cured or confused?

[myapneas]

I was diagnosed in 2015 with severe apnea ~40 events per hour in a home sleep study. (I couldn't sleep enough in the lab to get results). For about six months I used a full face mask with a ResMed Air 10 auto. I got pretty good results with the machine set in the 10-15 range. 

I also have severe chronic insomnia and after a while I gave up on the mask because it cost me too much sleep.

Now I have a new (and much better) sleep doctor. He has treated my severe Restless Leg Syndrome with Gabapenitin (yeah, i have a lot of issues) and it's basically gone - for now at least. The RLS wasn't diagnosed earlier because it was less severe then, and because it is not constrained to, or even primarily associated with my legs. 

I've also given up alcohol and am exercising daily and have lost about 20 lbs since when I used the machine.

Finally, I'm trying to get re-accustomed to the CPAP. I now have a nose pillow mask but am using the same machine.

So the weird part is that i started with the pressure set to 4-5 to make it easy to get used to.  It is recording very few events. My AHI is usually 3 or less - mostly hypopnias and RERA. At a setting of 6-9, I'm seeing an AHI of less than 1. The data is not great because I rarely make it through an entire night with the mask on, but it's pretty consistent.

I'm wondering now if the Apnea is:
- much better without the extra weight and alcohol
- the same, but the first diagnosis was flawed - maybe the original study was somehow conflating my RLS with apneas
- there's something wrong with my machine now
- the new mask makes a difference some how

Heck, IDK. Has anyone had an experience like this or recommendations? I'm guessing a new sleep study is the right course of action, but was hoping the Apnea Board hivemind could provide some insight.

thanks

[Gary1of2]

It would help us if you post your results . Look at my signature for help. Also did you change the settings on you machine from ffm to nasal?

[myapneas]

Thanks for the quick reply!

I did change the settings to pillow. I will post my results later today. (Have to run for a train.)

[Sleeprider]

We have seen some members treated to very good levels with low pressure, and it would be a mistake to think that would hold true for no CPAP pressure. It may be that with better physical condition, and abstinence from alcohol you take less pressure to treat your condition. It's speculation without doing an actual sleep study. If you have the good fortune to be able to use low pressure and get very good results, then adapting to the machine and making it part of your routine should be easier. That's a good thing.

[HalfAsleep]

A few questions to add to the mix:

1. What does your sleep doc say about resuming CPAP?
2. Do you sleep better with the CPAP?
3. What about your current situation induced you to try CPAP again?
4. Have you developed any of the corollary conditions that would contribute to helping you make a decision...e.g. stroke, diabetes, drowsiness while driving, etc.
5. Is your mouth and/or mask leaking such that it would distort the AHI data?

[myapneas]

@HalfAsleep

A few questions to add to the mix:
Answers below:

1. What does your sleep doc say about resuming CPAP?
I think we both assumed it was necessary because of the earlier diagnosis

2. Do you sleep better with the CPAP?
No. Worse typically.

3. What about your current situation induced you to try CPAP again?
I believed that I needed it based on the study, and hoped that dealing with the RLS would make it more achievable.

4. Have you developed any of the corollary conditions that would contribute to helping you make a decision...e.g. stroke, diabetes, drowsiness while driving, etc.
no stroke, diabetes, etc. Daytime drowsiness only when I don't get enough hours of sleep

5. Is your mouth and/or mask leaking such that it would distort the AHI data?
It always reports a small amount of major leakage when i remove it because I use the auto-on/auto-off setting. (Airline baggage handlers broke the on-off button). I don't believe I'm mouth breathing

[HalfAsleep]

I think I would consider using CPAP for 6 months or so, see how things go, and then reassess.From what I read here (I am a newbie), it takes a while to settle into treatment.

[I_will_never_sleep_again]

Had a similar experience.  My prescribed pressure was 16 with a full facemask in my sleep study, AHI in high 40's. Gave up drinking, and lost some weight.
I turned pressure down to 11 with good results, AHI 1-3 range. Then I switched to a nasal mask (Dreamwear) and had problems with air coming out of
my mouth at 11 pressure on exhale only. I thought maybe that meant my pressure was too high, so I turned it down to 9. My AHI is always less than 1 now, usually 0.2 .
I wondered if my machine was recording them correctly. I did a simple test. Look at the clock, hold your breath a couple times during the night and check sleepyhead
the next day to see if it records them. My machine was recording them fine. I still think I need the cpap because If I fall asleep in my recliner, I wake myself up from stopping breathing.
I just think for SOME people the nasal mask works wonders. I think the FFm makes me mouth breathe and forces my tongue to fall back requiring more pressure
to clear. I went from having mostly Obstructive apneas,  to having 1-3 CA'S per night only , my leak rate is almost zero. My problem is I still sleep like crap and wake feeling tired. I
am guessing the poor sleep has another cause that I haven't figured out yet.