My challenges

[Art Vandelay]

Hello everyone!
I have been lurking for the past month and I have waited to ask my questions until I felt I was educated enough about my own treatment, machine and to try to ask the right question. I have read thousands of great posts and so much good advice here.
I will have more questions about something I am working through, but I wanted to start with this one.
 
My question is this: Are there any suggestions to help me keep my mask on all night?
I am unable to keep my mask on while sleeping. I am very comfortable with the mask being on my face and have zero trouble falling right to sleep with it on or even waking up to go to the bathroom and removing it. There has to be something that is triggering me to remove the mask. 
I range from 45 minutes to three and a half hours of sleep before I remove the mask. Almost all nights, I have no recollection of taking it off. I just wake up, and it is off. I usually try to put it back on and continue. Most times, it is far enough into the morning, I am awake and thinking about work and other things and I am not able to return fully to sleep. I feel like I am sort of sleeping, but not really, if that makes sense.
I am learning to read the Oscar and SleepHQ charts, but I have a very long way to go before I can determine if there is an issue that relates to my problem.
My DME last week switched me to a F&P Evora mask and I really like it. I was having severe issues breathing out through my nose with several other masks. P10 N30 F20 and F30. I would wake up in the middle of the night unable to breathe out of my nose. So far, the Evora has been great. Now, I just need to be able to keep it on all night. Is there anything I can do short of taping it to my head? Suggestions?
 
I am posting three Oscar charts and my settings are shown.
They are from Thursday, Friday and Saturday of this past week. I am not posting last night, I only made it 55 minutes. I truly have no idea I am taking the mask off. The one thing I really like about Oscar is that I am able to select each individual sleep session and analyze it and see the numbers for that one particular time. For example, Friday night, there were three. The first was good, solid sleep, the second was for 3 minutes. I woke up, realized my mask was off, put it back on and almost immediately freaked out because I couldn’t breathe and took it right back off and fell right back to sleep. I don’t know if this was a dream or if I really felt that way. I woke up 2 hours later and put the mask back on for 2 hours and 14 minutes and this was one of those sort of awake, sort of asleep. I like to see each sleep session and not averaged.
 
I am male, 60 years old and have a full beard with no issues with the mask seal. I had an in-home sleep study last June
The study lasted for 5:54
pAHI 41.2
pRDI 41.9
Central apnea 1.5/hr
Average oxygen saturation 294.5 minutes at 88% or less
Minimum oxygen saturation 60% (YIKES)
Heart rate 74 bpm
 
Thank you for any information, suggestions, or advice. I completely understand the importance of my treatment and I am willing to put in the work to make myself feel better. I try every single night, no matter how bad the previous night was.

   
   
   

[Sleeprider]

Art, welcome to Apnea Board. You have what appears to be a rather high flow limitation and very asymmetrical respiratory flow rate chart, with a very compressed inspiratory wave (top) and a hairy exhale wave with more rapid expiration. Events are clustered suggesting a possible positional issue. I'd like to get a closer look at the flow rate, meaning an image zoomed in far enough to see the individual wave forms in a 3-4 minute view so we can see what might be going on. Do you feel you often inhale through the nose and exhale orally? Do you sense congestion while masked up? You mention some pretty severe oxygen desaturations. Do those correspond to events on the CPAP? Your tidal volume and minute vent are somewhat low. What is your height? With regard to removing the mask, I don't see a large leak at the end of sessions, so at first glance it appears you are actually turning off the machine manually and removing the mask. What if we made that more difficult?

[Art Vandelay]

1) I'd like to get a closer look at the flow rate, meaning an image zoomed in far enough to see the individual wave forms in a 3-4 minute view so we can see what might be going on.
2) Do you feel you often inhale through the nose and exhale orally?  
3) Do you sense congestion while masked up?
4) You mention some pretty severe oxygen desaturations. Do those correspond to events on the CPAP?
5) What is your height? 
6) so at first glance it appears you are actually turning off the machine manually and removing the mask.  What if we made that more difficult?

Hello and thank you so much for your reply. I will answer your questions in the order you answered them. 
1) I chose a random section to zoom in on. Is there a specific area you would like to see?
2) I feel I breathe in and out through my nose 95% of the time with the mask on
3) No congestion whatsoever- Breathing is clear
4) I'm sorry- I do not know what you are asking
5) I am 6'-0 and weight 251. I have lost 37 pounds since the beginning of February. 
6) I use the auto start and stop. When I take the mask off, the machine shuts itself off in about 4 or 5 seconds. 

I am so excited you have taken the time to look at this. If you need any other graphs or more info, I am grateful for your help and will happily send it. 

   

[Sleeprider]

We can see from this closeup a chronic inspiratory flow limitation that is present on every breath. Most breaths display a flattened respiratory peak and some are even downward sloping before expiration begins. You are expending considerable effort on every breath to get the air you need to satisfy your respiratory requirement, and that is the practical definition of flow limitation or upper airway resistance syndrome (UARS).  

Apologies...I don't mean to leave you in suspense, but I have to throw some meat on the grill.  Be back in a bit.

