CPAP Mystery -- Why Isn't It Working?

[Tabbycat]

Something very weird is going on with my CPAP therapy.
I need help figuring out what it is.

I've been away from the board awhile.  To recap, I was diagnosed with OSA in April 2012.  My AHI is very high if on my back, but measured at 19 on my side.  I have never slept on my back except during the sleep test.  I've used CPAP on and off since then, mostly on since changing to a ResMed S9 AutoSet and a P10 nasal mask.

For several years now, I've slept with the S9 for 5-6 hours per night.  I then usually wake up and have to use Xanax to get back to sleep for another 1-3 hours -- usually without CPAP.  Most of the time I just can't get back to sleep with the mask on.  

I rarely feel I get enough sleep any more.  Before I turned 50 in 2011, I woukd often sleep 9-12 hours if needed, and wake up feeling refreshed.  My sleep quality seems poor, even though my S9 says my AHI is always 0-2.  Once in a rare while I manage to sleep an entire night on the mask. I then wake feeling pretty good, but rarely great.

Here's the weird part:

For various reasons, usually involving a hotel night, I sleep without the mask.  Not only is my sleep usually not worse, it's frequently better.  I spent last night in a hotel without CPAP, and slept only seven hours.  But I woke up feeling really good -- better than I've felt in months.  I even had that tingle in my leg muscles that I used to feel after getting a particularly restful sleep.  And the feeling has lasted all day.  Not a single yawn.

I have had the feeling for a long time now that there is some aspect of CPAP therapy that is doing me more harm than good.  I'm just not sure what it could be.  

I do have some theories but I'd rather hear yours first so you're not influenced.  Maybe one of you has run into a similar situation and has some insight?

I welcome anything helpful.  
Just one ask, please: no jumping to conclusions.

Thanks.

[Melman]

Welcome back. I see you have SleepyHead. Posting some data would be helpful. See the links blow for how to organize and post your data.

[trish6hundred]

Hi Tabbycat,
WELCOME BACK! to the forum.!
Hopefully, you will figure out your CPAP mystery, good luck to you.

[DeepBreathing]

From what you say there is something about the CPAP therapy which is disturbing your sleep to the extent that the disturbance outweighs the positive benefits. Off hand I can think of a few things which might be happening, but these are only guesses - as mentioned above, it would be good to see some charts.

Mask discomfort: The mask may be irritating your skin. It may not fit well and be squeezing your nose or other parts of your face. (I see you're using the P10, so maybe it's irritating your nose). The headgear may be too tight or too loose or pressing on a sensitive area or trigger point. (Being a P10 it's highly likely it doesn't fit properly - it is a shocking example of poor design). The little connector hose might be rubbing on your face. The mask might be leaking - either blowing into your eyes or making "face fart" noises. The exhaust vent might be blowing onto exposed skin.

Humidity: May be too high or too low. Or the air temperature may too warm or too cold. You might be getting rainout - drops of water coming through the mask.

Hose: The hose might be getting tangled, or pulling on you or moving under you so you're sleeping on top of it.

Noise: The noise of the machine might be irritating - too loud or maybe there is a whine or whistle. Else the noise might be rising and falling as you inhale and exhale.

All of these are physical phenomena, any one of which can disturb your sleep without actually waking you. So you might not even be aware of them. There are also psychological issues around being tethered to the machine.

No answers here but a lot of things you might want to think about and see if any apply to your case.

[chill]

As you have an autoset, I will add pressure changes.  I think that I have slept better since putting my auto machine into CPAP mode. I need to change it back to auto to verify.  Auto mode is not better for everyone.

[quiescence at last]

I would also try a low pressure setting for a couple nights and this will record how you breathe and sleep, even though it is not at the right treatment level.  If comfortable breathing at pressure of 6, (min 6 max 6.4) try that level with EPR set at either 1 or OFF.  Then you can see what kinds of events you have with minimal intrusion.

reviewing some of your past posts, I wonder if you still have a Pulse Ox device, and could you post a night of pulse Ox only without the APAP machine?  Of particular interest is what variations to pulse rate occur throughout the night.

I do not think I have ever seen any of your sleepyhead charts.  could you dredge one up for us from recent past and post it?

QAL