2 Months into CPAP - okay AHI - lots of CA's - still feeling horrible. HELP!

[madamsleepsalot]

Hello, I was diagnosed 2 months ago with OSA. My AHI was 7.4. I had my titration, got a machine and went home. I frequent the r/SA subreddit. A few things I want to note: I started sleeping 8+ hours a night with my mask on right away. I did have some issues with my mouth opening with my WISP nasal mask. I got a chin strap and that has helped.

Since starting treatment I have had probably 5 days where I had "amazing sleep". But other than that I still feel like my tired foggy/groggy/need to nap self. 

I downloaded OSCAR yesterday and at first was really confused by all the data and not knowing how to read it. But one thing I am noticing is almost ALL of the events I am seeing on the OSCAR results are from Clear Airway events. It looks like I am having very little mask leakage. 

Can someone help me? Tell me what to upload? Or how to read this?

[Sleeprider]

Your chart shows us you are using a fixed pressure of 6.0 with EPR set at 2. Your AHI is mainly CA events, but we see a lot of flow limitation in your results with a 95% index of 0.16. I think this is the most likely suspect in your continuing fatigue. I think you will benefit from setting the mode to Autoset, and using a minimum pressure of 6.0 and maximum pressure of 10.0. This will let us see how you respond to higher pressure. I think you may need a higher EPR setting of 3, but let's take this one step at a time and just change the mode and look at the results of a pressure range of 6 to 10. I'm sure you were referred here by Gideon (Bonjour on Reddit?), so I'm sure he will be along to offer a suggestions or two.

[madamsleepsalot]

Sleeprider,

Thanks for your response. Can you go into more detail? I don't know what a flow limitation is ( I did just google it, but I still don't understand) and why this might have to do with my lack of feeling better.

[Gideon]

A few things.
Flow Limits are untimed but are essentially mini Apneas and hypopneas.

My approach is slightly different than Sleeprider.
The flow limits will, IMHO, push your pressures higher, likely more than you need so first
Set min pressure = 7
Increase EPR to 3. Both changes are to fight your flow limits. This action may increase your Central apnea but that will be good to know.

Your current central apnea say to ignore it for now, but watch it. If centrals increase too .much we will suggest a correction.

Also enable auto mode as that will provide better stats.

Mode: Auto
Pressure 7-9, we could see 7-7 but this keeps the range small
EPR=3

[Sleeprider]

Here is our wiki on flow limitation http://www.apneaboard.com/wiki/index.php...limitation

I have no disagreement with Gideon and normally go straight to 3-cm of EPR. Where we differ is, i would still go to Autoset mode and use a range of pressure, but set the maximum to a manageable level. I suggested 10 cm, which certainly fits that criteria.

[madamsleepsalot]

   

I put the machine on auto set with a min of 6 max of 10. I left my EPR the same (2). I had it start me like it has been at 4 with a 20 min ramp.

Here are the result:

[Dormeo]

How are you feeling today? With low AHIs, you're really shooting for the subjective benefits of feeling more rested, energetic, and clear-minded.

Just to explain flow limitations a little more. Sometimes the tissues lining the airway relax when we fall asleep, and that can mean that we have to work harder to inhale. It takes an extra effort to overcome the limitation and complete the inhalation. Over the course of the night, that can be tiring. In addition, making the repeated effort can keep you from getting enough deep and REM sleep, both of which you need to get restorative sleep.

[madamsleepsalot]

I actually feel a lot better this morning. When I woke up I didn't feel tired/groggy. 

I've been up for 4 hours and I don't think I've yawned once. And I've had enough energy to tackle two big things I've been saying I wanted to accomplish for about a year (closet clean out!).

I'd definitely say this is my 3rd best nights sleep of my life. The first being the titration and the second being a few weeks ago.

[Dormeo]

That's excellent news. Gideon and Sleeprider can guide you further about any additional fine-tuning of your settings, but I'd recommend sticking with your current ones for at least a few more nights, then reporting back with a representative chart and -- very important -- a summary of how you felt during the day.

[Gideon]

I would still like you to increase EPR to 3 with min 7 or higher..

Your flow limits are still high. If this doesn't feel as good as your current setting go back to them. It is IMHO important to do this comparison without looking at you numbers so you are not influenced by them.