CPAP not helping?

Hi everyone,

Tried out 8 of minimum pressure last night. I woke up feeling fine, but the AHI is still unchanged at a 4.92 and the clusters of OAs are still present. I do not recall waking up during the night. See the graphs below.

Overview:


Zoomed-in view:


Following up on Miss Emerita's suggestion, I took a photo of my head position when I'm [accidentally] sleeping on my back. Am I "tucking my chin down" too much as suggested?

No, you're not tucking your chin in the photograph. Then again, we do all sorts of stuff we're not aware of when we're asleep. Might be worth trying a collar for a week just to see if it makes any difference.

My best guess is the cluster is probably REM related...might be a combination of REM and supine.
It is something I saw a lot when I was first starting my therapy and I am documented REM dependent (REM makes my OSA much worse) and I just had to keep increasing the minimum pressure until I broke the clusters up.

Now it might be related to airway position and a cervical collar might be of benefit. I don't normally go down that road until I have reached a point with the pressure where I just can't use more pressure to deal with things because more pressure causes its own set of problems.
Mainly because the idea of wearing something else on my face/head/neck just isn't very appealing to me but lots of people use them and don't have any issues.

If it were me....I would move to 9 cm minimum....but you can try other options if you wish or if you get to a point that higher minimums are just more of a problem for you.

Things went a lot better last night with a min pressure of 9. Graph below.



I don't recall waking up on my back and woke up on my side, so maybe there was a positional factor helping. Will have to spend a few more nights at this pressure to see the average result. I did, however, wake up once in the middle of the night with some stomach reflux and feeling like I was about to throw up. I had had dinner 3 hours before going to bed and was sleeping on my right side. Weird.

We will gladly take last night's results an run with it for a few nights to see how things trend.
Good job on last night...watch the belly issues. It might have been the meal too close to bed time and it might be the beginning of some issues with aerophagia from the increased baseline pressure. We don't want to trade one problem for another.

Not a great night last night. Everything went well for the first two hours, but then I woke up at around 3 am with a very stuffy nose. Since starting CPAP, I will occasionally wake up in the middle of the night with swollen sinuses and an almost completely blocked nose. Never had this before CPAP, and my sinuses usually return to normal size ~20 minutes after taking the mask off. This hadn't happened in a while, but happened again yesterday. I use Nasacort daily to help alleviate this. I've got my heated hose at a setting of 3 (medium) and humidity at 5 (max). Anyway, here's the graph for the 3ish hours I got to wear the mask last night. Will keep recording.

Anxiety--oh, heck yes!
Chin up--we will get through this.

You know that old saying "crap happens"...or actually something else happens but you get the drift.

If this congestion was a common occurrence I might say reduce the humidity level but since it is rare...not so sure it is related to humidity.

Is it one side or both sides? It might be that you are just experiencing a normal but highly annoying "nasal cycle".
https://en.wikipedia.org/wiki/Nasal_cycle

PorcoRosso wrote: ↑

Sun Mar 22, 2020 9:54 am

Not a great night last night. Everything went well for the first two hours, but then I woke up at around 3 am with a very stuffy nose.

flonase can help with that. it's otc so no prescription. you can find it at your grocery store or-

https://www.amazon.com/Flonase-Allergy- ... 1584899538

good luck!

Thanks everyone for your suggestion. @zonker I used Flonase for about a year without any noticeable improvement, and have recently changed to Nasacort to see if it works better. So far Afrin is the only thing that has worked for me, although it causes horrible rebound congestion the next night after I use it. @Pugsy the congestion caused by CPAP is on both sides, and higher up in the nose (as opposed to a congestion in the lower turbinate area). When my sinuses get swollen due to CPAP, the area where my cheeks meet my nose becomes slightly raised due to the swollen sinuses.

Here's the graph from last night:


I definitely swallowed some air during the night, and woke up again with a slightly bloated stomach (though not as bad as two nights ago). I also have a [very] mild headache despite the low AHI. I did notice a higher number of RERAs and FLs than usual. I believe the Periodic Breathing at the end has to do with me becoming awake. On to the next night.

PorcoRosso wrote: ↑

Mon Mar 23, 2020 10:15 am

Thanks everyone for your suggestion. @zonker I used Flonase for about a year without any noticeable improvement, and have recently changed to Nasacort to see if it works better. So far Afrin is the only thing that has worked for me, although it causes horrible rebound congestion the next night after I use it.

i'm sorry it doesn't work for you. and thank you for getting back to me about it. i really don't like making a suggestion then having the suggestion ignored!

Alright, here's last night:



Tried my best to continue at 5:30 am despite a stuffy nose, but it got almost 100% blocked and I had to take the mask off to go back to sleep (the congestion disappeared within 10-15 min). Anyway, this time I made the effort to write down the time whenever I woke up during the night. At 5:15 am, I recorded waking up while lying on my back. This seems to pinpoint the later cluster of apneas pretty much spot-on. If I'm not tucking my neck and still getting apneas from the occasional half-hours on my back, should I be thinking of increasing the minimum pressure even further?

It seems like there are two separate problems hurting my sleep at this point:

1) Sinuses getting swollen with use of CPAP
I am seeing an allergy doctor today, and will be getting a new mask (DreamWear Full-Face Mask) in the mail shortly.

2) The cluster of apneas that shows up whenever I'm lying on my back, which hasn't been solved by an increase in the minimum pressure (from 5 to 9)

A good chunk of that cluster around 5 AM is central apneas...more pressure won't fix those.

You could try more minimum again but if those events are arousal related....you may have been awake prior to knowingly been alert/awake enough at 5:30 to note the time.....more pressure won't fix even the OAs if you were for sure asleep.

You also have a small cluster of OAs at around 3:40.....maybe REM (timing would be right)...if for sure asleep a little more pressure might help those.

You can try more minimum if you want to see what happens. The worst that might happen is you get some aerophagia issues and not everyone gets those. I see pressures of 16 and don't have a big problem with belly issues.
So that's a maybe in terms of belly issues.

I don't know what to make of your congestion issues. Since we don't know what is causing it we can't do anything to fix it.
And it's not normally something you see every night.
You might consider reducing the humidity a bit and see if it results in any change in the congestion....like either more or less times where the congestion happens. Maybe it's related to humidity...maybe you need more...maybe you need less.

Have you tried doing a couple of squirts of simply saline type of solution right before bed?

The CAs are strange to me. They seem to happen in between OAs, and from the Flow Rate graph alone I cannot personally tell the difference between the two. Here's an example, where the two OAs at the beginning look largely identical to the CAs on the right:

Can you give me a longer stretch zoomed in showing that first OA more to the right side so I can see the flow rate preceding the flagged OA at 04:51:00.

That OA might be real...the rest of the flagged stuff looks more like arousal breathing to me but the first one might be real and caused the arousal which then in turn caused the other stuff to get flagged.
So maybe a real first OA and then the rest of it false positives...