Where Do I go From here?

[Gideon]

Bonjour:

Thank you for the list.

I would select from it, an occasional mild morning headache, wakening during the night, dry mouth and sore throat, and restless sleep.

Although this is subjective, I don't feel well rested and fresh. I eagerly look forward to removing the mask in the morning and sometimes relinquish it prematurely during the night. I really have to "talk myself into keeping the mask on". Once in a while, I can escape having to use the tape, but most often it's necessary to avoid air escaping from my mouth, no matter where I place my tongue, or what method I try.  It looks to me like I will be eternally stuck with tape. One or two nights a month, I abandon the mask altogether JUST to get a break, even though I suffer from headaches next day. I have to remind myself just how BAD it is to NOT use CPAP.

If this makes any sense, I dread the nighttime and having to sleep with this system even though I know full well what the alternatives are. I have tried a full mask but found it unacceptable due to frequent leaks. Also tried nasal pillows but for me personally they are more disruptive than the nasal. I've fiddled with the humidity to no avail ... we have 43% RH in this house, so anything more and 1 on the dial causes water collecting in the mask. 


Thanks for your concern and assistance.

Howie

Non-Restorative Sleep; is "I don't feel well rested and fresh."
Why do you "really have to talk myself into keeping the mask on".?
The usual advice we give for this is to use your system while awake, reading, watching TV, anything you find enjoyable.

The list represents terms defining symptoms that doctors are told to look for.  The purpose is for you to frame how you talk to your doctor.  These items help define why CPAP is not working for you.
You may want to review this wiki in addition to the thread that Sleeprider pointed you to. Justifying_Advanced_PAP_Machines

Maybe you could get an ASV to trial for a couple of weeks.  At least a Sleep Study on ASV.
Fred

[Howie51]

Sleepster:


My apologies for failing to reply to your question. The short periods using CPAP are generally because upon awakening for the 2nd or 3rd time, and despite trying my best to "Leave the mask on", it is sometimes all I can stand for the night. At 5-6am I'm ready to take the mask off and try hard to get a few hours of CPAP-Free sleep if that makes any sense.

It feels as if I'm just not sleeping deeply, the mask feels annoying and tight (I have experimented endlessly with too tight, too lose, and just right, washing my face and shaving beforehand, etc., etc.,) using a pillow to prop my chin, but I still have frequent arousals. It's as much of a matter of badly wanting to get rid of the tape off my face as well because I am forced to tape my mouth.

My latest discovery comes after attempting to vary my nasal medications. I have now tried using 1 antihistamine before bed, and a nasal spray after the first arousal (Generally around 1-2am),. This appears to work better, and it tells me my AHI goes down if the nasal issues are attended to. I have even managed to get a 0.00 AHI reading once last week, at 1 AM, but that changed to a 3.5 by 6:30 AM. Odd. High AHI and sinus conditions seem to go hand in hand.

Cheers
Howie

[Howie51]

Thanks, Bonjour,

I'm better educated than my family doctor at this point. I have a prescription for an ASV (from her if needed), just trying to figure out on my own if I actually would benefit from one, because the costs are a little higher than the other machines, and I do not have insurance, nor am I using a sleep clinic right now. I'm solo.

Neither home sleep study in the last decade identified CSA, am I am now considering an overnight lab study to determine once and for all.

Cheers
H

[Sleepster]

At 5-6am I'm ready to take the mask off and try hard to get a few hours of CPAP-Free sleep if that makes any sense.

Of course it makes no sense. You don't sleep when you're not using your machine. You've just convinced yourself that you do.

On the other hand, what you are doing is taxing your cardiovascular system increasing the risk of heart disease or stroke. You are also adding to your anxiety level by depriving yourself of oxygen and making your brain go into a panic mode to wake you up over it.

And another thing it's doing is interfering with your adaptation. We all have to adapt, it's just that it's harder for some of us than others. The ony alternative is a miserable sleep-deprived life and and early death.

I have even managed to get a 0.00 AHI reading once last week, at 1 AM, but that changed to a 3.5 by 6:30 AM. Odd. High AHI and sinus conditions seem to go hand in hand.

Yup, AHI fluctuates. Your AHI looks good. You need to focus on compliance. And leaks, too.

[Howie51]

Exactly! And of course, this is the battle I'm fighting ... But I was asked, and I'm trying to be as honest as possible about how I feel.

All in all I think I'm winning but the question still remains: Is ASV the next option. That one hasn't been answered.

Cheers & many thanks
Howie

[jaswilliams]

All in all I think I'm winning but the question still remains: Is ASV the next option. That one hasn't been answered.

I see no reason for an ASV even if al the CA’s are real there are not enough to worry about, if your having disturbed sleep then not breathing for 10 seconds whilst you roll over in bed has just given you 1 CA.


I repeat the number of CA’s at not enough to be of concern, you need to concentrate on sleep hygiene, keeping the mask on and sleeping with the machine. I don’t think you will sleep more with an ASV


Jason

[Howie51]

One additional puzzle:

Is there any chance I'm having discomfort (In part) due to using an incorrect machine for my condition? I ask this because occasionally when I am aroused, I have the sensation that I'd stopped breathing. During these times, I typically wake with a tight feeling in my head (Close, but not quite a headache). Would an oximeter be recommended?

Cheers
Howie

[Howie51]

Jason .. I posted a reply before your response arrived. Thank you!

[Sleeprider]

Howie51, would you be interested in trying a maximum pressure of 10 cm? Your settings have been 6-8 EPR 2 and your pressure consistently averages near the top of that range. When you do have apnea, they are divided between central and obstructive. I think that there are a couple things left to try before jumping into ASV. I would try 6 to 10 EPR 2, and if centrals increase, then I would cut back on EPR by 1. Let's try some alternatives, starting with higher maximum pressure and see if it gets us anywhere.

[Howie51]

Sleeprider: Most definitely. It's been a while since I've tried numbers that high, but I am willing to give it a chance. 

Will check back after things have stabilized one way or another.

Cheers & thanks for the suggestion
Howie