[CPAP] Suddenly starting to feel bad again.

[ALCF98]

Hi everyone,

I've been using CPAP for a while now, and at first, it was amazing! I had so much more energy, my headaches were gone, and I felt like I was finally getting good sleep. But lately, things have taken a turn for the worse. ?

I'm feeling exhausted during the day again, the headaches are back, and I often wake up to find I've pulled the hose off my mask in my sleep (no idea how!).  It's like I'm not getting any quality sleep anymore, even with the machine.

To give you some context, I need to keep my AHI below 1.3 to really feel good.  When my AHI is that low, I have tons of energy and feel much better overall.  But lately, my AHI has been creeping up, and I can definitely feel the difference.

I've included my OSCAR results below. Does anyone have any ideas what could be causing this sudden decline? Any insights would be greatly appreciated!

[SarcasticDave94]

Welcome to Apnea Board,

Since your median EPAP pressure is about 8, you may want to increase the minimum pressure to 7 or 8. Along with this edit, you might want to add EPR 3 full time. By this, you gain bilevel therapy.

Follow this pressure guide for EPR to work fully

Min pressure 5 EPR 1
Min pressure 6 EPR 2
Min pressure 7 EPR 3

You can see within the flow limits graph that busy area. EPR which parallels pressure support on the bilevel will help reduce these.

Note you may have to try EPR 1 then 2 then 3 to see which is the best balance between flow limits control and minimizing CA increase.

[ALCF98]

Thank you for your reply! Do I set it to ramp or full? It seems I have to set it to one of those. 

Could weight loss have anything to do with it?

[SarcasticDave94]

EPR on, your number choice between 1-3, full time so it would help always.

Weight plays the part of Apnea influence, but not by itself. In 2016, I was 300 lbs with an AHI 74. I had to do bariatric sleeve surgery to reduce weight. I'm disabled mobility wise, no way to exercise it off. I have comorbidity of COPD too. Sleeve done 9/2016, within a year was at 200 lbs. Did new sleep study and it was 37, about half but still severe.

[Dormeo]

Excellent advice from Dave. In your place, I'd go ahead and start with a minimum of 8 and full-time EPR of 3. These settings should help to reduce your flow limitations and snores, as well as the big pressure swings, all of which may well be disrupting your sleep.

You may see an uptick in CAs, but unless it's large, I wouldn't worry too much. Your CAs are probably coming after brief arousals; this is pretty common and may well settle down with time.