[CPAP] Still feeling fatigued with CPAP

[antlane]

Hi all,

I've been a CPAP user (Airsense 10 Elite - not autoset) for the last year having been diagnosed with moderate OSA with a score of 15.

I took to the CPAP machine instantly and it has reduced my AHIs down to below 1 (my wife seems to love the machine more than me as it means I don't keep her awake snoring  ).  For the first couple of days, I felt euphoric but very quickly, I am back to feeling fatigued and without much energy.

I'm sure I'm probably feeling better than before treatment but I'd appreciate it if someone could look at my data from SleepyHead to see if there's more that can be done.  I've attached a daily report which is pretty representative (in fact it has more events than most days) as well as two screens from the overview report.

Thanks in advance for any help/advice!

           

[SarcasticDave94]

Hi antlane

Welcome to AB. I'll let the charts to better knowledgeable. Now as for your recovery from feeling poorly, some people do feel better consistently very soon after treatment begins. As far as I am aware though, most gradually feel better in small steps over several weeks or months. Take note that you have been under apnea's spell for probably some years and recovery cannot happen overnight. Not to discourage you, but that's the reality of what many of us have had to deal with. Keep up with the therapy and it will pay off in time.

[Walla Walla]

Might try increasing the EPR to 3cm. Also increase the minimum pressure to 7cm to offset for the increased EPR. It should help you breath easier.

[Gideon]

There are 4 types of "events", counting snoring, that in and of themselves can be disruptive, your charts are missing an important one, Flow Limits.  Please add this to your charts vertically shrinking them to include them on the same page.

Event Definition Apnea, Hypopnea, Flow Limitation[edit]

• Apnea: 80% to 100% reduction in airflow for >= 10 seconds
  
  
• Hypopnea: 50% to 80% reduction in airflow for >= 10 seconds
  
  
• Flow Limitation: <50% reduction in airflow for >= 10 seconds
  

These events may be either Obstructive or Central in nature They represent different degrees of similar events. All of these may be disruptive. While Central Hypopneas are important in diagnosing Central/Mixed/Complex apnea they are not monitored in most Sleep Studies nor on Sleepyhead

Working with EPR as Walla Walla suggested to EPR 3 with Min Pressure 7 is one way of minimizing Flow Limits.
.

[mesenteria]

"...
I took to the CPAP machine instantly and it has reduced my AHIs down to below 1 (my wife seems to love the machine more than me as it means I don't keep her awake snoring  ).  For the first couple of days, I felt euphoric but very quickly, I am back to feeling fatigued and without much energy...."

This could be me.  I am an Elite user, successful, but I cannot say that how I felt before being diagnosed is much like how I feel today, 14 months into treatment.

My only symptom was the development of atrial fibrillation in June of 2017.  This came out of the blue.  A couple of weeks later, before seeing anybody but the emerge physician, I went to my daughter's cabin by invitation to do some fishing.  She complained that I sounded like a rock crusher when I slept.  First I knew of this because She, WhoMustBeObeyed had not been complaining.   

Long story short, I have gained 10 pounds, sleep better, and am now feeling very sleepy in front of the TV.  Now it's She who has the apnea/hypopnea problems and I lie awake unless I can get her to wear a collar.  I can't say I feel lethargic.  I have energy, I can still power walk and run, although my heart medication precludes anything like the output I enjoyed pre-AFib.  But, while I NEVER felt the need to doze off in front of the TV, suddenly that is part of my reality.

My message, I hope is clear, and that is that you are not unique, nor are you alone.  This sleep disturbance affects us mostly as we age, and that condition has its own compulsions and changes even without the added sleep problems.

As a good friend, a very good-looking man with a Latin complexion, but who was also a bit pudgy, used to say to his audiences: "I used to have the body of a Greek god.  Now I have the body of a goddam Greek!"

[antlane]

Thanks for everyone's responses.

I've attached a new screengrab from Sleepyhead including the Flow Limit graph.  It would be interesting to see if the therapy is working as expected.  Apart from asking me what the AHI numbers have been, my doctor hasn't looked at any of the data.

I'd guess that I'm not suffering central events (although that's obviously just a guess).  My doctor said that from the shape and size of my jaw, it's not a surprise I have OSA and have probably been suffering with it since I was 16.  I'm a little overweight but not disastrously so.

Re: increasing the minimum pressure, I have the non-autoset model set to 8.  Unless I've misunderstood, there is no minimum pressure setting, only a constant pressure.  Would someone mind clarifying?

Thanks again!

[Sleeprider]

Antlane, I think we can see in this last graph what we suspected would be present. First, you have some outstanding results and your AHI reflects that your therapy is very successful. The flow limitation in your graph is fairly persistent and is higher when OA and H events occur. The best move here may be to increase EPR to the maximum of 3 which should improve the flow limits and perhaps reduce the hypopnea events which are closely related. You are very close to optimized settings, and the only thing that might remain is very gradual increases in pressure to see what feels and works best.

With the Elite, your pressure is fixed, and you have to manually titrate. EPR provide exhale pressure reduction, and this does affect therapy. As you are seeing in our posts, we will recommend pressure increases for OA and decreases for CA. We try to use more EPR if hypopnea and flow limitation are present, and will reduce EPR if CA emerges. It's a pretty straight-forward approach and one you can use yourself. Again, your results are very good, so not much additional work is needed here to optimize.

[antlane]

@Sleeprider - thanks for this.  I've increased the EPR and in a few days, will have a look at the results.  I'll the increase the pressure incrementally every few days to try to eliminate Flow Limitation as best I can.

Thanks again.