[CPAP] Trouble staying asleep with CPAP

[sarahsleeps]

Thank you for sharing Jay51! What you describe definitely sounds a lot like what’s happening for me. I was told many many years ago that I wouldn’t be a good candidate for septoplasty because my deviated septum actually made one nostril useable, like one extra extra small nostril and one small one, if they evened them maybe I’d have two extra small ones instead. I don’t know if that makes any sense and I’m sure there are updated procedures since then so I’m looking forward to seeing an ENT again and looking at all the options, septoplasty, turbinate reduction, polyp removal, and maybe even tonsillectomy or adenoid removal.
How was your recovery after surgery?
Thanks again for your time and input!

[Jay51]

The first couple of days after surgery were rough.  ENT said surgery on Thursday, then rest Fri, Sat, Sun, and should be largely recovered the following Monday (about 3 to 5 days or so).  Lots of blood and mucous drainage those 1st couple of days, but well worth it in hindsight IMO.  I did my own cost-benefit analysis after consulting with ENT, and I am grateful I had the surgery.  A small price to pay for much improved nasal breathing.  Less congestion now, too, I have noticed.  You have multiple issues affecting your nasal breathing just like I did also.

[sarahsleeps]

Thanks again for sharing Jay! I’m glad that the surgeries were helpful for you and it’s encouraging to hear. While you were awaiting your surgery was there anything that helped you get through the night with your pap therapy? I’m keen to tweak my settings but I also sometimes wonder about positioning. I have been trying to lay on my left side so that my right nostril (the one that blocks) would remain as open as possible, but then my left nostril clogs a bit and I also wonder if just accepting a total blockage of the right nostril by laying on my right side would give me less flow resistance overall. I’ve tried propping a couple pillows up and sleeping on my back upright but that doesn’t tend to make much difference, if anything I think I open my mouth more and my jaw falls back more in that position.
I’m shocked that sleep doctors don’t seem to want to explore what is actually causing the obstruction with OSA before starting pap therapy. Mine wouldn’t even entertain looking at my airway when I mentioned that I experience trouble with nasal breathing. I had to complain to my family dr twice in order to get a referral to an ENT. If I weren’t online reading forums like this I don’t think I’d even necessarily know that these surgeries were an option!
Anyways thank you again for sharing your experience with me!

[Jay51]

One thing that helped me pre-surgery were over the counter nasal dilators.  Amazon has them and many other places.  I personally like the ones made of silicone rubber instead of a metal material because they were easier to tolerate for me.  They come in many shapes and sizes.  I wedged them into my nose at night and they kept my nasal passages open better for better nasal breathing.  They are relatively inexpensive.   Look them over and see if you could use them comfortably at night in your nose beneath your mask.  Read the reviews on them also.  

Keep following Sleeprider's suggestions, as they will optimize your pap therapy and make it easier also.

[sarahsleeps]

Thanks so much Jay! I will look into the nasal dilators, and of course following Sleeprider’s suggestions. Grateful for the help!

[sarahsleeps]

Hi Sleeprider, Jay51, CPAPfriend and anyone else that takes an interest in this thread! Firstly thank you so much for taking the time to look at my issues and help with your input!

An update for today...I did not yet take the plunge of changing my pressure settings, last night I felt like going right into 7 might be hard so I decided to start by removing my ramp, so starting pressure at 5 rather than 4. I could not fall asleep. I don't actually think that had much to do with removing the ramp as a starting pressure of 5 felt ok. Maybe when i ramp at 4 it is a little easier to take some deep mouth breaths when getting settled but I'm sure the difference is negligible. I'm usually still awake when my ramp is done anyways.

Basically I was awake from around midnight to around 4:30am, and in and out of cpap therapy even more than  the previous few nights. I've attached screen shots from my full night as well as zoomed in several areas. I included all the graphs for the full night. Should tidal volume look all over the place like this?

12:48-12:52 - I am definitely awake here so I am looking at this to try to further understand the flow rate / flow limitations and what my breathing is doing. Shouldn't it look more regular when awake? I seem to have some weird peaks even here?

3:18-3:22 - I must have started to doze here as a cluster of events starts. Pressure is still low and hasn't started to increase yet. No flow limitations that i can see here (yet). Worried about these CA events. Could this be treatment emergent central apnea?

3:22-3:26 - More CA and Hypopnea events, flow limitations start and pressure increases.

3:28-3:33 - More CA and Hypopnea events, pressure increasing.

