Are my symptoms even coming from sleep apnea? OSCAR attached

[apmea]

Hi there, I’ll try to keep this as short yet detailed as I can...

38F, normal BMI. For some time, I’ve been experiencing waking up feeling as if I’m extremely hungover and barely slept. Headaches, groggy, sensitive to light, a little dizzy, etc. with extreme daytime tiredness (needing to nap to function) despite getting 8-9hrs of sleep. After a nap I usually feel a little better for awhile. I’m also irritable and forgetful.

After thorough bloodwork (iron, b12, vit D, thyroid, etc) all came back normal I did a home sleep test. The sleep study result was I had mild OSA (AHI 9). I purchased a resmed airsense 10 auto hoping to get relief asap. I have been using the machine for 2 weeks, changing around the pressures/settings and have had no relief of symptoms at all. I feel worse with APAP as I also now wake up with ear pressure, a mask rash and swollen eyes.

I was just looking through my sleep study results and noticed all my events (100% hypopneas), occurred in supine. I was in supine 80% of the study night. The thing is, I typically don’t sleep supine, I sleep on my side. I only slept supine for the test as I had the chest strap and nasal cannula on making harder to side sleep.
I went to bed on my side last night, and when I did wake through the night, I noted I was still on my side. So, I don’t believe I roll over. I am starting to question if my symptoms are even coming from sleep apnea.

Here is last nights OSCAR data. I feel horrible today despite the 0.87 AHI and 9hr sleep.

[Crimson Nape]

Hi apmea!  -  
I see 2 things that may be contributing to your lousy feeling.  The first is, large pressure settings and swings.  This can cause micro arousals and interfere with sleep.  Secondly, you I:E ration is almost a 1:1.  Normally, your exhale time should be around 1.5 to 2.5 times longer than your inhale time.  The reduction of your exhale time prevents your body from properly expelling the CO₂.

My recommendation would be to:
1. Turn off the Ramp feature turned, if you have on.
2. Set your pressure range to  10 cm minimum - 12 cm maximum.
3. Set the EPR to 3 and make sure it is set to Full Time.  (For some reason, there is a ramp only option -  go figure!)

The above recommendations should:
1. Make sure you are at your therapy pressure from the beginning.
2. Constrain the pressure range to reduce pressure induced arousals.
3. Help remove the CO₂ from your system.
4. The increased exhale pressure reduction should allow you to exhale for a longer period.

Try it for a night and see if any of your symptoms are reduced or eliminated.

Good luck!
- Red

[apmea]

Thank you Crimson Nape! Will try tonight with these adjustments

[Dormeo]

I hope Red's suggested adjustments will soon give you restful sleep. But if you continue to experience your current symptoms, you might talk with your doctor about autoimmune diseases and about chronic fatigue syndrome. More here:

https://www.mountsinai.org/health-librar...-disorders

https://www.cedars-sinai.org/health-libr...drome.html

Thinking along these lines is premature, but I wanted to mention these two possibilities while I was thinking of them. Middle-aged women are more likely to experience both kinds of conditions, and although these links don't mention light sensitivity, it can definitely play a role in some autoimmune diseases.

At any rate, tuck that in your back pocket just in case.

[jwest]

I agree with tightening up your pressure range. APAP can be helpful to new users, but mainly for pointing out what pressures my be suitable on a fixed or tighter pressure. With such a "low" score, all that pressure variation could be doing you more harm than good.

Something else that might be worth considering is making sure your mouth/bite is closed while you sleep, using tape, a chinstrap, or cervical collar.

Good luck, and keep us updated!

[apmea]

hi everyone, thank you for your input! I made the changes suggested for a few nights (pressure 10-12, EPR 3). I havent noticed any changes in how I feel.. still waking up with headaches and groggy as if I hadn't slept much. 

Attached is a screenshot from OSCAR with the new settings. I had taken the mask off in the early morning, which I now see from the data I was having a bunch of events which is probably why I was restless with it. I am wearing an F30I hybrid mask. Been thinking of trying nasal pillows to see if its more comfortable but I tend to wakeup with my mouth open so it might be less effective.

Any suggestions or input?

[Dormeo]

With the revised settings, you've reduced your flow limitations quite a bit, and you've smoothed out your pressure lines. You could tighten your range even further -- e.g., min = max = 10 -- though I'd be inclined to let these settings ride a while longer to see how things go.

As jwest says, you could try several methods for keeping your mouth closed if you want to try nasal pillow masks. The advantage of pillows is that with so much less contact with your face, there are fewer places for leaks to develop. The machine can compensate for the leaks you're having, but they made be disturbing your sleep. Here's some more information.

1. Tongue position. Try putting the tip of your tongue behind your upper front teeth. Then position the main part of your tongue up against your upper palate. Finally, give a little suck or swallow to create a bit of suction. You should now be able to open your mouth while breathing entirely through your nose. Practice this during the day, and see if you can get it grooved in deeply enough to help while you are asleep at night. For some people, this is really all it takes to avoid mouth leaks.

2. Collar. If your jaw tends to drop down during the night, pulling your mouth open, then a soft cervical collar, or a firmer snore collar, can be a big boon. More here:
http://www.apneaboard.com/wiki/index.php...cal_Collar

3. Although chin straps tend to pull the jaw back, which is not helpful, the Knightsbridge Dual Band strap has a design that pulls the jaw straight up, which makes it a possible alternative to a cervical collar.

4. Tape. Some people (including me) rely on tape to keep the lips from opening. (I can't rely entirely on the tongue thing.) When the lips open, all too often that eventually leads to a noisy and disruptive mouth leak. To see whether tape would be feasible for you, I recommend that you invest in a box of Somnifix strips. They are very gentle on the skin but hold well. Be sure to curl your lips inward per instructions before placing the strip. If these work for you, then you can experiment with lower-cost options.

Note about tape: Some people avoid it, for two reasons. (1) If you suddenly need to vomit in the night, the tape could lead to your aspirating some vomitus, which would be bad. However, you can sacrifice one strip to see for yourself how well you can pull you mouth open in an emergency using only your jaw muscles. For me it was easy. (2) If there is a power failure and your machine goes off while you're sleeping, you won't be able to do the natural thing and open your mouth to breathe. As for that, out of an abundance of caution, I've put a circuit alarm in a plug on the same circuit as my machine. It will wake me up immediately if I lose power to the machine.

[apmea]

thanks for the tips on nasal masks. I have one on order as I think that it will probably be more comfortable long term than the hybrid mask im wearing now.

After a fairly restless night I decided to try a fixed pressure of 10 last night. Overall I felt like I slept well as I only recall waking to change positions twice and kept my mask on. 

I did however still wake up with a headache and feeling very groggy and tired (all of this is still going strong hours later). Is it unreasonable for me to think that if I am having these "good" nights I should wakeup feeling somewhat refreshed?

[Dormeo]

People can take a while to start feeling the benefits of successful PAP therapy. For one thing, it can take time for you to get fully acclimated to the new experience. Although you may not remember many wake-ups, short arousals may still be occurring and can disrupt the progression of your sleep states during the night. You may also be contending with sleep debt, which builds up over time and can take a while to be discharged.

So although it's probably not what you want to hear, you may need to be patient and stick with this for at least another month or so before trying to evaluate whether it's helping you.

Keep us posted on how things go, would you?