Hi - unable to get a restful sleep on CPAP and at my wit's end.

[gohoos1998]

            Hi all - I had a recent sleep study and found that I had an AHI of 30 WHILE wearing my fully advanced oral appliance. It is clear I need CPAP at this point. 

That being said, I feel much worse on nights when using CPAP vs nights when I don't. More tired, foggy, more anxious. It seems to me that treatment itself is fine (AHI below 3), but I am waking up a to, which kind of defeats the whole purpose of using the CPAP, which is to get restful sleep. I am ripping the mask off (some nights knowingly, some nights unknowingly). I also have a deviated septum if that is useful. 

After looking at data over a few days, it's clear that leaks are causing some awakenings, but it is also clear that that is not the only thing. I would really appreciate some help. 

For some context, I wear nasal pillows. Last night, I also tried a cervical collar because I definitely chin-tuck. Because I utilized a collar, I lowered the pressure to a fixed 11 with EPR 3. 

Here are my screenshots from last night. Really appreciate it because I am starting to think of throwing it out.

[SarcasticDave94]

In September 2023, you posted a sleep study with 10 CA and a bunch of Hypopnea. What did you get on this test?

With that other test you possibly had predominant Central Apnea. If that's the case still, you would be wanting ASV instead.

Add the sleep study report in detail soon. You have many threads, so if there's any other sleep studies tell us where they are to see the results.

This is an if at the moment, if CA is your big issue, CPAP can be made to help some, a VAuto helping a bit more, but not a true treatment if the CA are bad enough, and again the ASV as the real treatment of choice.

Had any of these sleep specialists talked to you about that CA and Hypopnea only issue?

PS oral appliances will not likely help CA. Central Apnea by nature hand no obstruction for the appliance to help with.

[gohoos1998]

Hey Dave, 

Really appreciate your response. You're correct - my initial study had 10 CA's. Now, I have my PLMD under control - it seems like the PLMD and Apnea were "jockeying" for supremacy, and now that the PLMD arousals are treated, the apnea has come to the forefront. 

AHI was 29.6 using 3A/RDI scoring and only 4.5 using 4% scoring, so it looks like a lot of the hypopneas are between 3% and 4%. No central apneas or obstructive apneas in this most recent study - it is all obstructive hypopnea. Respiratory arousal index of 25 or so.

I posted the new sleep study in a different thread but will move it here for convenience. https://www.apneaboard.com/forums/attach...?aid=73596 

Now that I am thinking about it, could this be considered UARS? 4.5 AHI with 4% scoring and a 30 AHI with 3A/RDI scoring? Not sure if 3A scoring and RDI are considered analogs or if slightly different.

Doctor and I have not talked about centrals, especially after the most recent test showed none. He thought that the mouthguard could alleviate the hypopneas, but we saw that wasn't the case. Wants me to move onto PAP therapy, or perhaps bi-level IF after awhile we don't see improvement with CPAP. My understanding is bi-level is better for UARS, which is why we'd go to that.

Thanks again for all you do here.

Should I continue in this thread whenever I have questions instead of making new threads?

[SarcasticDave94]

No big deal, but if you want to keep this as your main one, that's fine. Just add info here going forward.

If you can get the ResMed AirCurve 10 or 11 VAuto bilevel you may be set for the best results. The AutoSet will be helpful, but VAuto more so.