3:36-3:41 - I think here is where I have woken up, and you can see I eventually give up. Flow limitations and pressure are high (pressure at 12), yet my breathing still looks shallow? Shouldn't flow limitations and breathing improve with the higher pressure? Isn't that the point of CPAP?

3:56-4:00 - I try again. Pressure is stable but still having CA's, Hypopnea, and a RERA.

I'm definitely in my head about all this because I realize when I turn off CPAP, I'm having a terrible sleep anyways, and so I end up fighting sleep and laying awake almost all night. When my body can't take it and falls asleep for a short time, I'm waking up all anxious that I was having apneas. I got out of bed at 6am so altogether I probably had like 2 hours of sleep and most of that was junk sleep.

My flow limitations - is this caused by my obstruction? I know I have major nasal issues, but as of now I don't know where the actual obstruction is that is causing my OSA so maybe it's actually my soft palatte or tongue or a combo etc. But I see way more CA events on my data than obstructive. Does that mean the CPAP is actually working on preventing the obstructive ones? Or I just don't have enough sleep data to really tell? If CPAP can't get through my nasal obstruction, should i still be using it while i await an ENT consult? Can it be making anything worse? As a reminder my AHI at sleep study was 77 with majority obstructive (not sure the exact break down - there were some centrals).

At the beginning of the night I did switch the mouthpiece on my mask. I usually use a small but I decided to try a medium in case that was more comfortable or gave me a better fit. I ended up feeling like the medium might be covering my nostrils a little with silicone, and so I went back to the small. According to the little fit template that comes with the mask I am a small, just trying things here and the CPAP provider was nice enough to let me try the medium on a free trial.

Plan is to work my way up to adjusting to a more stable pressure as per Sleeprider's suggestion. Seeing as my pressure right now is trying to go as high as 12 when there are events, would 7-9 be too low? Or do we think I would sleep through the events better at a max of 9, even if I still have them?

I know I've dumped lots of info and questions here. Feeling a bit overwhelmed today (and tired of course lol), so very thankful for this group and any input users here may have. Thank you!

[Jay51]

Great job hanging in there Sarah.  A stop-gap measure may be trying these nasal dilators in the mean time.  They are on Amazon for about $10.  Nose Vent Sinus Relief Dilator (Pack of 8 Various Sizes) - A Simple Solution for Nasal Snorers - Reusable Snoring Device to Enjoy a Peaceful Night's Sleep - by Mobi Lock

[sarahsleeps]

Thanks for the encouragement Jay! I’m going to order the dilators today, I’m not sure how they’ll work for me as my nose is so sensitive to anything right now. But willing to try!

Funnily enough my CPAP provider just called me to tell me they planned to set my pressure today and they were going to set it to 9. I mentioned adjusting the range to 7-9 instead and yes Sleeprider was totally correct that they can’t do that without speaking to the lab/sleep dr first. They are checking and calling me back, not that it matters, we all know I can set it myself anyways. They were telling me my data looks pretty good, ahi isn’t down to 5 but is under 10. I’m like yeah that’s cause I’m awake half the time. It isn’t working well in reality, but I guess they just look at the numbers without any real detail.

So glad I found this board and Oscar!

[sarahsleeps]

Update for today, hoping someone could please take a look and let me know any thoughts? Last night I showed Cheyne Stokes Respiration for the first time. I am extremely worried. I've attached the night view as well as a couple of close ups of the beginning and middle of the CSR.

Last night sleep was terrible and I found it very difficult to put the cpap back on in the early morning as I normally try to do. I had complete blockage on my right side of my nasal airway and thought that was causing the discomfort, but seeing the CSR this morning on oscar has freaked me out.

I have not adjusted my pressure except for removing my ramp. I am awaiting call back from the CPAP provider and was going to try some different pressure ranges once they got back to me and weren't looking at my data any longer.

Does anyone know if this is real CSR?  Thank you so much in advance for your input!

[Sleeprider]

CSR (Cheyne Stokes Respiration) is a particular form of periodic breathing alternating between hyperventilation and hypoventilation, characterized by a gradually decreasing respiratory volume with a CA event at the nadir, and gradually increasing volume out of the apnea. You don't have it, but unfortunately Resmed erroneously labels all periodic breathing as CSR causing a lot of concern and anxiety. Your particular version shows an oscillation of airflow that may or may not feature an apnea. We also note inspiratory flow limitation which suggests some airway restriction or obstruction. Normally, the CPAP responds to CA events with a reduction in pressure, but you can see the pressure increases in these charts in response to flow limitation.