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+--- Thread: Just started 6 days ago! (/Thread-Just-started-6-days-ago)
Just started 6 days ago! - benjaminjaquith - 09-27-2024
Hello all! I have been on the road to my sleepless journey for far too long now. It has taken 9 years to realize that my poor sleep isnt just me aging. Realizing something wasn't right brought me to bring it up to my dr. My dr figured it was medication related so we went through that route until inevitably it changed nothing and I underwent a sleep study. AHI of 37, worse when supine, at least now I had answers. I have sleep apnea! Not great news but it was news I could deal with! Now I can start working on healing myself! I put a ResMed device through insurance and was denied.... A friend gave me his older AirSense 10. Paid out of pocket for new hose, filters, water chamber, was fitted with a mask (Philips Dreamwear full face) and had the prescription put into the machine (5cm/h2o to 15cm h2o). Went home and started using it immediately while on my pc. Took awhile to get used to it but wasn't bad. The first night was not great, I had leaks and woke several times. To be expected. 3 days in and I was starting to get the hang of it. Raised the minimum pressure to 8cm and the slight claustrophobic feeling disappeared. Much more comfortable now when initially worn. Next day I test positive for COVID, (felt pretty awful and found out several co-workers tested positive.) Following day was rough, feeling horrible. Body aches, fever, headache, etc. Here's the amazing part. I used the CPAP all day resting and I started to dream! I haven't had dreams in FOREVER! My AHI from the first day to COVID was 11-12 nightly. I got my mask leaks ironed out (small tension adjustments looser and a shave), and my AHI plummeted to .4! I was EXCITED! Yes, I felt lousy with COVID but the treatment was working. I was dreaming again too! I then learned about OSCAR and SLEEPHQ and started importing my data for a closer look and I am seeing events that aren't being flagged, which means there's potential to dial in my treatment. (Considering I am on 8-15, auto, no EPR and humidity set to auto I am elated that I am "close" to anything resembling good sleep with so little effort, especially without a titration study done.) I would love it if more seasoned eyes could look at a few nights of OSCAR information and see where I could tweak settings, fitment, any ideas at all. Thank you all in advance as having a community like this for something this intricate is beyond amazing.
RE: Just started 6 days ago! - coutherino - 09-28-2024
Welcome! I'm glad to hear it's been going well so far. You seem to have adapted pretty quickly, and that's always a good sign for CPAP related things. It makes the process of optimizing your therapy much easier.
I looked at the data you provided, which I'll get to in a sec, but it'd also be helpful if you could send a few full night views as well.
As for the ones you sent, those are definitely breathing related arousals. At least the first two. You can see a clear drop in the flow rate, or a flattening of the wave, followed by an arousal. This doesn't necessarily mean you need to be on a higher pressure (you might) but your leak is definitely worsening the problem, which just based on these 3 screenshots is quite high. A high leak can and will make your therapy ineffective. If enough air is escaping your mask so that there isn't enough getting into your airway to stabilize it, you're inevitably going to have events all throughout the night as your airway collapses. Now, I'm not sure if that's what's happening, which is why a full night view could be helpful. If you could also post a few 4-5 minute sections of your breathing during a time you're sure you're asleep where there is no leak, it will help me determine if you need to be on something higher than 15, which is around where APAP had you at during the three screenshots.
RE: Just started 6 days ago! - benjaminjaquith - 09-28-2024
Thank you for the reply! I have attached the requested screenshots, hopefully they are what youre looking for. These are from my "best rested" day recovering from covid when I could just rest and use the machine.
RE: Just started 6 days ago! - coutherino - 09-28-2024
Thanks, those are exactly what I wanted. I kinda just crudely marked them so you can see what I'm talking about. I'll post them below. The first image is just me highlighting the differences in your breathing when there's no leak and when there is a leak. The second image is directly comparing them, where there is no leak on the left of the red bar and lots of leak on the right side. You can clearly see the difference. On the left your breathing is nice and smooth except one small spike—which seemed to be caused by a momentary leak spike—and on the right side it's all wonky, with multiple large spikes. It's probably a combination, but leak doesn't always disturb your sleep because it's lowering the effectiveness of your therapy. Leak itself can cause arousals, especially if it's large and/or highly variable. Which yours is both.
