3 Month Review

[mcman56]

I have been on CPAP for about 3 months now.  My primary symptoms were feeling groggy and what felt like a sinus headache sitting behind my eyes.  The headache seems gone or mostly gone.  I would also wake up gasping for air and that is gone.  However, I still feel a kind of groggy.  It is not forefront like the inability to concentrate that I read about on here.  It is more background when sitting around not doing much or waiting.  I'm 65 which can not help and I have never been a high energy person.  Still, I expected more from this treatment.  I wake a little at night but generally think I sleep pretty well, maybe too much.  I even take naps. 

I started out with an AHI in treatment around 5 to 10 which has now drifted down to around 2, still mostly CAs.  Blood O2 used to have quite a few dips down to even 70% but now only has occasional short dips below 90% with an average around 95%.  Average time in apnea is around 2 minutes.   I just had periodic blood work and all looks well.   

Is there anything I could try to improve results from this treatment and decease the groggy feeling?

     

   

   

[quiescence at last]

Looks like everything's going pretty good. I don't have any observations or suggestions for you.

QAL

[Ratchick]

You could try pushing your EPR to 3... that might help squash the flow restrictions. That's about the only thing I could think of really. You look to be averaging at a pressure of around 7.5 or so, and you're not maxing out, so there's no reason to alter the max right now, though if you really wanted, you could increase your min pressure to 7.2 or 7.4. The centrals at the start of your historical data I'm guessing were just treatment-emergent while you got used to the extra ventilation at night. However, this is generally a good looking chart. If you're a little prone to them, you may see some more with the EPR on 3, but I'd give it a few days and see what happens, personally. You ought to switch the ramp off as well, if you can tolerate that. It's set to 20 minutes so that means every time you restart the machine, you're losing 20 minutes of therapy. So on your chart, you lost an hour of therapy time.

It can be really easy to assume there'll be a magical fix but sometimes that just isn't the case, especially if you have other things that might be contributing, like frequent waking from non-CPAP/Apnea sources etc. Also, some medications won't help either. How often are you napping, and for how long? Sometimes just improving your sleep hygiene a little can make big differences. Do you know what kind of things are waking you?

For me, the biggest help has always been the headaches. Before I started, I would get 1-2 migraines a week, which probably doesn't sound so bad... but they would last 3 days at a pop and I couldn't even keep water down as I was throwing up every 10-20 minutes. Utter misery. And even between those, I would have a headache on waking, it would take me 2 hours to fully wake up and come around... and I didn't really realise how much better I felt until the one day I fell asleep for an hour without the machine on. Then it was like night and day.

[mcman56]

Thanks for the reply.  I have been told that ramp does not accurately report in Oscar from my machine so I'm not sure where the 20 minutes comes from.  When I look on the ResMed, ramp is set to AUTO and I believe that is what the ramp of 2 represents in Oscar.  The machine is supposed to sense breathing that represents sleep and then ramp up.  

I like to read after lunch and frequently dose off for 20 minutes or so.  Prior to CPAP, it was more like one hour or more. I'll have to try wearing my O2 ring to see what that looks like.  I don't use the CPAP machine at that time.  I generally feel like I sleep OK at night although the one thing that does wake me is leaks around the nose pillows.  I have always squirmed around a bit while sleeping so the head straps get moved.  I have not been able to resolve this issue.

[Ratchick]

You're correct that OSCAR sometimes doesn't report it right, the 20 minutes came from the chart you posted, where it said the ramp time was 20 minutes... but I guess it doesn't use that with the auto mode. Generally speaking, if you CAN do without it, then you may as well. The auto setting doesn't always get it right, and so you may end up with stretches where you're not getting the best therapy. But it's up to you at the end of the day.

As with the naps, generally speaking, it's best to be using your CPAP for all sleep (even power naps) but at least the pulse ox will give you an idea of if your sats are dropping without it.

With the leaks, have you tried different masks etc to see if anything else might suit you better? If you're an active sleeper, you may find the P30i better (or you can replace the headgear for the P10 with... I feel like it might be the headgear for the N30? I know it's been discussed on here).

[pholynyk]

Ratchick is right - if the Ramp Mode is 2 - which reports as Auto in v1.3.0 - then the Ramp Time should be ignored - in v1.3.0 it is not displayed (IIRC)

[mcman56]

I looked up the N and P models.  The P fits into your nostrils and seals on the inside.  Does the N fit over and seal on the outside?  Does it work with facial hair?  The other issue I'm having is a sore spot on the flesh between nostrils where the nasal pillow sits.  I have been using Vaseline through out the day and it went away once but then came back.  It is not severe but irritating, sort of what you might get with a bad cold and lots of nose blowing.

[desaturator]

Is there anything I could try to improve results from this treatment and decease the groggy feeling?

Have you, or your doctors, been able to rule out potential causes of this feeling that might have nothing to do with breathing or sleep? Anemia, electrolyte disturbances, vascular disorders, vitamin D (especially in the winter) etc., etc? Just a thought.

Best wishes, DS

[Ratchick]

A Nasal mask is basically like a small FFM that covers your nose and upper lip. Nothing inserted into your nostrils. How exactly it seals will depend on the mask itself.

It could be that the pillows are the wrong size, or that their angle isn't quite right for you. They shouldn't be rubbing badly enough to cause permanent soreness throughout the day.

[Dormeo]

For nasal soreness, try Lansinoh. It's a cream for nursing mothers, but it is very helpful in soothing and healing delicate tissues around the nares. Petroleum can tend to degrade the materials often used in mask interfaces. Use just a little bit of Lansinoh per application.

If the night you posted is typical, I'd suggest you try going for several weeks using these measures: go to bed at the same time each night; get up 8.5 hours later; don't nap. Your grogginess could be from sleeping too long. Counterintuitive, but a real possibility. Regular times for going to bed and getting up are key to good sleep "hygiene." And when you feel the urge to nap, try taking a little walk or doing some little task to occupy yourself. The urge may pass.