New here, probably should have looked into this site years ago. My sleep quality shifted negatively about five months ago, and am struggling to figure out what to do. Although even before that, i have had sleep difficulties overall for about 20 years now. A little about me:
I am a 61-year-old male, 5' 8" 150 lbs, not overweight, though with the standard middle-aged belly fat. First diagnosed with hypopnea in 2006, later with sleep apnea. Air pressure on first CPAP started at 6, then through various sleep studies was reset upwards to 8, then 9, then 10, then 12. Then a study suggested it should be back to 10, but my body did not agree with those findings. The last sleep study I had was in 2021, and for some reason, they did not even put me on a CPAP. Claimed my AHI wasn't high enough, but doc later said I did of course need a CPAP, so I don't know what went on there. So, I don't have CPAP data from the most recent test, but doc set me up with an Autoset, min 10 max 16. It took me years to get used to using a CPAP at all, and I often got intense drymouth. Mostly I have humidifier set to one less than max (5 or 5.5 out of 6 on ResMed S9, and 7 of 8 on my current ResMed S10 AirSense. I have tried all three mask types, but ended up with nasal mask due to the fact that nasal pillows forced too much air up my eustachian tube, and my ears popped all the time, and I have yet to find a full face mask that doesn't leak somewhere. Either right into my eye, or out the cheek area. Only way to stop a leak was to strap it on so tightly that it hurt. Have been using ResMed N20 nasal mask for some time now.
Current CPAP does not have wifi. An earlier machine did, but I did not use MyAir due to certain small print stipulations in the user agreement that I found objectionable. I find the stats on the machine to be less than helpful, as the pressure is only shown as an average. It seems clear that I need higher pressure in the second half of the night, when I have much more REM sleep per cycle. It often feels though, that the Autoset does not increase the pressure as fast as my body needs it, so I often wake up. Generally AHI readings are between 0 and 5. Central does not seem to be a factor.
Biggest issue over the last five years or so has been aerophagia or bloating. I get way too much air down the wrong tube and end up with bad gut pain. If I lower the minimum setting, it helps with aerophagia, but then I don't sleep as well. I think it is possible that at some point my setting was set too high, and my body got used to getting more air, despite the increased aerophagia, and now finds a 'normal' amount insufficient. I don't know if this the case, but it seems to be. When using CPAP, i am on my back. I have found that aerophagia increases DRAMATICALLY if i am on the CPAP and roll onto my side, or even slightly to one side or the other. Only way I have found to combat aerophagia is to have my neck as forward as it will go, this seems to close off the UES better. But I end up with a sore neck.
Because I use a nasal mask, I have had to tape my mouth shut for years. I use Rite Aid first aid paper tape, and it has worked for the most part, but sometimes later in the night there is some leakage. January of 2021 was the first time I found i needed to use the CPAP all night, every night. Up to that point, I was using it for part of a night, or all night some nights a week, but not every night. But the last several months I have just not been able to put up with using it all night, due to abdominal pain from bloating, or extreme dehydration, or both. It is very dry where I live, so I usually run a room humidifier all night, as well as the one attached to my CPAP.
It has never been fully determined why I even HAVE apnea in the first place. I have come to believe, due to bodily feedback, that my apnea had multiple causes. Perhaps the biggest cause is GERD and/or other acid reflux issues, which runs in my family. I also have allergies, and sometimes get post-nasal drip which can block nighttime breathing. And just aging has probably caused the tissue in my throat to sag a bit, so I kind of get blockage from below, above and in the middle. I have a hard time with antacid medication though.
All through the 1990s I slept every night all night on my back without problem. In 1999 I had my thyroid removed due to a tumor. No doctor I have met thinks that that had anything to do with my later apnea, but I started waking up with pain from sleeping on my back starting in the early 2000s. It does feel like the area near the scar tissue from the surgery is related somehow. When I push the loose outer skin of my lower neck together, I often feel that some kind of blockage feeling that was there opens up a bit. This 'some kind of blockage feeling' is of the kind that I did not notice it was there until my maneuvering shifted it and it felt better. But I have been unable to tighten the skin in my lower neck, and don't know exactly what is going on inside there, and how it is or is not causing any blockage. I have read some cases of people with apnea breathing better after thryoidectomy; I have yet to read about anyone developing apnea after that surgery. But I can't rule that out as one of the main causes, if only circumstantially.
So, where I am at now: I average 3-4 hours with CPAP, 3-4 without per night, sometimes starting the night with CPAP, sometimes putting it on and mouth taping etc. in the middle of the night. Some nights I seem to get ok sleep, many nights I don't, and feel tired and needing a nap during the day. It just seems to be getting worse. And for some reason about last November, my body suddenly stopped feeling like min 10 was enough, so I slowly upped the minimum pressure to 11, then 12. which is where it is at now. And I continue to struggle most days with too much air down my esophagus. And I haven't gotten any help from doctors, so I am hoping someone here can give me some suggestions.
Thanks very much,
zzzdeprived