My CPAP journey officially underway

[lightwolf1]

Hello all, new member but have been perusing for a while, trying to learn all I can as I begin this therapy.

Last night was my first night with this CPAP journey, and I got through it.  I have a lot of anxiety over this, so I'm wading in slowly, and have the pressures lower than prescribed, so I can acclimate, mentally and physically, to doing this.  I will move them to prescribed over the next week.

As I hinted, this isn't my first try at CPAP.  Probably about 5 years ago, I was diagnosed with sleep apnea, and didn't tolerate CPAP well, but then I was wearing the 'fighter pilot' mask and that was very anxiety producing.  After about two weeks of waking up with the mask across the room, I lost about 15-20 pounds of weight in a month and a follow-up study found no or insignificant apnea, and my sleep was actually great -- I was fully functioning again and all was good.  That changed exactly one year ago, and this last year has been a real struggle.

I had found my 'trigger weight' for apnea and am below that now, and have been for most of this last year +, so something new is in the mix.  Cardiology, Pumonology, Neurology, all say I'm either fine or I'm operating above normal specs.  I do have GERD, but that has been around for ALL my life, and is not worse.

I offer that just as background and context.  For last night, I really just wanted to replicate what was done at my titration study.  That went OK until they put the pressure at 9cm, and then I had many arousals and eventually woke up and stayed awake.   Last night, around the same time (5am), I woke and had a very hard time exhaling against the flow, which the machine display showed as 9.6.  I could not exhale with a closed mouth -- I had to open my mouth and then a rush of air would follow like deflating a tire -- a strong and prolonged exhale.

I've attached two overviews and one detail -- hopefully this is enough to start.  There was bathroom break at about 1:30 and another awakening at 3:30, after each was awake for about 10-15 minutes reading.  I would appreciate your thoughts and thank you in advance.  This is a great service to people.

[lightwolf1]

Last night's charts.  The CSR after 5am in interesting.  I was AWAKE then -- I am sure.  Bathroom break at 4:44.  Never went back to sleep.  Before I got up for that, awoke definitely feeling like I was fighting the machine -- could neither inhale or exhale easily -- exhale worse.

All pressures were moved up 1 cm toward prescribed.

Overall feeling: definitely less rested than yesterday.

[OpalRose]

Hi lightwolf1,
The one thing I notice is the "clusters" of Obstructives. This indicates your are sleeping in such a way that you are cutting off your air supply.

This is called "Positional Apnea" where your head/neck tilt forward and tucks into your chest, and can occur whether you are on your back or side.

Many here use a "soft" cervical collar to help with this issue.
http://www.apneaboard.com/wiki/index.php...cal_Collar

Another thing you can try is to sleep on your side and tuck the corner of your pillow under your chin to support it. This is what I do and it works well.

Also, what type pillow do your use? A taller pillow can push your head forward into your chest if on your back. Try using a thinner pillow.

One thing I want to point out is that until you correct this sleep position, no amount of raising the pressure will help with the Positional Apnea.

I would ignore the CSR at 5am. Unless you see this as a pattern, it's nothing to worry about, especially if you are awake.

[lightwolf1]

Thank you OpalRose.  I really appreciate your thoughts and suggestions.  I agree, and was concerned about position after looking at the results from my titration and study.  I actually have a cervical collar coming soon, and got a cervical pillow a few days ago, and I think it might be too tall -- your comments drive that home.  I'm a side sleeper, and I'm sure I go into the fetal position a lot. 

Any other suggestions from the group will be greatly appreciated.

[lightwolf1]

Positional Apnea is absolutely the big gorilla in my sleep room.  If it wasn't obvious before, I think last night provided some good evidence.  I had concluded it would probably be my first dragon to slay after getting my titration results and then reading up on this site.  Thank you all.

Pretty bad night last night, even though my AHI was better.  I've posted the overall night along with two details I think are important.  The first, around 00:15 was single OA followed by about 90 minutes of little tidal flow.  The second, around 13:08, devolved into what looks like a classic Cheyne Stokes for the next 30 minutes or so, even though the machine didn't flag it.

I didn't change any pressures last night, but after doing some reading on this site, I decided to try sleeping without the wedge (which I hate anyway 'cuz it kills my back) since that can contribute to PA.  I started with a shorter neck contour pillow, then changed to the taller one because the other just didn't seem to be supporting well and I wanted to see the difference in the data.  I thought the change was at 1:30 but probably was actually a little later, when all the mask leaks occurred.

Other than the lack of tidal flow for 90 minutes, the first portion of the night is one I would take any night right now.  The second, not so much.  I was supposed to get a couple cervical collars on Friday (different sizes) but the Fedex tracking just said "delivery not attempted" even though it is right here in town.    Looks like I'm going to have to try to find one local today (everyone seems to be out at first glance) and bring back the wedge.

The real story of the night is how my heart compensated.  I wear a Wellue O2 ring and have for a few months, because I have an elevated risk of stroke and my sleep issues had me and my cardiologist concerned that I could suffer organ damage or worse from poor sleep.  It certainly isn't perfect, but it is useful for trends, and last night was the worst tracing I have had.  I had one 20 minute window 1:30 to 1:50 that had what for me is a normal rhythm -- sub 70 with little fluctuation.  Outside that I was as high as 228 and swinging wildly around.  I essentially did almost 6 hours of HIIT last night.  I think that was my body compensating to make sure I had the O2 I needed.  

Sorry for the long post.  Really don't want to do that, but I want to affirm that it is a big deal to work through.  I also wanted to affirm that, as many here know, AHI and the machine download may not be the whole story.  Without the cardiac tracing, I would not have known how much of a fight I was in last night.

Thanks for your patience.  Excuse me if I doze off . . . .

[lightwolf1]

Also, my cardiologist did test me for congestive heart failure, which I do not have, and artery disease, which I also do not have.  Actually have great arteries.  I'm reading the great post here on CSR outside heart issues.  Thanks again.