Some success at long last!

[FG_Rick]

First time poster, but not a CPAP newbie exactly. I am 71 yrs old, started using CPAP in 2015 but really struggled to handle the pressure my doctor wanted me to use (15) to get my AHI low enough. I would wake up fighting the machine to breathe or have massive leaks. I gave up in 2016.

Fast forward to 2020. I knew I continued to have poor sleep quality. A new mattress last year did nothing to help, and I worried about apnea affecting my health in other ways. I am in good health and average weight, but suffer from heart palpitations and have had pneumonia several times in my life. So I got a new mask insert for my Airfit 10, a new hose, and gave CPAP another try starting around April 1. Early results mirrored my previous experience. AHI ranged from 11 to low 20's, but mostly in the 12-16 area. The graphs seem to me to be lit up like a Christmas tree, so many events it was very discouraging. I was able to up my pressure a bit (max 12) by tightening the straps on my Airfit headgear, but overall I was feeling I needed help... either an appointment with a sleep doctor or a post to CPAPtalk, maybe a new mask or even new machine. Here was a typical night 2 weeks ago... AHI 16.5

Typical previous night 16.5

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Then I noticed a few nights where I had a stretch of maybe 3-4 hours with almost no events!! I couldn't explain it with anything I had done, but did find that I woke up a few times on my side. I mostly sleep on my back, and I know that causes obstructive apnea to be worse, but I was somehow assuming I couldn't side sleep with my face mask. I mostly was trying to prop myself up into a more upright position using pillows or the adjustable bed frame (my wife though is not a fan of having the head too high). So, this week I have been making a concerted effort to start sleeping on my side, and go to sleep with the mental intention of STAYING on my side. When I wake up to go to the bathroom, I switch sides. The results have been AMAZING (to me anyway). The past 5 nights my AHI has been under 7, and 4 of those nights it has been under 4. Last night I hit my all-time low of 0.96.

Here is a night this week at AHI 3.70. There are still a few events, mostly Hypopnea and Clear Airway. Don't know what to do about that... but maybe being under 5 is good enough?

Better night this week 3.70

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And this is last night, AHI 0.96. Not much to look at, but it seems like an accomplishment, as long as I can continue to successfully sleep on my side without mask leakage, and without rolling over onto my back.

Wow best night ever 0.96

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My only issue now is... even though I had this great low score last night, I still feel very tired and muddled today. I think the issue is that I am not waking up in the morning based on my natural sleep cycle. Somewhere between 5:00 and 6:00 every morning our two small dogs wake up and want to eat and go outside to pee. They jump on the bed and make noise and bump against us... they know how to wake a person up when they want to. If the dogs don't accomplish it, my cat jumps onto me - she is used to jumping up and perching on my chest, but now that I am side sleeping she is confused, but still manages to wake me up. Knowing that they are going to do this, maybe I can adjust my going to sleep time to allow proper sleep cycle timing?

[Julie]

And maybe you can start showing the dogs who's boss - after all what if something should happen to you, what will happen to them?

Close your bedroom door!

My cat likes to wake me early to eat, so I take his food from the fridge to a drawer (so it won't be too cold) but then go back in the bedroom and close the door for another hour or so - he won't starve after all and I get to be around longer to play this silly game with him .

They will just come in earlier and earlier if you don't draw the line!

[Respiration99]

When we look at the early charts, it's apparent that most of your apneas were coming in clusters, even with the pressure maxxed out. This is often a sign of positional apnea - especially when your chin drops down to your chest and puts stress on the windpipe. If you were trying to prop yourself up on pillows it's very likely that your chin was dropping down, and the props were making matters worse. Sleeping on your side has obviously removed this problem and your results speak for themselves.

You're still getting a few central apneas, but probably not enough to worry about. You can probably reduce them by turning flex down to a lower setting (or even turn it off), but that then becomes a tradeoff between AHI and comfort.

Regarding the animals - I agree with Julie: lock them out! It may be too late to train them (old dogs?) but our spaniel knows he's not allowed upstairs until we come down in the morning. We do have a doggy door so he can go outside if he needs to.

[bombayone]

Congratulations on your success. Determine priorities. If your pets cannot be managed, find them a new home.

[ChicagoGranny]

as long as I can continue to successfully sleep on my side without mask leakage, and without rolling over onto my back.

Using a foam cervical collar while sleeping on my back is as effective as sleeping on my side. It's something you might want to consider. The collar holds the head in the best position for airway patency and prevents jaw drop.

[Miss Emerita]

Congrats on the successful problem-solving! And I'd be willing to bet that the little clusters of CAs right before or after a wake-up are actually awake breathing. We breathe a lot less regularly awake than asleep, often pausing our breathing. So you might want to discount those mentally.

To preserve my fragile sleep as much as possible, I keep the bedroom door closed -- no cats allowed! But it'd be worth seeing whether a change in your sleep schedule would make a difference -- or whether the critters would just start pestering you earlier.

