Advice wanted for CPAP settings & central apneas

[Dormeo]

Time to raise your pressure. Try min 10 max 13 and let’s see what happens.

[EnigmaticToad]

Since there is a limit of 3 attachments per post, I will split results from the last 5 days into two posts.

It has been a pretty turbulent week for sleep. I feel like my ability to tolerate using a CPAP has been getting worse over time rather than better. I've had to use it while awake for the past 3 days to get to 4 hours of usage for insurance compliance -- something I've never needed to do before (occasionally I'd fail to make it to 4 hours, but not often enough that I needed to artificially boost the numbers on those days).

So that you can focus on times when I was asleep and ignore sessions when I was fully awake, the dates and times that I used the CPAP while awake are as follows:

• 5/12, 23:20 to 2:40. Actual sleep sessions begin at 3:20.
  
• 5/13, 6:30 onward.
  
• 5/14, 18:30 to 20:00 and then the last 15 minutes. (So 21:30 - ~23:45 is when I used it while asleep)
  

In the screenshots, I have marked these time ranges with a red underline under the flow rate graph. So remember - NO red underline on a session means I actually fell asleep during that session. A red underline means I did NOT fall asleep (and did not intend to).

It really is strange that I have no problem falling asleep initially, but once I wake up, I can't stand having the mask on. Ideally I just wouldn't wake up, but right now that isn't reality. In an attempt to improve comfort, I am going to try switching to a nasal mask rather than full-face. When I first started using a CPAP I felt that a full face mask would be best for me as I know I often breathe through my mouth, but in general that hasn't been the case nearly as much (as far as I can tell) on higher pressures.

I do not have the new mask yet though - still waiting to hear back on scheduling an appointment to try some out. So in the meantime, if you have a suggestion for a settings change, I can give that a try. If not, I will stick with the current settings for a bit longer and see if things get better.

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Second set of attachments. See previous post for context.

EDIT: Oh, it combined the two posts into one. Cool.

[Dormeo]

So sorry you're having a tough time. I'm trying to think how to make things more comfortable for you. It's hard for me to see a clear pattern to your wake-ups, but they do seem to come soon after periods that include OAs, snores, and/or flow limitations.

To address the snores and FLs, it'd be good to try EPR at 3. To compensate for the greater drop in your exhale pressure, you should raise your minimum by at least 1. Try those two changes for a night or two and let's see what happens. It may be you'll see more CAs, but unless you get a boatload of them, I wouldn't worry too much at this point about them.

Depending on how things go, you may then want to raise your minimum a bit more.

Why are the start times so different? Do you go to sleep at very different times each night?

I think you're smart to try out a new mask. Many people find a nasal mask comfortable; others prefer a nasal pillow mask. If you can afford to buy a mask on your own dime, Supplier #42 has a good return policy; this might enable you to try out more masks more quickly than via your DME.

Keep us posted, would you?

[EnigmaticToad]

Hello!

The first chart attached to this post is from 5/15, the first night on your suggested change (EPR to 3 with minimum pressure increased by 1). 

The second two charts are from last night - my first night with a new mask (AirFit N30i). I love this mask!  I still woke up a few times throughout the night, but there was no discomfort that prompted me to take off the mask, so I was able to just go back to sleep. The only exception is that the last ~hour and a half of sleep was without the mask on, because I was having a little bit of difficulty falling back asleep, so I decided to try taking it off. In hindsight, I don't think that actually helped and I probably would have been able to get back to sleep with the mask on. So going forward, I will be attempting to use it for the full night with no exceptions.

Overall, an enormous improvement in terms of comfort.

As before, sections where I used the mask while awake are marked with a red underline. Hopefully that will no longer be necessary.

I can post charts from 5/16 through 5/22 if you feel there would be a benefit in seeing them, but it's just more of the same. Central apneas did not make a significant comeback until last night.

Regarding your question about sleep times - I hope you will see more consistency going forward. I admit I've had difficulty for most of my life maintaining a consistent sleep schedule. For the past week I've successfully forced myself to stick to a schedule and I intend to keep it, as I do think that's a problem which needs to be addressed.

[Dormeo]

I'm so glad you found your "keeper" mask! And yes, keep it on; don't teach yourself bad habits. Soon you'll find it's just not an issue. And you're smart to work on your sleep schedule. I know from experience how hard that can be, but it's really important.

That was a lot of CAs that one night. The zoomed-in view shows that you were really not asleep during that burst of CAs, and I'd be willing to bet most of your CAs follow arousal breathing. In that sense, they aren't really *sleep* apneas. So I'd suggest you stick with your current settings for now; as you start sleeping better, and as your body adjusts to the EPR of 3, the CAs are likely to settle down. The benefits of the EPR for FLs and snores are clear.

[EnigmaticToad]

Hello. It has been a while since my last update.

The past few weeks have mostly consisted of me fiddling with settings to try to further improve comfort. I was having a problem on some nights where I'd feel like I'm having difficulty breathing through my nose, which would make it challenging to sleep. This was never accompanied by increased obstructive apneas, so I suspect it may have been a perception issue.

Regardless, I've been able to resolve it with gradual pressure increases. I think I've found a sweet spot at about 16. When I was using a full face mask, higher pressures resulted in greater discomfort. But using the new mask, it is the exact opposite, with higher pressures feeling more comfortable.

I've been able to use the machine for between 8-9 hours most nights. While that is a spectacular improvement compared to before, I confess it is still not for the full duration of sleep. I usually get about an hour to an hour and a half of additional sleep after removing the mask.

Now that I feel happy with where the settings are at from a comfort perspective, here are some charts.

Thanks!

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Two more charts.

[Dormeo]

Thanks for the update. You're having more CAs than we'd really like to see, but I still do suspect that they are set off by arousal breathing, with arousal being the more important issue than the CAs themselves. You could try reducing EPR to 2 to see whether that makes a difference, though I hesitate to recommend anything that might make you less comfortable using the machine most of the night. But if you feel like an experiment, maybe try that one.