[Treatment] New User Seeks Guidance

[Sleeper396]

Thanks to all who commented on my recent head cold (first ever that I had during CPAP treatment) causing terrible interrupted sleep sessions and significantly higher AHI. Though the head cold is all but gone, and the results were slightly better for a few days, the problems have returned to create continued higher AHI (now 6 AHI, as opposed to my being consistently at 1.7 AHI average); and what's worse is my broken sleep sessions -- all conditions that resemble where I was before any APAP treatment.  

I am at a loss for what to do next.  I am not sleeping in any meaningful way -- with so many one hour (or less) sessions that are not any better than my pre-treatment conditon!!  I would say that the timing was consistent with switching to my new ResMed AS 11 machine (from my AS 10), except that my head cold setback started the first night on the AS 10 and posted the worst results that I have had in the last 6 months (all on the older machine); so that is unlikely to be the issue.  


Maybe its time to increase pressures, since my CA's are only accounting for 50% of the 40 events last night. However, even that is not likely to help, as it appears from Oscar that pressures were elevated throughout all of the major non-CA events.  Maybe I'll go back to the AS 10 tonight, since I am running out of ideas. 

Once again, I am seeking guidance from the experienced members of the Apnea Board. Any suggestions would be so very greatly appreciated.  Please see last night's Oscar attached.

[Ratchick]

With the clustering of obstructive events, I'd wonder if there's some positional apnea going on. If so, you would need to consider maybe a flatter pillow or the use of a soft collar if it's persistent. You also have a lot of flow limits, and setting EPR to be on full time 3 may well help with that. It's possible that the EPR might worsen the centrals but that said, most of your centrals appear to be around the beginnings/ends of sessions and around the time of the obstructive clusters, which makes me think they might be something we can ignore for now if they're sleep-wake junk or a side effect of the arousals from the other events.

What is causing you to wake and stop/restart the machine? Most of the sessions don't seem to end with obvious events.

[Sleeper396]

With the clustering of obstructive events, I'd wonder if there's some positional apnea going on. If so, you would need to consider maybe a flatter pillow or the use of a soft collar if it's persistent. You also have a lot of flow limits, and setting EPR to be on full time 3 may well help with that. It's possible that the EPR might worsen the centrals but that said, most of your centrals appear to be around the beginnings/ends of sessions and around the time of the obstructive clusters, which makes me think they might be something we can ignore for now if they're sleep-wake junk or a side effect of the arousals from the other events.

What is causing you to wake and stop/restart the machine? Most of the sessions don't seem to end with obvious events.

Hi Ratchick - You are probably correct that positional apnea is a contributor. I had tried a collar and did generally OK with it, but was uncomfortable on certain nights, so removed it, and I have not been using it throughout this "setback" period.  I may try it again, if I can tolerate it comfortably. I do use a very flat pillow and sleep on my side. Originally, I was a back sleeper which was very bad for my AHI. 

I'll certainly consider your suggestion of full time EPR at 3.  Would you suggest my raising the pressures if I were to add the EPR, or leave pressures at my current settings of 8.4/13.6? Right now, I do not use EPR. I am not sure what is causing my awakenings.  It could be habitual, as I used to get up for bathroom trips hourly prior to CPAP; then cut that significantly until this head cold episode apparently causing this setback.   

Last night was somewhat better, with AHI slightly improved, and sleep sessions incrementally better.  I'm still hoping that it could be the residual impact of the head cold, which I would imagine could mess with my system for longer than expected.  

Thank you, Ratchick, for your patience with my "whining."

[Ratchick]

I suspect you're right about the head cold setting you back into your previous waking schedule (which is unsurprising, really). As it's improving, hopefully, that will continue too.

The machine will cope with EPR at 3 with the current settings, so maybe leave it, for now, to see how just changing one thing at a time works. You can always push the min pressure up if needed.

And you're welcome.

[Sleeper396]

Once again, I am coming to the Apnea Board with a request for help and guidance, as I am beginning to feel very despondent (as if I am losing the battle).  I don't want this to sound like whining again, so I will try to just get to the points and seek your recommendations. 

1- I was doing well after 7 months on APAP - most importantly going from 6 wakeups per night to 3 per night, which for me, was a triumph. (I have battled BPH and nocturia for many years and APAP appeared to be helping me a great deal). 
2- I caught a head cold 30 days ago, and since that point (despite fully recovering from the cold after 10 days), I seem to have regressed to almost where I started before APAP therapy
7 months ago. (I call this my "setback").
3- The single worst issue that I am currently facing is that my average sleep sessions are once again running one hour each (last night under 1 hour each), with 6-7 wakeups per night. I used to wake up because I had to pee; but now, I feel as if my wakeups are non-specific, and mostly from restlessness (without the urgency to pee that I used to have).  
4- My events are approximately 60% coming from Obstructive and Hypopneas, and 40% from CA's.  Previously I did not see much at all of Obstructive and Hypopnea events. Last night's AHI was 5.6, and for the entire last 30 days my AHI has more than doubled (from a previous 60 day average of 1.4 AHI, to now running between 3.6 - 5.5 AHI).

5- I am at the same pressure settings that were working well for me prior to my setback. 

Also of concern is that these issues seem to have caused a return of high blood pressure, which was well under control prior to this setback. I am even seeing frequent irregular heartbeats on my home BP monitor (although my EKG of this week was normal after I had it checked out of concern).

I did not use my collar last night, which might be a reason for the higher AHI (positional), and I will force myself to use the collar tonight, even though I find it very restrictive (despite keeping it relatively loose). Please view my Oscar report from last night, and any comments or suggestions would be greatly appreciated as always.  If you are unable to find any new suggestions beyond what has previously been attempted, then please just consider this my whining rant.  Thank you.