My Wife Keep Waking up at Night!

[gumleafau]

This is my first post!
My wife has been using a cpap machine for 6 months but getting nowhere with it!
She is 66 yrs old, weigh 38kg and 147cm in height and have syringomyelia (disorder in spinal cord).
She is trying different auto cpap machines by hiring them and settle on the Philips Dreamstation auto cpap with humidifier.
She have tried different masks as well, and briefly when using the AUTO cpap machine the results are as following:
1. Pillow mask feel more comfortable, AHI around 5 but with large leaks of 40% and 2% obstructive apnea each night. 
2. Full mask feel uncomfortable, AHI around 30 and little leaks but with 24% obstructive apnea and 6% Chenye Stroke Respiration each night.
She had a titration sleep study in the lab three weeks ago, and she is still waiting for the final result of the test. However she was given a preliminary pressure setting of 10cm H2O to try
on while waiting for the final result.
The Dreamstation is now set for fixed pressure of 10cm H2O and Ramp pressure of 5cm H2O, but the result is very similar when setting the machine in auto mode.
She still waking up at night and feeling tired during the day!
She also had a SpO2 test, and she worn the wrist monitor when she go to sleep. She worn it for 52 hours and 234 events occurred with SpO2 reading less than 88%.
Is she on the right track, or should she try a different machine to help her have a better quality sleep?
Looking forward for your comments and feedback!

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[gumleafau]

This is my first post!
My wife has been using a cpap machine for 6 months but getting nowhere with it!
She is 66 yrs old, weigh 38kg and 147cm in height and have syringomyelia (disorder in spinal cord).
She is trying different auto cpap machines by hiring them and settle on the Philips Dreamstation auto cpap with humidifier.
She have tried different masks as well, and briefly when using the AUTO cpap machine the results are as following:
1. Pillow mask feel more comfortable, AHI around 5 but with large leaks of 40% and 2% obstructive apnea each night. 
2. Full mask feel uncomfortable, AHI around 30 and little leaks but with 24% obstructive apnea and 6% Chenye Stroke Respiration each night.
She had a titration sleep study in the lab three weeks ago, and she is still waiting for the final result of the test. However she was given a preliminary pressure setting of 10cm H2O to try
on while waiting for the final result.
The Dreamstation is now set for fixed pressure of 10cm H2O and Ramp pressure of 5cm H2O, but the result is very similar when setting the machine in auto mode.
She still waking up at night and feeling tired during the day!
She also had a SpO2 test, and she worn the wrist monitor when she go to sleep. She worn it for 52 hours and 234 events occurred with SpO2 reading less than 88%.
Is she on the right track, or should she try a different machine to help her have a better quality sleep?
Looking forward for your comments and feedback!

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[gwc2795]

The machine is maxed out on IPAP all night. It is an auto machine, change the max pressure to 20 and see what it does. Post another chart so we can evaluate it. 

[gumleafau]

Thanks you for taken yours valuable time in responding to my post!
Back in March this year my wife have tied out the Resmed Airsense 10 Autoset with For Her Setting with Fisher Paykel Simplus full mask, and the results as attached!
My wife felt very tired after the fourth day with the full mask because she been woken up by large amount of obstructive apnea events each night.
So after the fourth day, and to get some relief she went back to using pillow mask which she experienced lesser obstructive apnea events but with large leaks from her mouth!
Looking forward for your response soon!

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[gumleafau]

Hi gwc2795,
The results of the attachments are maxed out from 4cm H2O to 20cmH2O and the Resmed Airsense 10 set in auto mode!

[car54]

Gumleafau,
 Is your wife on any medications and what affect does the syringomyelia have on her? I noticed that her respiratory rate is low. She may have bradypnea . It could be the cause of some of her problems. Here is a,
 link.https://www.healthline.com/health/bradypnea. I am no doctor, I'm just speculating.

car54

[Sleeprider]

Gumleafau, your wife has very severe OA that occur in clusters through the night that are also associated with SpO2 results that are a big concern. The pattern is that her therapy starts off quietly and after an hour or so, the first big cluster shows up. The clusters of OA are not responsive to higher pressure. I'm of the opinion your wife suffers from a positional apnea, and would benefit tremendously from a soft cervical collar that could prevent her chin tucking towards her chest. You are looking for a comfortable soft device that supports the jaw. I am positive this could make a much bigger difference in her therapy effectiveness and overall comfort than making adjustments to CPAP settings at this point. If she uses more than one pillow under her head, you need to cut her back to one, thinner pillow. I know this doesn't sound very scientific, but if you try it, I think you might be very surprised.

[Sleep2Snore]

Hi Gumleafau,

Welcome to the ApneaBoard.

I don't know how her spinal condition affects her, but it looks like the Nasal Pillows are working out the best for her.
If she is sitting upright at night or using two three pillows and she is sleeping on her back, her chin looks as if it is falling onto her chest when she gets a cluster of Apneas.  A soft collar to keep her chin up will help with the Apneas.  When using Nasal Pillows, make sure you start using the largest size of pillow and work down in size, it is a common mistake for people to use a size to small and restrict the amount of air getting in and out.  They should not go far into the nostrils, just the tips should go in and the mast of the pillow resting on the outside of the nostril.
The main problem with Nasal Pillows and masks is air escaping through the mouth.  It does help if you keep a small bottle of water by the bed so you can dampen the mouth again if it feels dry and air leaks.
It looks as if she is most comfortable with Nasal Pillows, so use them if it makes her feel better.  A soft collar will also help keep her mouth closed, if it is the correct size (don't get one that is to small) and it will also stop her tucking her chin into her chest and cutting off the air.  This will also cause low O2 results due to air not reaching her lungs.

Just read Sleepriders post, he is I think right that she my have to many pillows and needs a Soft Neck Collar to keep her chin and head from going towards her chest.  If the machine is not on AUTO set it to AUTO when you get a neck collar and hopefully things will be a bit better.  However, she may have other problems, but first get her a Soft Collar and wait a few days till she gets used to it then let's see how she is doing by posting new charts.  Sleeprider  is well in the know so listen to what he says.

I wish you all the best and I hope this help her.

[gumleafau]

Thanks you for your response to my post!
My wife taken is taken no medicine for her syringomyelia, but experiencing weakness in her left arms since she was diagnosed with such condition in 1986.
Her respiratory rate is around 17-18 breaths per minute at 95% of the night, that seem to be acceptable for normal rate of breathing for normal person!
However she is struggling for breathe when she talks, but since using a cpap machine for last six months that is improving slowly!
Obviously having obstructive apnea events at night does not help the situation and I am seeking help to reduce and minimize theses events!

[Sleep2Snore]

If you get the apneas down and the O2 is still low, she might require a supplement of oxygen at nights.
But wait to see what happens over the next while.