Need help with CPAP settings. including SPO2 and HR data

[jerop]

Hi Everyone, I've been a cpap user for 2,5 years and while i'm sleeping much better then before. I think there's still a lot of room for improvement. I'm a bit lost as to where to start improving things. As for background info. My starting AHI was 15. I'm am not overweight so I think my sleep apnea is caused by either poor jaw development due to mouth breathing and/or poor neck/back posture. My airway constricts quite quickly as it is now.

Currently do not tape, use a cervical collar or positional therapy devices. Every intervention i've tried resulted in my sleep quality getting absolutely trashed for a couple nights and me quickly giving up on trying it. So any advice is appreciated and I'm open to all options, but I especially want to focus on optimizing my cpap therapy.

Leaks rate seems a bit high ? It was actually much worse if you look at my history. I've tightened the mask again in the past week, but my nose is painful and the skin is damaged because of it. So not sure if that's sustainable. Aside from that my central apnea's are a bit concerning. Either way i'd like to move more towards 1 AHI or lower. I've attached the Oscar Data in the screenshots and I also have a sleepHQ link, but i dont have enough posts to include links yet.

[raylock1]

Your heart rate graph looks like mine when I am experiencing Atrial Fibrillation.  If you are experiencing Afib, even the slow rate type, that can affect sleep.  Good luck, hopefully some of the sleep experts will respond shortly.

[gainerfull]

What does your sleep study look like? What level did you experience the best quality sleep during the titration?

Are you seeing sp02 fluctuations like this even on your best AHI nights? How do you feel after sleeping?

Step one would be to solve the mask leaks because step two is to bump your pressure and you can't do that with how many leaks you're experiencing at the moment.

The best things I've found for leaks are cleaning the silicone of my full face mask and my face before use, using the humidifier and taping my mouth every night.

[jerop]

Your heart rate graph looks like mine when I am experiencing Atrial Fibrillation.  If you are experiencing Afib, even the slow rate type, that can affect sleep.  Good luck, hopefully some of the sleep experts will respond shortly.

Could you explain this a bit more or provide some information? Im a bit cluecless about this topic. What about my graph looks like Afib? I do agree the spikes in heart rate seems a bit worrying if that's what you meant. That doesn't feel like it would be good for restful sleep to me.

My fitbit versa is not giving me any irregular heartbeat rhythm notifications. I have 61 Resting heart rate which seems too low as my cardio is just okay. 16 Breathing rate, 29ms heart rate variability (again too low). My heart statistics always seemed a bit abnormal / not optimal to me, so your comment has me a bit worried.

[jerop]

What does your sleep study look like? What level did you experience the best quality sleep during the titration?

Are you seeing sp02 fluctuations like this even on your best AHI nights? How do you feel after sleeping?

Step one would be to solve the mask leaks because step two is to bump your pressure and you can't do that with how many leaks you're experiencing at the moment.

The best things I've found for leaks are cleaning the silicone of my full face mask and my face before use, using the humidifier and taping my mouth every night.

Thanks for the reply. This is a regular night for SPO2 fluctuations for me. The o2 ring app gives me 9.8 rating for this night and 9.9 for others. I did try taping last night and it dropped to 9.0 so hopefully that goes better tonight. I feel a lot better after sleeping then several years ago, so subjectively i'd say i can have good restful nights of sleep if everything is optimal (duration, no alchohol, 3 hours fasted, low stress). In contrast to before cpap i actually feel rested after sleep. But I'm still suffering from brain fog, lack of focus, do not have a lot of energy just enough really. So that's what led me to thinking there's room for improvement despite an okay AHI of 3.

I do not have a record of my sleep study. I'll see if i can i get it from the hospital.

I also did not have a sleep titration study specifically, just an at home sleep apnea test. They are two different things right? As far i know they just put me on 6 Fixed pressure. And when i switched from a full face mask to nose pillows i went under 5 AHI. After that all the adjustments i've made myself. 

I've tried taping last night, woke up several times and it got loose a couple times (i did wake up with it stuck at least). Leaks do not seem to have decreased unfortunately. I'll give it another try tonight and see if i get better results and then post those. My mask it as tight as it can be unfortunately, so that would mean i'd have to get a new mask if this doesn't work out?

