Lots of sleep but still dead tired

[Kathy14225]

I know no question is stupid but this is to prevent OAs correct? I'm butting into this post because I wanted to know about the collars but I'm having lots of centrals, a lot of nights no OAs at all. I do have a special pillow behind my neck so that's probably keeping my neck from kinking? I have a spinal disorder so have to sleep on my back in an adjustable bed.

[SarcasticDave94]

A collar will probably not help CA because CA meaning Central Apnea is a cessation of breathing typically unknown medical cause. This is why CA may also be called clear Airway. Obstructive Apnea is an obstructed airway typically the throat muscles relaxing, collapsing. OA may be lessened via a physical collar to prevent the positional collapse.

[SarcasticDave94]

Mostly members here will want your daily OSCAR chart. Most cases that's no zoom, but if there's a specific area of concern, you can include that as well.

There should be a default setting for OSCAR to display graphs in order.

[Markus11]

Last night I tried using my nasal mask--an AirFit N20. My problem is that I simply cannot get enough air flow through my nose. I've had one nasal turbinate reduciton surgery and every night I do a nasal rinse, use azelastine antihistimine nasal spray, apply a breathe right strip and take a citirizine oral antihistimine. Still I do not get enough air flow through my nose. I feel that the nasal mask would work, however if you covered my mouth long enough I would die. 

That is why I am using my AirTouch F20 full face mask. Does anyone have recommendations on nasal air flow?

I am going to lobby for another turbinate reduction surgery, as I hear nasal turbinates often partially grow back. My first surgery was like magic--for the first time in my life I could breathe through my nose. Up until then I had been known for chapped lips (now I understand from mouth breathing) ever since I was a child.


I also see that I am getting OAs on inhales where I do not exale. Going to try sleeping without EPR tonight and setting a wider range, 8-18cm H2O.

I also slept on a slight incline last night for a while before I found it uncomfortable, but you can see my sleep was great for that period. I will try giving the incline another shot tonight while I wait for my cervical collar to arrive.

[Markus11]

For some reason I cannot get detailed data from last night on my ResMed AirSense 11...Screenshot below is all I get.

However I feel so much better today than I have in a long time! Slept at a slight incline, and while I remember  waking up 6-10 times in the middle of the night I feel like a new man today. I think I can slowly get used to sleeping at an incline.


Screenshot:

   

[Crimson Nape]

Either you did not have the SD card inserted or fully inserted during this sleep session.

- Red

[Markus11]

Either you did not have the SD card inserted or fully inserted during this sleep session.

Thanks, Crimson! I must have not had the SD card fully inserted. Since resolved.

My scores are steadily improving! Last night AHI: 2.30, down from ~ 5.0 AHI average previous week. I attribute this to sleeping at a mild incline and focusing on side sleeping.

   

Looking at the wave forms on the Flow Limitation Wiki Page it seems I am exhaling through my mouth (which I believe to be the case).

Is this a problem in need of corrective action?

       

[Crimson Nape]

Mouth breathing is not a consideration if you are using an F20 FFM. That would only apply to masks that do not cover the mouth. You seem to need more pressure. Try increasing the min and max by 1 cm and trying it for the night. At some point, you will reach your optimum pressure (hopefully).

- Red

[Markus11]

I seem to be at the maximum pressure (13) before the aerophagia kicks in. I am currently at 12-13, no EPR. I can try inching that up.

Do you think increasing inspiratory pressure vs expiratory pressure is more important or both based on my graphs?

[CPAPfriend]

hey Markus11, sorry for the late reply.

Just looking at your data, you did best on EPR 3, fixed pressure of 13cm, though it was for only one night, but it did stand out.

Trying to force the nasal mask will probably not yield much fruit. It sounds like you have some pretty persistent nasal obstruction, and should all nonsurgical avenues for trying to correct it fail, then it's not unreasonable to consider surgery with the right doctor. Just as a small appended comment, you should be very very very careful with you decide to do surgery, should you go that route. From my experience (and of course I'm just a random on the internet), maxillary expansion seems to be the most helpful for the greatest number of patients, and Stanford actually updated the surgical protocol for SDB patients back in 2020 to reflect that. Turbinate reduction surgeries have low rates of efficacy and high rates of recidivism. I suggest not trying to push for another one (but again, I'm just a guy on the internet). If they're too aggressive and, for example remove the inferior turbinate almost entirely, then you could develop empty nose syndrome. Do you have your CT / CBCT scans by any chance?

As another note, it becomes increasingly difficult to make a nasal mask work at high pressures like yours. Usually around 14cm is where things get exponentially harder. 

Have you considered using an MAD together with your PAP therapy?

Keep in mind that when you increase EPR you basically decrease average pressure, so the general rule of thumb is to increase / decrease pressure in proportion to your increases and decreases of EPR. For example, EPR +1, then pressure +1. EPR -2, then pressure -2.

Increase EPAP until obstructions are resolved, then use PS (IPAP) to resolve the remaining obstruction seen in RERAs, hypopneas, snoring, etc.



@Kathy
yes, it will help with OAs in the sense that it will prevent some patients from tucking / turning their neck into the wrong, unfavourable direction. However, in addition, it will assist in keeping your mouth closed and your tongue at the roof of your mouth in its proper position. This is difficult or doesn't work well for many SDB patients though, because for many the whole reason they have SDB is because things don't fit to begin with. To support this line of reasoning, just think of a chinstrap; a chinstrap will not prevent you from tucking your chin, but it will help you keep your mouth closed, teeth in-contact, and tongue, as mentioned, at the roof of your mouth.