Sleep is going south, way south

[Quark]

Hello, I am new to the forum but have been on APAP since early June.  After suffering from nightime headaches for a couple of years I had an at-home sleep test which showed an AHI of 12 and an O2 nadir of 77%.  I was put on APAP at a pressure range of 4-16 and had immediate relief from my headaches for about a month, even though my AHI was still averaging between 7 and 8. Then, I started having mouth leak problems, and the headaches came back.  I went through a couple of mask changes finally settling on a full-face mask in August.  Pressure was adjusted to 7-13, and headaches continued.

I had a titration study in Sept. in which the pressure was kept steady at 7, and I had almost no events.  My sleep doc changed my machine to a fixed pressure of 7. The first night I woke up gasping for air and could not breathe or get back to sleep. I finally changed it back to 7-13, planning to gradually lower the upper limit since I don't seem to be able to tolerate big changes. I'm now at 7-11.  

The headaches have continued but were gradually improving until the past couple of weeks. My AHI had consistently dropped below 5 and was slowly (very slowly) decreasing to 3 and below. I felt well-rested and optimistic about my progress.  However, in the past couple of weeks I feel I've had a relapse with AHI increasing and worsening headaches. I don't really understand a lot of the SleepyHead data. Most of my events are CAs, even though on my original sleep test my OAI was 9.4 and CAI was 0.6.  Will decreasing my upper pressure help with the CAs? or has it made me worse in some way? My sleep doc is not much help, and I feel like I'm flailing around trying to guess at what will work for me.

The first 2 links below are to a recent "bad" night, in which I woke shortly after midnight with a pretty severe headache that lasted most of the following day. It was so bad I removed the mask and turned the machine off, which I never do.  I tried putting it back on a little later, but ended up removing it since I was feeling pretty awful. Therefore it's not a typical night but since it featured a bad headache I'm sharing the data below.  The next 2 links are to a more typical night where I didn't have a headache and slept pretty well through the night. The final two links are to 2 subsequent bad nights, the last one being last night. I woke up after about 4 hours of good sleep, and my AHI was less than 2 so all was ducky.  However, I could NOT get back to sleep, and whenever that happens (which until recently has been rare) my AHI soars even though I'm awake.  Became frustrated with tossing and turning and removed the mask and shut off the machine when AHI reached 3.5. Eventually fell asleep but woke feeling unrested. I would appreciate some insight!  I'm new to imgur so let me know if I need to do something different with these files.

https://i.imgur.com/jzKvP3u.png
https://i.imgur.com/7e1TqNc.png

https://i.imgur.com/X6tu3RL.png
https://i.imgur.com/H3dHwSZ.png

https://i.imgur.com/oMXUa05.png
https://i.imgur.com/B9DAZjm.png


<Moderator action: Links fixed>

[Ockrocket]

I will leave it to the more knowledgeable people on here to comment on the specifics of what you may need... but for the "starving for air" feeling I bumped my fixed pressure from 7 to 8 on my machine and no longer feel short of air. 
My air starving was usually when I first donned my mask if I had been doing something strenuous just prior to going to bed ( get your minds out of the gutter people.. we do that in the mornings when we wake up   ).. rushing around getting the garbage bins out is what usually catches me out, when I hear the garbage truck coming up the street. 

The choice between fixed or variable pressure settings is seen to be "pro-active vs reactive" to apnoea events by various medical minds, and others in the know, from what I understand.

[trish6hundred]

Hi Quark,
WELCOME! to the forum.!
Hang in there for answers to your question.
Good luck with getting CPAP therapy find-tuned to meet your needs.

[ajack]

sounds and looks like pressure induced CA, the good news is that most people settle down within 12 weeks.
To help for now, try turning off the epr, see how that goes. Then the forum will help you adjust the min and max to balance the OA/H and any bad CA.

I'd ignore everything while you are awake or just going to sleep or waking up, it's very normal to have the machine see it as events. It's only the sleep patterns I'd concentrate on.