[FG_Rick]

Thanks to all for your comments and advice. As to the dogs, I can tell you that I would be the one sleeping out in the hallway before the dogs would The dogs sleep on the bed... that's the way it has always been, and will always be. I have thought seriously about sleeping in the guest bedroom to see if uninterrupted sleep would make a difference. The cat would miss me, but maybe not the dogs.

[FG_Rick]

Using a foam cervical collar while sleeping on my back is as effective as sleeping on my side. It's something you might want to consider. The collar holds the head in the best position for airway patency and prevents jaw drop.

Thanks, this is very timely advice. The last two days when I have had the lowest AHI ever, I have also suffered from headaches all day, caused by very tight neck muscles. I'm hoping a neck collar or cervical support pillow would help.

[FG_Rick]

When we look at the early charts, it's apparent that most of your apneas were coming in clusters, even with the pressure maxxed out. This is often a sign of positional apnea - especially when your chin drops down to your chest and puts stress on the windpipe. If you were trying to prop yourself up on pillows it's very likely that your chin was dropping down, and the props were making matters worse. Sleeping on your side has obviously removed this problem and your results speak for themselves.

You're still getting a few central apneas, but probably not enough to worry about. You can probably reduce them by turning flex down to a lower setting (or even turn it off), but that then becomes a tradeoff between AHI and comfort.

Thank you for your insight on this. My Respironics REMSTAR Auto has both C-Flex and A-Flex. I recently switched the machine from C- to A-Flex and set it on the highest relief setting (3). Now that I'm going most of the night at lower pressures, I guess I can turn down the pressure relief. Maybe even turn it off, since my Min pressure is set to 9.

[ChicagoGranny]

Thanks, this is very timely advice. The last two days when I have had the lowest AHI ever, I have also suffered from headaches all day, caused by very tight neck muscles. I'm hoping a neck collar or cervical support pillow would help.

Collar fans use collars similar to this brand - https://www.walmart.com/search/?query=dmi%20collar

It may take a couple of tries to find the width and firmness that suit you.

[FG_Rick]

Sunday night I had my best night ever based on AHI score for the night 0.75! I had recently changed my A-Flex setting from 3 to 1. I am very pleased with this result, but have a question about the regular series of pressure spikes. I can't see that they are related to anything except very tiny bumps in the Leak Rate chart. I am side sleeping to prevent the Obstructive Apneas, so perhaps I am experiencing some very small mask leaks, but the spikes seem spaced so equally in a repeated pattern it's curious. Any ideas?

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Then, Monday night, I had a relapse back up to a higher AHI, but still below 5. I know I started out on my left side but when I woke up during the night I was on my back, and that was the cause of the cluster of events. most RERA and OA. The one that is a bit scary to me is the BND at 04:29:56. It apparently lasted 1 minute. Is that as serious as it sounds? I went back to previous charts and found another BND of 1 minute on June 3. Can someone explain what can cause this? I included the Resp. Rate chart to show that immediately after the BND the Resp. Rate remained highly variable for the next 12 minutes.

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On this chart I also see some of the regularly spaced pressure spikes that were on the previous night's chart.

thanks for any insight

[Pugsy]

Those saw tooth pressure spikes are nothing more than the auto adjusting algorithm checking things out.
Ignore them. The more you see them it usually means the better you are sleeping.
They are called pressure probes and they aren't really going up as fast as they look like and they aren't in response to anything at all.
Respironics machines in auto mode have always done them. I had a thread explaining it somewhere but I can't find it right now.

It's explained in the clinical manual. Do you have that manual?

[Pugsy]

Breathing not detected doesn't necessarily mean that you aren't breathing...it's just the machine can't sense breathing usually from some outside factor...big leak maybe or even getting up to go pee and leaving the machine running will do it. The machine doesn't think a human is attached. Unless you see large blocks of it....ignore it.

The 04:00 to approx 5:00 ugly on last night's report....you needed more pressure than the machine could deliver due to the max limit of 12. It wanted to go higher to prevent the apnea events. My best guess is you were probably on your back during that time and maybe in REM stage sleep.

Any special reason you are limiting the max to 12?

[FG_Rick]

Those saw tooth pressure spikes are nothing more than the auto adjusting algorithm checking things out.
Ignore them. The more you see them it usually means the better you are sleeping.
They are called pressure probes and they aren't really going up as fast as they look like and they aren't in response to anything at all.
Respironics machines in auto mode have always done them. I had a thread explaining it somewhere but I can't find it right now.

It's explained in the clinical manual. Do you have that manual?

Pugsy,
Thanks for the info. I have the REMstar User Manual, but no clinical manual.

[Pugsy]

Go here and request the clinical manual for your machine. It has more information in it than the user manual.
Instructions on how to request the manual via email are on the page about 2/3 way down.
https://www.apneaboard.com/adjust-cpap- ... tup-manual