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Uncomfortable Mild apnea sleeper - GoldenSilence - 07-17-2024
Hi friends, posting in hope of getting some advice from your collective experience. My physician has seemingly washed her hands of me after finding out I self-adjusted pressures. I am a doctor myself but not formally trained in sleep. I am on the second month of a CPAP Trial.
My Apnea is mild, 5.5 AHI all up but 12.1 during REM sleep. I figure REM is pretty important for memory and creativity thus I opted for treatment. Indeed, the most noticeable difference after starting CPAP is that I dream much more (mostly nightmares though). At any rate, about a month in, I am now feeling miserable - I am sleeping fewer hours, sometimes only 6 compared to my previous 8-8.5, waking more frequently and find it harder to fall asleep. I've tried a variety of pressures and I'm now going to trial 6-12 cmH20 without rise time.
I have troubling issues with nasal obstruction and am due for a minor procedure next month to help open things up. Sometimes I have air hunger at lower pressures (started at 4 minimum) but if the stars align and my sinus is clear, the CPAP feels comfortable, even enjoyable. (I do have quite an involved regimen to try and ensure sinus patency but it's not sufficient, thus the surgery). Clear sinuses almost never last the whole night, presumably due to turbulent air flow made worse by the CPAP.
Should I have been given a full face mask to start or would that likely be even less comfortable?
Appreciate any wisdom re: pressures or mask etc.
Thank you!
RE: Uncomfortable Mild apnea sleeper - GoldenSilence - 07-17-2024
More info
RE: Uncomfortable Mild apnea sleeper - HalfAsleep - 07-17-2024
I’m not a settings maven, but like most adults, I’d be suffocating at a pressure of 5. And the pressure graph that looks like an alpine mountain range generally indicates a pressure adjustment is needed. I’m sure someone will be along to help with settings soon.
No worries on getting fired by your sleep doc. If she’s typical, you’ll soon be more agile with sleep info and have way more data than she to base an analysis on. The doc may have one piece of paper with an aggregate number for your data for a whole month. And here you are, with about 10 charts for every night. So, yep, de facto you sacked your sleep doc by having faith in your abilities (and help here), but IMO this will be all to the good.
I, too, recently had a septoplasty. It has improved my life. However, it hasn’t really changed my experience with xPAP (I had a unit before surgery, but usage had lapsed). You seem to be doing very well with your current mask, unless it’s uncomfortable. Immediately after surgery, you’ll likely need a different mask if you are using the Dreamwear nasal version, since your nose won’t be functioning well at first, so mouth breathing would be necessary. You might also consider whether you will need to pay attention to positional apnea if you use a wedge pillow or have to significantly prop up your head after surgery.
On balance, I would never have used xPAP right after surgery: it’s way too much to handle. Drippy nose, nostril pain, upper lip numbness, cheek nervy-ness, sleeping all day, surgical micro sponges issuing from my bloody nose, referred pain, bloody gauze… I got my BIPAP after I healed, but, yep, no way I was in any condition to be using a mask for several weeks (perhaps 4, but I was a slow healer). I continue to use a hybrid full face mask (F40) even now my nose has healed, and that’s the way it’s going to stay: it just works best for me, as far as leaks and comfort.
So, there are different possibilities for integrating nasal surgery and xPAP, but it’s very individual.
RE: Uncomfortable Mild apnea sleeper - PeaceLoveAndPizza - 07-17-2024
You do not seem to have a leak issue, so the nasal mask is working from that perspective. You may want to consider giving nasal pillows a go as the air is directed into the nose without any extra space to fill. A full-face mask is not a bad idea either, but there is a longer learning curve with getting the proper fit and setup. One nice thing with a full-face mask is you can mouth breathe as required due to nasal congestion. Watch a few YouTube videos from LankyLefty27 on different masks to get an idea on each option.
I agree with HA about your pressure being low. The machine does adjust as needed to handle events, but the rise/fall of pressure may disturb your sleep. Seeing the rapidity of pressure increase at the start of therapy is a good indicator of low pressure.