[raylock1]

Could you explain this a bit more or provide some information? Im a bit cluecless about this topic. What about my graph looks like Afib? I do agree the spikes in heart rate seems a bit worrying if that's what you meant. That doesn't feel like it would be good for restful sleep to me.

My fitbit versa is not giving me any irregular heartbeat rhythm notifications. I have 61 Resting heart rate which seems too low as my cardio is just okay. 16 Breathing rate, 29ms heart rate variability (again too low). My heart statistics always seemed a bit abnormal / not optimal to me, so your comment has me a bit worried.

Well, I am not a doctor so I can not say that your chart looks like afib.  I can only say that mine looks that way when I am in Afib.  I have had afib for more than 20 years.  There were times when I could feel it and it would keep me awake.  More recently, I do not feel it so it does not affect my sleep (to my knowledge).  Afib is when the electrical system of the heart causes the heart to beat irregularly. I use a Kardia device and my watch to check it.  It shows up as a rapid change in the R to R time (heart rate) on an EKG.  My heart rate is slow, like yours, so it is less significant than someone who has a heart rate of say 150.  My GP will say that my heart is regular based on listening with a stethoscope but an EKG by my cardiologist will show otherwise.  In my case the oximeter will show pretty much a straight line at night when I am not in afib except for times that I am moving and a very zagged line when I am in Afib.  The attached picture shows a regular heart rate for the first hour of the night and afib later on.  If you are concerned your cardiologist could give you the best answer.

[gainerfull]

Thanks for the reply. This is a regular night for SPO2 fluctuations for me. The o2 ring app gives me 9.8 rating for this night and 9.9 for others. I did try taping last night and it dropped to 9.0 so hopefully that goes better tonight. I feel a lot better after sleeping then several years ago, so subjectively i'd say i can have good restful nights of sleep if everything is optimal (duration, no alchohol, 3 hours fasted, low stress). In contrast to before cpap i actually feel rested after sleep. But I'm still suffering from brain fog, lack of focus, do not have a lot of energy just enough really. So that's what led me to thinking there's room for improvement despite an okay AHI of 3.

I do not have a record of my sleep study. I'll see if i can i get it from the hospital.

I also did not have a sleep titration study specifically, just an at home sleep apnea test. They are two different things right? As far i know they just put me on 6 Fixed pressure. And when i switched from a full face mask to nose pillows i went under 5 AHI. After that all the adjustments i've made myself. 

I've tried taping last night, woke up several times and it got loose a couple times (i did wake up with it stuck at least). Leaks do not seem to have decreased unfortunately. I'll give it another try tonight and see if i get better results and then post those. My mask it as tight as it can be unfortunately, so that would mean i'd have to get a new mask if this doesn't work out?

Based upon how many obstructive events you're having at 7.0 cmH20 I'd be interested to see what your sleep data looks like after increasing your CPAP pressure to 9.0.

The problem is, with your leak rates it will be hard to tell if more pressure is effective as it could amplify your mask leak issue. Mouth taping takes some getting used to and feels foreign at first but gets easier the more you do it. Also, are you using the humidifier in your CPAP?

[jerop]

@raylock1 thanks! that's very helpful. Subjectively i've felt my heartbeat being irregular/dodgy sometimes out of nowhere. So what you said did resonate with me and i'll definitely look into aFib once i got my AHI and leak rates under control. There seems to be a strong link with afib and sleep apnea too unfortunately, so that might be quite common around here. Also really helpful too know that pulse rate can remain that stable during sleep.. looking at your chart that looks a lot more restful and healthy to me.

@gainerfull humidifcation is at 7. Actually getting more dry mouth from taping then i did before without, which seems counterintuitive. I've been on 7-9 apap for the last 3 nights. Which may have resulted in slight improvements (-0.5 AHI at most). Changed it to 9-11 last night as my new mask seemed to need more pressure to feel the same as 7-9 with my dreamwear.

Last night i made a lot of changes. changed my cpap filter, triple taped my mouth so it would stay taped. Changed mask to a newer Aifit P30I as i'd used my previous dreamwear for 2 years. The Airfit p30i seems to fit a lot more snug and leaks less when there's some movement. Both subjectively and objectively there's less leaks now. Did a neti pot nose clean and i tried out my first night with a sleeping collar.


