something to worry about but im not convinced. O2 has dropped to 79 at its lowest with multiple nights around 5 mins below 90%.

I tried changing PS min to 2 and didn't have any improvement for that week and had worse nights so changed it back, then tried raising PS max to 10 and had a similar experience so changed back to :
PS min 4
Ps max 10
epap min to 6 as suggested and haven't felt negative so left it at that.

Despite having very low AHI numbers i still have the headache in the morning which lasts all day despite paracetamol etc and is coupled with the usual lack of energy and brain fog.

Its been nearly a year since i started CPAP and whilst the headaches in the morning have receded that is the only real improvement I've seen so far.

All help in both threads has been incredibly appreciated, and any further suggestions more so.

[SarcasticDave94]

The stats look good here. I would think the oxygen dips being an issue still, although it's not evident in this chart. Anything where you're consistently at or below 89%, is a red flag.

[Jay51]

I am with Dave.  Lower SPO2 at night can cause headaches, too.   Either getting supplemental oxygen to bleed into your mask during therapy or raising the % of O2 from your oxygen concentrator to the mask seems like the most logical solution at this point IMO.  

If you sleep study had 5 cumulative minutes below 88% SPO2, then by Medicare you qualify for supplemental oxygen.  Also, your Dr.'s can prescribe supplemental oxygen based on other things as well for you.  Something to consider.

[redking2436]

Thanks for the replies, yeah i think the nurse brushing it off as nothing to worry about may have been wrong, she is mostly interested in ensuring I'm wearing the mask at night and ive made all the important pressure changes after input from this forum and its never been noticed on their end, coupled with no Dr ever talking to me about how things are I think lets things slip.

I'm going to try and contact the Dr directly and see what they say, I've attached some of the sleep ring data just in case anything else stands out.

[Jay51]

When you meet with the nurse again, have a copy of all of the nights where you spent roughly 5 or greater minutes below 88% SpO2 (*especially highlight the one where you drop to 79!)  This isn't a sleep study, but it is concrete data that you are still having problems with SPO2.