Struggling to maximize CPAP therapy

[Miss Emerita]

Why do you prefer the long-hose attachment on the top of your head? Is it to keep the hose out of the way? If so, have you ever tried a hose lift (hose stand)? You can use those with any mask that has a fairly flexible short hose.

And what exactly was unappealing about using tape on your mouth to control the flutter?

I didn't know about the hose lift or F30i FFM when I made that comment, but I have an angled headboard that creates a perfect space for the hose just behind and below the top of the mattress. I can flop around all I want without issue.

If you want to be able to try a greater variety of masks at some point, you might look into a hose lift. At home I use the Hose Buddy, very sturdy unit; when traveling I use the Arden Innovation collapsible lift. (Traveling, remember that?)

I found the Micropore tape decently effective, but too annoying to remove in the morning. I had to wet it with water and then contend with sticky residue. I much prefer the FFM at this point: no congestion, no dry mouth, and a better seal while side sleeping.

You might give Somnifix strips a try. They are gentle on the skin, hold well, and peel off without any trouble.
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[speedstream5621]

Back sleeping does encourage many more events, but while some people can manage to not do it in various ways, unless e.g. Pugsy reads your charts and says it matters - apparently it may not if other things are done properly - then you may not have to worry about it... but if you can, try some tricks to keep it from happening once asleep.

It took me 3 months of experimenting to appreciate how my sleeping position (back or side) affects sleep quality, and I've posted a couple graphs to help demonstrate the point.

• In the screenshot from 8/20, I was on my back from about 3-5am.

• In the screenshot from 8/21, I was on my side the entire night. I'm pretty sure each CA event is me switching sides.

Even with all the humidity settings maxed out, it doesn't take long to get a dry mouth on my back. Mask seal is great at 10 (adequate for side sleeping), but starts to become an issue at 11 (inadequate for back sleeping). Side sleeping definitely reduces the number of events, but I still wake up repeatedly throughout the night and remember it. I would say I am getting enough sleep only to get by at this point (no more risk of falling asleep at the wheel on my way to work).

Where would you guys go from here?

[speedstream5621]

Here's another screenshot from another night of side sleeping and waking up feeling pretty tired. If I'm zooming in and analyzing individual events correctly, it seems like many of them are either false positives or should be ignored due to just having woken up. That would mean my therapy is fairly effective at combating apnea at this point and that I'm suffering from a separate issue.

Is a minimum pressure of 10 too high if I'm topping out at 11.5? I've played around with Flex here and there and determined I definitely want it if the pressure is 11 or higher.

Thoughts?

[Julie]

No, it's not too high, the only problem would be if your max pressure was too low and keeping the min. from rising when it needed to. Very many leave the max at 20, the default high for the machine.

[speedstream5621]

I'm resurrecting this thread because I'm still struggling...lots of tossing and turning as a reluctant side sleeper. Barely adequate sleep - never fantastic sleep.

I woke up on my back with this morning with that last pressure spike at 9:45am. Maybe it's time to revisit everything. Does anything obvious stick out to you?

FYI - these are nights spent in two different beds. No major difference in sleep quality.

12-Jan-2025.jpg (808.31 KiB) Viewed 1874 times

[robysue1]

I'm resurrecting this thread because I'm still struggling...lots of tossing and turning as a reluctant side sleeper. Barely adequate sleep - never fantastic sleep.

Unfortunately there is nothing in either of these reports that screams, "FIX THIS". The AHI is reasonable (although some folks would want to see it lower), and the number of periods where you are clearly struggling with sleep-wake-junk (SWJ) or obvious restlessness is not really excessive. Moreover, to my eyes, some of the event clusters may be occurring those time frames where there is some SWJ going on. So on the surface, there's nothing in this data that screams you need more pressure to control your apnea.

You say you do "lots of tossing and turning as a reluctant side sleeper." May I ask why you are a "reluctant side sleeper?"

If your preferred sleeping position is NOT on your side, then my first piece of advice is to start sleeping in your favorite sleeping position. Seriously. When we try to force ourselves to sleep in a position that our body (or brain) is "reluctant" to do, it makes it more difficult to get into a good, sound sleep.

After recommending changing to a more comfortable sleeping position, my next recommendation is to look at other non-apnea related things that might be keeping you from getting the fantastic sleep you crave. As a start, think about your answers to this (long) list of questions. Some of your answers may very well explain why your sleep remains less than satisfactory even though your machine is nicely managing your OSA:

Do you have chronic pain issues?
Do you have a lot of stress in your life?
Are you taking any medication that may adversely affect your sleep?
How's your overall sleep hygiene?
Any past history of plain old garden variety insomnia? If so, how did you treat it and was the treatment successful?
Is it possible you are trying too hard to get at least 9 hours of "quality sleep"?
How's your sleeping environment?
Are you getting some physical activity most days? How much? Do you sleep better when you get physical activity?
Do you get a chance to go outside most days? Does your sleep improve when you've spent significant time outside?

Have you had a full physical exam recently? Lots of conditions beside sleep apnea have "bad sleep" as one of the symptoms. Have you been screened for thyroid problems recently? What about depression and/or anxiety? Is it possible that you've got something like restless leg syndrom (RLS) or periodic limb movement disorder (PLMD)? They're not the same thing, but both of them can ruin the quality of a person's sleep.

Have you had a full dental check-up recently? Some dental problems can adversely affect the quality of one's sleep. In particular, do you grind your teeth at night?

In closing, I'll say this: CPAP fixes bad sleep breathing. It doesn't fix bad sleep. But good sleep breathing is a necessary condition for good sleep, but not a sufficient condition for good sleep; in other words, you won't have good sleep if your sleep breathing is bad. But you can easily have bad sleep in spite of having good sleep breathing.