Cpap for 4 month, worked in the beginning but not much now

[Killiane69]

Hello everyone !

I'm new to this board, I was told from reddit that I could get some help with my situation here on this forum

English is not my native language so I do hope I don't do many errors in my explanation,

I got diagnosed with sleep apnea back last year, here's a quickrundown of my profile

Me : Age 29 , M , 1m76 (5,77 ft I think ?) , 86 Kilos (189 lbs)
1rst sleep study (before cpap) : sleep study an RDI of 33 (AHI 14 and RERA 19)
2nd sleep study (with cpap 7,5 Pressure) : RDI of 15 (RERA 7 and AHI 8), AHI are only hypopnea (50% are central, 50% are obstructive), RERA seems to be central but physician is not sure
I can scan them but they are in french, if you need some more infos about them maybe can I do some more translation
Current equipment : Lowenstein prisma smart, at first pressure was 5-11 then set to 7.5 , Pressure relief of 2 , Humidification , Mask is full-face (BMC F5 : https://www.medicalexpo.fr/prod/bmc-medi...89662.html )
Additionnal info : Always sleeping side, the 2 sleep study confirm this, really really low mouth breathing

To explain my situation a bit more,
I was always foggy and tired but since last year my condition really extremely worsened, Saw doctor, told me to do a sleep study, Bam, OSA

My sleep doctor then gave me a CPAP device (description above), we started in september at 5-9 pressure , at first it was a true revival, but it made my stomach hurt, we then switched after one month (october) to a fix 7.5 pressure, it worked too with less stomach pain,

In the meantime I saw a doctor specialized in Tongue placement in the mouth (honestly no idea how to translate this one), it seems that my tongue was really misplaced

Before doctor: Tongue was resting in the bottom of the mouth, tip touching lower jaw and teeth
After doctor: Tongue is resting in top of the mouth, bending like a hammock

After changing my tongue placement, It was easier to breath, and I feel more air can pass in the windpipe (hard to explain)

But after some time tiredness came back, november and december i felt more tired than at start of CPAP, still way more energic than before cpap nonetheless,

My stomach started to hurt again, I suspect that my tongue training helped me breath better but as I side effect to swallow more Air I guess ?
Also I take 2mg of melatonin before sleeping on the recommendation of my sleep doctor

I'm here to find some help about the two problems :

Stomach pain due to CPAP
My tiredness/nasal congestion/headeach pain coming back

Really thanks for any advice, from the bottom of my heart

I have oscar reading of my previous night (one night is missing cause I removed mask 10 minutes after sleeping ahah) :

   

   

   

[mesenteria]

Stomach pain is usually, not always or necessarily, the result of ingestion of air...aerophagia.  Some of us swallow air as we sleep.  You say you sleep exclusively on your side, but something seems to have changed and I wonder if now you're sleeping on your back a bit more than you used to...or than you think you do/did. 

Any weight loss?

We can see that your pressure is constant.  It's also somewhat lower than most/many of us have for the higher therapeutic setting.  I suggest you wait for more experienced advice, but I think you might be further ahead with a max of about 8-10.

[CPAPfriend]

hi killiane69,

how did the percentage of centrals that contribute to the AHI differ between sleep study 1 and sleep study 2?

Yes, that is a possibility. Remember, the pressure is working to push airway resistance out of the way, so if through your surgery the doctor eliminated some of that resistance, then the result COULD be an increase in aerophagia, as the machine could be delivering a pressure higher than needed.

For the stomach pain, you could: try a chinstrap or soft-cervical collar. There's also the option of reducing pressure gradually to see if you can maintain clean objective results at lower pressures. That said, there's a lot going on in your data, so maybe post some more information before we do anything. You have many leak spikes January 8th. Do the hypopneas / RERAs on the 9th look central or obstructive? Your tidal volume looks low.

Could you post your flow-limit graphs please

[Killiane69]

Stomach pain is usually, not always or necessarily, the result of ingestion of air...aerophagia.  Some of us swallow air as we sleep.  You say you sleep exclusively on your side, but something seems to have changed and I wonder if now you're sleeping on your back a bit more than you used to...or than you think you do/did. 