[attachment=70076]
[attachment=70077]
Now, this isn't throughout the entire night, and your breathing actually looks quite decent in the places where there isn't any leak, like in the screenshot you sent. But it immediately deteriorates when one pops up. If this is happening every night, even if your leak "numbers" look great, it can really fragment and disturb your sleep. Not only that, it's likely causing the APAP algorithm to jack up your pressure to a level you might not even need to be on as you start to have events because of the leak, which ironically only makes the leak worse. APAP in general is just something I... struggle to recommend. It has many other issues (which I can elaborate on in more depth if you want) and as such most people are usually better off on a fixed pressure.
My main recommendation is to try to eliminate leak entirely, if possible. Are you open to trying a nasal mask? They're typically much more comfortable and often are easier to control for leaks. Unless you have something like a deviated septum or chronic congestion, it would definitely help.
Aside from that, I'd recommend changing from APAP to CPAP, or at least trying a night with it. Your breathing looks pretty stable at around 12 during multiple points throughout the night where there is no leak, which is where I'd start. You could need a bit more, you might even be able to get away with a bit less. I won't be able to tell until I can see a full night with it. Regardless, APAP isn't doing an amazing job as is, especially in combination with leak.
I feel obligated to say that what matters most is how you're feeling. If even now you wake up feeling rested, you shouldn't let any of this take away from that. All it is, is an opportunity to potentially help you feel even better. It's a relatively simple problem to fix, all things considered. Apologies for the extremely long response lmao. One last thing, you mentioned uploading your data to SleepHQ. If you're comfortable with it, instead of sending screenshots every time, you can post your account link so people here can manually scroll through your data themselves. It's fine either way though, just something that might make it a bit easier. Hope this helped.
RE: Just started 6 days ago! - benjaminjaquith - 09-28-2024
Thank you SO MUCH for all of the information and in depth response! I have adjusted my mask again a little tighter on the chin with mask fit active and moved my jaw laying down, changed sides etc and kept a good fit so I will know more tonight. I did buy a nasal mask (also dreamwear) as I really like the fit. Got a nasal cushion and a nasal pillow. I do suffer from pretty bad sinus congestion, the pressure and humidity seems to help. I want to try them but really like the feel of the full face mask as I can occasionally change between nasal and mouth breathing. I'm sure I can figure out keeping my tongue in place and mouth closed for the nasal mask.
I also have been using apap just to find what pressure threshold works best for me, which ironically I'm now unsure of due to how you explained the pressure changes due to leaks. I think I will try 12cm and report back.
Thank you again, very much for your time and insight.
RE: Just started 6 days ago! - coutherino - 09-28-2024
No problem, glad I could help.
Quote:I want to try them but really like the feel of the full face mask as I can occasionally change between nasal and mouth breathing.
I understand this sentiment, but ultimately the goal should be to nasal breathe the vast majority of the time, just like you do when you're relaxed during the day, at least for those that are able to. This is very possible, as long as you're on the right pressure to guarantee you're not having apneas all throughout the night. That's typically how people with sleep apnea convince themselves they're naturally mouth breathers during sleep. They wake up gasping through their mouth, with a dry throat/mouth, people tell them, etc. When your airway is obstructed it's a lot easier to get as much air as possible if you're using your mouth. Typically people can return to nasal breathing once that's fixed. Obviously it's different if you have really bad congestion, though.
Quote:I'm sure I can figure out keeping my tongue in place and mouth closed for the nasal mask.
Unfortunately, if you want to use the nasal mask, you're probably going to have to tape your mouth. It's really the only way to prevent it if you're prone to relaxing your tongue during the night. I, and many other people do it. I would probably still be struggling with CPAP to this day if I didn't. That being said, if it's something you're not comfortable doing under any circumstance, it's probably best to stick with the full face.
Looking forward to hearing how it goes though, hope the advice I gave ends up helping. If you have any other questions I'm happy to help.
RE: Just started 6 days ago! - benjaminjaquith - 09-28-2024
Mouth tape for me would be really difficult to use. I have pretty bad claustrophobia, took a bit to get used to the mask. Even thinking about taping my mouth makes me feel like gasping. I'm really hoping I can iron out the mask leaks as I find it really comfortable, ultimately though, waking feeling refreshed is the top priority so I will do what I have to.
RE: Just started 6 days ago! - benjaminjaquith - 09-29-2024
I laid down last night with 15cm mask fit and moved around, moved my jaw, rolled side to side for a few minutes and couldn't break the seal so I think I have the adjustment close.
