[CPAP] A Different Problem Every Night, Yet so Close to Perfection?

[Dulcinea]

Hi, I'm brand new to this board. I have experienced a lot of benefits from CPAP but it's still *hard* to get used to! I feel like I have a different problem every night.

My latest is that my ears really hurt when I wake up in the morning. It started when I started using a chin strap with my hybrid mask to keep my mouth from opening in the night. I don't know if I need to try a different solution like a cervical collar or if I need to have my EPR adjusted (like someone in an older post said worked for them.) I'm also trying to get an appointment to try a different (nasal pillow) mask. 

The frustrating thing is that my numbers look good to my sleep doctor--low leak rates and low enough apneas. So they are reluctant to make too many changes. But I'm waking up a lot in the night and some nights are really rough. 

Some of the things that are plaguing me (at different times) are: a whistling sound from my mask (doesn't seem to register as a leak in my data), my mouth opening, I still sometimes snore a bit but in a different place in my throat than I used to (and way quieter according to my husband), I can't really sleep on my side without my mask leaking unless it's strapped on really tight.

Does anyone have any suggestions/encouragement for me?

   

[Sleeprider]

Why not set the machine in Autoset mode so it can respond to those periods of greater obstruction? I have no problem with your fixed CPAP setting of 10 cm EPR 2, but you would probably do better in Autoset mode with minimum pressure 10, maximum pressure 13 and EPR 13. Obstructive events and flow limits occur in clusters, so watch for sleep positions and pillow height that might cause chin-tucking or positional obstruction. https://www.apneaboard.com/wiki/index.ph...onal_Apnea Also look to set ramp on auto and increase the starting pressure as you are able to tolerate it. Ramp is for rookies.

[CPAPfriend]

Maybe a different chinstrap could remove that ear pain.

Is it possible the whistling sound occurs when you're laying over the side arches of the mask while laying on your side / side of your face?

Your flow limitation and RERA clusters are about one sleep stage apart, suggesting they're primarily taking place during REM, but we can't say for sure. It could also be positional. I agree with sleeprider. Your data looks very upper-airway-resistance-y, so configuring a narrow autoset range and upping EPR to 3cm could help. Even better if you can use the autoset For-her algo, should you have that machine.

[Dulcinea]

This is what happened when I used an Autoset 8-12. 

   

The changes in pressure were waking me up, and I don't think the machine is very good at responding to what I need. In the middle of the night I changed the max to 11 because I couldn't tolerate 12 but I still didn't get much sleep. I changed the whole thing back to CPAP 10 the next night.

I asked my doctor about AutoSense for Her, but she didn't seem to know much about it. I could try that--maybe it would be better at responding.

I'm not sure what to do about sleep positioning. I sleep mostly on my back but I'd like the flexibility to be on my side in case my hips or back start hurting in the night. The mask wasn't whistling last night--the night it was, was when I was on my back.

I'll try out the AutoSense for Her, and I could definitely increase the starting pressure. I'll report back what happens.

[Sleeprider]

Dulcinea, did you read the positional apnea wiki? That is why your flow limits and airway resistance go from zero to 60 in clusters in spite of pressure increases. Next stop, soft cervical collar. http://www.apneaboard.com/wiki/index.php...cal_Collar Please know if you use a chinstrap that pulls your jaw back, rather than upwards, it is part of the problem.

[PeaceLoveAndPizza]

The machine looks to be responding properly to the flow limitations as SleepRider said. With your pressure maxing out at 11 or 12, you need to either increase pressure or reduce flow limitations.

Using a pressure range of 9-15 EPR 3 should be more comfortable. Basically back to what SleepRider originally recommended.

Also, look giving a soft cervical collar a try. It will not bother your ears, will help with leaks, and by keeping your neck better aligned will help with flow limitations.

If you want to go with a fixed pressure route, you’ll need to use a pressure of 10 or 11 with EPR 3. Once again as SleepRider originally recommended.

[Dulcinea]

I just re-read the positional apnea wiki and it's starting to sink in. I am definitely going to try out a cervical collar. I will report back in a week or so when it gets here and I've had a chance to try it. Thank you so much for your help!

[Dulcinea]

Here is my latest chart:

   

These are the things I have changed over the past week:

1. I am trying a new mask: Dreamwear "Under the nose nasal mask" Seems to seal just as well as the full face mask, and doesn't press on my mouth.
2. My settings are back to AutoSense 8-12 and the EPR is bumped up to 3
3. I am back to wearing the chin strap
4. I turned off the ramp.

I'm still waiting for Amazon to deliver my cervical collar, but I'm impressed with the improvements so far. I am no longer at a crazed level of sleep deprivation. I'm waking up only 1-2 times in the night, and I'm not sure if it's apnea or hormones (hot flashes).

My ears don't hurt any more. I think it was the EPR change that helped. But I'll try the cervical collar also and see if anything changes with that. 

Thank you so much for all your suggestions and encouragement!

[Crimson Nape]

Based on the chart above, you are there. Anything below an AHI of 1 is great. Don't expect a 0.0. They can happen, but it is not the standard. The standard is, an AHI as low as you can obtain while achieving a good night's rest.

- Red

[Dulcinea]

I'm happy with my AHIs, I just want to feel more rested during the day, and not wake up so much in the night. I'm pretty happy the little yellow lines (RERAs) have disappeared from my OSCAR reports.