[Treatment] 6 Months still don't feel "me"

[Lucid]

You're doing the right thing to get a good check up.  It could be something other than sleep.  

I looked up your weight and height on the basal metabolic index (BMI) calculator:  


https://www.nhlbi.nih.gov/health/educati.../bmi-m.htm

You're in the top category, and that's not good.  It's not a perfect index -- muscle is more dense and heavier than fat, some people have larger bones, etc. -- but your weight is not borderline.  It's little wonder you're not feeling good.  There's also a special kind of sleep apnea due to obesity that is harder to treat.  I'll have to dig a bit to find a reference because my searches are just coming up with the usual association between sleep apnea and overweight.

If you can manage to lose just 5 percent of your current weight you'll notice a difference.  If you can get down to the overweight level, that will make a big difference.  A lot of people find that cutting carbs really works.

You're still young -- imagine how crap you'll feel in another five or ten years if you don't take this on.

[Lucid]

Here's what I was looking for:

Obesity-Hypoventilation Syndrome - A term applied to obese individuals who have abnormally slow and shallow respiration (hypoventilation) during wakefulness, resulting in an increased level of carbon dioxide in the blood.

I'm not sure that's relevant given what your charts show -- I hope someone more knowledgeable about how that would show up will comment.

Here's an article, too.  From what they're saying, I think this would probably be something more likely to happen to people way heavier than you are, but worth keeping in mind.

https://www.verywellhealth.com/treatment...me-3015246

[Melman]

Woke up today still feel crappy. Flow Limit chart seems way to high?

The best tool to lower your flow limits is EPR/ I suggest you increase it to 3.

[Phosin]

I have started dieting along with trying to be more active, times limited and best would be early morning but its hard to drag myself out of bed. Im stocky build so I hold a fair amount of muscle but yeah could lose 15 - 20kgs

[Lucid]

That's fantastic to hear, Phosin!    When you get down to 91.5 kg, you'll be back in the overweight range and feel way better.  

Please take time to give yourself credit for every kilo you lose and celebrate every 2.5 kg.  Each 2.5 kg is a significant stepping stone, and I think you'll feel a difference.

Don't beat yourself up if you regain; just get back on track.

I use an app called MyFitnessPal, where I can log food, exercise.  It can pull steps directly from my iPhone (if I allow), and once a week, it reminds me to weigh myself and enter my weight.  It shows me calories, grams of carbs and protein, etc.  I don't know if it's also available in Australia; if not there will be something similar.  It keeps me honest about what I'm eating, although basically just cutting down on carbs is what's helping me lose those pandemic pounds. 

Do you have a specific diet plan now?

[Phosin]

Currently just starting on smaller proportions then I will start tracking and calorie counting.

[Lucid]

That's a great start, Phosin!  It's the most practical thing to do.

I like counting calories because I don't have to make constant judgement calls and decisions about whether I've had enough.  Also I'm into data.  Even if you find that you hate counting calories and decide to look for a different approach, it's useful to do it for a while.  You learn which foods have a ton of calories that you need to really take care how much you eat, and you figure out what a portion size looks like.

(Of course, if your doctor tells you to count calories or gives you a specific diet plan, you should do that.)  

You've got a lot going for you:  you're still young and not dealing with a ton of chronic illness and medications yet; it sounds like your job isn't brutally sedentary; you've already made progress in dealing with sleep apnea; and, most importantly, you've made the decision to get your life back.

Sorry for talking your ear off, Phosin!  Unlike with sleep medicine, I do have formal nutrition training and simply love food.  Feel free to ask me anything here on Apnea Board about food, nutrition, or different approaches to losing weight, any time it would be helpful.

Take care and best of luck on your journey!

[RyGuy]

I've been struggling lately, too, friend. It may seem new-age and touchy-feely, but the first thing you need to do is show yourself a whole heap of compassion. Really. Don't talk to yourself as you the person you are today ("why isn't this working" "I hate this thing" etc.), talk to yourself as if you're talking to the 4-year-old version of yourself (I start with "little man..." as in "hey little man, I know it's been tough and you're struggling, but you've done really well this week using CPAP most nights, and you're fucking killing it in terms of effort, hang in there" etc.) It may seem silly at first (and I don't recommend swearing at actual 4 year olds haha), but a little self compassion when we're struggling can really make a big difference. Give yourself credit for all your effort.

With that out of the way, like you, my OSCAR data didn't really indicate why I was feeling like sh*t and even looked really good in a lot of ways. What I learned:

- really ask yourself about your comfort settings. Are your nostrils dry when you wake up? Your mouth? Do you find yourself ripping your mask off at night? Waking up in a panic? Too much humidity giving you a headache? Mask too loose or too tight? I foolishly set my humidity to auto and left it there, thinking the machine would adjust as needed. Nah. Winter (northern hemisphere) meant I needed to up my humidity a lot (and tube temp as a result)

- get full bloodwork done to determine how your body is really doing, and do so every 3 months until there are no warning signs or numbers out of range

- as you mentioned, see an ENT and talk to your doctor (I'm still waiting for my ENT appointment - Canada's healthcare system is no better it seems)

- ask your sleep therapist or similar for a take-home pulse oximetry test to see if your blood oxygen levels are dipping too low OR (like I'm about to) buy your own pulse oximeter to track your blood oxygen level (before I figured out I needed more humidity, I lowered my minimum pressure, so I fixed the humidity issue, but then the lower pressure meant I wasn't getting enough oxygen)

- like you, I don't have full use of my nostrils, but I've found a nasal rinse (neti pot or something like this https://www.amazon.ca/dp/B083M69HF9?ref=...tails&th=1) before bed helps along with breathe strips

These last few months on CPAP have made me feel a hell of a lot worse than sleep apnea ever did, but I know the apnea was slowly killing me. For the first time in a while I'm feeling hopeful, and I think you could be in the same boat - the main settings might be adequate, but it could be a comfort setting or maybe a non-CPAP-related issue (before my pulse oximetry results told me my pressure is too low, I was even considering giving up smoking weed!) so hang in there buddy.