luminaria - Therapy Questions

[luminaria]

Hello,

I am looking for some help with my CPAP settings. I received it back in August at the same time I went back to school. My CPAP titration study assigned me a CPAP pressure of 8. I was so excited to start sleeping with it and feeling better as I have been suffering from symptoms for 13 years and thought I finally had my answer. However, after my first night with it I woke up the next morning after 9 hours of use feeling the worst I'd felt in ages. I felt like I hadn't slept. I just chalked it up to needing to get used to the machine, so I forced myself to continue using it for the next week. Every day I became more and more sleep deprived. I started reading this forum and changing settings, turning the pressure down to a 5, then 6, then 7 trying to acclimate to sleeping with it. I still woke up completely non-functional. After about a month of trying to make myself use it, I gave up. I am a veterinary student and exams were starting and I could not afford to be so tired I couldn't study.


So, I took a month off. I requested a different mask from my provider which I am now using - the resmed N20, and it is much better, however I still feel like a complete zombie after sleeping with it. I'm at the point where I wake up about 2 hours after sleeping with the stupid thing and just take it off. And I feel horrible the morning after. I wake up with my nose extremely itchy and wet, I have turned the humidifier down to a 1. I also tried turning off EPR and that made things worse.

I have some theories about what is going on and I'd love some insight or advice from you guys. The first thing that is interesting to me is that on all of my sleep tests I have had 35-50 spontaneous arousals per hour. It was noted on my first test with a "sleep profiler" headband that I woke up and fell asleep 6 times in 30 seconds at one point. My question is, if I am having an apnea or hypopnea but it does not last the entire 10 seconds, is it scored only as a spontaneous arousal? Is my airway or body so sensitive to a lack of airflow that I have an arousal before it can even be scored? My at home apnea test showed only an AHI of 8 and my in hospital study showed an AHI of 6. However, I am so sleepy I can take up to two naps a day at times. It just doesn't make sense. I have had blood work and all parameters are always normal.

I am wondering why I feel so much worse after sleeping with CPAP and having an AHI of 0 or less than 1. Am I having many small leaks that are waking me up? Am I too sensitive to the pressure? Is it not solving whatever respiratory issue I am having?

The other question I have is about the waveforms I see in OSCAR. Sometimes the flowrate looks like there is no inhale or exhale for up to 7, 8 seconds and there is a lot of flat line between breaths, then followed by some sporadic looking breathing. Is this causing spontaneous arousals? Is this normal? I am attaching some screenshots of this. Please note the third one was from a nap and it was a very short recording.

Thank you to anyone who has read this entire thing, and if anyone has some advice for me I would greatly appreciate it. I just want to feel better.

[luminaria]

I have made a ton of progress in my CPAP journey, I've finally been able to get some good results using it rather than feeling worse on the nights I slept with it. I started mouth taping and figured that I must been having a ton of small mouth leaks throughout the night that were disturbing me and causing terrible quality sleep. So far I've had a total of 2 amazing days where I hardly felt tired at all in the last 3 weeks I've returned to using it.

However, my problem now is that even though I can sleep with it, the majority of my days aren't much better than sleeping without it. I've had some success and I want to raise the probability that I'll have more great nights. 

At the moment I am waking up about every 2 hours with the CPAP on, and from comparing apple watch data (showing times awake) and the times I'm having flow limits or leaks, that appears to be what is causing my awakenings. My titrated pressure is 8, but I have increased it to 9 which is giving me better results. However, when I try increasing at all over 9, I get lots of leaks (air blowing the tape off my mouth? air coming out of the mask?) and then I have a day feeling terribly tired, like I went backwards. Basically, my best results are at pressure level 9 but they are not ideal, and anything higher feels like I am going backwards. Is there anything I should change or try? I am already using EPR 3 which gives better results than not using EPR.

I have attached some screenshots of my OSCAR data. I may also be having some positional apnea? Or is my AHI getting worse as I go into REM?

[Crimson Nape]

luminaria - I have combined both your threads into one and renamed it, "luminaria - Therapy Questions". This was done since both threads were dealing with your therapy. It also allows the reader a better flow of events leading up to your current therapy level. Please keep further posts dealing with your therapy in this thread.

I will send you a PM confirming this action.

- Red