Guys,

Now that I've been using my AutoCPAP and nasal pillows (rotating with the nose-only mask at times) for 6 months, OSA symptoms started to return to me about 2 weeks ago. I again wake up earlier than I should, in depressed mood, and unrefreshed. The minimal pressure, which is set to 4.0 cm^2, stays at the same level in the morning as it had been when I fell asleep at night. The mouth is not dry - so I don't think that it means that I breath through the mouth at night, but the throat is sore, even though humidity is set to maximum. Is it the machine malfunctioning, or is it something wrong with me? I tested the machine pressure switching by plugging up the mask breathing holes with my finger, and it did switch gradually by 1 cm^2 up and then by another 1 cm^2 up, and so on (even though it wasn't quite instant).

I've already scheduled an appointment with the sleep clinic. But they keep me waiting, because the next available appointment is on Monday. So I have to suffer.

What do you think? :)

Why not switch to straight CPAP mode and see what happens?


_________________
5'9 234lbs 37 years Old Male
Original Sleep Study: AHI = 30

Owner of Remstar Auto A Flex M series
ResMed Ultra Mirage Full Face Mask
Viewer 1.0 Software, Smartcard Reader
Integrated Heater/humidifier
Prescribed setting: 7-10 Cm

I believe the problem is not with the machine. The problem is most probably with that I may be breathing by mouth (don't know exactly). Which might have well been caused by the fact that I recently started taking zopiclone every night to fall asleep. I ordered a full-face mask, and waiting for it to arrive.

Hello leloup,

Yes you could be breathing through your mouth, rendering your therapy ineffective.  Do you look at the data from your AutoCPAP?  If the leak rate is high it is very possible you are mouth breathing.  If you do not look at your data, your doctor or equipment provider should take a look.  A high leak rate usually results in a higher AHI.  Higher AHI =  less effective therapy.

The full face mask may be troublesome to get adjusted so it doesn't leak.  Follow the manufacturer's fitting instructions carefully and don't give up, sometimes we don't understand the fitting instructions very well at first.  If you keep having leaks go back over it and see if you could interpret something in the instructions differently.  If you don't receive any fitting instructions with your mask you can usually find them online at the manufacturer's web site.

If after using full face mask for a few weeks without known leakage, check your leak and AHI numbers.  If the leak number is down, but AHI is still high, please have your doctor review your data.  Some medications *may* require a pressure adjustment while you are taking them, and your doctor will know whether this is the case with you, if you've eliminated mouth breathing and excessive leaking as a cause of ineffective therapy.

Blessings,
--pseudonym

pseudonym - Thanks for your suggestions. I don't regularly look at my machine's data, even though I have the smart card reader and software. But to me - it's boring to see that kind of stuff and trying to interpret it. I'm quite busy a person, and I have no interest in that data. On Monday, I'm going to check with the sleep lab - they know well about leaks. BTW, what's AHI?

As to the masks, I tried several masks, and most of those non-nasal-pillow ones left noticeable marks on my face (I still have some remaining after 3 weeks), and were generally inconvenient.

Zopiclone seems to really be the cause that's been worsening my apnea. I reduced the dosage yesterday, and it was better last night. Most probably it made me be opening my mouth during the night, because even though the machine increased the pressure, it wasn't very high, and the sleep didn't seem fully restful.

What can I say? OSA is a little bit of a damnation, because sleep is very important for the human species.

AHI is basic data -- your apnea/hypopnea index (events per hour).  I'm a bit surprised you are not familiar with this term?  It is used all over this forum, in your sleep study reports, on your machine displays and in your data printouts.

I'm a busy person too, and the last thing I need is to waste my time on experiments without at least some basis in knowledge and not speculation.  If you don't wish to take an interest in your data, that's fine, no one says you have to do that (though there are people on this forum who would trade you in a heartbeat, their non-data recording CPAP for yours, so they could finally see their data!).  It is a shame and waste not to use the data to your advantage.  Do consider asking your equipment provider and/or doc to take a look at the data from your machine and see what's going on.  The machine collects some very helpful information and it can make a shortcut to a solution for you.  

However, I don't get the feeling you are interested in expending much effort toward finding root cause and solving the problem?  I hope you find a solution.  Good luck.

Blessings,
--pseudonym

leloup wrote:

... The minimal pressure, which is set to 4.0 cm^2, stays at the same level in the morning as it had been when I fell asleep at night. The mouth is not dry - so I don't think that it means that I breath through the mouth at night, but the throat is sore, even though humidity is set to maximum. Is it the machine malfunctioning, or is it something wrong with me? I tested the machine pressure switching by plugging up the mask breathing holes with my finger, and it did switch gradually by 1 cm^2 up and then by another 1 cm^2 up, and so on (even though it wasn't quite instant). ...

Am I not reading something right? Does the ^2 mean something I'm not grasping? 4 cms minimum pressure is toooo minimum for most people to breathe comfortably w/a CPAP mask on.

