New Member - Hello! [how long before considering adjustments?]

[skiajl6297]

Good morning, and thanks again for your thoughts!

I adjusted my settings last night and had a pretty bad night.  I don't know why but I had a really difficult time falling and then staying asleep.  A ton of tossing and turning, and found it difficult to get comfortable.  I didn't expect so much trouble from the change, but trouble it was.  I am attaching my charts from last night.  Not sure if these are helpful, given how broken my night felt.

A few observations - first, I noticed an improvement with the A flex setting to 2.  I changed it midway through the night to "feel" the difference over a few breaths, and clearly found 2 preferable to 1 or 3.  This was just done over a short period of time, but I had started my night on 2, and I finished it there.

I also noticed that my inspiration was better - I didn't find myself feeling starved for air on some of my larger inhalations.  I did however notice that my exhales almost seemed faster than normal - but I wonder if they were doing their job.  

My biggest takeaway was the big uptick in clear airway apneas.  I had single digits for both clear airway and obstructive apneas both nights prior, at my old settings.  After the change, I had 31 clear airway events recorded, although I question whether that data is good given my inability to stay asleep.  Hypopneas were around average for me with 32 as well - no real change from the prior nights.  Obstructives stayed around average for my prior nights.  OA stayed roughly the same, HY stayed roughly the same, and CA grew significantly.

Obviously time is a factor, and I am not going to quit just because of a bad night.  But last night felt like night one all over again!  Is that typical with making that kind of volume adjustment?  I will continue to post data, and would very much appreciate any insight you may find in my charts.  I am away from my machine all day again, so any requests for added info will need to be done this evening.  

Thank you all for your generosity of time and knowledge!

[Sleeprider]

I think it's early to draw conclusions. Keep with the Aflex at 2 and keep in mind your pressure only varied by 2-cm most of the night. Disrupted sleep commonly results in higher incidence of CA events, and it doesn't look like any major clusters.

[skiajl6297]

My plan is to keep pushing through - and I will remain patient! I am so tired today that I can't see how I won't sleep better tonight.

Also, I am giving another mask a try - going to see if I can tolerate nasal pillows with the Airfit P30i. I won't have them for several days, so should have time to see how I settle in to the new settings with my eson mask.

I also am going to further play with mask fit using the mask fit feature - I am close on strap adjustments, but think I can do a little better.

[Sleeprider]

While zoomed views are useful, we need to also see the full session at this point so we can try to correlate events and any breaks in therapy with time and pressure.

[skiajl6297]

While zoomed views are useful, we need to also see the full session at this point so we can try to correlate events and any breaks in therapy with time and pressure.

Here we go.  Attaching last night, and one of my prior rough nights.

[Sleeprider]

I think a minimum pressure of 5.0 might be better based on median pressure and the flow limits at low pressure. You This chart is really all we need, especially if you shorten the height of the graphs so more information fits.

[skiajl6297]

Quick check in from last night... felt better than prior but still not great.  

The two changes I made last night included refitting my mask using the mask fit function, and changing my "Mask Type" to type 1, to reflect the use of a nasal mask.  Everything else remained the same from prior night.  Obstructives stayed the same (roughly) and the centrals and hypopneas remain at their elevated levels (centrals slightly down, hypopneas slightly up).  

I slept, and feel better this morning, but not as good as other nights.   I also had several "large leaks" last night, which I find surprising. I re-fit my mask last night and feel like I had it really dialed in.  I noticed fewer facial leaks around my nose and upper lip in particular.  Is it possible some of these large leaks are me swallowing air?  I usually notice leaks, and often struggle with them.  I find it strange that I would have so many last night without noticing any.  I was also exhausted, so who knows.

I woke up both mornings after making the change, with what felt like a really bloated stomach, and had excess gas and stomach pain that lasted for about an hour after waking.  Is this possibly caused by these leaks?  

Also, I continue to see snores show up, particularly vibratory, and I don't recall ever seeing this issue prior to this machine.  Is this something that is introduced with increased pressure?

[skiajl6297]

Another night complete.  I spoke with my DME provider yesterday and am going to try a new mask (P30i Nasal Pillow).  I toss and turn alot, and I am hopeful the mask works for active sleeping, as advertised.  The DME thinks I am due for a titration study, and that will help clear up whether my Dreamstation is the best machine for my condition.  I have an appointment with my sleep doctor Monday also, and plan to walk through all of this, and ask for guidance on next steps. 

I woke up this morning feeling slightly worse than the prior night, with a bit of a headache.  Fatigue, anxious, grumpy.

I did bump the min back to 5 and think it helped overall, as my AHI was down slightly, although the machine clearly continues to find 8-9cm as my sweet spot pressure 90% of the time.  My obstructives seem to get better in the lower pressures, but with the pressures up, I end up with growing hypopneas and centrals.  It looks like 5-6cm seems to be a stable spot, but getting closer to 7+ I end up with increasing central/hypopneas.  Is my reading of the charts in line with others?  I wonder if a true bi level machine with an inhalation pressure of maybe 8-9 would work well with a exhalation pressure of 5-6?

I have noticed the first half of my nights is almost always better than the second half. For as long as I can remember my "best feeling" sleep always came during this early morning (2-6) time frame, and yet night after night, there are alot of flagged events at these times.  Could it just be representative of sleep stages?  Do we tend to have more hypopneas during certain stages?

Finally, I have a history of underlying mild heart problems (lone afib, noncompaction cardiomyopathy, taking blood thinners) and am curious how much data from sleep analysis should shared with the cardiologist?  Anything beyond just knowing that I am being treated?

Attaching my latest - forgot to adjust row heights, but will next time, apologies!  I know that trends matter more than individual nights, and I won't bludgeon the community with daily charts, and I do appreciate everyone's time!  I am the type that likes to have enough rope to hang himself with, particularly when it comes to understanding my own healthcare.

[skiajl6297]

Interesting new development. I have used decongestant (Afrin) nasal spray two total nights during treatment. Both nights I had otherwise unremarkable sleep. And both nights returned 2.4 AHI!

Closest other night was 5.6! Most others are still around 8.

I have had a lifetime of nasal congestion, allergies, stuffiness. I've had a septoplasty and turbinate reduction.

Could I need more? I know first-hand how addictive Afrin is and do not want to go down that road again.

[Dormeo]

Get thee to an allergist! He or she can prescribe drugs to help control symptoms and may be able to recommend other measures that would help, depending on what you’re allergic to.

I learned in January that I’m allergic to dust mites. Two nasal sprays and two kinds of pills are helping, and I’ve started allergy shots, which may kick in later this year.

Good luck!