NoOnesPerfect therapy thread

I started my APAP therapy at the beginning of May, and still have not had one decent night of sleep - been that way for many years though. I sleep 45 minutes to an hour and have an arousal event of some sort. Fall asleep again, and the story repeats all night long. I am exhausted all day every day. Thank goodness I am retired now - i lived on catnaps and caffeine pills when I had to work for a living. Had UPPP surgery 20 years ago, but it was not successful enough to fix the problem.

Here is a typical night for me - if I find I can't fall asleep, I get up and read for a while. The big leaks are from adjusting the mask to make it more comfortable and eliminate noise that sounds like air escaping the mask. Although the AHI looks high, they seem to be all, or mostly all, while I am awake - my breathing slows way down while I try to fall asleep again.

I use the Resmed Airsense 10 Autoset and the F20 Airfit full face mask, and yes, the machine is set up for FFM. It is actually tolerable, unlike the machines and masks I tossed across the room in my sleep 20 years ago (hence the UPPP surgery)

I recently upped the minimum pressure to 6, but it has made things worse so far - AHI is around 9 now, but with all the same patterns. Any comments or suggestions would be welcome - I don"t have a follow up appointment until the beginning of July with my sleep doctor.

NoOnesPerfect wrote: ↑

Sat May 25, 2019 3:54 pm

I recently upped the minimum pressure to 6, but it has made things worse so far - AHI is around 9 now,

Iet's see a night or two of that.

palerider wrote: ↑

Sat May 25, 2019 4:25 pm

Iet's see a night or two of that.

It’s been 3 nights with a minimum pressure of 6, all of which had an AHÍ of 7-9, along with the same basic pattern as the one I posted. I don’t feel any worse than I did before, so I have no problem continuing the experiment. I guess I should post a new screenshot in a couple days to show the effect after I have had a chance to adjust,

If you can show us a night's graph with the minimum 6 now, we can help you sooner. We need to see what the pressure is doing, what type of events you are having, if they are clustered etc. your ahi should have gone down with the pressure increase, so something a little different is going on. I have a few ideas. I'm sure palerider does too. But we try to base our advice on the data, not make blind guesses.

edit: as you can see, the numbers have gotten worse each night since I upped the pressure.

You can see that the machine wants to go higher than 15 to stop the OAs...It is blocked because you have max pressure of 15...Raise the Max to 20 and see if the AHI doesn't drop. You might also try reducing the EPR to 2.

NoOnesPerfect wrote: ↑

Sat May 25, 2019 5:03 pm

edit: as you can see, the numbers have gotten worse each night since I upped the pressure.

Raise it more, min 10, max 20.

I'm curious to know why the first graph is showing a total ahi of 7.05, buut below in the stats, it shows 5.03. Is the total based on the first half of the night, instead of the total night? The graph looks like a full night, but the session thing only shows 4+ hours.

Not sure how OSCAR works, but the flow rate and other graphs are for the highlighted section only - there is a large gap where I had the machine turned off while I relaxed and read before I tried to go back to sleep. The last hour or two after I tried to go back to sleep is excluded from those graphs.

It looks as though your events are clustered. After you’ve had a few nights at the new recommended pressures, you might in addition try using a cervical collar in case part of the problem comes from tucking your chin.

Increased minimum pressure to 6, maximum to 20, and changed EPR from 3 to 2. After 3 nights of this, I feel a bit worse, and my AHI is not improving. I will up the minimum to 8 tonight - going from 4 to 8 right away just seemed like too drastic a change at first - to see if that helps. I must admit that after a month of this I am starting to get discouraged. I won't give up, but it is getting depressing.

One thing I have noticed is that leaks dramatically increase when the pressure goes up beyond 11 - no surprise I guess - but tightening the mask enough to eliminate leaks is leaving marks on the bridge of my nose now. I'm not sure if that is really a problem since the tight mask is not uncomfortable (yet), but I know that I wake up completely when the leaks get bad enough to require adjustment, so I may just make it tight up front and see if that helps.

Any comments or suggestions would be greatly appreciated.

NoOnesPerfect wrote: ↑

Mon May 27, 2019 12:19 pm

Increased minimum pressure to 6, maximum to 20, and changed EPR from 3 to 2. After 3 nights of this, I feel a bit worse, and my AHI is not improving. I will up the minimum to 8 tonight - going from 4 to 8 right away just seemed like too drastic a change at first - to see if that helps. I must admit that after a month of this I am starting to get discouraged. I won't give up, but it is getting depressing.

One thing I have noticed is that leaks dramatically increase when the pressure goes up beyond 11 - no surprise I guess - but tightening the mask enough to eliminate leaks is leaving marks on the bridge of my nose now. I'm not sure if that is really a problem since the tight mask is not uncomfortable (yet), but I know that I wake up completely when the leaks get bad enough to require adjustment, so I may just make it tight up front and see if that helps.

If EPR 3 feels better, I'd encourage you to use it.

I started with the airfit f20, and before I knew it I had an open sore on the bridge of my nose. Don't overdo on the tightening. I called the sleep doc and they switched me to the Airtouch f20. Memory foam. I found it to be much more comfortable and could control leaks better. YMMV.

What does your sleep study say about REM vs n-REM AHI?

Noone’s perfect: Looks like you may not have flags enabled for central apneas. On the Daily page, look in the bottom left corner and make sure you see black and green, not black and red, next to CA. If it’s black and red, just click to get black and green.

Why do you have Large Leak flagging turned off?
Anything else turned off down on the Flags (lower left below the graphs)?

Here is the last screenshot, but with the two other event flags turned on. Also, the shot for last night. From the chart and the way I feel, I basically got little to no sleep last night. I remember numerous times waking up and adjusting the mask to eliminate the "farting" leak sounds, but the only large leak event flagged was at the very end of the period, after which I finally gave up and got out of bed. With AHI numbers ranging from 5-10, horrible sleep quality, and little consistent change from adjusting settings, I have to wonder if OSA is the only problem I am dealing with. The only meds I take (first thing in the morning) are a diuretic for BP, and a PPI for GERD. Neither should result in the level of sleep problems I have. I will keep working with the APAP hoping for better results, but it may be time to ask my sleep doctor and PCP to get together and chat.