Your mouth isn't dry so leaks don't really sound like a problem.

No, the pressure change would NOT be instant, they are designed to gradually build up pressure from the pressure you are at when an event occurs to the pressure needed to stop an "event" in small increments. With a Resmed it builds up slowly in .2cm increments. I'm not sure about the amount of cm increments the Respironics increase pressure by. And if you were testing right after turning your xPAP on and you use Ramp it can take some time to build up from 4 cms to 6 cms which is the pressure most find comfortable for breathing w/a mask on when awake, much less to whatever your pressure need is. Or that you "fake" by plugging the exhaust holes w/your finger tip.


_________________
Some people are like Slinkies... Not really good for anything, but they still bring a smile to your face when you push them down a flight of stairs.
Resmed VPAP Auto. Humidaire 3i, Simplicity & Micro masks, ResScan 3.4, S8 ResLink, Embla oximeter.

pseudonym - yes, I understand that maybe I should pay more attention to my xPAP data. I didn't know what AHI was, but I knew that I woke up to 300 or even 400 times per hour. What I'm going to ask the sleep clinic to do is to analyze my data a little deeper.

CrohnieToo wrote:

Your mouth isn't dry so leaks don't really sound like a problem.

But my throat was sore. I decreased my Zopiclone dosage by half, and it seems to have made it better. And no more headaches during the day. But, still, I wake up too many times (to decrease my pressure with the "ramp" function) and that's why I feel unrefreshed and even apathetic most of the days. What I want is just for the night to come, and sleep as long as possible, because when I wake up, I'm not amazed about having woken up. I mean I have no choice anyway. I have to work.

cm^2 means square centimetres.

CrohnieToo wrote:

No, the pressure change would NOT be instant, they are designed to gradually build up pressure from the pressure you are at when an event occurs to the pressure needed to stop an "event" in small increments. With a Resmed it builds up slowly in .2cm increments. I'm not sure about the amount of cm increments the Respironics increase pressure by. And if you were testing right after turning your xPAP on and you use Ramp it can take some time to build up from 4 cms to 6 cms which is the pressure most find comfortable for breathing w/a mask on when awake, much less to whatever your pressure need is. Or that you "fake" by plugging the exhaust holes w/your finger tip.

Thanks for the info. That's probably not the machine, but my breathing through the mouth.

The measure of CPAP pressure is "centimeters of water": cmH2O.  Not 'square centimeters'.

Blessings,
--pseudonym

I still doubt that it is mouth leaks if your mouth isn't dry. I really suspect that you need a pressure change, that that 4 cms is way too low. Do be sure to share w/us what your DME supplier has to say and to suggest. We would appreciate that.


_________________
Some people are like Slinkies... Not really good for anything, but they still bring a smile to your face when you push them down a flight of stairs.
Resmed VPAP Auto. Humidaire 3i, Simplicity & Micro masks, ResScan 3.4, S8 ResLink, Embla oximeter.

pseudonym - you're right, it simply branded in my memory as "cm^2" instead of cm/H2O. I don't know what that measure means anyway.

I went to the sleep clinic (or whatever it is) today with my machine, they checked it and said that my leak level is very good, and said that I definitely do not breath through the mouth at night. (Which means I'll need to return the full-face mask, which is coming, without the need of trying it). I was amazed. They changed the minimum pressure to 5 cm presuming that my new shallow and short sleep problems might have been due to low minimum pressure. (I also suspect the sudden (I didn't know it was sudden) Zopiclone dosage decrease (by half) might be a reason as well). Then I suggested to them that I didn't have any such problems in the past, when I was using the machine, and the lady suggested that I try sleeping without the mask two nights and see if maybe I don't need any CPAP now. They'd also mentioned that my AHI level has dropped to 3.5 times per night, and the maximum pressure hasn't usually gone higher than 6.5 cm over the last few weeks of the data.

leloup wrote:

... cm/H2O. I don't know what that measure means anyway.

It is the amount of pressure required to raise a column of water 1 centimeter in height.  I believe there are other criteria, such as a specific ambient temperature and doing this in the presence of 'normal' earth gravity.  What does that mean...  Dunno that it matters      What does matter is that the pressure is measureable by some "standard" and this is it!  

Please consider taking some time to read through the Sticky posts at the top of each of these forums.  Awealth of information is available there such as terminology for CPAPs, sleep studies, etc.  The main site associated with this forum also has good information available.  You can improve your understanding quite a bit with just a small amount of effort.

Blessings,
--pseudonym

Last night, I tried sleeping without the machine, and guess what - I still had OSA, and I felt not good (but "not good" different from yesterday's "not good") after waking up. Especially a few hours later. The minimal pressure on my machine was actually set to 6 cm, and I've already tried to sleep with it this evening, but couldn't fall asleep. Going to try it tonight as well.