My Apnea is getting worse! And I am very tired

[oldfart59]

[attachment=12056][attachment=12056][attachment=12057][attachment=12058]I found that I was getting very tired lately, even fell asleep in a board meeting.   I had not been checking my CPAP till just this morning, its at 7.94, I loaded it into Sleepyhead, and saw that it has been increasing over time, worst was 13! I attached screen shots. Is there an issue with my machine and need it checked? I was down to <1 last year

Do I need to increase the pressure?  Do settings have to be changed periodically?  All I know is that I am very tired and I don't like it

[Diotima245]

Try setting pressure to 8/19 for one night.

[Melman]

I'm not adept at reading ASV charts but the clustering ofyour events suggests a positional issue in which you tuck your chin to your chest. Do you use a soft cervical collar? Many have found that to be very effective for the elimination of positional apnea. It has worked well for me.

[sheepless]

the collar will certainly help reduce ahi, particularly the clusters of events. if it was my chart I'd also observe what happens after raising min epap to 5. higher if indicated. epap is needed to head off ua and h as both are probably obstructive.

[mesenteria]

I agree with everything suggested, particularly sheepless' observation that, if it's true, your minimum pressure of 4 is certainly starving you.  Most won't tolerate that low of a setting, and need a minimum of 5-6.  Clustering most often is indicative of you wanting to sleep, but in a fixed position over a short period, persisting, and falling into a series of events that are caused by the same conditions...that being on your back, or head off the edge of a large pillow and tilted at a weird angle.  You're closing off your windpipe a bit too much.

How old is the cushion you're using?  We see reports that people get anywhere from a month to many months of use, but it depends on both the type of mask and the users.  It may be time to replace yours, or adjust the headgear...or the pressure.

[jaswilliams]

If they were my figures I would raise my ps max to 15, your machine is reaching the limits of your settings and still failing to regulate you breathing

[ajack]

I think Melman has the main problem being positional and it seems like that to me too. You have had advice to try the collar.
It can also be mask leak, where the machine will drive up the pressure to try and clear, but can't. You have a FFM. I would be clean shaven and do a mask fit function that blows high pressure.

It seems that you will also need to raise your pressure. The machine is choked down. Were you titrated on the machine in a lab?
I would try the min epap 5 suggested, you will see if more is needed.
min epap 5
max epep 15
min ps 3 (you may find some PS more comfortable)
max ps 19 (to allow the machine to work through it's full range if needed. Default is 15)

[oldfart59]

I'm not adept at reading ASV charts but the clustering of your events suggests a positional issue in which you tuck your chin to your chest. Do you use a soft cervical collar? Many have found that to be very effective for the elimination of positional apnea. It has worked well for me.

I looked up what this soft cervical collar is, and found a foam neck brace. I see walgreens sells them I will try it, but it is not comfortable. I'll see if I can sleep with it on and report back.

Also, I had the pressure set down to 4 as I was waking with stomach pain from the air pressure. But I will now have to find the tread that tells me how to get to the screen to adjust my machine again and try the settings ajack provided.

As for the cushion, it is not ripped, and I clean it every night. I also bought this cloth that fits between the mask and my skin, that stops the leaking. Do you think it is still leaking? I thought you only need to replace the cushion when it rippes. 

Well, If I have learned one thing, it is that when the AHI is high (Or not wear my mask), I am tired the next day!

I'll post back with my findings

[oldfart59]

Thanks all for the advise

So I tried the neck collar, it was awkward to sleep with, it still did not seem t o help much, see cart, I have ordered a new cushion for the mask to see if that helps. I did notice that there is leaking going on at the humidifier. I wonder if the increase in AHI issue is due to leaking other then at the mask, as I do not notice any mask leaks ( not waking up and it is not making noise like it does when I do have mask leaks). I will asso try increasing the lower pressure. (Once I remember how to get to the screen to let you adjust the pressure).

[PoolQ]

I will let you know what worked for me. My numbers were close to yours. AHI not perfect but not bad either. Leaks were under control. Using the AirCurve and a full face mask. Yet I was not sleeping well.
Get the manual for the AirCurve and while working through what was said in the above posts, consider what my issue turned out to be.
Look at the following settings:
1. Ti Min - this is the minimum time that the machine wants you to inhale. This for me was not an issue and I did not change it
2. Ti Max - This is the maximum that the machine will provide support for. after this time the pressure will drop. It's like right near the end of your inhale someone pinches your nose closed, cutting your inhale short. This was a problem for me as I take long slow inhales. I just set this to max (5 seconds) just because I don't have a "problem" with the length of my inhale
3. trigger - this is how sensitive the CPAP is to the start of your inhale. For me this was also an issue and I set it to more sensitive
4. cycle - this is how sensitive the CPAP is to the end of your inhale. for me this was not an issue after adjusting Ti Max and so I left it unchanged.

all of the above are comfort settings. this is setting how the machine interacts with your breathing. For me, the default setting were uncomfortable enough that I was not getting good sleep. I was sleeping but not soundly and was waking up a lot. What you want is to not even notice that the machine is there. No interference with breathing at all. These settings can help.

Unfortunately these are all "try it out" settings. Change one at a time and find the sweet spot: is it better, worse, or no change" if you start changing some settings you may need to go back and do a fine adjustment to the first settings you tried first. This will take some tewwking if this is what is going on with you.

The good news is that you already have the machine you need to do this. Oh and you really don't want the Doctor mucking around in this. You will be changing a lot of settings and trying them, you don't want to have to do a Doctors office visit with each change. A sleep test cannot do it either, there is no measurement they can use. It's the old "do you feel better or worse" and you need to work through it.