2 Years of CPAP & Still Somewhat Tired

[oz02]

Hello,
 
I was diagnosed in 2015 with moderate sleep apnea with an AHI of 17.0 and after a titration sleep study was prescribed to use a CPAP machine with a pressure of 7. Not knowing any better I received a Airsense 10 CPAP and have been sleeping with it ever since, and the difference it has made for how I feel is fantastic. However, I did and am still finding that I never wake up refreshed, and am still considerably tired in the mornings and evenings. Originally I thought I was experiencing mouth leak so I have been sleeping with a chin strap / mouth taped (which I think has helped but I can't be sure).
 
Recently I stumbled across this forum and came to the realization that there is more I can do to improve how I feel. My DME was kind enough to lend me an Airsense 10 Autoset for Her for "diagnostic" purposes as well as a full face mask (which I have held off trying as of yet), and I've been trying to analyse my data myself over the past few weeks. So I suppose my question is, looking at my data below, is there anything I can do to improve on my therapy? It seems from the data that mouth leak is not the issue, or is it?
 
I also purchased a CMS50D+ oximeter, and while my SPO2 stats seem to be ok, my PR is wacky. Below is data from last night, which is pretty typical for most nights before, any suggestions?
 
PS I apologize for not having the oximetry data imported into sleepyhead, there seems to be a bug with sleepyhead which is not allowing me to match the oximetry data with a specific date.
PPS I realize that last night's data is for under 5 hours of sleep (so it is expected that I would be tired), however I usually get 6.5-7 hours of sleep
 
Thanks in advance for the help!

[oz02]

Sorry I didn't realize the min 4 posts rules, see below for my data:

[attachment=3849]
   

[Charlie Sue]

Hi, it is never popular when I say this, but here I am anyway. I too have not felt better utilizing cpap, despite using it for two years. My specialist told me that about 10% of patients continue to have excessive daytime sleepiness. I think it depends on how complex your situation is. I have had crippling insomnia for 30 years and cpap did not help that. I do manage my sleep hygiene and stress and I have my thyroid and other relevant biochemical factors checked regularly and I do use my cpap regulalrly because using it lowers my risk for heart disease and diabetes. I am so happy to know that this treatment can be life changing for some people, yet it is critical that we recognize that it is not the be all end all for everyone. I wish you the best and hope you find the treatments that work best for you.

Charlie Sue

[trish6hundred]

Hi oz02,
WELCOME! to the forum.!
I wish you good luck on your quest for better, more restful sleep.

[OpalRose]

Sorry I didn't realize the min 4 posts rules, see below for my data:

You had a couple leaks during the night, but not bad enough to affect therapy.  Just keep a watch on it.
If you are mouth breathing, try using a soft cervical collar.  This helps support your jaw and keeps your mouth from dropping open.

As far as your pressure range.....a minimum pressure of 4cm can cause some to feel air starved.
I would adjust that upwards to 6cm.  And since your bumping up against your max pressure, you could move to 10cm.

[oz02]

Thanks for the responses. OpalRose, I will try and increasing the max pressure, but I don't think the min pressure is the issue - when using my Airsense 10 CPAP which is set for constant 7cm I don't experience that min pressure and yet I am still tired. Also, any comments on my PR? I forgot to post the actual graph above, so here it is:
   

[Sleeprider]

ozO2, this is a great opportunity to really dial in your pressures and get really comfortable with the machine. Your first chart shows that with variable pressure from 4-8 you pegged the meter quite a bit of the night but had great results. What I'd like you to try is is EPR, exhale pressure relief. It can make pressure so much more comfortable. My suggested strategy will be to use your original pressure, but add in EPR and see if you find it more or less comfortable. There are so many variables with the Autoset For Her with 3 different auto algorithms. Your results are great as-is, at 1 AHI. What we want to do is experiment to find settings that are the most comfortable. That goes beyond the numbers.

My suggestion would be a minimum pressure of 7 with EPR on Full time at 2. This will give you a starting pressure of 7/5 (inhale/exhale). This should feel really good. To ensure you avoid obstructive apnea and hypopnea, set the maximum pressure to 11.0. The pressure will only go as high as needed. You can use the Autoset standard, soft or For Her algorithm. Should not matter much. Give this a try and let's see where you can go for results and comfort. The only issue I see for now is you have some moderate mask leaks. We can deal with that separately if needed.

If you find you really like the Autoset, I bet you can get it since your supplier is so cooperative. I nothing else, you can buy it on Amazon for about $440.

[Sleepster]

It seems from the data that mouth leak is not the issue, or is it?

While your leak rate stays under the officially-accepted rate of 24 L/min most of the time, I would say that based on my experience with my own mouth leaks, I do not like the looks of your leak rate graph.

It goes up and down too much, and seems correlated with the pressure, meaning that when the pressure goes up so does the leak rate. Which is what we'd expect to see when mouth-leaking is a problem. Think of the seal between the back of your tongue and the roof of your mouth as a valve. Behind that valve is high-pressure air, but in front of it the lower pressure of the air in your bedroom. The bigger the difference in pressure the more likely it is that the valve will leak. Switch to a full face mask and you have high pressure on both sides of the valve, so even if the valve opens it won't leak!

The officially-acceptable leak rate of 24 L/min simply means that at that leak rate the machine can still maintain the pressure splint in your airway so it won't collapse and you won't have apneas. But in my opinion it can still disturb your sleep and thus cause the symptoms you're experiencing, at least it did for me.

I agree with OpalRose that you're hammering against your pressure max of 8 way too much and should change your pressure range to something like 6 to 10.

But since you have the full face mask try that, too. Don't forget to change the mask type setting on your machine's menu.

[Walla Walla]

Your O2 and pulse rates are fine.

[oz02]

Thank you all for the responses.

Since I last visited this forum, I've tried switching to a full face mask, which after trying various options I found that the resmed F20 is really the only mask that doesn't leak (hence the delay in reposting - it took some time to figure that out). Since that switch my AHI has gone up to 2-3 for most nights and I'm still feeling tired (but a bit less so!) so I am looking for any suggestions to improve on my therapy. Below are graphs from a pretty average night.

Thanks again for the help!