I slept last night with 12cm pressure in CPAP mode. Mask came down once because I somehow twisted the headpiece moving around. I must have pulled it away from my nose and I don't know how long it was like that. I put it back on and "couldn't breathe" through the mask until I realized the top was twisted. (It's a Philips dreamwear full face with top hose). After that it stayed on rest of the night. Pressure was comfortable. I'm uploading the data now to sleephq and posting a link so you can scroll through and see all of the data.
https://sleephq.com/public/teams/share_links/1cc33edc-707c-4fcd-b8ca-56476970cbb1
I feel tired this morning but again I'm also getting over the last leg of COVID so that could be it too. I know it's early yet to really feel the benefits of this machine. I am just glad I'm comfortable sleeping with it. Everything else will come in time.
RE: Just started 6 days ago! - coutherino - 09-29-2024
I think your SD card glitched last night or something. Part of the night there's no flow rate data from like 7:00-10:45. It also seems like you're still on APAP. Honestly I'm not sure if this is even the right night, but according to SleepHQ it should be, so I'll just comment on what I see.
Your leak looks really good for most of the night. Good job on that, if you can keep it that way while also making sure the mask is comfortable, it'll help a lot. I marked your data a bit and posted it below. Within the black rectangles are periods I think you switched to your back, and within the red is a period of leak near the end of the night, which is probably what woke you up. Just wanted to give another example of what happens to your breathing when there's leak. It's very wonky during that period. Within the first black box you can see a sharp drop in the flow rate graph, an increase in flow limitation (I'll explain that later) and a response from your APAP by significantly raising the pressure to 15. All this combined has me pretty convinced you switched to your back for that section.
[attachment=70101]
In this next screenshot, I show an example of normal breathing on the top, flow limited breathing in the middle, and a hypopnea on the bottom. You can see the flow limitation graph in both Oscar and SleepHQ, and all it is is the measuring of the flattening of the waveform of your breath. What you want to be seeing is nice, rounded breaths like in the top image. The bottom 2 images are from the period when you were on your back. APAP surprising correctly had you at the highest pressure within your range during this time (15) but even still this wasn't enough. Your breathing was quite obstructed during this time, until it eventually led towards a hypopnea near the end, likely waking you up and causing you to turn back on your side, which is when your flow rate returns back to normal and APAP slowly climbs back down. Basically what all this means is stay off your back unless you want to be using more than 15 cmH2O.
[attachment=70102]
As for the rest of your data, there's definitely some pretty consistent flow limitation. But that doesn't really mean anything. What matters is, is it waking you up? Maybe. That threshold is different for everyone. For now, I have a slight change to my recommendations. Being able to actually scroll through your data is insightful. I'd say start with a fixed pressure of 13 instead of 12, but make sure to stay off your back. If you really want to stay on APAP... I'd still raise your minimum to 13 and raise your max to 16 to (maybe) compensate for switching to your back. No guarantees it will, though.
In the grand scheme of things, it seems to be going really well so far to be honest. It's great that you feel comfortable with the mask and the pressure already. I've seen people suffer through a lot worse for a lot longer. The fact you seemingly have leaks mostly solved already is pretty incredible.
RE: Just started 6 days ago! - benjaminjaquith - 09-29-2024
What's odd is I am at 12cm as soon as I switch the machine on and start breathing. Stays like that all night. It was definitely more pressure than the 8cm I've been using. If I relax my cheeks it puffs them right up. Didn't really do that on 8cm. Weird that it's showing apap.
In any event though it's good that the data looks ok for being on CPAP for only a week. I am definitely comfortable setting CPAP mode to 13cm and sleeping the night with it. If I don't twist my hose again (fluke accident) and stay off my back I might have something here!
If I find that I cannot for whatever reason stay off my back I think I will try the above recommendations along with a different (flatter?) pillow and/ or a soft cervical collar. Maybe it's just my tongue relaxing though, I'm not sure. I do know if I sit upright and press my soft palate while breathing I can feel a restriction as well as if I intentionally relax my jaw to my chest, same thing. That probably explains why the pressure has to go so high when I'm on my back. Ultimately I would like to keep the pressure limits lower (lower pressures avoid centrals?) and try to learn to sleep on my sides more. (Which is always how I fall asleep, for some reason I just can't stay there and always end up on my back.)
I am looking forward to tonight's sleep and I am SO grateful for all the insight you have given me as well as knowledge of what all the graphs mean.