Headache, Brain Fog, Dizziness, Nausea after APAP Use

[geosyncline]

Hello Everyone,

Machine: ResMed AirSense 11
Mask: ResMed F30i (formerly F&P Brevida)

Most recent settings:
Pressure Range: 8-20, machine settled on 10.0 for most recent night.
EPR Setting: 1
Most recent night's AHI: 0.50 (OA 0.1 / CA 0.4)
Leak: 14L/min
APAP Heated Humidifier Setting: 2 (out of 8)

Sadly no OSCAR data yet due to not knowing about needing to have the SD card in the machine during use.

New forum member and CPAP user here after several years of brain fog & sleepiness, and then a few months of waking up choking and gasping for breath, led to my finally getting diagnosed with OSA / unknown apnea this past summer. Thank you all so very much for maintaining this community and generosity for helping folks out. I've learned more on here in a few days than in my manyvisits to my sleep medicine office. The reviews here helped me to find a mask that both fits and is comfortable (as much as that's possible).

Due to various novice mask and pressure issues, and issues described below, and unhelpful responses from my sleep medicine office when I contact them for help (variations on "just stick with it") , I've been using my APAP sparingly over the past 3 months since I've gotten the thing. It's been a tremendous struggle, and, in general, using the APAP for more than a night or two in a row had resulted in severe enough sleep deprivation that I had a flare-up of my Chronic Epstein-Barr syndrome, let alone not being able to drive, work, or even do chores around the house. Because of this I am now in non-compliance with my insurance, and have made a referral to a dentist to discuss an oral appliance.

Lately I've generally been feeling rested enough (relative term for me) that I felt ready to give the APAP another go. The new mask (ResMed F30i) is a huge help, and beyond its finicky fit creating some leaks throughout the night, it's been a completely different experience than before.

But...

Last night I tried my first full night with the APAP after a few nights of taking it off halfway through due to lack of sleep.  I woke up several times throughout the night, due to what I thought were mostly mask leaks / getting used to the mask.  I woke up in the morning, however, feeling awful: headache behind the eyes, dizzy, slightly nauseous, shadows beneath the eyes, with eyes feeling drained and puffy, and have been incredibly tired the entire day.  I had these symptoms using the APAP before with different masks and pressure settings. Based on other threads it seems like I might be re-circulating my own breath and inhaling too much CO2?  I'm unsure what to do to correct it, though from reading other threads on here it seems like turning my EPPR up to 3, and lowering my minimum pressure, might be a start. The F30i has two exhaust vents as well (hence the high leak number?). I had brought up my pressure, and lowered my EPR, from previous nights because the magnitude of the delayed "surge" on the inhale was keeping me awake. I'm hesitant to set my minimum pressure higher due to issues with mask seal and, previously, experiencing what other folks on here describe as sleep-onset CA events at higher pressures (which is not the most fun experience).

Another thing that is happening is that since using the F30i mask, there's been a faint gurgling / fast-flapping sensation on the inhales that I haven't experienced before. It's mildly distracting. I checked the mask and tube for condensation and debris, and found none, and also tried checking the air filter on the machine, and that doesn't seem to be the cause either.  I checked the mask to make sure the face-tubes weren't getting pinched either, and the sensation persists.

I've also been having some severe dry mouth while using the F30i. I'm presuming this means I need to increase humidifier setting. My goal is to get back to using the F&P Brevida with a chinstrap after finally getting several good nights' sleeps with the F30i.

Thoughts? I'd love to get the APAP to work for me and experience the magic everyone talks about. Unfortunately, so far, I've been having quite the opposite result.

I don't have OSCAR nor oximeter data for last night, though I have now properly set up the APAP with an SD Card and have a Wellue Checkme on the way.

