CPAP journey start - please help (thread)

[Sleeprider]

Could the headache after a morning sleep without CPAP be due to apnea or not using the therapy?

[Negligee1136]

Could the headache after a morning sleep without CPAP be due to apnea or not using the therapy?

Really hard to say to be honest, but I am suspecting that. 

Perhaps my focus now should be on resolving the times sleeping without CPAP since the numbers look good while on CPAP. 

For some reason, I sleep less hours with CPAP than without. I take the mask off. This is weird to me because I don't find the P10 I use uncomfortable at all, in fact it seems very helpful in keeping my nose working all night (without it, I wake up with a semi or fully blocked nose). 

It's like, I wake up more frequently with CPAP (or at least these awakenings are more intense in that I actually remember them), and sometimes it's challenging to go back to sleep; whereas without CPAP, I could be waking up just as much (for all I know) but never remember that and never struggling to go back to sleep. 

This is true specifically for the second half or the night or in general late night / morning sleep; in the first part of the night, there is no such issue, so I am focused on REM-related issues for finding problems. 

This screenshot is what happened yesterday when I woke up and turned off the CPAP: I read this as some breathing-related effort ending in OA and in an awakening. Those flow rates preceding that look rounded, but they are very low (sub 18). The bump in the pressure doesn't seem very dramatic at that time so hard to imagine that is that disruption from pressure increase led to that awakening. However this is just the last awakening, in other awakenings preceding that we have established these look spontaneous.

What I am now suspecting also with your assistance is that instead of there being issues left in CPAP therapy optimization, it seems more likely the problem is in sleeping with CPAP AND getting enough hours of sleep at the same time. If I sleep without CPAP, I do get the hours - but of garbage quality. With CPAP, all looks good - but just not that many hours. I will wake up with sub-7 hours of sleep.

- Does this sound like a good lead and any thoughts on this?
- I will just continue as-is for a week or so and re-assess

[Sleeprider]

The 7:54 sigh is just a larger than normal inhale followed by exhale. No obstruction. That is likely movement or a yawn. The OA does not appear to be obstruction and looks like two inhales and a breath-hold. I agree with the way your thinking is evolving on this. For me, sleeping without the PAP is not an option. Power went out at 5:00 am the other night, and that was the end of my night. I called in the outage and tried to rest until daylight, but as I drowsed off I always awoke abruptly with a classic snore. I think I can relate to your epic headache. There is nothing unusual about awaking during the night, but my approach to it is to just remain relaxed and not discontinue therapy. I also try not to look at the time or certainly the phone.

[Negligee1136]

Thanks. 

I have been listening to Thelankylefty27's videos and there's one titled "Why You Feel Worse with CPAP and How to Feel Better"

I will continue CPAP this week as mentioned, but that video makes me wonder whether i could be suffering from "leak-related arousal" rather than anything breathing-related at all. 

I am attaching a screenshot with some sections highlighted. Focusing on leaks. What lankylefty mentions is that leaks from nasal masks, regardless of how small, can cause an awakening - so to look at short, even very small leaks (not the prolonged, stable ones) and look for related arousals. What I see by doing this is indeed short leaks that have a corresponding spike in the flow rate (an arousal?) (my highlighted section from 4:20 to 5:40) while the "stable leak" later (7:30 - 8:00) is not associated with such flow rate spikes. 

I am therefore now considering whether there is a "leak related arousals" thing going on here. Will try mouth taping.

[Negligee1136]

Hey just a small update.

Been waking up better. More and more convinced the mouth leaks are the residual problem here. I think I am so close to success.

[Negligee1136]

--- minor UPDATE ---

So it's day 3 or 4 or trying to fix this. I wake up better as I mentioned. Getting out of bed is no longer torture, but I have had good sleep before and this is still not it. Sleep feels light, there's awakenings everywhere.

Apple Watch data evidences still strong sleep fragmentation. I believe OSCAR data shows fragmentation too (the spikes in the flow rate, see screenshot).

This seems to be leak-driven. Beard was shaven and mouth taped but that didn't help much.

I will try the tongue-suck-to-the-roof because it seems apparent to me there are myofunctional issue. Might even get a myofunctional therapist. BUT IN THE MEANTIME...starting to give up on the P10 which I will miss greatly.

An F30i is on the way.

[Negligee1136]

Hello, I am still fighting here to get results. Not much so far

I have a number of CA events now. I am not sure these are central, I think they are more like unclassified. Can someone help decipher what these are? 

This has been a particularly bad night (subjectively) with intense sleep deprivation and basically non functional during the afternoon until I took a nap.

[Sleeprider]

I agree with your assessment the apnea are not conventional CA. It two examples the flow become obstructed or flow limited entering the apnea ant the third is mid-arousal. Hard to say for certain, but this may be really ephemeral positional obstruction. Just brief chin tucks or other flow limitation that does not result in full obstruction of the airway, but restricts flow enough to mark an apnea with open, or partially open airway.

You are using fixed pressure and it might be interesting to allow some limited pressure increase to see if these events can be treated.

[Negligee1136]

I agree with your assessment the apnea are not conventional CA. It two examples the flow become obstructed or flow limited entering the apnea ant the third is mid-arousal. Hard to say for certain, but this may be really ephemeral positional obstruction. Just brief chin tucks or other flow limitation that does not result in full obstruction of the airway, but restricts flow enough to mark an apnea with open, or partially open airway.

You are using fixed pressure and it might be interesting to allow some limited pressure increase to see if these events can be treated.

Thank you sleeprider, indeed to be honest they resemble more in flow the couple of hypopneas I got. 

I will increase the range a bit. Good to know at least there is no treatment emergent CA as of yet. No treatment emergent CA is also encouraging for me because I am looking to arrange BPAP to try higher PS to see if any subjective improvement.

[lexit957]

Just wanted to say keep going! I gave up in my therapy since I felt like I wasn’t getting anywhere but now thinking I need to go back to it. My numbers are somewhat similar to yours btw.