Looking for some help - not sure what's gone wrong

[RogerRover]

Hi all,

I've been using a CPAP machine for about 5 years and been loving it - I don't travel anywhere without it.
However in the last 2-3 months, the effectiveness has gone down. I've been waking up several times at night, feeling zombie-fied and irritable all day. The evenings are the worst.

The actions I took to solve this were to start daily exercise, lose some weight, give up alcohol (yes, really!), no snacks after dinner and a regular sleep schedule.
Still didn't help, so with some internet searching, I found this forum, downloaded Oscar and looking at the pattern of bunched up events, i even went out and bought a neck brace.

However, there's still no improvement. So now I'm putting up my Oscar charts, hoping some of the experts can suggest some change I can make.

Machine - ResMed AirSense 10 Autoset
Mask - Full face; Phillips ComfortGel (one year old)
Pressure, humidifier, temp - all set to Auto

I've included 3 days charts, in case you need to see patterns. I also had to reduce the size quite a bit to meet the forum rules, so I hope it's still legible.


Thanks in advance for your time!

           

[Shadowpup]

Six months ago, my AHIs went into the teens. Someone mentioned that I have a long neck. It’s true. Two 4” colors fastened into an eight inch collar solved my problem. Last 30 days, average AHI 0.01. Best wishes for a speedy resolution. PS: I pulled R&R down under at a station outback in 1969. Great people and amazing country.

[Dormeo]

Hello, RogerRover. To follow up on shadowpup's post, you are having clustered obstructive apneas, and they may result from your tucking your chin down toward your chest. A soft cervical collar is well worth trying. Also, if you sleep on your back on a high pillow or stack of pillows, try using a single flat pillow and/or sleeping on your sides.

But I suspect you also need to raise your minimum pressure and uncap your maximum. You also have a heavy flow-limitation graph. Finally, you are using a long ramp period.

So I would recommend that you revise your settings to a minimum of 11 and a maximum of 20. If you are very sensitive to pressure changes, you could make that min = 11 and max = 15 for now. I predict you'll want a higher minimum and maximum, but it makes sense not to try to get there all at once.

I also recommend that you increase EPR from 2 to 3. This might help with the flow limitations.

Finally, I recommend that you shorten or eliminate your ramp period. If you continue to use ramp, please revise the ramp pressure to at least 8. You want to give the machine a jump on dealing with events.

If you make these changes, please post a chart so we can see what, if anything, got better or worse.

I would also like you to think carefully about what might have changed in your life around 2 to 3 months ago. Weight gain? New medication? Change in your sleep environment (new pet, curtains, mattress, pillows, etc)? Change in sleep position? Change in daytime exposure to sunlight? Change in exercise?

[RogerRover]

Hi Dormeo,

Thanks a lot! the changes helped. I made all the suggested changes, except that I raised the max pressure to 15 (instead of 20) for now.
Avg AHI of 2.4. New chart attached here.

However, there was so much of leak (with trumpet sounds!) in the beginning that I had to strap the mask real, real tight. It's not repeatable for me, because my nose now hurts like blazes
Is this normal? That for these pressures, the mask needs to be crazy tight?
Will reducing the ramp pressure help?

Regarding the cervical collar, i got one a week ago. The 3 charts that I uploaded in my first post were with the collar.
Last night, I couldn't wear the collar for the first half, because with the extra tight mask, I just felt too claustrophobic. However, when I woke up in the middle (around 2 AM), I put it back on.

About sleeping position, if I flop on my back, the airways just slam shut and I wake with a gasp. So I always sleep on my side, with my head on my arm.
I tried a memory foam side-sleeper pillow. It was awesome, but the moment i turned onto my back, my neck would hurt. So now I don't use a pillow at all.

Regarding what changed earlier, as part of the Corona lockdown, I gained weight, stopped exercising, started snacking late-night and had no fixed sleep times. So yeah, basically a recipe for disaster. But now I'm back on track

@shadowpup - yes, this is a beautiful land. An AHI of 0.01? wow!!

Thanks!

   

[SarcasticDave94]

I'd say no mask discomfort or pain would be considered normal. Either try a different sized cushion or swap to a different mask. You need one that fits well and has minimal leaks.

[Dormeo]

Much improved numbers! Can you feel any subjective difference in how you feel today? I think you will want to inch up your min ramp, min pressure, and max pressure, but leave things right where they are for now. You want to get used to how this feels and see what kind of trend develops.

As Dave says, no, you should not have to tighten your mask to the point where it hurts you. Finding the right mask can be quite a quest. If you've gained and then lost weight, that could make a difference to the contours of your face, calling for refitting, perhaps with the help of an online video for your particular mask. I also see you've had your current mask for a year. It may be time to replace it.

There are FFMs that don't touch the bridge of the nose at all. Whether they are for you is something only you can figure out, but that might be worth looking into. And -- worth asking, anyhow -- do you breathe through your nose during the day? If so, you might be able to use a nasal interface, which would be easier to fit, given the reduced perimeter where it touches your face.

Sounds like you're doing all the right things about the inactivity, weight gain, and all the other ills that lockdown can bring us. Onward!

[Shadowpup]

...
@shadowpup - yes, this is a beautiful land. An AHI of 0.01? wow!!

Make that AHI 0.1.  My bad.

[RogerRover]

Hi Dormeo,

Yes, I can feel a difference in how I wake up. The evenings are also better

I loosened the mask to the point of no-pain. As a result, there are lots of leaks and the noise is waking me up. But when i do sleep, it's happy sleep
Chart for last night attached.

I breathe through my nose during the day, but when asleep, my mouth opens while exhaling.
What's a nasal interface btw? Couldn't find anything on the internet.
I also searched for videos to adjust mask fit, but most of them focussed on getting a good fit while lying on your back. None of them went on to show you how to adjust it when on your side.

Anyway, i think it's time for a new mask for me. And then slowly inch up the pressure.

Thanks for the support so far!

   

[Dormeo]

It's very good to hear you're feeling better during the day. Your numbers are certainly a lot better than they were, and they will probably get better still. As you inch your min and max up, they will probably get better still. But do take this slowly; you want to see trends and give your body time to adjust.

By nasal interface, I just meant either a nasal mask or a nasal pillow mask. A cervical collar might do a good job of keeping your jaw up. Some people also report success with the Knightsbridge Dual Chin Strap, which pulls the jaw up, rather than up and back, as other straps do.

You might want to consider trying a pillow mask. It has the smallest number of running inches of contact with your face and therefore the fewest opportunities to leak. A minimalist mask is the ResMed P10; I liked mine for quite a while. I also liked my Aloha mask, which was a little more stable. I used Pad-a-Cheek strap covers with the Aloha for extra comfort. But every face is different, so what works for me may not work for thee. If you try out a nasal pillow mask, be sure to get a fit pack of all the pillow sizes.

On the supplier list linked above, I know that suppliers #1 and #14 have nice return policies on masks.