Any weight loss?

We can see that your pressure is constant.  It's also somewhat lower than most/many of us have for the higher therapeutic setting.  I suggest you wait for more experienced advice, but I think you might be further ahead with a max of about 8-10.

Hello mesenteria !

No weight loss but it seems that I gained muscle and lost fat
Wife told me that Im always sleeping side, at least when she's awoke

hi killiane69,

how did the percentage of centrals that contribute to the AHI differ between sleep study 1 and sleep study 2?

Yes, that is a possibility. Remember, the pressure is working to push airway resistance out of the way, so if through your surgery the doctor eliminated some of that resistance, then the result COULD be an increase in aerophagia, as the machine could be delivering a pressure higher than needed.

For the stomach pain, you could: try a chinstrap or soft-cervical collar. There's also the option of reducing pressure gradually to see if you can maintain clean objective results at lower pressures. That said, there's a lot going on in your data, so maybe post some more information before we do anything. You have many leak spikes January 8th. Do the hypopneas / RERAs on the 9th look central or obstructive? Your tidal volume looks low.

Could you post your flow-limit graphs please

Hello Canadian friend !
First sleep study could not tell if they were central or obstructive, only the second sleep study had this information

I will check out the soft collar, it seems im doing chin tucking, it will help at last, do you have some collar recommendation ?

It was not a surgery but more akin to tongue musculation and placement exercise !

How can I tell if hypnopeas and RERAS on the 9th are central or obstructive ? 

I don't have the flow limitation graph on OSCAR, seems like lowenstein cpap does not have it,

I will post flow rate with FL enabled and flow rate zoomed

   

   

   

Thank you guys for helping !

[Killiane69]

Last night I tried with a soft collar but the result were not very brigth (it was even worse than usually)

   

But the stomach pain was better I think,
I still feel tired nonetheless, does somebody has any ideas ? Can I provide you with more infos or oscar screen that could help ?

Thank everyone for your help !

[TechieHippie]

I thought I had a lot of flow limitations but yours are super high, I'm curious to see what that means.

What I wanted to share (and I really need to take my own advice) is that there are exercises that really help with tongue positioning. I need to pull mine out again because I too think a lot of my "positional" apnea is probably from my tongue. I did have two tongue release surgeries a couple years ago, but I need to keep up my tongue muscle tone, the new reach isn't everything. Ones you could try are tongue-press against the roof of the mouth, (hold 10 seconds, repeat 5-10 times), tongue suction and hold (30 sec to 2 min), sticking tongue out rounded like a cylinder (I couldn't round my tongue at all pre-surgery), and others. Search for "myofunctional exercises" and see what are slightly challenging. Do them in a mirror to watch for jaw involvement or any other compensation. I do tongue stretches as well, and I think they help a lot. I should do those now....I don't like to do them immediately before bed because sometimes I've gotten vertigo that way.

[Killiane69]

I thought I had a lot of flow limitations but yours are super high, I'm curious to see what that means.

What I wanted to share (and I really need to take my own advice) is that there are exercises that really help with tongue positioning. I need to pull mine out again because I too think a lot of my "positional" apnea is probably from my tongue. I did have two tongue release surgeries a couple years ago, but I need to keep up my tongue muscle tone, the new reach isn't everything. Ones you could try are tongue-press against the roof of the mouth, (hold 10 seconds, repeat 5-10 times), tongue suction and hold (30 sec to 2 min), sticking tongue out rounded like a cylinder (I couldn't round my tongue at all pre-surgery), and others. Search for "myofunctional exercises" and see what are slightly challenging. Do them in a mirror to watch for jaw involvement or any other compensation.  I do tongue stretches as well, and I think they help a lot. I should do those now....I don't like to do them immediately before bed because sometimes I've gotten vertigo that way.

Yeah i'm doing everyday my tongue exercises, but unfortunately its not doing that much now 

I'm bumping this post, I do think everyday is looking grimmer and grimmer and drepession is starting to kicking in, I really need help,

What can I do / post / show on oscar to have my situation sorted ?

Sorry if i seem aggressive, iam at the end of my rope and despair is here