NewlyDiagnosed therapy thread

[NewlyDiagnosed]

I'm baffled and hoping for some insight and suggestions.  I've been using Dreamports for the last couple of weeks and taping with kinesiology tape.  I'd previously been using nasal pillows, with two problems - they often leaked, and for some reason I would always wake up after 2-4 hours and tear them off.  The Dreamports are great, no leaks at all from the ports, and very comfortable.  No problem wearing them all night, and when I wake up in the morning I can't even tell that I'm using CPAP - I'm not even aware of the air coming in.

Despite the fact that the Dreamports don't leak, and I've been taping my mouth completely, I was still having leaks.  I've experimented with lowering the maximum pressure and changing the machine setting from "nasal" to "pillows."  I was not sleeping well, and waking up multiple times during the night.  I became aware that what was waking me up was the sensation of air coming into my cheeks, often as I was drifting off and my tongue moved.  I started working on the tongue exercise, but no improvement yet. 

Last night I added the Somnoseal, with tape over it.  I seemed to sleep well, slept though the night without waking up even once.  This hasn't happened for many years.  But my Oscar results are awful, many OA events.  Until last night, my event rate had been very low, and mostly meaningless CAs.  Leaking is lower, and flow limits are lower than they've ever been.  Maybe I need more pressure?

One most possible factor - I had a glass of wine last night.  I've had hardly any alcohol since starting CPAP, because I feel better if I don't drink at all, and I believe that it interferes with sleep. Maybe this contributed to the OAs, but I had a glass of wine two nights while I was on vacation last month, and it didn't seem to have any effect.

I've attached the past 3 nights:

July 18, pressure 7-11, "pillows" setting, mouth tape
July 19, pressure 7-10.6, "nasal" setting, mouth tape
July 20, pressure 7-10.6, "nasal" setting, mouth tape + Somnoseal

I'd be very grateful for any suggestions.

[Dormeo]

The clustering makes me think you may have experienced positional apnea. This occurs when your sleep position induces OAs, mainly via tucking your chin down toward your chest, which can slightly narrow your airway. Maybe you curled up more than usual on your sides; maybe you slept on your back more than usual; maybe your pillows were higher than usual?

At any rate, the wine may have been the culprit, so I'd leave the settings alone tonight and see what happens. If you get this many OAs again, then raising your min and max will be in order, along with checking carefully on possible positional issues.

[NewlyDiagnosed]

Thanks, Dormeo. Positional factors are not in play; I always sleep flat on my back without moving all night (except for occasional experiments with side-sleeping to see if that improves my results). Same pillow.

I will try again tonight without the wine.

[NewlyDiagnosed]

No wine last night, returned max pressure to 11, and setting to "pillows."  I'm racing to get to work so haven't done more than take a quick look, but miraculously, the leaks are completely gone!  I still have quite a few events, though.  I'm wondering if I was having this many events before but the leaks were masking them.

I woke up a couple of times, but I think I slept pretty well.  I've ordered an Oura ring to get more information on this.

[Dormeo]

Yes, your leak graph is a thing of beauty! The OAs not so much. How would you feel about raising your maximum, to maybe 13? Whether it does or doesn't help, we might learn something that way.

And you might want to take a look at this, in the wiki:

https://www.apneaboard.com/wiki/index.ph...onal_Apnea

[NewlyDiagnosed]

Hi, Dormeo,

I'll raise the max pressure to 13 for tonight.

I read the link, and I can see the pattern of clustered events and diminished flow rates.  Expanding the latter, I can see that my breath forms went flat for several periods before OAs.  Is another possibility that I temporarily lost the urge to breath (central apnea?)  But the machine is identifying obstructions, correct?  Going back through my data, I do not see many OAs at all.  But my leak rate was always high so perhaps the OAs were not recognized?

I'm having trouble imagining what is causing the positional effects.  I'm flat on my back the entire night, without moving, my pillow is fairly thin, and I position my head so that it is on the "downslope" and my chin is higher than normal relative to my throat.  It seems very possible that my jaw is falling open, though, and maybe that has similar effects.  I have a SCC, wore it one night and tore it off before too long.  I will try it again tomorrow night. 

Thank you so much for the help!

[NewlyDiagnosed]

Raised the max pressure to 13, and pressure went up as high as 12. There were fewer OAs. I woke up after 1+ hours of what felt like deep sleep because there was some leaking. I actually got up and took out the SD card and checked Oscar results. I think that the leaking was from the adhesive on my nose. I did a patch and that seemed to solve it.

The higher pressure is helping. Should I just rely on this or should I try the SCC?

[NewlyDiagnosed]

Oscar results

[Dormeo]

I don't know why OAs started showing up recently, and that may remain a mystery. But I'm glad the change in your settings helped, and I'd suggest you stick with them for another 3 nights or so before trying to assess them.

About the adhesive on your nose: do you prep your skin before attaching the Dreamports? I use alcohol pads (sold in the diabetes supplies section of my drugstore), and they work well.

[NewlyDiagnosed]

I'll try that - it will be interesting to see how it goes.

I do carefully prep for the Dreamports with witch hazel, and I let it dry. I don't have a problem with the adhesive. Occasionally I reinforce the ports with a small piece of the adhesive (from where I trim the ports), if there is a slight wrinkle or other area that looks like it might be a problem. I'm sure this is what happened last night, a small leak around the adhesive part that I successfully patched.

Thank you!