Thanks!
Geosyncline

[geosyncline]

Additional information:

Diagnosis was "Mild Sleep Apnea" with an AHI of 14 based on an at-home test.
Machine should read "Airsense 11 Autoset"
Autoset set to Soft Response

[Jeff8356]

I will be hard for anyone to make educated suggestions without actually seeing the data.  So get a chart or two posted when you can.  There are links in my signature if you need help with that.
I will try to answer a couple of non therapy questions for you.
The flaps/vents on the mask are usually to prevent asphyxiation.  Like if you rolled over and crushed your tubing, you would still be able to breath.
Masks are also designed with intentional leaks in them.  There should be a setting in the machine to set the type of mask you are using.  That will tell the algorithm how to adjust for the intentional leaks.  So what you see for the leak rate in OSCAR should be zero even with the intentional leaks.  Anything above zero is usually a mask fit problem (or hose not connected snugly) and that will need to be worked on.
The gurgling sound usually means you have water in your hose somewhere.  But I have also seen it coming from an overfilled humidifier tank and a large leak (like you mentioned above).  Working on the mask leaks and checking the water level may fix that.
The headaches and such may be something different.  I got them in the beginning but it turned out to be partly from hypoxemia (which I seem to be sensitive to), and partly from dry air.  I bought a heated hose and experimented with the heat and humidity setting over time.  Now it rarely happens.  It might be worth looking into.
So get that SD card into the machine and get that oximeter fired up and lets see some data so we can get started on the rest!!!!
Do you have the software for the oximeter yet?  It can be downloaded from Wellue's website for Mac or Windows.
Good luck on your journey!

[RodMyers]

quick answer, kick the minimum from 8 upwards.

That was my issue

[Ratchick]

You've got some general advice here, but yes, let's see some charts. Unfortunately, you have to push through the tough first days - almost nobody settles into xPAP without issues and it's the continued use that will make it more tolerable and hopefully have you sleeping far better.

[geosyncline]

Hi All,

Thank you for the help!  Screenshots of the 3 hours I managed to use it last night are attached. Hopefully I followed the instructions correctly! I included the Advanced overview and a zoomed in shot of the single hypoapnea during this period.

From the start of the log until 3:15 I was awake and waiting to fall asleep and adjusting the mask to control leaks, etc...  By my recollection I was only asleep from 3:15 to 4:56... the big pressure increase at 4:56 and resulting mask leak woke me up. At that point I took the mask off so I could actually get some restful sleep to be functional at work today.

I'm still waiting for the Welllue O2 monitor to come in the mail, but will post more graphs as I attempt to do a full night again and see if I have the same symptoms as I did on prior nights.

I really do want it to work, but things are also at a point where further disruptions to my sleep / functioning come with high risk to other chronic health issues, in addition to loss of income (I've used up all my PTO, and have had to start taking unpaid leave, on days/weeks where I'm not functional following bad xPAP nights ). Also, my DME supplier is threatening to take the machine back, or have me pay for it out of pocket, due to noncompliance. I'm calling them today to see if we can work something out.

Thanks again,
Geosyncline

[Ratchick]

Your chart looks pretty good. You're breathing a little fast, but that's about it, other than leaks. You might want to push up your minimum pressure to 7 or 8 and try EPR of 2 or 3 Full Time to help squash those flow limits. I'm definitely interested to see how the oximetry data looks when your pulse ox arrives.

[geosyncline]

Thanks! I'll try tonight with an EPR of 2. I had it set to 1 for this run.

I'm realizing, too, that "gurgling" wasn't the right sound to describe the sensation on inhale... it's similar to the sensation on inhaling when one has a chest cold, or when would describe ones breathing as "wheezy" or "rough". After experimenting with some other masks today during lunch I'm pretty sure it's the mask and some combination of my mouth puffing out and slight leakage with the F30i. It's a shame it's such a fickle fit because, for me, it's been the most comfortable mask so far. Maybe I should try the N30i with a chinstrap.

[SarcasticDave94]

Look at Fisher and Paykel masks to see what you think. I have both the Simplus and Vitera full face. They need very light tension to seal very well. They have nasal and pillows masks too if you prefer. The RollFit cushion bellows is their secret ingredient.

Your leaks are likely robbing you of the rest the good data result indicates you should be getting.

[OpalRose]

Agree with raising the minimum pressure.  Ideally, you should set it to 7min, possibly 8 to allow the full use of EPR of 3.  

The use of EPR is not only a comfort feature, but will help with Flow Limitations, which are driving your pressure upward.  This high maximum pressure may be disruptive.

Try lowering your maximum pressure to 14cm. In other words, narrowing your pressure range a bit should give a more restful sleep.

It's important you try to meet compliance. The DME can take the machine back, as insurance won't pay them if you aren't using your machine.

It has helped some to use the machine with mask on for an hour before bed, maybe sitting up watching TV or reading. This helps adapting to the mask and the pressure.
It's key to finding the right mask with minimum leaks.