I think with a bit higher pressure it may also help with some of the congestion.
Try the following:
Mode APAP
Min pressure 9
Max pressure 14
EPR 3 full-time
No ramp
That seems a good place to start fine-tuning things. If you want to give it a try for a few nights then post some more charts, many here can help tweak things.
No comment on the surgical option. HA has far more real experience.
RE: Uncomfortable Mild apnea sleeper - eok361 - 07-17-2024
others in here are far better at diagnostics than i, but a couple things i'd try are.
1. turn the ramp off, or significantly reduce the time. or if you're going to keep it on, raise the initial pressure some.
2. tighten up the min/max, if you're going to continue with APAP.
you could try CPAP mode around 10.5 cmh20 for a night or two.
your numbers aren't all that bad, imho. you really just need to do some tweaks.
As far as total sleep time, you might just not require as much sleep anymore. but if you aren't feeling rested, then some adjustments need to be made.
good luck.
RE: Uncomfortable Mild apnea sleeper - HalfAsleep - 07-17-2024
Once your settings suit, and your body has more experience with the unit, you may very well find that you sleep longer hours and feel more rested. That could take a month or two. Even subtle adjustments in the meantime might help this process along, e.g. experimenting with temp and humidity.
RE: Uncomfortable Mild apnea sleeper - GoldenSilence - 07-17-2024
Thank you everyone, I appreciate your thoughtful replies.
My doctor didn’t technically fire me but she seemed uninterested. I asked for assistance with settings, even asked if she wanted to program it herself. There was lots of ‘it’s up to you’ and ‘the machine is clever enough to work it out itself’ in her replies. Oh well.
I had a septoplasty and turbinoplasty 10 years ago. This procedure is to dissect a resultant adhesion which my surgeon thinks is causing ‘surgical failure’. It should have less bleeding than the previous procedure but yes I will probably need to go off CPAP for 2 weeks at least.
I am also concerned about a high starting minimum pressure because I get irritable with the CPAP mask on. I also use a manta eye mask and ear plugs and while I am not formally claustrophobic, it does feel like a lot on my head. My heart tends to pound when I lie down and is worse when the CPAP is running, even while awake. That’s already been investigated and nothing is formally wrong with my heart so I just put it down to discomfort. I will watch the video as it seems a full face mask might make this worse although bypassing the nasal congestion issue. Perhaps I will increase the pressured but introduce a ramp starting at 6 (rather than 4 as previous).
I will fiddle in the coming fortnight. Thanks again.
RE: Uncomfortable Mild apnea sleeper - HalfAsleep - 07-17-2024
Adjusting the temperature and humidity might help with the irritable mask-on. Settings will make a big difference.
Ramp may cause more problems than it solves.
RE: Uncomfortable Mild apnea sleeper - GoldenSilence - 07-23-2024
I'm just updating this. Unfortunately, I have not good results.
With setting the CPAP pressures to 9-13 I really struggle to get to sleep. I could be dead tired when I hit the bed but putting the mask on wakes me right up. My heart races and I feel more like going for a run than falling asleep. Except, it's the middle of the night. I have tried EPR at 3, 2, 1 and off.
I can fall asleep more easily with lower minimum pressures but then the machine hikes the pressure fairly quickly. One night, it woke me up in a panic at a pressure of 12.9 and my heart rate refused to settle for several hours. Not fun.
So, I'm basically thinking to return the device for lack of a better solution. My apnea is purely positional and while I know positional therapy is not as good, I'm not sure what alternative I have. I appreciate everyone's time, at any rate, so thank you.
RE: Uncomfortable Mild apnea sleeper - PeaceLoveAndPizza - 07-23-2024
Understand that the difference between your original settings and the one you are struggling with is no more than a whisper’s volume of air.
The best thing you can do is to acquire a ResMed AirCurve 10 (or 11) Vauto. The options available on that machine are far more advanced than what you are working with today. You can likely use much lower pressure with a bit more pressure support to achieve better sleep.