Help needed with CPAP therapy

[ravik]

Hi,

I have been on this forum several times. I have been using CPAP for past 18 months. For last couple of months I am waking up several times during the night. Although my AHI is low (between 1-2 with CPAP), it seems like I am not getting any good sleep.

I wanted to get any information before I see my doctor. I can feel in middle of the night I am waking up due to blocked airway and stopped breathing and CPAP machine is not helping.

I have upped my pressure for last 3-4 weeks from 8 to 10 and now to 12. I also take Remeron 7.5 mg (for sleep) before bedtime and I gained (side effect of remeron) 10lbs in last 6 months (I weigh 150lbs now).

I am not sure what is going on. I am tired all day. I am looking for anything unusual from charts. Please help.

I have my daily chart below:

https://imgur.com/a/QOHXB7T

[ardenum]

Maybe ask your doc to switch to doxepin instead, theres no weight gain.

[ravik]

Thank you Crowtop, yes, I am going to do something about remeron. Wait gain is not good in any case.

I would still need some other advice why am I getting so much fragmented sleep. I should mention that I am very light sleeper and can wake up due to pressure changes or light snores or air leaks on face or any part of skin.

[gwc2795]

ravik were you taking Remeron 7.5 mg in May 2017 when you made your original post? Your pressure is 2cm higher that in the May 2017 time frame. I see that you are not using fixed pressure which worked so well for you May 2017. I notice 16 pressure spikes and I think with your sensitivity to pressure change might be fragmenting your sleep. Any thoughts?

[Sleeprider]

Ravic, welcome back. Would you please do a close-up of your Flow Rate graph? The instruction are in the Organizing your Sleepyhead Charts Wiki. I'd like to see why the machine thinks your expiratory time is so short. Last time you were here you made some pretty good progress, but you had some pretty bad flow limits, and eventually used a C-collar and higher pressures. Where are we at on all that.

[ravik]

Hi gwc2795,

No, I was not taking Remeron in May 2017. My doctor suggested to use pressure 8-15 in June 2017, after that and it was working OK for few months.

[ravik]

Ravic, welcome back.  Would you please do a close-up of your Flow Rate graph? The instruction are in the Organizing your Sleepyhead Charts Wiki.  I'd like to see why the machine thinks  your expiratory time is so short.  Last time you were here you made some pretty good progress, but you had some pretty bad flow limits, and eventually used a C-collar and higher pressures.  Where are we at on all that.

Hi Sleeprider,
Thanks for getting back. The fixed pressure of 8 worked for few weeks (May-June 2017) and then I started having issues again. I have attached flow rate for last night. I am still using C collar.

https://imgur.com/a/xhPAIFr

[Sleeprider]

Results are flow limited as you can see by the flow chart. I would add .5 of minimum pressure. If I could put you on bilevel that would be the preferred approach to dealing with this. Your event rate is very low, but I think pressure support would make your sleep more refreshing. If you ever get the chance to make the move to bilevel, just do it.

[ardenum]

I didnt mention this but taking a sleep pill makes my therapy fail too, it relaxes me and everything in my mouth to the point a pressure of 20 wasnt working. I then switched to Vauto and that fixed the problem with falling and staying asleep. 

However i now have hundreds of microarousals a night. The base dose for doxepin is 40mg i take 5mg, id try cutting down on mirtazapine(remeron) in your case, its a very strong sleeping pill. Ten times stronger then doxepin. If I take the minimum recommended dose of 40mg I start to choke at night. Maybe theres something similar for you happening there.

[ravik]

Hi gwc2795,

No, I was not taking Remeron in May 2017. My doctor suggested to use pressure 8-15 in June 2017, after that and it was working OK for few months.