FINALLY! Some good news though. I got 1.52 AHI last night which is the best AHI i've seen in weeks. I go below 2 AHI 1-2 times a month at most so this is probably not a fluke. The results might actually be even better then the data shows as i was pretty much fully awake from 6 AM, so those OA can probably be disregarded. And these are the best results yet for my 02 ring with no drops below 93%. It's so exhausting to keep trying new things to improve CPAP just to end up sleeping worse and not reducing my AHI. I think the sleeping collar made the biggest difference. I have pretty bad neck/back (nerd neck) posture so i already had a suspicion this could really work for me.

Definitely feel more rested today then normal. And it's so nice to feel a bit more in control and gain some confidence that it can get better. Still woke up 3 times though either due too the itchy sleeping collar (already ordered some new ones), or very dry mouth or the taping. Or perhaps all three. So there's definitely still some adjustment period needed. And probably need to up my humidification, even though it's already at 7.

Has anyone else experienced dry mouth from taping? And this leak rate is good enough right? or should i strive for better? Any advice based on my charts would still be highly appreciated

[raylock1]

Has anyone else experienced dry mouth from taping? And this leak rate is good enough right? or should i strive for better? Any advice based on my charts would still be highly appreciated

I found initially that taping did not work very well.  I think enough moisture seeped through which partially dislodged the tape and allowed air leaks which still resulted in a very dry mouth.  I found that taping plus a chin strap was much better.  I finally settled on 3M Kind Removal Silicone Tape - 2 Inch  which I order from Amazon or Ebay and which I could use without the chin strap.  One inch was not effective, but 2 inches works pretty well for me. 

There is an excellent write-up on leaks in the Oscar section of the wiki.  I found it answered a lot of my questions.

[jerop]

I found initially that taping did not work very well.  I think enough moisture seeped through which partially dislodged the tape and allowed air leaks which still resulted in a very dry mouth.  I found that taping plus a chin strap was much better.  I finally settled on which I order from Amazon or Ebay and which I could use without the chin strap.  One inch was not effective, but 2 inches works pretty well for me. 

There is an excellent write-up on leaks in the Oscar section of the wiki.  I found it answered a lot of my questions.

thanks for that recommendation, I'll have a look at that article. Fixing leaks is definitely my #1 priority right now. I also ordered the BLEEP sleep mask which should arrive next week, so hopefully i can then truly experience what difference a leak free experience makes. Any recommendations on the chin straps by the way? I've tried several and they were all completely trash honestly. They didn't seem to offer any significant amount of resistance to my jaw at all.


Previous night stats:
- AHI: 1.52 -> 4.67
- CA: 0 -> 3.5
- OA: 1.35 -> 0.58
- 02 Score: 9.9 -> 9.3
- Lowest 02: 93% -> 87%
- Drops: 0 -> 17
- no changes in pressure or mask
- a lot more leaks
- Aerophagia
- 3 awakenings


Changes from previous night:
- Switched from tan itchy more restictive collar to more comfortable and less restrictive blue collar
- No tape
- old regular pillow
- Tried to wear the "FaceFormer" which is a sleep apnea training tool at night to see if it could reduce leaks
- slightly less tight mask

Woke up 3 times again so it's not the tape that causes that. I've narrowed that down to either a supplement i'm taking or the sleeping collar. Despite every objective measurement pointing towards my sleep being trash last night. I'm actually not feeling that tired. So best case scenario my benchmark for decent sleep is very very low and my sleep quality can still get a lot better once i've found everything that works for me.

Conclusions:
I'm pretty sure 9 to 11 pressure is too high for me. Also suffered from aerophagia this night which i never have. Thankfully my obstructive apnea's seem to be decent now. So i'll switch to 9 fixed pressure for tonight, no collar and use tape again. Hopefully i can get a continous sleep tonight with less CA's and leaks with these changes. Faceformer does not seem to be worthwhile for reducing leaks either. It also looks like taping massively reduces my CA's despite the pressure being the same, will need some more data to confirm this.