[Pressure] Pressure problems, panic, fatigue, any help appreciated

[peterdeltoro]

Hi everyone, I’ve been having some issues with what might be pressure, but unsure.  My health insurance is garbage right now, so I can’t afford to get another sleepy study at the moment. Hoping you vets might be able to shine a light on anything out of the ordinary.

Diagnosis history: 
Diagnosed in 2016, moderate apnea (ahi 27), given an air sense 10(not autoset) and Airfit p10 mask at 11 cm pressure

Chinstrap for mouth breathing

Medications: 
Valium and Adderall(panic disorder and adhd, hasn’t changed since diagnosis)

Recently had a blood panel that insurance did cover as part of a free once yearly physical, all normal(including thyroid)

This worked well for a while, but last year I quit drinking, began lifting weights heavily, and lost a significant amount of weight(75 lbs). Mouth leaks have always been somewhat of an issue, so I self-titrated the pressure(at 7 now) as I lost weight when they started getting worse. AHI has been very good, usually under 1. 

Aside from the mouth leaks, I do wake up occasionally in a panic to breathe, ripping the mask off and jolting upright. Sometimes my hands and body are numb/tingling. I also end up not being able to sleep for as long as I’d like(waking up at 3-4am, and unable to fall back asleep) and am extremely tired throughout the day.

Is my pressure too low? Or Do I maybe not need the machine anymore? I don’t know what to make of it. 

Any help is appreciated!

Attached are some sleepyhead data from a “good” night where the mouth leaks haven’t been too bad recently:

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More from sleepyhead:

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[DeepBreathing]

G'day Peter. welcome to Apnea Board.

The first thing that jumps out is that your machine is doing its job and keeping your apnea well under control. The second is that there are persistent flow limitations which could be causing you discomfort leading to the need to remove the mask. And the third is a fairly early bed time and wake-up time. May I ask if that's normal for you?

Before we go much further I'd like to ask you to reformat your graphs please. The instructions can be found here: http://www.apneaboard.com/wiki/index.php...ganization Basically we need to see the following graphs: Event flags, Flow rate, Pressure (not mask pressure), Leak rate, Flow limitations and snore. Turn off the pie chart as that covers up useful information. Please use the F11 key to maximise the window then F12 to take the screenshot. That way we should get everything we need in one screen at a reasonable size.

You asked if maybe you no longer need your machine. Having made such a big lifestyle change and lost so much weight (congratulations - I keep promising myself to lose weight), it's likely that your pressure needs have changed but experience is that apnea never goes away entirely. Only a proper sleep study can tell for sure. However, even with the machine there are flow limitations which indicate the continuing need for a machine.

At this stage I'd be inclined to bump the pressure back up to 8.5 or 9 and see what effect that has.

As for the mouth leaking, there are lots of techniques to combat it, including the tongue trick, chin strap, soft cervical collar, etc. You could also consider going to a full face mask, which has its own issues but mouth leaks would be resolved.

[peterdeltoro]

Thank you so much for taking the time to respond! I've worn a chin strap since shortly after beginning CPAP, and tried all the methods to mitigate mouth leaks, including mouth taping. A full face mask might be something I have to bite the bullet on and pay out of pocket. 

I normally go to sleep at 9pm, and have to be up for work at 5 am. May have been just worn out on this particular day.

Regarding flow limitations, unless I don't completely know what to look for in the graphs, but it looks like it's been a little high for a while now. I've reformatted the graphs and added one from about a year ago, when my pressure was 11cm, and they look pretty similar in that regard. 

Maybe I've needed slightly higher pressure the entire time?

Recent 8cm:

   

Older 11cm: