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Can someone solve the Mystery?
#1
Gross 
Can someone solve the Mystery?
Hi All, 

Apologies for all the long info, figured I be as detailed as possible, so someone can attempt to figure this out.

I've never had a problem with sleep, or really any ever sleep-related insomnia issues growing up, besides waking up every night at least once to use the restroom. I never felt tired or fatigued, and felt completely refreshed after such nights.

I'm 26 years old, 155lbs, relatively in good shape. (used to go to the gym everyday, now i struggle to go once a week.) 
--------

Last year (2023), towards the end of October, I came down with either the Flu or Covid...a day after I went out to a bar. 

After getting sick that one time, sleep has never been the same. I started walking up 3+ times a night about 1.5/2 hrs, every night. To preface I was studying for the LSAT during this time-period and I'm sure stress played a role in some of this too. 

Since that time and up to today, I only remember one time that I have slept through a whole night without waking up. To add, in July 2023 I did start waking up at the same time every night around 3am, but would still feel refreshed the next day, and I've had such episodes every now and then, but eventually this had always subsided, and it did before I got sick.  

I've been on a search mission for the past year and a half trying to figure what was casuing all this fatigue and extreme tirdness. Thankfully it is not to the point where I can't get out of bed, but I feel those dark circles weighing me down every day and it is extrememly difficult to focus. Just keeping up wth everyday tasks/freinds/social outings, is extremely difficult. Moreover, I'm currently in Law School, which just makes it that much more difficult, and I can see it play out and take a toll on my schooling, as well as completely destroying any energy to get into the gym (though I occasionally power through). I used to be able to stay up late at night and wake up completey fine the next day, work, study, and go to the gym but something just went haywire suddenly last year, and I feel like I've pulled an all nighter the prior night these days. 

I eventually turned to an at-home sleep test (watchpat) and here were the findings:

March 204

OSA:
Sleep time: 6.48 
AHI: 10.7 (total 73 events)
RDI: 20.4 (total 139 events)
O2: 92%-97%

- I do have a deviated septum and pretty significant overbite (always have)

- The test did not detect any CSA. 

Below are my findings for the last year from Booldwork: 

- I had blood work done in July 2023 (which all results were normal except elevated Testostrone) 
- I had blood work done in December 2023, after battling this for 3mts, because I felt something was off. My Testostrone was now down to the lower level end of the spectrum, and my Liver ALT was 87- was talking a bunch of ashwaganda for sleep). Doc gave me Ultra and MRI on Liver, and everything came back fine. (had a spot on it, that apparently had always been there from childhood). Doc then tested me for mono, and it came back positive for anitbodies, but not that i had a current infection. I also had Mono in 2018
- Thyroid is fine, Cortisol is fine, Vitamin D a bit low (always has been, so been supplementing), A1c- 5.2. STD test - All clean. 
- Last bloodwork showed an ALT of 54. 

I eventually went to a sleep doctor, who pretty much said, I have UARS...Bada Boom Bada Bing, here's a CPAP. I've been doing the therapy for the past 2 months, and been playing around with the pressure settings, because I still feel horibble. The fatigue is the worst every other day. One day I feel relitively ok, and the next day I feel horrible. Its like a viscous cycle. If I take a sleeping pill (small dose), I do feel more refreshed in the morning, but crash hard towards the evenining. I dont gasp for air, I dont snore, I dont feel out of breathe in the middle of the night. I just open my eyes, and then usually just fall back right asleep, but this happens multiple times a night..(also the outside of my nose itches sometimes like crazy and this wakes me up from time to time.) 
 
What is going here? I almost always have no events according to the machine and OSCAR, if I do it's always below 1 AHI, almost always 0.(some value). I played with just the auto settings and the pressure never goes above 7. I have tried a pressure of 5,6,7, all give me 0 AHI result. To, add im not really stressed, anxious, or depressed... just extremely tired. 

Current setting: 
5 pressure, Ramp 45min, EPR 3, humidity on. 

Any insight on what is going on? Do I even have sleep apnea? Can you get sudden onset Sleep Apnea? How can I be tired with a 0 AHI, especially when I don't have any RERA events either, usually?

It is just really discoouraching, when the machine is supposed to stop the so-called "obstruction," and when it shows there aren't any, I still feel like i stayed up all night clubbing. 

Attaching My OSCAR Reports here. Please let me know any additional info I can provide that can help for anyone to solve this or shed some light on what is going on, along with any advice you may have. 

Cheers!


Attached Files Thumbnail(s)
           
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#2
RE: Can someone solve the Mystery?
Your FLs decrease with increasing CPAP pressure. At the EPR =3 Setting, you should not go below 7 cm pressure.  
You might wake up before a fully developed obstruction event because some FL increases. To find it out, you might want to try the following settings: 

Mode: APAP
Min pressure 7 cm
Max pressure 10 CM
EPR=3
Ramp off 
Standard response.   

You might want to post Oscar's outcome. Turn the calendar off and ensure all the statistics and instrument settings are visible.
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#3
RE: Can someone solve the Mystery?
Thanks G.! I'll go ahead and give it a shot, and set those pressure settings, and report back. Here's a snapshot from a couple days ago when I had the pressure setting at 7cm, if it can further help.


Attached Files Thumbnail(s)
           
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#4
RE: Can someone solve the Mystery?
Check out this video about looking at individual breaths:
https://youtu.be/XVscmoOW29U?si=fvYdV_V6bpbk-1Z0
Also this one: Low AHI but still feel like sh*t?
https://youtu.be/JwvVSP1HY-Y?si=gatVO1zoYBKOJsIH
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#5
RE: Can someone solve the Mystery?
It would help if you set up your Oscar charts a little differently.  On the first page, we need to see the following, and only the following, in the order listed:

Event Flags
Flow Rate
Pressure
Leak Rate
Flow Limits

We need to be able to read to the very bottom of the Flow Limits.  Thanks! Smile
Machine:  ResMed AirCurve 10 Vauto
Mask:  Bleep DreamPort Sleep Solution
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#6
RE: Can someone solve the Mystery?
(Yesterday, 05:11 PM)Deborah K. Wrote: It would help if you set up your Oscar charts a little differently.  On the first page, we need to see the following, and only the following, in the order listed:

Event Flags
Flow Rate
Pressure
Leak Rate
Flow Limits

We need to be able to read to the very bottom of the Flow Limits.  Thanks!  Smile

Will Post the charts in that form moving forward! Still a bit new to the Oscar platform, and what charts are the really important one. Thank you for the tip, Deb!! Smile
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#7
RE: Can someone solve the Mystery?
(Yesterday, 04:10 PM)katbrat Wrote: Check out this video about looking at individual breaths:

Also this one: Low AHI but still feel like sh*t?

Thank you!! Will give these a watch, Kat.
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#8
RE: Can someone solve the Mystery?
Update from last night. Upped the pressure range from 7cm-10cm with EPR 3, no ramp. Was tossing and turning up until 1am. 

Looks like more events than at the previous lower pressure of 5cm? To add, I turned the machine off within the first 5 minutes of going to bed to readjust, and it somehow how displayed "15" events/hr. Might have glitched out? I've never seen that before. 

I do feel a bit better today, but i did take half a unisom, and I did take the mask off around 5am, and then slept without it untill 8am. 

Any insights on these events as opposed to almost no events at a lower pressure? Is the higher pressure being more effective on the UARS, even though the machine picks up more events?


Attached Files Thumbnail(s)
       
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#9
RE: Can someone solve the Mystery?
Well it looks like I turned off the EPR on accident, and that can explain that lol.
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