[Art Vandelay]

Thank you for shedding some light on this. Please take your time to reply. I am not going anywhere. 
I just did some reading on UARS and I have many of the symptoms on the list. 
I am overweight. Diagnosed with type II diabetes 3 years ago. I am under huge amounts of almost unmanageable stress at work and even more so at home. I went to the doctor in June because I was having severe brain fog and unable to concentrate. It had been happening for several months but I waited until it was so extreme, I couldn't remember what I just worked on or details of emails or phone call I just had. I had/have sticky notes everywhere and then couldn't remember what my notes were about. I snore like a bull dozer. My daughter can hear me snoring in the basement. I went to the doctors and they gave me the once over. My cognitive abilities were terrible. I couldn't do simple math problems counting change back or remember details in a story that they read and asked me questions on. Turns out I am extremely anemic as well. 

They ordered the at home sleep test and here I am. I started therapy on July 21 and I received no instruction or training from my doctor. I went to the office to pick up my machine and was handed the case and that was it. I asked if they were going to show me what to do and I was told the instructions are in the bag with the machine. I am not kidding. 
My wife was diagnosed with pulmonary hypertension in June of 2020 (Due to years of untreated sleep apnea) and is disabled because of it. When she got her machine, we both went in for formal training and they fitted her with multiple masks and explained everything to both of us. She only took a few days to get used to the CPAP therapy and loves it. I did not get anything like that. 
I have spoken once on the phone with my doctor and have another phone appointment on the 29th. When I explained all of this to him, in an email before the last call and during the call he told me to just be patient, it takes some people longer to adjust than others. He has not addressed any issues, diagnoses or long term outlook -UARS or otherwise with me.

I feel very relieved to have found this forum. I am very hopeful I can learn and understand what is wrong with me and work to resolve this. Even when I was having so much trouble breathing out I tried every single night. I am not afraid to fail as long as I can keep getting back up again. My doctor and DME company both said they have never heard of problems exhaling with a mask on. Maybe they should come here and do some reading, there are dozens of questions asked and hundreds of replies about it. 

Thank you. 
BTW my name is Brad. I am a huge Seinfeld nerd- Hence, Art Vandelay. I was trying to be clever.

[Sleeprider]

Okay, back! Fajitas. It's hard to know what's going to work here, but I'm going to suggest taking the minimum pressure to 9.0, b. I think you'd benefit from the higher pressure support of a bilevel, but the opening gambit has to be higher minimum pressure because you're already using maximum EPR. I think it is the airway resistance that makes you pull the mask without awareness. It's hard to breathe and you naturally look for the easy way to make it easier, so removing the mask is not the answer, but when we're mostly asleep it's the first thing to go. Take a look at the positional apnea wiki because your clusters of events makes me thing that is an issue http://www.apneaboard.com/wiki/index.php...onal_Apnea

You can be a Seinfeld fan, but let's not hear about "shrinkage". I have a pool and am totally sensitive to this subject, so I keep it warm.

[Art Vandelay]

Thank you so much  for your reply.
I will set the minimum pressure to 9 tonight and see report back. The Wiki makes perfect sense and I understand it completely. I will go to town tomorrow and pick up a cervical collar. The soonest Amazon can get me one is Wednesday and I don't want to wait the extra day. Any recommendations on sizing?

Elaine: "I don't know how you guys walk around with those things"

[Sleeprider]

The soft cervical collar wiki points to some user reviews of different collars. Check out the bottom of the article, or just look at the Reviews forum. http://www.apneaboard.com/wiki/index.php...cal_Collar

[Art Vandelay]

Good morning!
I had something happen last night/this morning and I am hoping you might be able to tell me why.
Last night, I raised the minimum pressure from 7 to 9 when I went to bed. I have not had issues in the past when the pressure was at 9 and higher. I watch my machine frequently and see what the pressure is in relation to my breathing.
I had a difficult time feeling like I was not getting enough air and I had terrible mask leaks. I washed my mask yesterday morning and attempted a nap yesterday afternoon. There was no leaking or problems of any kind during the nap. I made it 26 minutes last night before freaking out feeling like I could no longer breathe or get enough air. I took off the mask and after calming down I fell right to sleep. I woke up at 5 this morning and put the mask back on. Other than being tighter than usual from fiddling with it last night, there were no leaks and I was able to breathe in and out without any issues. I don't understand why the difference. Even when I was able to get the leaks to stop last night, the breathing never got any easier.
The two oscar charts below are both zoomed in to 3 and 4 minutes. First is from the terrible episode last night and the second is from this morning when I could breathe.
Anything you could add would be very much appreciated.
Thank you. 

   
   

[Sleeprider]

These are both very short sessions, and I'm reluctant to draw any conclusions from them. They look like an entirely different person from the tidal volume, respiration rate and other statistics. The pressure started at 9.0 and never got above 11.5 in a 26 minute session, and the 33 minute session maxed out at 9.5. You have experienced higher pressures with no problems. I think we toss this one and try again.